【作者】 张帆；

【导师】 王祥瑞；

【作者基本信息】 上海交通大学 ， 麻醉学（专业学位）， 2017， 硕士

【摘要】 目的观察探究经皮穴位电刺激对非小细胞肺癌术后炎症反应的影响。方法30例小细胞肺癌拟行胸腔镜下肺叶切除术的患者,随机分为经皮穴位电刺激组(A组,n=15)和经皮穴位假电刺激(B组,n=15)。两组均采用全凭静脉麻醉,以咪达唑仑、舒芬太尼、罗库溴铵以及丙泊酚靶控输注诱导,以丙泊酚靶控输注、瑞芬太尼持续输注和顺式阿曲库铵按需给予维持麻醉,使维持Bis值于40至60之间。术毕均使用患者自控静脉镇痛泵。A组于诱导前30分钟、术后6小时和24小时进行30分钟电刺激,以韩式电针仪同时刺激双侧后溪穴、支沟穴、内关穴和合谷穴直至术毕,刺激频率为2/100Hz疎密波,刺激强度为引起感觉阈的2至3倍。对照组在相同穴位上粘贴电极片,不做电刺激。两组均于诱导前(A组为电刺激前)(T0)、术后1小时(T1)和术后25小时(T2)留取血样。该实验主要观察指标为术后1小时两组患者血清TNF-α、IL-1β、IFN-γ和CXCL-8,次要观察指标为镇痛评分、术中镇痛药物用量、术后25小时两组患者血清TNF-α、IL-1β、IFN-γ和CXCL-8。结果:A组中因术后病理为良性病变或非NSCLC剔除1例,B组中因术后病理为良性病变或非NSCLC剔除2例。实验结果表明两组间T0、T1和T2血清TNF-α、IL-1β、IFN-γ无显著差异。B组T1时刻血清CXCL-8比T0时刻显著升高(P=0.001),A组在T1时血清CXCL-8明显低于B组(73.39±12.72p/ml vs 91.13±12.63pg/ml,P=0.004)。A组术中瑞芬太尼单位时间单位体重用量较B组显著降低(0.0996±0.0344ug/kg/min vs 0.1436±0.0485ug/kg/min,P=0.011)。结论:TEAS可抑制炎症反应,降低CXCL-8升高,且具有显著镇痛作用,可减少术中镇痛药物用量。更多还原

【Abstract】 Objective The purpose of this article is to find the effects of transcutaneous electrical acupoint stimulation on postoperative inflammatory response on non-small-cell lung cancer(NSCLC)patients.Method We selected the 30 patients who would receive video-assisted thoracoscopic lobectomy surgery due to NSCLE.The patients were randomized into two groups: Transcutaneous Electrical Acupoint Stimulation(Group A,n=15)and Transcutaneous Sham Electrical Acupoint Stimulation(Group B,n=15).Both groups were received total intravenous anesthesia.The anesthesia was both induced with midazolam,sufentanil,rocuronium and propofol TCI and was maintained with propofol TCI,remifentanil continuous infusion and cis-atracurium if needed.The Bis was maintained at 40 to 60.Patients in group A were stimulated on SI3,SJ6,PC6,and LI4 on both side by Han’s Acupoint Nerve Stimulator from 30 minutes before introduction to the end of surgery.The stimulate frequency was 2/100 Hz and the stimulate intensity was the maximum current that could be tolerated when the patient was awake.The control group received only TIVA general anesthesia and sham electrical stimulation.Group A also received stimulation at 6 hours and 24 hours after surgery.Serum from patients of both groups will be collected at before surgery(T0),1h(T1)and 25h(T2)after surgery,respectively and serum levels of TNF-α,IL-1β,CXCL-8 and IFN-γ at different time points will be measured.The primary outcome measures are serum TNF-α,IL-1β,CXCL-8 and IFN-γ levels at 1h after surgery.The secondary outcome measures include VAS score,the dose of analgesics during operation and the serum levels of TNF-α,IL-1β,CXCL8 and IFN-γ at 25 h post-surgery.Result 1 patient from Group A and 2 patients from Group B were excluded because of benign lesions or not NSCLC according to postoperative pathology.There are no statistical differences of the serum level of TNF-α,IL-1β and IFN-γ between Group A and Group B at all three time points.In Group B,the serum level of CXCL-8 at T1 is statistically higher than that at T0(P=0.001).The serum level of CXCL-8 of Group A is significantly lower than that of Group B at T1(73.39±12.72p/ml vs 91.13±12.63pg/ml,P=0.004).The dose of remifentanil in Group A is significantly lower than that in Group B(0.0996±0.0344ug/kg/min vs 0.1436±0.0485ug/kg/min,P=0.011).Conclusion TEAS can decrease the serum level of CXCL-8 and suppress the inflammatory response.It also has an analgesic effect and can reduce the use of analgesics.更多还原