摘要
目的:探讨经皮穴位电刺激(TEAS)对行脊柱开放性手术的腰椎间盘突出患者的免疫平衡、术后感染以及临床预后的影响。方法:选取2021年3月—2022年12月北京中医药大学东直门医院因腰椎间盘突出症于全麻下行脊柱开放性手术的患者112例,采用随机数字表法分为单纯全身麻醉组(对照组)和穴位电刺激复合全身麻醉组(试验组),每组各56例。观察入室后麻醉前(T0)、气管插管时(T1)、切皮时(T2)、置入第一个椎弓根钉时(T3)、术毕(T4)、术后第1天(T5)、术后第2天(T6)患者的血清指标[IL-2、TNF-α、干扰素-γ(IFN-γ)、IL-4、IL-6、IL-10、转化生长因子-β(TGF-β)、IL-17]水平、脑电双频谱指数(BIS)值的变化、术后并发症(切口感染、恶心呕吐),以探讨TEAS对患者的免疫平衡以及临床预后的影响。结果:与T0时比,对照组IL-17水平在T4时明显升高(P<0.05);两组患者的TGF-β水平在T2、T4、T5、T6时均明显降低(P<0.01,P<0.05)。与对照组相比,试验组的IL-2水平在T4及T6时明显降低(P<0.01);试验组IL-4水平在T3及T4时间点明显升高(P<0.05);试验组IFN-γ水平在T1及T5时明显降低(P<0.05);试验组IL-17水平在T4时有所下降(P<0.05);试验组的TGF-β水平在T3时明显升高(P<0.01)。两组患者切口感染率试验组(1例,1.7%)低于对照组(5例,8.9%),差异有统计学意义(P<0.05);两组患者术后恶心呕吐率试验组(8例,14%)低于对照组(24例,43%),差异有统计学意义(P<0.05)。在BIS值的比较中,术毕时试验组BIS值高于对照组(P<0.05)。结论:围手术期在双侧内关、合谷、足三里、三阴交穴位应用TEAS可以改善患者的免疫平衡、降低炎症反应,升高抗炎反应,从而减少术后感染的发生,同时能够缩短患者苏醒时间,有效减少恶心、呕吐等术后并发症的发生。
Objective:To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS)on the immune balance,postoperative infection and clinical prognosis in patients with lumbar disc herniation undergoing open spine surgery.Methods:A total of 112 patients who met the inclusion criteria were selected as the research subjects,who were divided as a simple general anesthesia group(control group)and an electrical acupoint stimulation combined with general anesthesia group(experimental group)according to the computergenerated random table,with 56 cases in each.The serum indexes(IL-2,TNF-α,IFN-γ,IL-4,IL-6,IL-10,TGF-β,IL-17),BIS value and postoperative complications(incision infection,nausea and vomiting)were observed before anesthesia(T0),tracheal intubation(T1),skin incision(T2),insertion of the first pedicle screw(T3),the end of operation(T4),the first day after operation(T5)and the second day after operation(T6)to explore the effect of TEAS on the immune balance and clinical prognosis in patients undergoing open spine surgery.Results:Compared with T0,IL-17 levels in the control group increased more at T4 time point(P<0.05);TGF-βlevel in both groups increased at T2,T4,T5,T6 time points(P<0.05).Compared with the control group,IL-2 level in the experimental group was significantly lower at T4 and T6 time points(P<0.01);the level of IL-4 in the experimental group was significantly higher at T3 and T4 time points(P<0.05);the level of IFN-γ in the experimental group was significantly lower at T1 and T5 time points(P<0.05);the level of IL-17 in the experimental group was significantly lower at T4(P<0.05);TGF-β levels were significantly increased at T3(P<0.01).The incision infection rate of the experimental group(1,1.7%)was lower than that of the control group(5,8.9%),with statistical difference(P<0.05).The incidence of postoperative nausea and vomiting in the experimental group(8,14%)was lower than that in the control group(24,43%),with sighificant difference(P<0.05);The BIS value of the experimental group was higher than that of the control group at the end of operation,showing statistical difference between the two groups(P<0.05).Conclusion:The application of TEAS during peri-operation can improve the patients’immune balance,reduce the inflammatory reaction,increase the anti-inflammatory response,thus reducing the occurrence of postoperative infection.Meanwhile,it can shorten the recovery time and significantly reduce postoperative complications such as nausea and vomiting.
作者
钱旭雯
李国艳
刘国凯
汤雯倩
李春黇
QIAN Xuwen;LI Guoyan;LIU Guokai;TANG Wenqian;LI Chuntian(Department of Anesthesiology,Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China;Department of Anesthesiology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Acupuncture,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)
出处
《温州医科大学学报》
CAS
2024年第6期446-451,共6页
Journal of Wenzhou Medical University
关键词
经皮穴位电刺激
免疫平衡
并发症
预后
脊柱开放性手术
transcutaneous electrical acupoint stimulation
immune balance
complications
prognosis
open spinal surgery
作者简介
第一作者:钱旭雯,住院医师,Email:1484524700@qq.com;通信作者:李国艳,副主任医师,Email:liguoyanbeijing@163.com。
