【摘要】：目的:探討針?biāo)帍?fù)合麻醉對(duì)不停跳冠狀動(dòng)脈旁路移植手術(shù)患者圍術(shù)期免疫球蛋白及補(bǔ)體的影響。方法:選擇擇期行不停跳冠狀動(dòng)脈旁路移植手術(shù)的患者50例。隨機(jī)分為兩組,每組25例。針?biāo)帍?fù)合組(A組)25例,對(duì)照組(C組)25例。A組于麻醉誘導(dǎo)前30min、術(shù)中持續(xù)及術(shù)后3次(術(shù)后6h、24h、48h)行經(jīng)皮穴位電刺激,頻率為2Hz/100Hz,術(shù)前術(shù)后電刺激強(qiáng)度為引起感覺(jué)閾強(qiáng)度的2~3倍即10~15m A,術(shù)中麻醉期間刺激強(qiáng)度為30m A,刺激部位是雙側(cè)中府、云門(mén)、列缺和內(nèi)關(guān)穴,30min/次;C組也以同樣的裝置和時(shí)間點(diǎn)連接在患者相同穴位上以同樣頻率但以較小電刺激強(qiáng)度4m A進(jìn)行電刺激。兩組患者均采用方案相同的全憑靜脈麻醉。對(duì)圍術(shù)期兩組患者血漿免疫球蛋白Ig G、Ig A、Ig M及補(bǔ)體C3、C4的數(shù)據(jù)進(jìn)行比較。結(jié)果:兩組患者Ig G、Ig A值在術(shù)后24h、72h均較術(shù)前明顯下降,Ig M、C3、C4值在術(shù)后24h較術(shù)前明顯下降,術(shù)后72h恢復(fù)到術(shù)前水平;與C組相比,A組術(shù)后24h、72h Ig G、Ig A值較術(shù)前下降幅度相對(duì)較小,術(shù)后24h Ig M、C3值較術(shù)前下降幅度較小,組間差異有統(tǒng)計(jì)學(xué)意義(均P0.05)。結(jié)論:針?biāo)帍?fù)合麻醉可有效減輕不停跳冠狀動(dòng)脈旁路移植術(shù)患者圍術(shù)期免疫球蛋白及補(bǔ)體抑制,具有調(diào)節(jié)圍術(shù)期機(jī)體免疫功能的作用。
[Abstract]:Objective: to investigate the effect of acupuncture and medicine combined anesthesia on immunoglobulin and complement in patients undergoing coronary artery bypass grafting. Methods: 50 patients undergoing coronary artery bypass grafting were selected. They were randomly divided into two groups, 25 cases in each group. There were 25 cases in group A and 25 cases in control group. Group A received percutaneous electrical stimulation 30 minutes before anesthesia induction and 3 times after operation (6 hours, 24 hours and 48 hours after operation). The frequency was 2 Hz / 100 Hz. The intensity of electrical stimulation before and after operation was 2 or 3 times that of sensory threshold. During anesthesia, the stimulation intensity was 30 Ma. In group C, the same device and time point were used to connect the same acupoints with the same frequency but with a small electric stimulation intensity of 4mA. Patients in both groups were treated with total intravenous anesthesia with the same regimen. The data of plasma immunoglobulin (Ig) G G Ag G M and complement C 3 C 4 were compared between the two groups during perioperative period. Results: the Ig GG A value of the two groups was significantly decreased at 24 hours after operation compared with that before operation. The value of Ig MMC C 3 C 4 decreased significantly at 24 h after operation and recovered to the preoperative level at 72 h after operation, and the decrease range of Ig IgG A at 24 h and 72 h after operation in group A was relatively small compared with that in group C, and the value of IgA in group A was significantly lower than that in group C at 24 h after operation, and the value of IgA in group A was significantly lower than that in group C. 24 hours after operation, the decrease of Ig MMA C3 was smaller than that before operation, and the difference between groups was statistically significant (P 0.05). Conclusion: combined acupuncture and medicine anesthesia can effectively reduce the immune globulin and complement inhibition in patients undergoing coronary artery bypass grafting and can regulate the immune function during perioperative period.
【作者單位】： 北京首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院-北京市心肺血管疾病研究所麻醉科;航空總醫(yī)院麻醉科;
【基金】：科技部國(guó)家重點(diǎn)基礎(chǔ)研究發(fā)展計(jì)劃“973”資助項(xiàng)目(2013CB531902)
【分類(lèi)號(hào)】：R654.2

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