针刺对体外循环心内直视术患者血管通透性的影响

目的 评价针刺对体外循环心内直视术患者血管通透性的影响.方法 择期行体外循环心内直视术患者32例,年龄18～60岁,体重指数19～28 kg/m2,ASA分级Ⅱ或Ⅲ级,心功能NYHA分级Ⅰ或Ⅱ级,随机分为2组(n=16):对照组和针刺组.针刺穴位取双侧内关穴、列缺穴和云门穴,参数为:AM2/100 Hz疏密波,刺激强度2～4 mA,刺激波宽0.2～2.0ms,刺激时间从麻醉诱导前30 min持续至术毕.于术前和术毕时,收集尿液,采用ELISA法测定尿微量白蛋白浓度.于术前24 h和术后24 h时,抽取中心静脉血样,测定丙氨酸转氨酶、门冬氨酸转氨酶的活性和总胆红素、尿素氮、肌酐的浓度.结果 与对照组比较,针刺组术毕尿微量白蛋白浓度降低(P＜0.05).两组患者肝、肾功能各指标比较差异无统计学意义(P＞0.05).结论 针刺可降低体外循环心内直视术对患者血管通透性的影响.

Effect of acupuncture on vascular permeability in patients undergoing open heart surgery under CPB

Objective To investigate the effect of electro-acupuncture (EA) on vascular permeability in patients undergoing open-heart surgery with CPB. Methods Thirty-two NYHA class Ⅰ or Ⅱ and ASA class Ⅱ or Ⅲ patients with BMI of 19-28 kg/m2 undergoing open heart surgery with CPB were randomly divided into 2 groups ( n = 16 each): Ⅰ control group and Ⅱ acupuncture group . The patients were premedicated with intramuscular phenobarbital 0.1 g, pethidine 50 mg and scopolamine 0.3 mg. Anesthesia was induced with midazolam, propofol, fentanyl and vecuronium and maintained with TCI of propofol and fentanyl in both groups. The patients were acupuncture points (neiguan, lieque, yunmen) were selected for stimulation with stimulator. Acupuncture stimulation was started from 30 min before anesthesia induction and continued until the end of operation. The level of sedation was monitored by BIS and maintained at 40-60 during operation. Urinary microalbumin concentration was used as a parameter of vascular permeability, and was measured before and at the end of operation. Blood samples were taken 24 h before and 24 h after operation for measurement of ALT, AST, total bilirubin, BUN and Cr. Results The two groups were comparable with respect to sex ratio, age, body weight, ASA physical status, and preoperative ejection fraction. There was no significant difference in renal and liver function between the 2 groups.Postoperative urinary microalbumin concentration was significantly lower in acupuncture group than in control group. Conclusion Acupuncture can reduce the effect of open heart surgery performed under CPB on vascular permeability.