TEAS联合右美托咪定对腹腔镜胃癌根治术老年患者的肺保护作用

目的:探讨合并慢性阻塞性肺疾病的老年患者，行腹腔镜胃癌根治术时，联合应用经皮穴位电刺激及右美托咪定对肺的保护作用及其可能机制。方法:将120例行腹腔镜胃癌根治术老年患者随机分为对照组、右美托咪定组（右美组）和经皮穴位电刺激组（TEAS组），每组40例，对照组给予常规麻醉，右美组按规定速率泵注右美托咪定，TEAS组在麻醉完成后按右美组相同泵注方案给予右美静脉泵注，并在摆好手术体位后连接电针仪，持续电刺激双侧三阴交、足三里穴至手术结束。三组麻醉与术后镇痛方案相同。观察三组患者术后肺部并发症、肺功能、监测血清IL-6、TNF-α水平及测定血清MDA、SOD的含量。结果:三组患者的一般资料、术前肺功能、血清IL-6、TNF-α、MDA和SOD的含量比较差异均无统计学意义（P>0.05）。与对照组相比，右美组和TEAS组手术后肺部并发症发生率降低，肺功能各指标升高，血清IL-6、TNF-α下降，且TEAS组优于右美组（P<0.05）；与对照组和右美组相比，TEAS组血清MDA水平显著下降，血清SOD的含量明显升高（P<0.05），而对照组与右美组两者差异没有统计学意义（P>0.05）。结论:经皮穴位电刺激联合右美托咪定应用于合并慢性阻塞性肺疾病老年腹腔镜手术患者，能降低患者术后肺部并发症，更为有效的改善患者肺功能，减轻炎症因子和氧自由基损伤，维持机体内环境稳定。

Lung protective effects of TEAS combined with dexmedetomidine in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer

Objective:To investigate the lung protective effect of transcutanclus electrical acupoint stimulation（TEAS） combined with dexmedetomidine in aged patients undergoing laparoscopic radical gastrectomy for gastric cancer.Methods:120 elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer were randomly divided into control group，dexmedetomidine group (Dex) and transcutanclus electrical acupoint stimulation group (TEAS)，40 cases in each group.In the Dex group，dexmedetomidine was pumped at the prescribed rate，TEAS group was connected to the electroacupuncture apparatus after anesthesia induction，and continued electrical stimulation was performed to bilateral Sanyinjiao and Zusanli points until the end of the operation.Anesthesia and postoperative analgesia were the same in the three groups.Postoperative pulmonary complications，pulmonary function，serum IL-6 and TNF-α levels，serum MDA and SOD levels were observed in the three groups.Results:General information，preoperative lung function，serum IL-6，TNF-α，MDA and SOD levels of the three groups were not statistically significant (P>0.05).Compared with the control group，the incidence of pulmonary complications in the Dex group and TEAS group was lower，pulmonary function indexes were higher，serum IL-6 and TNF-α were decreased，and these results in the TEAS group were better than the Dex group (P<0.05).Compared with the control group and the Dex group，serum MDA level group decreased significantly in the TEAS，serum SOD level increased significantly (P<0.05)，however the difference between the control group and the Dex group was not statistically significant (P>0.05).Conclusion:TEAS combined with dexmedetomidine in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer can reduce postoperative pulmonary complications，improve pulmonary function effectively，and play a role in maintaining the stability of internal environment by alleviating the damage of inflammatory factors and oxygen free radical.