针药复合麻醉对心内直视手术患者免疫功能变化的影响

作者	单位
杨庆国	北京积水潭医院麻醉科
杭燕南	上海第二医科大学附属仁济医院麻醉科
孙大金	上海第二医科大学附属仁济医院麻醉科
陈锡明	上海儿童医学中心麻醉科
王祥瑞	上海第二医科大学附属仁济医院麻醉科
许灿然	上海第二医科大学附属仁济医院麻醉科
姚建玲	上海第二医科大学附属仁济医院麻醉科

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中文摘要:

目的 :观察电针对体外循环心内直视手术患者免疫功能的影响 ,并对针药复合麻醉用于心内直视手术予以评价。方法 :选择心房间隔缺损修补术患者 30例 ,分全麻组 (A组 )、针麻组 (B组 )和全麻复合电针麻醉组 (C组 )。分别于麻醉前、转流前、停转流后 30min和术后 2 4h采集外周静脉血 ,测定自然杀伤细胞活性 (NKCA)和细胞培养上清液中干扰素 γ(IFN γ)、白细胞介素 2 (IL 2 )的水平。结果 :NKCA于转流前A组明显降低 ;B组却明显升高 ,且明显高于A组和C组 ;C组无明显变化。停转流后 ,3组均明显下降 ,B组明显低于A组。术后 2 4h ,各组进一步降低 ,C组明显高于B组。IFN γ和IL 2水平于停转流后 3组均降低 ;术后 2 4h ,各组进一步显著降低 ,但C组明显高于B组。结论 :电针可增强NKCA ,但针麻不能改善体外循环引起的NKCA、IL 2、IFN γ抑制 ,提示应激性免疫抑制作用具优势效应。全麻复合电针亦不能完全改善体外循环引起的NKCA、IL 2、IFN γ抑制 ,但要优于单纯全麻和针麻 ,提示全麻复合电针对应激反应的良好控制可部分改善体外循环引起的免疫功能抑制。

英文摘要:

Objective: To observe the effect of electro-acupuncture (EA) on alteration of immune function of patients undergoing open-heart surgery with cardiopulmonary bypass (CPB), and to appraise the value of acupuncture-drug compound anesthesia in the operation. Methods: Thirty patients undergoing atrial septal defect repairing operation were selected and divided into three groups, Group A was the general anesthesia group; Group B, the acupuncture anesthesia group and Group C, the general anesthesia plus EA group. Peripheral venous blood of patients was collected at different time points, i.e. before anesthesia, before CPB, 30 min and 24 hrs after CPB, to determine natural killer cells activity (NKCA), and the levels of interferon-γ (IFN-γ) and interleukin-2 (IL-2) in supernatant of cell culture were also tested. Results: NKCA was significantly lowered in Group A before CPB but increased in Group B, while no evident change was found in Group C, so the level of NKCA in Group B was significantly higher than in the other two groups. It lowered in all the three groups after CPB, especially evidently in Group B, so as to cause the NKCA level in Group B lower than that in Group A. The lowering further progressed, 24 hrs after CPB, NKCA in Group B was more reduced than that in Group C. Levels of IFN-γ and IL-2 lowered in all the three groups after CPB, and further lowered at time point of 24 hrs after CPB, but the parameters in Group C were significantly higher than those in Group B. Conclusion: EA could enhance NKCA, but acupuncture anesthesia couldn′t inhibit the suppressive effect of CPB on NKCA, IL-2 and IFN-γ, suggesting that the immunosuppression induced by stress has a prior effect. General anesthesia plus EA yielded better effect than general anesthesia and acupuncture anesthesia, but it couldn′t improve the immunosuppression completely, indicating that the compound anesthesia could partially improve the immunosuppression induced by CPB.

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