文章摘要
经皮穴位电刺激对老年冠心病患者术后心率变异性和超敏肌钙蛋白T的影响
Effects of transcutaneous acupoint electrical stimulation on postoperative heart rate variability and high-sensitive cardiac troponin T of elderly patients with coronary heart disease
  
DOI：10.12089/jca.2018.07.003
中文关键词: 经皮穴位电刺激  冠心病  自主神经系统  心率变异性  全身麻醉  超敏肌钙蛋白
英文关键词: Transcutaneous electric acupoint stimulation  Coronary artery disease  Autonomic nervous system  Heart rate variability  General Anesthesia  High-sensitive cardiac troponin
基金项目:河北省卫计委重点学科跟踪项目(GL-2016-29) 河北省优秀人才基金
作者单位E-mail
李惠洲 050051,石家庄市,河北医科大学第三医院麻醉科  
吴川 050051,石家庄市,河北医科大学第三医院麻醉科  
刘飞飞 050051,石家庄市,河北医科大学第三医院麻醉科  
赵爽 050051,石家庄市,河北医科大学第三医院麻醉科  
杨淑红 050051,石家庄市,河北医科大学第三医院手术室  
刘朋 050051,石家庄市,河北医科大学第三医院麻醉科  
刘欣 050051,石家庄市,河北医科大学第三医院麻醉科  
王明洁 050051,石家庄市,河北医科大学第三医院麻醉科  
王秀丽 050051,石家庄市,河北医科大学第三医院麻醉科 wangxl301@aliyun.com 
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中文摘要:
      
目的 评价经皮穴位电刺激对老年冠心病患者术后心率变异性(HRV)和超敏肌钙蛋白T（hs-cTnT）的影响。

方法 选择合并冠心病择期全麻下拟行腰椎后路减压植骨融合内固定术的患者50例, 男30例, 女20例, 年龄65～80岁, BMI 19～27 kg/m2, ASA Ⅱ 或 Ⅲ 级。采用随机数字表法分为两组: 经皮穴位电刺激组(T组)和对照组(C组), 每组25例。T组于诱导前30 min至术毕经皮电刺激双侧内关穴、郄门穴, 频率为4/20 Hz 疏密波, 电流强度以食指或中指微微发颤为宜(得气指证)。C组在相同穴位上贴电极片并连接治疗仪但不做电刺激。于术前1 d、术后1、3和5 d记录R-R间期并计算HR、总功率(TP)、低频功率(LF)、高频功率(HF)和LF/HF。于麻醉诱导前、术后2 d 晨采集静脉血 3 ml, 分离血清后测定hs-cTnT含量。记录术后心悸、胸闷、胸痛等心脏不良反应情况。

结果 与术前1 d 比较, C组术后1、3和5 d HR明显增快, HF明显降低, 术后1、3 d TP明显降低(P<0.05);T组术后1 d HR 明显增快(P<0.05)。与C组比较, T组术后1 d HR明显减慢, TP和HF明显升高(P<0.05)。与麻醉诱导前比较, 两组术后2 d hs-cTnT含量均明显升高(P<0.05)。T组术后2 d hs-cTnT含量明显低于C组(P<0.05)。两组术后心脏不良反应差异无统计学意义。

结论 经皮穴位电刺激内关、郄门穴可通过调节老年冠心病患者术后1 d迷走神经功能, 降低术后2 d 血中hs-cTnT含量, 改善术后心肌缺血。
英文摘要:
      
Objective To observe the effect of transcutaneous acupoint electrical stimulation (TEAS) on postoperative heart rate variability and high-sensitive cardiac troponin T of elderly patients with coronary heart disease.

Methods Fifty patients with coronary heart disease, 30 males and 20 females, aged 65-80 years, ASA physical stutes Ⅱ or Ⅲ, undergoing elective lumbar decompression and fusion internal fixation surgery, were randomly divided into 2 groups using random number table: TEAS group (group T) and control group (group C). Patients in group T received TEAS (disperse-dense waves, frequency 4/20Hz) at the points of PC6 (Neiguan) and PC4 (Ximen) from 30 min before anesthesia induction till the end of surgery, the optimal intensity was adjusted to maintain a slight twitching of the midfinger or ring finger (De-Qi response). Patients in group C received electrode plate at the same acupoints without any electrical stimulation. R-R interphase were collected 1 day before surgery, 1, 3 and 5 d after surgery. The R-R interphase were used for calculating HR, total power (TP), low-frequency (LF) power, high-frequency (HF) power and LF/HF. 3 ml of venous blood was collected before the induction of anesthesia, 2 d after surgery, the serum was isolated for the measurement of serum concentration of high-sensitive troponin T (hs-cTnT). The postoperative cardiac adverse reactions such as palpitation, chest tightness, chest pain were recorded.

Results Compared with the baseline before the surgery, HR in group C increased significantly and HF in group C decreased significantly 1, 3 and 5 d after surgery, TP decreased significantly 1, 3 d after surgery (P<0.05), HR in group T increased significantly 1 d after surgery (P<0.05). Compared with group C, HR in group T decreased significantly, TP and HF in group T increased significantly on 1 d after surgery (P<0.05). Compared with the time before anesthesia induction, hs-cTnT concentration in both groups increased significantly 2 d after surgery (P< 0.05), it was significantly in group T lower than group C (P<0.05). There was no significant difference in the incidence of postoperative cardiac adverse reactions between the two groups.

Conclusion TEAS at the points of PC6 and PC4 can reduce the concentration of serum hs-cTnT 2 days after surgery, improve postoperative myocardial ischemia via improving vagus function of elderly patients with coronary heart disease 1 day after surgery.
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