摘要
目的:探讨经皮穴位电刺激(Transcutaneous Electrical Acupoint Stimulation,TEAS)复合药物全麻行控制性降压对肝脏的影响,并为临床行针药复合麻醉提供实验依据。方法:18只雄性比格犬随机分为单纯药物全麻组(单纯全麻组)(6只)、单纯药物全麻行控制性降压组(对照组)(6只)和经皮穴位电刺激复合药物全麻行控制性降压组(实验组)(6只)。后两组动物均以异氟醚联合硝普钠行控制性降压,将动脉血压降至60%基础平均动脉血压(Mean arterial pressure,MAP)水平并维持60min,单纯全麻组不行控制性降压。实验组采用TEAS干预处理,刺激强度(4±1)mA,频率2/100Hz,穴位选用犬双侧"合谷(LI 4)"、"曲池(LI 11)"、"足三里(ST 36)"、"三阴交(SP 6)",电刺激在动物生理状态稳定后开始至维持目标MAP60min后停止。采用激光多普勒组织血流仪监测相应时间点肝组织表面血流的变化,用免疫组化法检测术后肝组织中GSH活性、T-SOD活力以及MDA含量的变化,并采用TUNEL法检测术后72h肝组织细胞凋亡数。结果:在行控制性降压至目标低血压(T3)时,对照组肝血流显著低于基础水平(P<0.05),而实验组肝血流未明显降低,在目标低血压维持10min(T4)时,两控压组肝血流显著低于各自基础水平(P<0.05),在维持20min至维持60min阶段(T5～T7),两控压组肝血流显著低于单纯全麻组水平和各自基础水平(P<0.05),且对照组肝血流维持水平更低,在血压回升阶段,实验组肝血流上升明显,在血压回升10min(T8)时,实验组肝血流已基本恢复,而对照组肝血流仍低于同期单纯全麻组水平,在血压回升60min和回升结束(T11～T12),实验组肝血流明显高于对照组水平(P<0.05)。与单纯全麻组相比,控制性降压术后两控压组GSH活性均有显著升高(P<0.05),且实验组较对照组相比升高趋势更明显。实验组SOD/MDA比值显著升高(P<0.05),而对照组升高不明显。实验组肝组织细胞凋亡数(3.2±1.09)明显低于同水平对照组(5.47±1.02)(P<0.05),但与空白组(3.49±1.42)相比,无统计学差异(P>0.05)。结论:TEAS复合药物全麻行控制性降压能有效改善肝组织血流的低灌注状态,增强肝脏的抗自由基能力,抑制肝细胞凋亡,起到肝保护作用。
Objective：To observe the effect on the liver in controlled hypotension by transcutaneous electrical acupoint stimulation（TEAS） combining general anesthesia, and to provide the experimental evidence for clinical acupuncture anes thesia combined with drug. Methods ： Eighteen male beagles were randomly divided into three groups ： general anesthesia group （blank group, n = 6 ） , general anesthesia induced controlled hypotension group （control group, n = 6 ）and general an esthesia combining TEAS with controlled hypotension group （experiment group, n = 6）. The.later two groups were admin istered the same anesthesia with Isofluane inhalation and intravenous sodium nitroprusside （SNP） for controlled hypoten sion, the blank group was not treated with controlled hypotension. To lower the mean arterial pressure （MAP）to 60% bas ic MAP for 60rain ,in experiment group ,TEAS[ （2/100Hz, （4± 1 ） mA ] was applied to Quchi（ LI 11 ） ,Zusanli（ ST 36）, Hegu（ LI 4 ）, Sanyinjiao（ SP 6 ）from the beginning of physiological conditions stability to the end of maintained low MAP.The dogs＇ indicators were the surface of liver blood flow in corresponding time points which were monitored by Laser Doppler blood flow meter,the changes of liver GSH activity,T SOD activity and MDA content which were detected by immunohistochemistry, and the number of apoptotic cells after 72h which were checked by TUNEL assay.. Results：At the target low blood pressure of maintaining stage（T3 ）in controlled hypotension, the liver blood flow of the control group was significantly lower than base level （P 〈 0.05 ）, while the experiment group was not obviously declined, at the time of main taining stage for 10 minutes （T4 ）, the two pressure controlled groups were significantly lower than each basal level （P 〈 0.05 ）, at the stage of maintaining 20 to 60 minutes（ T5 T7 ） ,the two pressure controlled groups were significantly low er than each basal level and blank level（P 〈 0.05 ） ,compared with the experiment group,the liver blood flow of the con trol group maintained a lower level. In the recovery phase of blood pressure （ T8 ～ Tl2 ） , the liver blood flow of the experi ment group was significantly increased, in the time of rising for 10miniutes（ Ts ）, the experimental group has been re stored,while the control group was significantly lower than blank group. In the time of rising for 60 miniutes and rising end（TH T12 ）, the liver blood flow of the experiment group was significantly higher than control group, between the two groups there was statistically significant difference （ P 〈 0.05 ）. Compared with the blank group, the two pressure con trolled groups＇ GSH activity showed significantly increase （ P 〈 0.05 ）, and the increasing trend of the experiment was more obvious, compared with the blank group, the T SOD/MDA ratio of experiment was significantly higher（ P 〈 0.05 ）, while the control group was increasing less. The number of apoptotic cells of the experiment group （3.2 ± 1.09）was significant ly lower than the level of the control group （ 5.47 ± 1.02 ） （ P 〈 0.05 ）, but compared with the blank group （ 3.49 ±1.42 ）, there was no significant statistical difference （ P 〉 O. 05 ）. Conclusions ： TEAS combining general anesthesia for controlled hypotension can improve the liver＇s blood flow in the lower perfusion, enhance the ability of the liver against free radicals and inhibit apoptosis of liver cells, which play an active role in fiver protection.
出处
《中华中医药学刊》
CAS
2012年第10期2167-2171,I0001,共6页
Chinese Archives of Traditional Chinese Medicine
基金
国家重点基础研究发展计划(973计划)资助项目(2007CB512506)
浙江省"重中之重"学科经费资助项目
关键词
经皮穴位电刺激
针药复合麻醉
控制性降压
自由基
细胞凋亡
transcutaneous electrical acupoint stimulation
general anesthesia by TEAS integrated with drug
con-trolled hypotension
free radicals
apoptosis
