文章摘要
曲立哲,白 冬,孙 瑜,俞红丽,王燕颖.点针刺对全麻下行微创LC术后患者胃肠功能及血清NO、MPO、HSP90、OXA水平变化的影响[J].,2022,(9):1749-1753
点针刺对全麻下行微创LC术后患者胃肠功能及血清NO、MPO、HSP90、OXA水平变化的影响
Effects of Multi-point Acupuncture on Gastric Function and Serum NO, MPO, HSP90 and OXA Levels in Patients after Minimally Invasively Laparoscopic Cholecystectomy Surgery under General Anesthesia
投稿时间:2021-10-12  修订日期:2021-11-08
DOI:10.13241/j.cnki.pmb.2022.09.030
中文关键词: 多点针刺  NO  MPO  HSP90  OXA  胃肠功能
英文关键词: Multi-point acupuncture  Nitric oxide  Myeloperoxidase  Heat shock protein 90  Orexin A  Gastrointestinal function
基金项目:上海中医药大学预算内项目(2020TS094)
作者单位E-mail
曲立哲 上海中医药大学附属市中医医院麻醉科 上海 200071 13761003275@139.com 
白 冬 上海中医药大学附属市中医医院麻醉科 上海 200071  
孙 瑜 上海中医药大学附属市中医医院麻醉科 上海 200071  
俞红丽 上海中医药大学附属市中医医院麻醉科 上海 200071  
王燕颖 同济大学附属东方医院特诊部 上海 200120  
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中文摘要:
      摘要 目的:探讨多点针刺对全麻下行腹腔镜胆囊切除术(LC)后患者胃肠功能及血清一氧化氮(NO)、髓过氧化物酶(MPO)、热休克蛋白90(HSP90)、食欲素A(OXA)水平的影响。方法:选取2018年9月~2020年9月我院全麻腹腔镜胆囊切除术(LC)的患者107例,采用随机数字表法,将其分为针刺组(n=55例)及对照组(n=52例)。对照组术后给予常规治疗;观察组在对照组基础上给予多点针刺,时间分别为:术前30分钟(采血后)、术后4-6小时、术后两天,每日两次,每次留针30 min;取穴为双侧三阴交、足三里、上巨虚、内关、合谷、百会、印堂穴。检测两组术前30分钟(针刺前)、术后30分钟、术后第3 d的血清NO、MPO、HSP90、OXA水平的变化;记录术后第一次肛门排气时间、第一次肛门自主排便时间、肠鸣音的恢复时间,观察术后48 h恶心呕吐、腹痛、腹泻等发生情况。结果:术后30 min,与术前相比较,NO、MPO、HSP90升高,OXA下降,差异有统计学意义(P<0.05);术后第3 d,与术后30 min相比较,NO、MPO、HPS90下降,观察组水平较对照组低,差异均有统计学意义(P<0.05);术后第3 d,与术后30 min相比较,OXA升高,观察组水平较对照组高,且差异有统计学意义(P<0.05)。术后48小时,观察组腹胀、恶心呕吐及腹痛的发生率明显低于对照组,差异有统计学意义(P<0.05);观察组术后首次排气排便时间、肠鸣音恢复时间低于对照组,差异有统计学意义(P<0.05)。结论:多点针刺可显著促进全麻LC术后胃肠功能恢复,加快术后腹胀、恶心呕吐及腹痛缓解;显著降低全麻LC术后患者血清NO、MPO、HSP90水平,升高血清OXA水平。我们推测,OXA信号通路增强,可能是多点针刺治疗全麻LC术后胃肠功能紊乱神经内分泌免疫调节机制中的一个靶点。
英文摘要:
      ABSTRACT Objective: To investigate the effects of multi-point acupuncture on gastrointestinal function and serum levels of nitric oxide (NO), myeloperoxidase (MPO), heat shock protein 90(HSP90) and orexin A (OxA) in patients undergoing laparoscopic cholecystectomy(LC) under general anesthesia. Methods: A total of 107 patients undergoing laparoscopic cholecystectomy(LC) under general anesthesia in our hospital from September 2018 to September 2020 were selected and divided into acupuncture group (n=55) and control group(n=52) by random number table method. The control group was given routine treatment after surgery. The observation group was additively given multi-point acupuncture on the basis of the control group, and the time was: 30 minutes before surgery(after blood collection), 4-6 hours after surgery, and two days after surgery, twice a day, each time for 30 min; The acupoints selected are bilateral Sanyinjiao, Zusanli, Shangjuxu, Neiguan, Hegu, Baihui and Yintang. The serum levels of NO, MPO, HSP90 and OXA in both groups were detected 30 minutes before the operation (before acupuncture), 30 minutes after the operation, and 3 days after the operation. The time of the first anal exhaust after surgery, the time of the first anal voluntary defecation, and the recovery time of intestinal sounds were recorded. The occurrence of nausea, vomiting, abdominal pain, diarrhea and other conditions 48 hours after surgery were observed. Results: 30 min after operation, compared with before operation, NO, MPO, HSP90 increased, OXA decreased, the differences were statistically significant(P<0.05). On the third day after surgery, compared with 30 min after surgery, NO, MPO and HPS90 decreased, and the levels in the observation group were lower than those in the control group, the differences were statistically significant(P<0.05). On the 3rd day after surgery, compared with the 30 min after surgery, OXA level in the observation group was higher than that in the control group, and the differences were statistically significant(P<0.05). 48 hours after operation, the incidence of abdominal distension, nausea, vomiting and abdominal pain in the observation group was significantly lower than that in the control group, the differences were statistically significant (P<0.05). The first postoperative defecation time and bowel sound recovery time of the observation group were shorter than those of the control group, and the differences were statistically significant(P<0.05). Conclusion: Multi-point acupuncture can significantly promote the recovery of gastrointestinal function, and accelerate the relief of abdominal distension, nausea, vomiting and abdominal pain after LC general anesthesia. The serum levels of NO, MPO and Hsp90 were significantly decreased, and the serum level of OXA was increased in patients after LC under general anesthesia. We speculated that the enhancement of OXA signaling pathway may be a target in the neuroendocrine immune regulation mechanism of gastrointestinal dysfunction after multi-point acupuncture in the treatment of LC under general anesthesia.
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