目的 研究围术期电针对肺切除术后心律失常的干预作用以及心律失常发生风险的影响.方法 纳入2020年1月—2022年10月接受肺切除手术的314例肺癌患者,根据随机数字表法将其分为对照组157例与电针组157例.对照组患者接受常规的围术期处理,电针组在对照组的基础上电针内关、外关、心俞、神门、通理、尺泽、合谷穴.比较两组患者心律失常发生情况,检测白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CPR)及N末端脑钠肽前体(NT-proBNP)水平,视觉模拟量表(VAS)进行疼痛评分,并采用多因素Logistic分析围术期采用电针疗法对肺切除术后发生心律失常的影响因素.结果 与手术前比较,两组麻醉清醒时的IL-6、TNF-α、hs-CPR、NT-proBNP水平、VAS疼痛评分降低(P＜0.01).与对照组比较,电针组室性及房性早搏发生率、心律失常的总发生率降低(P＜0.05,P＜0.01),电针组麻醉清醒时IL-6、TNF-α、hs-CPR、NT-proBNP水平、VAS疼痛评分降低(P＜0.01),手术前后IL-6、TNF-α、hs-CPR、NT-proBNP水平、VAS疼痛评分差值升高(P＜0.01).多因素Logistic回归分析显示,麻醉清醒时的IL-6[OR=2.030,95％CI(1.250,3.297)]、TNF-α[OR=3.147,95％CI(1.391,7.118)]、hs-CPR[OR=1.972,95％CI(1.078,3.609)]、NT-proBNP[OR=1.683,95％CI(1.013,2.796)]水平升高是肺切除术后心律失常发生的危险因素,TNF-α[OR=0.089,95％CI(0.011,0.741)]和 hs-CPR[OR=0.242,95％CI(0.084,0.695)]差值升高是心律失常发生的保护因素.结论 围术期电针疗法可有效降低心律失常的发生概率,为肺切除术后心律失常的预防提供新的策略.中国临床试验注册中心(No.ChiCTR2100047499).
Objective To study the effect of perioperative electroacupuncture(EA)intervention on arrhythmia after pneumonectomy and the influence of risk on new-onset arrhythmia.Methods A total of 314 lung cancer patients who received pneumonectomy from Jan,2020 to Oct,2022 were included,and they were assigned to the control group(157 cases)and EA group(157 cases)according to the random number table.Patients in the control group received conventional perioperative treatment,while those in the EA group received EA at Neiguan(PC6),Waiguan(SJ5),Xinshu(BL15),Shenmen(HT7),Tongli(HT5),Chize(LU5)and Hegu(LI4)combined with conventional treatment.The occurrence of arrhythmia in the 2 groups were compared.The serum level of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CPR),NT-pro brain natriuretic peptide(NT-proBNP)were detected.Visual analogue scale(VAS)was used to assess pain score.Multivariate Logistic regression was used to analyze the effect of high-risk factors of EA for arrhythmia after pneumonectomy during the perioperative period.Results Compared with before surgery,IL-6,TNF-α,hs-CPR,NT-proBNP and VAS pain score in the 2 groups decreased when awake from anesthesia(P＜0.01).Compared with the control group,the incidence of ventricular and atrial premature beats,and the total incidence of arrhythmia decreased in EA group(P＜0.05,P＜0.01),IL-6,TNF-α,hs-CPR,NT-proBNP and VAS pain score decreased in EA group when awake from anesthesia(P＜0.01),and the difference value of IL-6,TNF-α,hs-CPR,NT-proBNP and VAS pain score between before and after operation increased in EA group(P＜0.01).Multivariate Logistic regression analysis showed that the increasing of IL-6[OR=2.030,95％CI(1.250,3.297)],TNF-α[OR=3.147,95％CI(1.391,7.118)],hs-CPR[OR=1.972,95％CI(1.078,3.609)]and NT-proBNP[OR=1.683,95％CI(1.013,2.796)]when awake from anesthesia were risk factors for arrhythmia after pneumonectomy.The elevated differential values of TNF-α[OR=0.089,95％CI(0.011,0.741)]and hs-CPR[OR=0.242,95％CI(0.084,0.695)]were protective factors for arrhythmias after pneumonectomy.Conclusions Perioperative EA therapy can effectively reduce the incidence of arrhythmia and provide a new strategy for the prevention of arrhythmia after pneumonectomy.(Chinese Clinical Trial Registry,No.ChiCTR2100047499).
周正清;张永燕;高静雅
上海中医药大学附属岳阳中西医结合医院麻醉科(上海 200437)
肺癌;肺切除术;围术期;针刺疗法;心律失常;中西医结合;随机对照试验
lung cancer;pneumonectomy;perioperative period;acupuncture therapy;arrhythmia;integrative medicine;randomized controlled trial
《中国中西医结合杂志》 2024 (002)
143-148 / 6
上海市卫生健康委员会科研课题计划任务(No.202040310)
10.7661/j.cjim.20231009.248
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