文献类型：期刊文献

中文题名：经皮穴位电刺激对全膝关节置换术患者免疫功能与术后恢复的影响

英文题名：Effect of percutaneous acupoint electrical stimulation on immune function and postoperative recovery in patients with total knee arthroplasty

作者：逯晓婷[1];段蓉蓉[1];秦晓宇[1];黄伟华[1];丁声双[1];张杰[1];王春爱[2]

第一作者：逯晓婷

机构：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000;[2]甘肃省中医院麻醉科,甘肃兰州730000

第一机构：甘肃中医药大学临床医学院

年份：2024

卷号：37

期号：12

起止页码：1213

中文期刊名：中国骨伤

外文期刊名：China Journal of Orthopaedics and Traumatology

收录：CSTPCD;;Scopus;CSCD:【CSCD_E2023_2024】；PubMed;

基金：中医药传承创新平台[编号:甘卫中医涵(2020)203号];甘肃省重点研发计划(编号:20YF3FA020)。

语种：中文

中文关键词：经皮穴位电刺激;膝关节置换;围术期;免疫抑制

外文关键词：Transcutaneous electrical acupoint stimulation;Knee replacement;Perioperative;Immunosuppression

摘要：目的:探讨经皮穴位电刺激(transcutaneous acupoint electrical stimulation,TEAS)对全膝关节置换术(total knee arthroplasty,TKA)患者围术期免疫功能与术后恢复的影响。方法:自2021年11月至2022年7月择期行单侧TKA患者80例,按照治疗方法不同分为TEAS组与假TEAS组。TEAS组40例,男9例,女31例;年龄61~79(66.90±5.86)岁;身体质量指数(body mass index,BMI)为19.53~30.47(25.34±2.83) kg·m^(-2);左侧21例,右侧19例;美国麻醉医师学会(American Society of Anesthesiologists,ASA)Ⅱ级30例,Ⅲ级10例;于麻醉前30 min在双侧合谷(LI4)、内关(PC6)穴和非术侧足三里(ST36)、三阴交(SP6)穴行TEAS,至手术结束,频率为2/10 Hz的疏密波,电流强度为患者可以耐受和(或)肢体肌肉节律性抽动。假TEAS组40例,男9例,女31例;年龄60~80(67.35±4.29)岁;左侧27例,右侧13例;BMI为20.02~30.09(25.02±2.23) kg·m^(-2);ASAⅡ级28例,Ⅲ级12例;在相同穴位上连接电极片但不进行电刺激。比较两组术前、术毕、术后24 h的CD3+、CD4+、CD8+、NK细胞百分比含量,术后感染情况,术后48 h内恶心、呕吐、腹胀、瘙痒发生率以及首次下地时间、住院时间、恢复质量-15 (quality of recovery-15,QoR-15)评分。结果:与假TEAS组比较,TEAS组于术后24 h的CD3+、CD4+T淋巴细胞表达明显升高(P<0.05);术后48 h内恶心的发生率以及术后早期下地时间明显降低(P<0.05)。术后继发感染情况、呕吐、腹胀、瘙痒等不良反应以及住院时间比较,差异无统计学意义(P>0.05)。结论:经皮穴位电刺激可以改善TKA患者围术期细胞免疫,减轻免疫抑制,减少术后不良反应的发生率,促进患者术后早期恢复。
Objective To evaluate clinical effect of transcutaneous acupoint electrical stimlation(TEAS)on perioperative immune function and postoperative recovery in patients with total knee arthroplasty(TKA).Methods From November 2021 to July 2022,80 patients with unilateral TKA were selected and divided into TEAS group and sham TEAS group according to different treatment methods.There were 40 patients in TEAS group,including 9 males and 31 females;aged from 61 to 79 years old with an average of(66.90±5.86)years old;body mass index(BMI)ranged from 19.53 to 30.47 kg·m^(-2) with an average of(25.34±2.83)kg·m^(-2);21 patients on the left side,19 patients on the right side;according to American Society of Anesthesiologists(ASA),30 patients with gradeⅡ,10 patients with gradeⅢ;TEAS were administered at the bilateral Hegu(LI4),Neiguan(PC6)and non-operative Zusanli(ST36)and Sanyinjiao(SP6)points from 30 min before anesthesia to the end of operation,the frequency was 2/10 Hz,current intensity was tolerable and/or muscle rhythmic twitches of limbs were performed.There were 40 patients in sham TEAS group,including 9 males and 31 females;aged from 60 to 80 years old with an average of(67.35±4.29)years old;27 patients on the left side and 13 patients on the right side;BMI ranged from 20.02 to 30.09 kg·m^(-2) with an average of(25.02±2.23)kg·m^(-2);28 patients with gradeⅡand 12 patients with gradeⅢaccording to ASA;Electrodes were attached to the same points without electrical stimulation. Percentage contents of 24 h CD3+,CD4+,CD8+ and NK cells,postoperative infection,incidence of nausea,vomiting,abdominal distension and pruritus within 48 h after surgery,the first time on the ground,length of hospital stay and quality of recovery-15 (QoR-15) score were compared between two groups. Results Compared with pseudoteas group,expressions of CD3+ and CD4+ T lymphocytes in TEAS group were significantly increased at 24 h after surgery (P<0.05). The incidence of nausea within 48 h after surgery and the time spent on the ground early after surgery were significantly decreased (P<0.05). There was no significant difference in postoperative secondary infection,adverse reactions such as vomiting,abdominal distension,pruritus and hospitalization days (P>0.05). Conclusion Percutaneous acupoint electrical stimulation could improve perioperative cellular immunity in patients with total knee replacement,alleviate immunosuppression,reduce incidence of postoperative adverse reactions,and promote early postoperative recovery.