The Effect Of Immunologic Function By Subcutaneous Analgesia At Acupuncture Point In Postoperative Patients

Objective:1 To assess the analgesic effect of the postoperative multimodal analgesia on patients undergoing laparoscopic cholecystectomy by observing vital signs, VAS score and dose of postoperative analgesic opioids.2 To evaluate the effect of the immunologic function by investigating the changes of IL1-β, TNF-α and CD4+、CD8+as well as CD4+/ CD8+ in serum.Methods:Eighty ASA grade I or II patients, scheduled for elective laparoscopic cholecystectomy surgery,were randomly divided into four groups with 20 patients in each group:group A (subcutaneous analgesia at T8 Jiaji acupuncture point,n=20), group B(subcutaneous analgesia at Zusanli acupuncture point,n=20), group C (subcutaneous analgesia,n=20), group D(intravenous analgesia,n=20). Intravenous access were opened after patients entered operation room and 0.5mg hydrochloric penehyclidine was injected intravenously 0.5h before induction. ECG、NIBP、SpO2 and the BIS were monitored. Induction and maintenance of anesthesia were same in all groups. Analgesia pump was connected after the tracheal extubation.The vital sign and VAS score were record before induction( TO), after tracheal extubation (T1)and 6h(T2),24h (T3)and 48h (T4)after postoperative analgesia. The frequency of pressing PCA and the total dose of sufentanil in the process of postoperative analgesia were recorded as well.3ml peripheral venous blood was collected at the time points of T0、T2、T3 and T4 respectively. IL1-β and TNF-α in serum were analyzed by ELISA. The count of CD4+> CD8+and the ratio of CD4+/CD8+ in peripheral blood were detected by flow cytometry.Results:1 Comparing with T0, HR of all patients increased significantly at T1 and T2 (P<0.05). MAP of all groups increase significantly at T1(P <0.05). There is no significant difference in HR and MAP at other time points and between each groups(P>0.05).2 Comparing with T1, VAS scores at other time points were significantly lower(P<0.05). There were no significant difference in VAS scores between each groups(P>0.05).3 Comparing with the group D, the frequency of pressing PCA and the total dose of sufentanil were significantly decreased in group A and B(P<0.05), and there was no significant difference in group C(P>0.05).4 Comparing with TO, IL1-β and TNF-α in serum of all groups were significantly increased at all time points(P<0.05). Comparing with the group D, at T3 and T4, IL1-β and TNF-α in serum were significantly lower in group A and B(P<0.05).5 Comparing with TO, the ratio of CD4+/CD8+ were significantly lower at T3 and T4(P<0.05).The count of CD4+ decreased significantly at T4. Except group A, the count of CD8+ in other groups increased significantly(P<0.05) at T4. There was no significant difference among groups (P>0.05)Conclusions:1 All patients in groups had been provided contented analgesia by multimodal analgesia.2 Comparing with traditional intravenous analgesia, subcutaneous analgesia at acupuncture point could decrease the dose of narcotic analgesic and attenuate the suppression of immunologic function caused by postoperative pain.