Effects Of Acupuncture In Perioperative Period On Stress Response For Surgical Patients

Object ive1.To observe effects of acupuncture in perioperative period on cardiopulmonary, gastrointestinal functions and analgesia for surgical patients.2. To discuss effects of acupuncture in perioperative period on stress response, including inflammatory response, oxidative stress and psychological stress for surgical patients.3. To research mechanisms of acupuncture in perioperative period on stress response for surgical rats.MethodClinical Study1. Grouping Method:60patients who scheduled for gynecological laparoscopic surgery and met the inclusion criteria were divided randomly into control group (30cases) and acupuncture group (30cases).2. Treatment Method:Control group received gynecological postoperative based treatments only; Acupuncture group received both acupuncture and gynecological postoperative based treatments. Acupuncture method: mind-regulation formula with acupuncture which created by Prof. Zhang hong. The points are sishencong(EX-HNl), shenting(GV24), yintang(EX-HN3), bilateral neiguan(P6) and bilateral sanyinjiao (SP6). Course of Treatment: Acupuncture group received acupuncture at time1hour before operation, and2hour,1day,2days,3days after operation,30minutes one time, QD, for5times.3. Observation Indexes:(1)The effect of acupuncture in perioperative period on body functions for surgical patients:①Analgesic effect;②Cardiopulmonary function;③Gastrointestinal function;④Adverse reactions and complications after operation.(2) The effect of acupuncture in perioperative period on stress response for surgical patients:the observation indexes are ACTH and Cor in plasma.(3) The effect of acupuncture in perioperative period on acute inflammatory response for surgical patients: the observation indexes are IL-6and IL-10in serum.(4) The effect of acupuncture in perioperative period on oxidative stress for surgical patients: the observation indexes are MDA and NO in plasma.(5) The effect of acupuncture in perioperative period on psychological stress for surgical patients:the observation indexes are SAS and SDS.Experimental Study1. Grouping Method:30male SPF Sprague-Dawley rats rats were divided randomly into3groups:control group (30cases), operation group (30cases) and operation plus acupuncture group (30cases).2. Experimental Procedure:(1) To establish surgical trauma models of rats with partial hepatectomy.(2) Acupuncture method:The points are sishencong(EX-HN1), shenting(GV24), yintang(EX-HN3), bilateral neiguan(P6) and bilateral sanyinjiao (SP6). Electroacupuncture instrument of G6805was used to stimulate the points of bilateral neiguan(P6) and bilateral sanyinjiao (SP6) with dilatational wave,1-2mA in intensity for30minutes. Adjusting the intensity to make muscle vibrating slightly and avoid rats screaming. Operation plus acupuncture group received acupuncture at time1hour before operation, and2hours after operation,30minutes one time, QD, for2times.(3) Drawing tissues:The rats in three groups were sacrificed to separated liver, hippocampus and hypothalamus in the same time when the stress response is the strongest in partial hepatectomy rats, that is12hours after operation., then freezing samples as soon as possible.3. Observation Indexes:(1) Liver histopathological examination was used.(2) The expression of GR in liver was detected by using immunohistochemistry assay.(3) The expression of GR mRNA in hippocampal was examined by reverse transcription-PCR (RT-PCR).(4) The expression of CRH mRNA in hypothalamic was examined by reverse transcription-PCR (RT-PCR).ResultsClinical Study(1)The effect of acupuncture in perioperative period on body functions for surgical patients ①Analgesic effectThere was no difference in all the parameters between the two groups at6hours after operation. VAS at1day,3days after operation in two groups were significantly lower than those at6hours after operation (P<0.05), and VAS at1day,3days after operation in acupuncture group were significantly lower than those in control group (P<0.05). BCS at1day,3days after operation in two groups were significantly higher than those at6hours after operation (P<0.05), and BCS at3days after operation in acupuncture group were significantly higher than those in control group (P<0.05)②Cardiopulmonary functionThere was no difference in all the parameters between the two groups before operation. SBP after operation in two groups were significantly higher than those before operation (P<0.05). DBP after operation in control group were significantly higher than those before operation (p<0.05). HR after operation in control group were significantly higher than those before operation (P<0.05), and HR after operation in acupuncture group were significantly lower than those in control group (P<0.05). There was no statistically difference in SPO2and RR in both two groups before and after operation, and there was no statistically difference in SPO2and RR between the two groups③Gastrointestinal functionThe time of first exhaust and the time of first defecation after operation in acupuncture group was significantly lower than that in control group (P<0.05)④Adverse reactions and complications after operation.No complications were found in both two groups in the observation period, and there was no statistically difference in the incidence of adverse reactions between the two groups.(2) The effect of acupuncture in perioperative period on stress response for surgical patientsThere was no difference in all the parameters between the two groups before operation. ACTH, Cor at6hours,1day after operation in two groups were significantly higher than those before operation (P<0.05), and ACTH, Cor at3days after operation in control group were significantly higher than those before operation, too (P<0.05). ACTH, Cor at6hours,1day after operation in acupuncture group were significantly lower than those in control group (P<0.05)(3) The effect of acupuncture in perioperative period on acute inflammatory response for surgical patientsThere was no difference in all the parameters between the two groups before operation. IL-6at6hours,1day,3days after operation in two groups were significantly higher than those before operation(P<0.05), and IL-6at6hours,1day,3days after operation in acupuncture group were significantly lower than those in control group (P<0.05). IL-10at6hours,1day after operation in two groups were significantly higher than those before operation (P<0.05), and IL-10at3days after operation in control group were significantly higher than those before operation, too (P<0.05). IL-10at6hours,1day after operation in acupuncture group were significantly lower than those in control group (P<0.05)(4) The effect of acupuncture in perioperative period on oxidative stress for surgical patientsThere was no difference in all the parameters between the two groups before operation. MDA at6hours,1day after operation in two groups were significantly higher than those before operation (p<0.05). Although the overall difference between the two groups was not statistically significant, MDA at6hours,1day after operation in acupuncture group were significantly lower than those in control group (P<0.05).NO at6hours,1day,3days after operation in two groups were significantly lower than those before operation (P<0.05), and NO at6hours,1day after operation in acupuncture group were significantly higher than those in control group (P<0.05)(5) The effect of acupuncture in perioperative period on psychological stress for surgical patientsThere was no difference in all the parameters between the two groups before operation. SAS, SDS at7days after operation in both groups were significantly lower than those before operation (p<0.05), and SAS, SDS at7days after operation in acupuncture group were significantly lower than those in control group (P<0.05)Experimental Study(1) Liver histopathological examinationControl group:Basically normal hepatocy were observed under light microscopy with HE stain. Operation group:The phenomenon of hepatocy swell and balloon-like degeneration were widespread. The fat drops were observed in hepatocytoplasms partially. Operation plus acupuncture group:The phenomenon of hepatocy swell and balloon-like degeneration were partially.(2) The expression of GR in liver (immunohistochemistry assay)The GR expression of normal hepatocy is high. The GR expression of hepatocy in operation group was significantly lower than that in control group (P<0.05). There was no statistically difference in the GR expression of hepatocy between operation plus acupuncture group and control group.(3) The expression of GR mRNA in hippocampal (RT-PCR)The GR mRNA expression of hippocampal in both operation group and operation plus acupuncture group was significantly lower than that in control group (P<0.05), and the GR mRNA expression of hippocampal in operation plus acupuncture group was significantly higher than that in operation group (P<0.05)(4) The expression of CRH mRNA in hypothalamic (RT-PCR).The CRH mRNA expression of hippocampal in both operation group and operation plus acupuncture group was significantly higher than that in control group (P<0.05), and the CRH mRNA expression of hippocampal in operation plus acupuncture group was significantly lower than that in operation group (P<0.05)Conelus ion1. Mind-regulation formula with acupuncture in perioperative period for surgical patients can effectively relieve postoperative pain, maintain postoperative cardiopulmonary functions, and promote postoperative gastrointestinal function.2. Mind-regulation formula with acupuncture in perioperative period for surgical patients can adjust postoperative stress response to reduce the possibility of the secondary damage of excessive stress response.3. Mind-regulation formula with acupuncture in perioperative period for surgical patients can adjust postoperative inflammatory stress response to reduce the incidence of infections and complications.4. Mind-regulation formula with acupuncture in perioperative period for surgical patients can adjust postoperative oxidative stress to reduce the incidence of ischemia and hypoxia in tissue and organ.5. Mind-regulation formula with acupuncture in perioperative period for surgical patients can adjust perioperative psychological stress to improve the patient’s psychological condition and prevent postoperative infection.6. Animal experiments showed that:In the postoperative stress response, mind-regulation formula with acupuncture in perioperative period for surgical patients can reduce the possibility of the secondary damage, and enhance the ability to resist damages and repair traumas.In summary, mind-regulation formula with acupuncture in perioperative period has good regulation on many aspects of stress response for surgical patients.