The Effect Of Perioperatively Transcutaneous Electrical Acupoint Stimulation On Immune System In Patients Underwent Major Spine Surgery

ObjectiveTo investigate the effect of perioperatively transcutaneous electrical acupoint stimulation on immune system and clinical outcomes in patients underwent major spine surgery.MethodsWe randomized 90 patients undergoing elective posterior nucleus pulposus of lumbar spinal nerve resection lysis of vertebral with fixed cage implantation surgery under general anaesthesia for their spinal stenosis and degenerating intervertebral disc into the following two groups:total intravenous anesthesia+TEAS group(Group T,n=45),who underwent TEAS over acupoints of bilateral Zusanli(ST.36),Sanyinjiao(SP.6)30 min before induction and during operation with frequency of 2/15Hz and 2/100Hz respectively,additional treatment for patients of T group were performed with TEAS over acupoints of bilateral Taichong(LR.3),Neiguan(PC.6)with frequency of 2/15Hz for 30-minute sessions once a day during period of postoperative 4d.Total intravenous anesthesia group(Group Q,n=45),who had the same electrode placement but no electrical output.Counts detection of T lymphocyte subtypes,natural killer cells and cytokines of interleukin-6 and interleukin-10 was performed using the peripheral blood samples collected in pre-operation,and postoperative 1h,day 1,day 3 and day 5 respectively.The characteristics,vital signs,time of operation and anesthesia,hemorrhage,transfusion of fluid,urine,consumption of anesthesia,the onset time of muscle relaxant time,the time of anesthesia recovery and extubation,intraoperative awareness,adjuvant drug as well as postoperative mortality was recorded.ResultsDemographic information.Of the 90 patients,6 were excluded:For the reason of more than 50%hemorrhage during operation refer two(one in group Q,and one in group T),and 1 due to serious postoperative complication(in group Q),other 3 in group Q due to incomplete data collection.At last,84 patients completed the study and 40 in group Q 44 in group T.It is comparable for the characteristics between two groups with no significant differences(P>0.05).primary outcome of immunity.As shown in Table 2 to 6,In comparison with the level of CD3+,CD4+T cells and ratio of CD4+/CD8+ before operation(TO)for each group,there were shown a trend of decrease at T1-T2 point,and presented significant differences with numbers of CD3+ T cells at T3-T4 in group T compared with group Q.Numbers of CD8+ were postoperatively gradual decreased and reached significant differences for each point compared with baseline value at TO except that level at T2 in group Q(all P<0.05).Compare with the value of CD56+ NK cells at TO in each groups,counts of CD56+ were higher at T1-T2 and lower at T4.For both groups,There were significantly higher differences concerning the counts of interluekin(IL)-6 and interluekin(IL)-10 than that initial stage at TO in the period of postoperation(P<0.01).And group T had significantly lower concentration refer to IL-10 in group Q at T4.Respectively,the numbers of white blood cell(WBC),percentage of Neutrophils(NE%)and percentage of lymphocytes(LYM%)were presented statistically significant higher and lower than that level at TO throughout the postoperative observation in each group(P<0.01),and there were significantly lower for NE%in group T than that counts in group Q at T2(P<0.05).Secondly outcomes.Compare with group Q,the change of heart rate at the end of operation and after tracheal extubation were significantly lower in group T(P<0.05).The consumption and index of remifentanil were decreased than that in group Q(P<0.05).The onset time of muscle relaxant before intubation was shown marked decrease than that in group Q(P<0.05).Less bleeding and lower rate of homologous blood transfusion as well as lower rate of using Urapidil injection in in group T compared with group T.There were significant differences between group Q and group T associated with the VAS score in first two days after surgery and the later had lower score(P<0.05).The rate of postoperative and nausea and vomiting(PONV)as well as dizziness were consider significantly lower in group T(P<0.05).ConclusionsPerioperative TAES was able to decrease inflammatory response and restore the postoperative immunosuppression of patients underwent major spinal surgery.Also,it could be able to make clinical outcome better.Therefore,TAES at special acupoints could provide a novel therapeutic intervention strategy for clinical immune dysfunction.