| Objective:To observe the effect of propofol or sevoflurane with transcutaneous electrical acupoint stimulation(TEAS)on perioperative immunity among patients with gastrointestinal tumors,and to discover more optimal anesthesia method and perioperative intervention,and to provide theoretical evidence for improving perioperative immunity among patients with gastrointestinal tumors.Methods:A total of 80 inpatients diagnosed as gastric cancer or colorectal cancer by general surgery and rectal surgery at Lanzhou General Hospital(2016.05-2016.10)were recruited for radical operations.There were 48 males cases and 32 female cases aging from 30 to 78.By random number table method,all subjects were evenly divided into four groups,namely A group(propofol),B group(propofol+TEAS),C group(sevoflurane)and D group(sevoflurane+TEAS).Narcotrend value of anesthesia depth maintained 40 to 60.Four acupoints,Hegu,Neiguan,Zusan and Sanyinjiao,received electro-acupuncture,and the treatment was conducted at the same time period 30 min before surgery,during the whole operation process,1d and 2d after surgery for30 min via 2/100 Hz dilatational wave.The maximum intensity by patient tolerance was provided as 15~25m A.During the operation,vital signs,anaesthetic dosage,operation duration,intraoperative bleeding,fluid infusion volume and type,urine volume,VAS score after completely PACU analepsia from extubation and first postoperative anal exhaust timing.Venous blood(4ml)were drawn on T1(30min before surgery),T2(after surgery),T3(24h after surgery)and T4(72h after surgery),and flow cytometry were applied to detect the percentage of T-lymphocyte subsets(CD3+,CD4+,CD8+ and CD4+ /CD8+),and ELISA was used to measure the serum levels of s IL-2R,IFN-?,TGF-?,COX-2 and VEGF.Results:1.No statistical difference in age,weight,intraoperative bleeding,operation duration,fluid infusion volume and urine volume was found among four groups of patients(P>0.05);2.No statistical difference in intraoperative anaesthetic dosage was found among four groups of patients(P>0.05);3.In comparison within groups and among groups,no statistical difference in HR,BP,SBP,DBP,MAP,Sp O2 and Narcotrend score was found before anaesthesia,tracheal intubation,skin incision and after surgery(P>0.05);4.No statistical difference in VAS scores after completely PACU analepsia from extubation was found among four groups of patients(P>0.05);5.First postoperative anal exhaust timings of B group(32.60±6.65h)and D group(32.50±5.65h)were lower than A group(59.20±9.41h)and C group(56.00±11.93h),the difference was statistically significant(P<0.05);6.Comparing to T1,levels of CD3+,CD4+ and CD4+/CD8+ were reduced at T2 and T3,but the level of CD8+ was elevated(P<0.05).at T4,levels of CD3+,CD4+ and CD4+/CD8+were significantly elevated,but the level of CD8+ was reduced(P<0.05);no statistical difference of CD3+,CD4+ and CD4+/CD8+ was found at T1 among four groups(P>0.05);comparing to A and C groups,levels of CD3+,CD4+ and CD4+/CD8+ in B and D groups at T2,T3 and T4 were higher,but the level of CD8+ was lower.No statistical difference was found between A group and C group(P>0.05);7.Changes in perioperative levels of s IL-2R,TGF-?,COX-2 and VEGF: all above indicators in T2 were elevated than T1,and the elevations in group A and group C were significant(P<0.05);levels in T3 were still higher than results in T1 regardless of gradual decrease;indicator levels from T4 were significantly reduced,but the levels were still lower than T1 even in B and C groups with the most significant decrease(P<0.05);in the comparisons between A and C as well as B and D,no significant change was found in concentration of s IL-2R,TGF-?,COX-2 and VEGF,but levels in B and D were both lower than A and C(P<0.05);8.Change in perioperative level of IFN-?: IFN-? of all four groups were reduced at T2,and significant decreases were found in A group and C group(P<0.05);levels of T3 were still lower than T1 regardless of gradual elevation;levels of T4 were higher than T1 after significant elevation(P<0.05);in the comparison s between A and C as well as B and D,no significant change was found in concentration of IFN-?(P<0.05),but levels in B and D were both higher than A and C(P<0.05).Conclusion:This study indicated propofol or sevoflurane with transcutaneous electrical acupoint stimulation was able to enhance the reduced perioperative immunity among patients with gastrointestinal tumors.Via TEAS intervention,postoperative immunity was improved than before anesthesia,and first postoperative anal exhaust timing was shortened,which promoted threcovery of gastrointestinal function.However,pure application of propofol or sevoflurane had little effect on perioperative immunity among patients with gastrointestinal tumors. |
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