Effects Of Transcutaneous Electrical Acupoint Stimulation Combined With Dexmedetomidine On T Lymphocyte Subsets And Postoperative Recovery In Patients Undergoing Total Knee Arthroplasty

Objective:The purpose of this study was to investigate the effects of transcutaneous electrical acupoint stimulation（TEAS）combined with dexmedetomidine on T lymphocyte subsets and postoperation recovery in patients undergoing total knee arthroplasty.Methods:From April 2018 to August 2019,60 patients with knee osteoarthritis treated in the Second Hospital of Shanxi Medical University were included.According to the random number method,they were divided into control group（group C）,dexmedetomidine group（group D）and TEAS combined with dexmedetomidine group（group T+D）,each with 20 cases.Group C received no electrical stimulation and 0.9%sodium chloride injection was pumped simultaneously.After anesthesia,group D received dexmedetomidine with a load of 0.5μg/kg for 10 min,followed by 0.4μg/（kg·h）to the suture.The T+D group underwent TEAS at bilateral Hegu and Neiguan points 30 min before anesthesia until the end of operation,and dexmedetomidine was pumped at the same time.The pumping program was the same as that of group D.All operations were performed by the same team of chief physicians,and the anesthesia and postoperative analgesia protocols were the same.Blood samples was collected before anesthesia（T₀）,at the end of surgery（T₁）and 24 h after surgery（T₂）,and the levels of T lymphocyte subsets（CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺,CD4⁺CD25⁺Treg）were detected by flow cytometry.Visual analogue scale（VAS）was used to assess the degree of pain during resting status and functional exercise after the surgery.The incidence of postoperative adverse reactions,knee flexion and extension range of motion and length of stay were recorded.Results:Compared to the level before surgery,CD3⁺and CD4⁺significantly decreased after surgery and at 24 h after surgery（P<0.05）.Compared with group C,CD4⁺/CD8⁺was significantly increased in group D and T+D at the end of the operation（P<0.0167）,and CD3⁺,CD4⁺and CD4⁺/CD8⁺were significantly increased in group D and T+D 24 hours after the operation（P<0.0167）.Compared with group D,CD3⁺,CD4⁺/CD8⁺were significantly increased in group T+D at 24 h after surgery（P<0.0167）.Compared with group C,VAS score of group D and group T+D significantly decreased at rest 1 and 6hours after surgery（P<0.05）.Compared with group D,VAS score of T+D group was significantly reduced at rest 2,6,12 h after surgery（P<0.05）.Compared with C group and D group,VAS score of T+D group was significantly reduced during functional exercise 6,24 h after surgery（P<0.05）.Compared with group C,the incidence of postoperative nausea and vomiting in group T+D group was significantly reduced（P<0.05）.There was no statistically significant difference in knee flexion and extension range of motion and the length of stay between the three groups（P>0.05）.Conclusion:Patients with knee osteoarthritis undergoing total knee arthroplasty have certain immune suppression after surgery.The combination of TEAS and dexmedetomidine can improve patients’immune function,reduce postoperative VAS score,reduce postoperative pain,and reduce the incidence of postoperative nausea and vomiting,thus facilitating postoperative recovery.