Application Of Transcutaneous Electrical Acupoint Stimulation In Pulmonary Surgery For Patients With Tuberculosis

Objective By comparing the use of analgesic drugs during the perioperative period of lung surgery,the level of Inflammatory mediators such as TNF-α,IL-6 and IL-8,and the change of blood gas analysis,as well as the proportion of T lymphocyte subsets（CD3+,CD4+,CD8+,CD4+/CD8+）and natural killer cells（NK cells）in patients with tuberculosis,to analyze the analgesic effect of transcutaneous electrical acupoint stimulation（TEAS）,and its influence on the pulmonary oxygenation function and inflammatory reaction caused by one lung ventilation,as well as its regulation on immune function.Methods Sixty-two Pulmonary tuberculosis patients who underwent thoracotomy and empyema clearance under general anesthesia,with physique grades I or II of ASA,were randomized into two groups:group T（TEAS 2Hz/100Hz）and group F（Sham TEAS）.TEAS on bilateral Hou Xi,Zhi Gou,Nei Guan and He Gu points were applied to the patients in group T starting from 30min before induction of anesthesia until the end of surgery,with the electrical stimulation parameters:density wave,frequency of 2/100Hz,the maximum intensity is to the patients’tolerance.The same management were applied to patients in group F,with shame TEAS for control.The induction of analgesia and continuous anesthesia used in the two groups were the same.The index of hemodynamics and respiratory mechanics were recorded at before induction of anesthesia（T0）,the moment of one lung ventilation（T1）,1h after one lung ventilation（T2）,the end of one lung ventilation（T3）,and the end of operation（T4）.At T1,T2,T4,arterial blood samples were taken.The use of PCA was recorded at 24 hours（T5）and 48 hours after operation（T6）.The contents of inflammatory mediators and lymphocyte subsets were monitored at T0 and 5 days after operation（T7）.Results There was no significant difference in the general situation between the two groups（P>0.05）.Compared with Group F,the quota of MAP,Paw,P_ETCO₂and Sp O₂in Group T was not statistically different at all time points（P>0.05）,while the heart rate was lower during the one lung ventilation（T1,T2,T3）,and the difference was statistically significant（P<0.05）.The amount of sufentanil used in each period,the total and effective press times of PCA,and the VAS scores in group T were all lower than those in group F,with statistical difference（P<0.05）.There was no significant difference in PH,Pa CO₂,Pa O₂and oxygenation index between the two groups（P>0.05）.At T0,no significant difference was found in inflammatory factors as IL-6,IL-8 and TNF-αbetween the two groups（P>0.05）,which were all lower in group T at T7,but only TNF-αwas statistically different（P<0.05）.Besides,we found no significant difference in CD3+,CD4+,CD8+,CD4+/CD8+and NK cells between the two groups（P>0.05）at T0,while at T7,the levels of CD3+,CD4+,CD4+/CD8+and NK cells in group T were higher,and lower level of CD8+in the meantime,but they were not statistically significant（P>0.05）.Conclusions Transcutaneous electrical acupoint stimulation can effectively reduce the use of narcotic analgesics in patients with pulmonary tuberculosis during perioperative period,with good analgesic effect.And it can alleviate the inflammatory reaction during the one lung ventilation period,but has no obvious effect on the immune function or pulmonary oxygenation function.