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EFFECTS

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EFFECTS

    EFFECTS

WormJ.Acup-Mox.Vo1.11,No.1,March,2001

    ;EFFECTSoFELECTRoACUPUNCTUREoNPLASMA

    ;CATECHoLAMINEANDANGIoTENSIoN?INoPENHEART

    ;SURGICALPATIENTSUNDERGOINGCARDIoPULMoNARYBYPA

    SS

    ;YangQingguo(杨庆国)HangYann(杭燕南)SunDajin(孙大

    )ChengXiming([~锡明)

    ;WangXiangrui(:E祥瑞)XuCanran(许灿然)YaoJianling(姚建玲)

    ;DepartmentofAnesthesia,RenjiHospitalA{liatedtoShanghai

    ;SecondMedicalUniversity,Shanghai200001,China

    ;ABSTRACTTostudytheeffectsofelectroacupunctureonsympatheticadrenomedullary(SA)systemandrenin-an.

    ;giotensin-aldosterone(RAA)systeminopenheartsurgicalpatientsundergoingcardiopuImonarybypass(CPB),30pa-

    ;tientswithatriaIseptaIdefectwererandomlydividedintogeneralanesthesia(GA)group,acupunctureanesthesia

    ;(AA)groupandacupuncturewithgeneraIanesthesia(AGA)group.PeripheraIbloodsamplesweretakenbeforeares.

    ;thesiaand30minafterCPB.Theplasmaconcentrationsofnorepinephrine(N

E),epinphrine(E)andangiotensin?(A

    ;

    ?)weredetected.Results:PlasmaNEandEofpost-CPBincreasedsignificantlyinGAgroupandAAgroup,butde.

    ;creasedsignificantlyinAGAgroup.PlasmaA?

    ofpost-CPBincreasedsignificantlyinGAgroup.butnomarked ;changeswerefoundinAAgroupandAGAgroup.Conclusions:AcupuncturecanimprovetheA?responsetocardiac

    ;surgeryandCPB.AGAbutnotAAcaninhibitthecatecholamine(CA)responsetocardiacsurgeryandCPB.

    ;KEYWORDSElectroacupunctureCardiacsurgeryCardiopuImonarybypassCatecholemineAngiotensin?

    ;Duringcardiacsurgery,SAsystemand

    ;RAAsystemhaveanintensiveresponsetoskin

    ;ineision,sternotomyandmanipulationofthe

    ;heart;however,themostremarkableresponse

    ;occursduringCPB.TheincreaseofCAandA?

    ;maytmpatrtherecoveryotpostoperattvepa

    ;tients.Severalstudiesdemonstratedthat

    ;acupuncturehadaregulatoryactiononSAsys

    ;ternandRAAsystem[31.

    ;Whatchangesofthe

    ;SAsystemandRAAsysteminresponsetocar. ;diacsurgeryandCPBwillhappenwhenusing ;acupuncturehavenotbeenreported.Ourstudy ;aimstoobservetheeffectsofelectroacupuncture ;onSAsystemandRAAsysteminopenheart ;surgicalpatientsundergoingCPB.andtoprovide ;afoundationfortheadvantageofAGAincardio. ;vascularsurgery.

    ;1METH0lDS

    ;1.1Patients

    ;Thirtypatientsundergoingrepairofatrial ;septaldefect,ASAIII,withoutevidenceof

    ;endocrinedisorder,wererandomlydividedinto ;threegroups.Patientprofilesaresummarizedin ;Table1.InAAgroup,onepatientwasexcluded ;becausetheacupunctureanesthesiafailed. ;1.2Anesthesiamethods

    ;GAgroup:1)Premedication:intramuscu. ;1arinjectionofSodiumPhenobarbital0.060.1

    ;g,Pethidine50mg,Scopolamine0.20.3

    ;mg.2)Induction:Midazolam0.05mg/kg,E. ;tomidate0.2mg/kg,Fentanyl46~g/kgand

    ;Vecuronium0.1mg/kgwereusedtoinduce ;anesthesia,thentheendotrachealtubewasin

    ;serted.3)Maintenance:Theadditionaldosesof ;FentanylandVecuroniumwere2~g/kgand ;0.05mg/kgseparately.Desfluranewouldbein. ;haledorDroperidoliniectedintravenouslywhen ;thedepthofanesthesiawasnotenough. ;AAgroup:Premedicationwasthesameas ;thatofGAgroup.Anesthesiawascarriedoutac. ;cordingtotheAAmethodofopenheartsurgery ;ofXuandcolleagues.BilateralNeiguan(PC ;6),Lieque(LU7)andYunmen(LU2)werese

    ;?ThisstudywassupportedbyagrantfromtheNationalScienceFoundationof

    China(No.969061101)

    ;

    ;?

    ;6?WorldJ.Acup-Mox.Vo1.11,No.1,March,2001 ;lectedtobepuncturedandstimulatedwitha ;G6805ElectroacupunctureApparatus(Shanghai ;EighthMedicalDeviceFactory,Shanghai,Chi

    ;na)bysettingtheparametersbeingcontinuous ;waves.0.52.0msdiphasicsharppulsesand3

;

    ;4Hzfrequency.Stimulusintensewasregulat

    ;edaccordingtopatients’responsesandthepro—

    ;ceduresofoperation.Operationwasstartedafter ;20mininductionofelectroacupuncture.Electri

    ;calstimulationwouldbestoppedwhenheparin ;wasadministrated,startedagainwhenpro

    ;taminewasgiven.AGAgroup:acupuncture ;withgeneralanesthesiawasperformedusing ;electroacupuncturestimulationbasedonGA. ;1.3Bloodsamplepreparationandassay ;Peripheralvenousbloodsampleswerecol

    ;lectedbeforeanesthesiaand30minafterCPB ;andplacedinchilledanticoagulativetubesand ;centrifugedat3000rpmfor20minat4?.The

    ;separatedplasmasampleswerestoredat70?

    ;untilassayed.PlasmaNEandElevelswere ;measuredbyhighperformanceliquidchromato

    ;graphy(B10RAD.USA;1640BIORADElec

    ;trochemicalDetector;1956079BI()-RADPlas

    ;maCatecholamineAnalysisColumn).PlasmaA ;IIlevelwasmeasuredusingradioimmunoassay

    ;kit(BeijingMedicalBiotechniqueCO.,Ltd., ;Beijing,China)

    ;1.4Statisticalanalysis

    ;Thedatawereexpressedasmean?standard ;deviation.Meanswithingroupsandbetween ;groupswerecomparedusingStudent’sttest

    ;andOnewayANOVAwithsubsequentBonfer

    ;ronimethod.P<0.05wasconsideredtobesig

    ;nificant.

    ;2RESUL

    ;Table1showstheclinicalprofilesofpa

    ;tients.Therewerenosignificantdifferencesin ;age,weight,andoperativedurationbetween ;groups?

    ;ChangesofNE,EandAIIareshownin

    ;Table2.PlasmaNElevelinGAgroupandAA ;groupincreasedsignificantly(P=0.009,P= ;0.000)whereasthatinAGAgroupdecreased ;obviouslyincomparisonwithpreanesthesia(P

    ;=

    ;0.011)andalsolowarthanthatinGAgroup ;(P=0.000)andAAgroup(P=0.000)after

;CPB.Nosignificantdifferencewasobservedbe

    ;tweengroupsbeforeanesthesia(P=0.918). ;PlasmaElevelhadasimilarchangetoNE

    CPBincreasedinGAgroup ;leve1.Elevelofpost

    ;(P=0.013)andAAgroupstrikingly(P= ;0.136)butdecreasedinAGAgroup(P= ;0.010)andlowerthanthatofGAgroup(P= ;0.015)andAAgroup(P=0.008).Nosignifi

     ;cantdifferencewasobservedbetweengroupsbe

    ;foreanesthesia(P=0.166).

    ;PlasmaAIIlevelafterCPBincreasedinGA ;group(P=0.000)andhigherthanthatinAA ;group(P=0.000)andAGAgroup(P= ;0.000),whereasnosignificantchangeswere ;foundinAAgroup(P=1.000)andAGAgroup ;(P=1.000).Nosignificantdifferencewasob

    ;servedbetweengroupsbeforeanesthesia(P= ;0.288).

    ;Table1.ProfilesofthePatientss,

    ;

    ;WorldJ.Acup-Mox.Vo1.11,No.1,MaF’CA,2001

    ;Tae2.Chn昏口flmaCAandA(smL)

    ;*beingsignificantwithingroupsAsignificantbetween ;groups

    ;3DISCUSSION

    ;Inthepresentstudy,plasmaNEandElev

    ;elsdecreasedsignificantlyinAGAgroup;plasma ;AlIlevelhadnosignificantchangesinAAand ;AGAgroups.

    ;Understress,thenociceptivesignalstrans

    ;mittedtothecentralnervoussystemviaafferent ;fibresactivatesecretionofhypothalamo-pituitary ;hormonesandsympatheticnervoussystem,that ;increasesthereleasingofNEbysympathetic ;nerveterminalsandsecretionofEbyadrenal ;medulla.Duringcardiacsurgery,CAhasanin

    ;creasingresponsetosternotomyandmanipula

    ;tionoftheheart,especiallytheCAresponseto ;CPBisremarkable1.Severalstudiesdemon

    ;stratedthatacupuncturecouldreducetheexcita

    ;tionlevelofthesympatheticnerve.Wangand ;colleaguesobservedaremarkablereductionof ;plasmaCAwhenusingacupuncturetherapyto ;treatthesequelaeofcerebralapoplexy….Qian,

    ;etaladministratedAAto25patientsofthyroid. ;abdominalorthoracicsurgeryandobserveda ;30%reductionofplasmaCAafteranesthesiaI. ;However,thepresentstudydemonstratedthat ;AAwasunabletoinhibittheelevationofCAre

    ;sponsetoCPBbutAGAcould.Itwasprobably ;becausethestressresponsetoopenheartsurgery ;andCPBwassointensivethatAAorGAcould ;notcompletelyblocktheafferentpathsofstress ;signals.whereascombinationofGAandAA ;producedflcomplementaryaction,soCAre

    ;sponsewasinhibited.

    ;A11belongstoRAAsystem.Thissystem

    ;maintainselectrolytebalance,intravascularfluid ;volume,andbloodpressurethroughcontrolof ;peripheralvasoconstrictionandNaexcretion. ;ConcentrationsofreninandAlIincreasedsig. ;nificantlyduringCPBandmightremainelevated ;foruptoseveralhoursaftersurgery,that ;mightberelatedtotheincidencerateofpostop

    ;erativehypertension[.

    ;Sun,etaltreatedhypertensivemodelof

    ;ratswithacupuncturetherapyandobservedthat ;plasmaconcentrationsofrenin,A11andaldos. ;teroneaftertreatmentreducedsignificantlycom. ;paredwiththatofpretreatment.Thepresent

    ;studydemonstratedthatplasmaAlIlevelafter ;CPBincreasedinGAgroupwhereasnosignifi

    ;cantchangeswerefoundinAAandAGA

    ;groups.Itindicatedthatelectroacupuncture ;couldcompletelyinhibitAlIresponsetocardiac ;surgeryandCPB.

    ;Theunderlyingmechanismsofacupuncture ;inregulatingSAsystemandRAAsystemhave ;notbeenunderstoodcompletely.Itmayberelat. ;edtothemechanismofacupunctureanalgesia.It ;hasbeenprovedthatacupuncturecouldactivate ;endogenousanalgesiaregulatorysystemwhichis ;representedbyopioidpeptides.Endogenousopi

    ;oidpeptidesarecentralneurotransmitterswhich ;havemultipleregulatoryactions,includingregu. ;1atoryactiononsympatheticnervouscenter. ;Reninissecretedmainlybygranulocytesinjuxta

    ;glomerularapparatus

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