Abstract
Objective To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on one-lung ventilation-induced injury in patients undergoing esophageal cancer operation. Methods The participants (n = 121) were randomly assigned into TEAS and sham groups. The TEAS group was given transcutaneous electrical stimulation therapy. The acupoints selected were Feishu (BL13), Hegu (L14), and Zusanli (ST36) and were treated 30 minutes before induction of anesthesia; treatment lasts 30 minutes. The sham group was connected to the electrode on the same acupoints, but electronic stimulation was not applied. The levels of oxygenation index (PaO2/FiO2) and alveolar-arterial oxygen tension difference (A-aDO2) before one-lung ventilation (T1), 30 minutes after one-lung ventilation (T2), 2 hours after one-lung ventilation (T3), and 1 hour after the operation (T4) and the levels of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) at T1, T2, T3, and 24 hours after the operation (T5) were taken as the primary endpoints. The incidence of postoperative pulmonary complications, removal time of thoracic drainage tube, and length of hospital stay were taken as the secondary endpoints. Results Compared with that, in the sham group, the level of PaO2/FiO2 in the TEAS group was significantly increased at T2, T3, and T4, and the level of A-aDO2 was significantly reduced at T2 and T3 (P < 0.05). Besides, compared with that, in the sham group, the level of serum TNF-α at T2, T3, and T5, as well as the level of serum IL-6 at T3 and T5, was significantly reduced, whereas the level of serum IL-10 at T3 was significantly increased (P < 0.05). The incidences of pulmonary infection and pleural effusion in the TEAS group were significantly lower than that in the sham group, and the removal time of thoracic drainage tube and the length of hospital stay in the TEAS group were significantly shorter than that in the sham group (P < 0.05). Conclusions TEAS could effectively increase the levels of PaO2/FiO2 and IL-10, reduce the levels of A-aDO2, TNF-α, and IL-6, and reduce the incidence of pulmonary complications. Moreover, it could also contribute to shorten the removal time of thoracic drainage tube and the length of hospital stay.
Highlights
Esophageal carcinoma is one of the malignant tumors with high morbidity and mortality in China, the preferred treatment of which is surgical treatment [1]
Anesthesia was maintained by continuous inhalation of isoflurane as well as intermittent injection of fentanyl (1 to 2 μg/kg) and vecuronium (0.05 mg/kg). e end-tidal carbon dioxide partial pressure (PETCO2) and peak airway pressure were monitored simultaneously. e respiratory parameters mentioned above remained unchanged during one-lung ventilation, and the orifice of the unventilated endotracheal tube was opened in the air, causing the operated-side pulmonary collapse
Compared with that at T1, the level of PaO2/FiO2 in both groups decreased at T2, T3, and T4, while the level of A-aDO2 increased at T2 and T3 but decreased at T4 (P < 0.05); compared with that in the sham group, the level of PaO2/FiO2 in the transcutaneous electrical acupoint stimulation (TEAS) group increased at T2, T3, and T4, while the level of A-aDO2 decreased at T2 and T3 (Figures 2(a) and 2(b))
Summary
Esophageal carcinoma is one of the malignant tumors with high morbidity and mortality in China, the preferred treatment of which is surgical treatment [1]. After the Evidence-Based Complementary and Alternative Medicine restoration of two-lung ventilation, the recruitment maneuvers of collapsed alveoli cause ischemia-reperfusion injury of lung tissue, aggravate the ischemia and anoxia of lungs, trigger the release of massive inflammatory factors [6, 7], and induce pulmonary inflammatory response, thereby leading to pulmonary injury and the increase of postoperative pulmonary complications [8]. During the thoracic surgery with one-lung ventilation, the blood flow volume of lungs in nonventilation side reduced to 20% to 25% of cardiac output due to the impacts of body position and pulmonary vasoconstriction in hypoxic condition [9] This part of blood flow is in hypoxic status owing to poor oxygenation, which could trigger the release of inflammatory factors [10]. Lung tissues receive obvious mechanical stretch during the recruitment maneuvers of collapsed lung. e following changes including restoration of oxygenated function and opening of pulmonary vessels could induce pulmonary ischemia-reperfusion injury, accompanied with the production of massive oxygen free radicals [11], which lead to upregulated expression of multiple inflammatory factors and inflammatory mediators, systemic inflammatory response, cascade reaction of lung tissue, and aggravation of ischemia/hypoxiainduced lung injury [12]
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