电针刺预防胃肠道应激性黏膜损伤的机制董树安余剑波[摘要]背景胃肠道在围手术期极易发生应激相关性的黏膜损伤(stress-relatedmucosaldamage，SRMD)，在多脏器功能障碍综合征（multipleorgandysfynctionsyndrome，MODS）发生、发展中的作用正日益引起人们的关注。目的就电针刺预防SRMD的可能相关作用机制进行综述。内容电针刺对应激性胃黏膜损伤具有一定的保护作用，其机制可能是通过减少胃酸分泌、增加胃黏液层和胃黏膜厚度、抑制活性氧（reactiveoxygenspecies，ROS）生成和细胞内Ca2+超载、降低垂体-下丘脑-肾上腺轴的活动以及调控机体内源性内皮素-1/一氧化氮和环氧合酶2/前列腺素E水平等实现的。趋向SRMD形成机制比较复杂，而电针刺对其发挥的保护作用不能用单一的机制解释，可能是多种机制共同参与的结果。电针刺；氧化应激；缺血/再灌注；一氧化氮；环氧合酶2/前列腺素E2；神经内分泌紊乱Mechanismsofelectro-acupunctureinprophylaxisofstress-relatedmucosaldamageDONGShu-anYUJian-boDepartmentofAnesthesiology,TianjinNankaiHospital,Tianjin300100,ChinaBackgroundStress.relatedmucosaldamage(SRMD)isaveryconnoncomplicationduringtheperioperativeperiod,anditplaysagreatroleintheinitiationandprogressionofmultipleorgandysfynctionsyndrome(MODS).ObjectiveThisreviewsummarizedthemechanismsofelectro-acupunctureinprophylaxisofstress-relatedmucosaldamage.ContentElectroacupuncturehasaprotectiveeffectonstressgastricmucosalinjury,whichmaybebyreducinggastricacidsecretion,increasinggastricmucuslayerandmucosalthickness,inhibitedreactiveoxygenspecies(ROS)productionandintracellularCa2+overloadandreduceHPAaxisactivityandregulationofbodyET-1/NOandCOX-2/PGE2endogenouslevelsachieved.TrendThemechanismofSRMDisverycomplex,andtheprotectiveeffectofelectroacupunctureonstressgastricmucosalinjuryisnotuniquetoonesinglereason,maybethecombinationofsomemechanism.Electro-acupuncture;Oxidativestress;Ischemia/reperfusioninjury;NO;COX-2/PGE2;Disturbanceoftheneuroendocrinesystem10.3760/cma.j.issn.1673-4378.2011.10.019300100，天津市南开医院麻醉科万方数据585万方数据586万方数据@@1.YueY.Mechanismsofpostoperativepain.ChineseMedicalJournal,2007,120(22):1949-1950.@@2.KotaniN,HashimotoN,SatoY,etal.Preoperativeintradermalacupuncturereducespostoperativepain,nauseaandvomiting,analgesicrequirement,andsympathoadrenalresponses.Anesthesiology,2001,95(2):349-356.@@3.AliT,HartyRF.Stress-inducedulcerbleedingincriticallyillpatients.GastroenterolClinNAm,2009,38(2):245-265.@@4.RhoSW,ChoiGS,KoEJ,etal.Molecularchangesinremotetissuesinducedbyelectro-acupuncturestimulationatacupointST36.MolCells,2008,25(2):178-183.@@5.MoonPD,JeongHJ.UseofelectroacupunctureatST36toinhibitanaphylacticandinflammatoryreactioninmice.Neuroimmunomodulation,2007,14(1):24-31.@@6.MedzhitovR.Toll-likereceptorsandinnateimmunity.NatRevImmunol,2001,1(2):135-145.@@7.Paul-ClarkMJ,McMasterSK,SorrentinoR,etal.Toll-likereceptor2isessentialforthesensingofoxidantsduringinflammation.AmJRespirCritCareMed,2009,179(4):299-306.@@8.SuX,LeeJW,MattlayZA,etal.Activationoftheα7nAChRreducesacid-inducedacutelunginjuryinmiceandrats.AmJRespirCellMolBiol,2007,37(2):186-192.@@9.PnigeJS,JaffreySR.Pharmacologicmanipulationofnitricoxidesignaling:targetingNOSdimerizationandprotein-proteininteractions.CurrTopMedChem,2007,7(1):97-114.@@10.ShahV,LyfordG,GoresG,etal.Nitricoxideingastrointestinalhealthanddisease.Gastroenterology,2004,126(3):903-913.@@11.HwangHS,HanKJ,RyuYH,etal.Protectiveeffectsofelectroacupunctureonacetylsalicylicacid-inducedacutegastritisinrats.Wo...
