评价经皮穴位电刺激（TEAS）联合中医情志干预对腹腔镜直肠癌根治术患者免疫功能和心理应激的影响。 【方法】将100例住院拟行腹腔镜直肠癌根治术治疗的患者随机分为A、B、C、D 4组，每组各25例。A组给予麻醉前TEAS 30 min，B组给予持续TEAS至手术结束，C组给予麻醉前TEAS 30 min + 中医情志干预，D组给予持续TEAS至手术结束+中 医情志干预，其中，TEAS取穴足三里（双侧）、三阴交（双侧）、百会、内关（双侧）。观察各组围术期指标以及术前与术后3 d 免疫功能指标、Th1/Th2细胞分子机制、心理应激反应指标的变化情况，并比较各组的不良反应发生情况。【结果】（1）围术 期指标方面，4组患者的手术时间、出血量、输液量比较，差异均无统计学意义（P＞0.05）；D组的舒芬太尼用量、瑞芬太尼 用量、术后苏醒时间、术后24 h 痛觉模拟量表（VAS）评分均低于A组、B组、C组（P＜0.05），而B组、C组的上述指标均低 于A组（P＜0.05）。（2）免疫功能指标方面，D组术后3 d的T淋巴细胞亚群CD3+、CD4+及自然杀伤（NK）细胞水平均高于A组、 B组、C组（P＜0.05），而B组、C组的上述指标均高于A组（P＜0.05）。（3）Th1/Th2细胞分子机制方面，D组术后3 d的血清白 细胞介素2（IL-2）、γ干扰素（IFN-γ）水平均高于A组、B组、C组（P＜0.05），血清白细胞介素10（IL-10）水平均低于A组、 B组、C组（P＜0.05），而B组、C组的血清IL-2、IFN-γ水平均高于A组（P＜0.05），血清IL-10水平均低于A组（P＜0.05）。 （4）心理应激反应指标方面，D组术后3 d的焦虑自评量表（SAS）和抑郁自评量表（SDS）评分均低于A组、B组、C组（P＜ 0.05），而B组、C组的上述评分均低于A组（P＜0.05）。（5）不良反应方面，A组出现1例恶心呕吐，B组出现2例恶心呕吐、 1例头晕，C组无不良反应，D组出现1例恶心呕吐，不良反应发生率分别为4.0%（1/25）、12.0%（3/25）、0.0%（0/25）、4.0% （1/25），组间比较，差异无统计学意义（χ2 = 0.400，P = 0.527）。【结论】针对腹腔镜直肠癌根治术患者，TEAS联合中医情志 干预可有效调节患者围术期免疫功能，减轻应激反应，缓解患者紧张焦虑状态，同时可产生一定的镇痛作用，减少阿片类 药物用量，提高患者围术期舒适度及手术耐受水平。

To evaluate the effects of transcutaneous electrical acupoint stimulation（TEAS）combined with Chinese medicine emotional intervention on immune function and psychological stress in patients undergoing laparoscopic radical rectal cancer surgery. Methods A total of 100 patients hospitalized for laparoscopic radical surgery for rectal cancer were randomly divided into 4 groups of Group A，B，C，and D，25 patients in each group. Group A was given TEAS for 30 minutes before anesthesia，Group B was given TEAS continuously until the end of the surgery，Group C was given TEAS for 30 minutes and Chinese medicine emotional intervention before anesthesia， Group D was given TEAS continuously until the end of the surgery together with Chinese medicine emotional intervention. TEAS was performed at bilateral Zusanli（ST36）points，bilateral Sanyinjiao（SP6）points， Baihui（GV20）points，bilateral Neiguan（PC6）points. The changes of perioperative outcomes and the changes of parameters associated with the immune function，molecular mechanism of Th1/Th2 cells，and psychological stress response before the surgery and 3 days after the surgery in each group were observed. Moreover，the occurrence of adverse reactions in each group was compared. Results（1）The differences of perioperative outcomes operation time，bleeding volume and infusion amount were not statistically significant among the 4 groups（P＞0.05）. The Sufentanil dosage，Remifentanil dosage，postoperative awakening time，and 24-hour postoperative pain Visual Analogue Scale（VAS）scores of group D were lower than those of Groups A， B， and C（P＜0.05）， and the above indexes of group B and group C were all lower than those of Group A（P＜0.05）.（2）Three days after the surgery，the levels of immune function indicators of T lymphocyte subsets CD3+，CD4+ and natural killer（NK） cells in Group D were higher than those in Groups A，B，and C（P＜0.05），while the above indexes in Groups B and C were higher than those in Group A（P＜0.05）.（3）Three days after the surgery，the levels of parameters associated with the molecular mechanism of Th1/Th2 cells such as interleukin 2（IL-2）and interferon gamma （IFN-γ）in Group D were higher（P＜0.05），and the serum interleukin 10（IL-10）level was lower than those in Groups A，B，and C（P＜0.05）；the serum IL-2 and IFN-γ levels in Group B and C were higher（P＜0.05）and serum IL-10 level was lower than those in Group A（P＜0.05）.（4）Three days after the surgery， the scores of the psychological stress response indicators of self-rating anxiety scale（SAS）and self-rating depression scale（SDS） in Group D were lower than those in Groups A，B，and C（P＜0.05），while the above scores in Groups B and C were lower than those in Group A（P＜0.05）.（5）In Group A，there was one case of nausea and vomiting；in Group B，there were two cases of nausea and vomiting and one case of dizziness；no adverse reaction occurred in Group C， and there was one case of nausea and vomiting in Group D. The incidences of adverse reactions in Groups A，B，C and D were 4.0%（1/25），12.0%（3/25），0.0%（0/25），and 4.0%（1/25），respectively. The intergroup comparison showed no statistically significant difference among the 4 groups（χ2 = 0.400，P = 0.527）. Conclusion In treating patients undergoing laparoscopic radical surgery for rectal cancer， TEAS combined with Chinese medicine emotional intervention can effectively regulate the perioperative immune function， reduce the stress response，and alleviate the anxiety of the patients. Moreover，the therapy exerts certain analgesic effect， which leads to the reduction of the dosage of opioids and the increase of perioperative comfort and surgical tolerance of the patients.

R245.9

广东省中医药局科研项目（编号：20221158）；广州市科学技术局科技计划项目（编号：202201020564）