控制性降压联合穴位电刺激对术后认知功能障碍的影响

Effect of Controlled Hypotension Combined with Transcutaneous Electrical Acupoint Stimulation on Early Postoperative Cognitive Dysfunction in Spinal Surgery

目的:探讨七氟烷麻醉下以硝酸甘油行控制性降压联合穴位电刺激对术后认知功能障碍的影响。方法:选择ASAⅠ～Ⅲ级,45～65岁行单节段腰椎切开复位内固定手术患者75例,随机分为穴位刺激联合硝酸甘油控制性降压组(T组,n=36)及单纯硝酸甘油控制性降压组(N组,n=39),分别给予相应的治疗。结果:术后1、3dT组术后认知功能障碍发生率较N组明显降低(P<0.05,P<0.01);5d发生率两组无显著差异(P>0.05)。术后各时间点两组患者血清S-100β浓度均较术前升高(P<0.05,P<0.01)。术后1、3dT组血清S-100β较N组明显减低(P<0.05,P<0.01),术后5d两组无显著差异。结论:七氟烷麻醉下行控制性降压联合经皮穴位电刺激可降低术后认知功能障碍的发生率。

Objective To investigate the effects of transcutaneous electrical acupoint stimulation （TEAS） combined with controlled hypotension on early postoperative cognitive dysfunction （POCD） under sevoflurane anesthesia in spinal surgery.Methods Seventy five patients between 45 and 65 years,scheduled for single spinal surgery with ASAⅠ～Ⅲ,were randomly divided into controlled hypotension combined with TEAS group （group T,n=36） and regularly controlled hypotension group （group N,n=39）.All patients received general anesthesia for tracheal intubation and maintained with inhalation sevoflurane （BIS：45～55）.In group N,controlled hypotension was performed with nitroglycerin intravenously until MAP decreased by about 30% with the lowest limited above 55 mmHg.In group T,HAN＇S TEAS at Hegu,Quchi,Zusanli,Sanyinjiao was continued from 30 minutes before anesthesia to the end of the operation,and maintained with the same level of the pressure as group N by controlled hypotension.Mini-metal state examination （MMSE） and the level of serum S100 protein were assessed at preoperative,postoperative 1 d,3 d,5 d respectively.POCD was diagnosised when MMSE score declined 2 compared with baseline.Results Among the patients studied,there was no significant difference between the two groups before the operation.At postoperative 1 d,POCD incidence was 15（38.5%） in group N,5（13.9%） in group T （P〈0.01）.At postoperative 3 d,POCD incidence was 7（17.9%） in group N,3（8.3%） in group T（P〈0.05）.At postoperative 5 d,the prevalence of cognitive dysfunction was similar between the two groups.At postoperative 1 d,3 d,5 d the level of serum S100 protein of the two groups was higher than that before the operation,and compared with group N,the level of group T＇s serum S100 protein was significant lower at all times（P〈0.01,P〈0.05） exclude at postoperative 5 d.Conclusion Controlled hypotension combined with TEAS under sevoflurane anesthesia when applied to single spinal surgery should decrease the incidence of POCD.