电针预防老年患者术后认知功能障碍的临床观察

Clinical Observation of Electroacupuncture on Postoperative Cognitive Dysfunction in Elderly Patients

目的:观察术前电针刺激对全麻下行全膝置换老年患者术后认知功能障碍(POCD)发生率的影响及与血清S-100β蛋白、IL-1β、IL-6和α-TNF表达的关系。方法:选择全麻下行单侧全膝置换术老年患者85例(男39、女46),随机分为电针组和对照组。电针组在麻醉后手术前于百会和神庭穴电针刺激30 min。术前1 d、术后1 d和术后7 d采用简易智能量表(MMSE)评价患者认知功能,并于诱导前、术毕和术后1 d采血检测S-100β蛋白、IL-1β、IL-6和α-TNF。结果:最终79例患者完成评分和随访,电针组34例,对照组45例。电针组和对照组术后1 d POCD的发生率分别为20.59%和42.22%,两组间差异有统计学意义(P<0.05),术后7 dPOCD的发生率分别为8.82%和13.33%,两组间差异无统计学意义(P>0.05)。血清S-100β蛋白、IL-1β、IL-6和α-TNF表达术毕时两组均较术前增加,有统计学差异(P<0.05),术后1 d的表达与术前比较无统计学差异(P>0.05)。术毕和术后1 d两组间比较均无统计学差异(P>0.05)。结论:术前电针对全麻下行单侧全膝置换老年患者术后认知功能障碍的发生有一定的预防作用,术前电针不能降低血清S-100β蛋白、IL-1β、IL-6和α-TNF表达。

Objective： To observe the effect of electroacupuncture （EA） on postoperative cognitive dysfunction （POCD） in elderly patients undergoing total knee arthroplasty under general anesthesia and the relationship with expression of S - 10013 protein, IL - 1β, IL - 6 and α- TNF in serum. Method： Eighty - five elderly patients （ 39 males ,46 females） were randomly allocated to EA group and control group. EA group was treated by Baihui and Shenting with electrical stimulation for 30 min after induction. All the patients were assessed their cognitive function with MMSE 1 d before operation, 1 d and 7 d after operation. And taking blood before induction, at the end of operation and 1 d after operation, S- 10013 protein,IL- 1β,IL- 6 and α-TNF were tested. Result：A total of 79 patients completed the tests （34 in EA group and 45 in control group）. The incidence of POCD in EA group and control group was 20.59% and 42.22% 1 d after operation, and 8.82% and 13.33% 7 d after operation, respectively. Statistical analysis showed significant difference between groups 1 d after operation. Compared to those before anesthesia induction, at the end of operation, both groups＇ serum S- 10013 protein, IL- 1β, IL- 6 and α- TNF rose markedly, and there was no significant difference between them. l d after operation,both groups＇ serum S- 100β protein,IL- 1β, IL- 6 and α- TNF declined, and there was no significant difference compared to those before induction and between two groups. Conclusion：EA may have some effects on the incidence of POCD in elderly patients undergoing total knee arthroplasty under general anesthesia, but has no effect on the expression of S- 10013 protein,IL- 1β,IL-6 and α-TNF in serum.