经皮穴位电刺激复合全麻对妇科腔镜手术后认知功能的影响

Effect of TEAS Combined with General Anesthesia on Cognitive Function of Patients Undergoing Gynaecological Laparoscopy

目的探讨经皮穴位电刺激(TEAS)复合全麻对老年妇科腹腔镜患者术后认知功能的影响。方法选择择期行腹腔镜下卵巢囊肿切除术的老年患者60例,随机分为经皮穴位电刺激复合全麻组(治疗组)和全麻组(对照组),每组30例。治疗组经皮穴位电刺激30 min后开始全身麻醉,对照组在对应穴位贴上电极刺激片后静置30 min。于术前、术毕、术后1、3 d抽取静脉血3 m L,测定血清S-100β和白细胞介素-6(IL-6)浓度。于术前1 d、术毕、术后1、3、5 d应用简易智力状态检查量表(MMSE))进行评分,并计算术后1、3、5 d术后认知功能障碍(POCD)发生率;统计麻醉中异丙酚、瑞芬太尼用量,记录麻醉、手术和术毕意识恢复时间。结果两组血清S-100β蛋白、IL-6术毕和术后1 d均较术前升高(P<0.05),术后3 d恢复至术前水平;组间对照各时间均无显著差异(P>0.05)。两组MMSE评分比较,术后1、3d治疗组高于对照组(P<0.05);组内比较,治疗组术后1 d、对照组术后1、3 d评分明显降低(P<0.05)。术后1、3d治疗组POCD发生率明显低于对照组(P<0.05)。两组术中平均所需异丙酚和瑞芬太尼量差异显著(P<0.05,P<0.01);苏醒时间组间比较差异显著(P<0.05)。结论 TEAS复合全麻能够减少术中麻醉用药量,缩短术毕苏醒时间,降低老年患者POCD的发生率,并且血清S-100β蛋白和IL-6浓度变化与术后认知功能的损害程度密切相关。

Objective： To investigate the effect of combining TEAS （transcutaneous electrical acupoint stimulation） with general anesthesia on the cognitive ability of patients suffering from the gynecological laparoscopic surgery. Methods： Totally 60 elderly patients undergoing laparoscopic surgery for resecting ovarian cyst were randomly divided into 30 cases of TEAS and anesthesia combining group （the control group） as well as complete anesthesia group （ the treatment group）. In the A group, patients were electronically stimulated on subcutaneous points and lost their sensation in the whole body after 30 minutes, patients of B group were applied the slice of electrode stimulation standing for 30 minutes. Respectively, 3ml of venous blood was drawn on the 1st and 3rd day before and after the surgery as well as at the end of the surgery to determine the concentration of S-100β and IL-6 in serum. On the 1 st day before the surgery, at the end of the surgery as well as on the 1st, 3rd and 5th day after the surgery, the MMSE （Mini-Mental State Examination） was used to evaluate the scores and the incidence rate of postoperative cognitive dysfunction （POCD） was calculated on the 1st, 3rd and 5th day after the surgery. The amount of propofol and remifentanil used for anesthesia was counted and the time of anesthesia, surgery and consciousness recovery was recorded. Results： The serum levels of S-10013 and IL-6 at the end of the surgery and on the 1st day after the surgery were higher than those before the surgery （P〈0.05）, and re- covered to the same levels as those before the surgery on the 3rd day after the surgery; all kinds of time in comparison of the two groups were not significantly different （P〉0.05）. The MMSE score of A group on the 1st and 3rd day after the surgery was more than that of B group （ P〈0.05 ） ; in comparison of the patients within the groups, the scores of A group on the 1st day and of B group on the 1st and 3rd day after the surgery markedly decreased （P〈0.05）. The POCD inci- dences of A group on the 1st and 3rd day after the surgery were significantly lower than that of B group （P〈0.05）. Dur- ing the surgery, the used amounts of propofol and remifentanil compared between the two groups were significantly differ- ent （P〈0.05, P〈0.01 ） ; the difference of conscious-recovering time between the two groups was significant （P〈0.05）. Conclusion： TEAS combined with general anesthesia can reduce the dosage, shorten the recovery time, reduce the inci- dence of POCD in elderly patients, and the changes of serum S-100β and IL-6 levels are closely related with the degree of postoperative cognitive function.