甲强龙联合经皮穴位电刺激对老年患者术后认知功能的影响

Effects of Methylprednisolone Combined with Transcutaneous Acupiont Electric Stimulation on Postoperative Cognitive Dysfunction in Elderly Patients

目的研究甲强龙联合经皮穴位电刺激对老年患者术后认知功能的影响。方法选择行下腹部手术的老年患者60例,随机分为经皮穴位电刺激组(T组)和甲强龙联合经皮穴位电刺激组(M组)。T组给予电刺激,M组给予甲强龙联合电刺激。于术前1 d及术后第1、2、3、7天,用MOCA量表评估患者的术后认知功能;测定患者在诱导前(T0)、术毕(T1)、术后24 h(T2)、48 h(T3)血清Aβ1-42、p-Tau浓度;计算患者术中脑氧饱和度(r SO2)平均值及较基础值下降的最大百分数(r SO2%max)。结果M组术后第2天MOCA评分较T组升高,且术后认知功能障碍发生率低于T组(13.3%vs 23.3%);M组在T2、T3时的Aβ1-42及p-Tau浓度较T组低(P<0.05)。2组r SO2基础值、围术期r SO2平均值以及r SO2%max比较,差异无统计学意义(P>0.05)。结论甲强龙联合经皮穴位电刺激可降低老年患者术后认知功能障碍的发生率。

Objeetive To evaluate the effects of methylprednisolone combined with transcutaneous acupiont electric stimulation on postoperative cognitive dysfunction （POCD） in elderly patients. Methods Sixty elderly patients scheduled for hypogastrium surgery were recruited for the study and randomly divided into two groups ： transcutaneous aeupiont electric stimulation group （T group ） and methylprednisolone combined with transcutaneous acupiont electric stimulation group （ M group ）. The patients in T group received electric stimulation, and those in M group were administrated with intravenous methylprednisolone and electric stimulation. The incidence of POCD was evaluated with Montreal Cognitive Assessment （ MO- CA） at the time points of one day before the surgery, one day, two days, three days, and seven days after the surgery, respectively; the serum Aβ1 - 42 and p- Tan concentration was determined at the time points of the time before the induction （T0）, the end of the surgery（T1 ）, 24 h, and 48 h after the surgery （T2, T3 ） ; the average rSO2 and the maximum reduced percentage compared with the basic value （rSO2%max） during the operation were calculated. Results The MOCA score at two days after surgery was higher and the incidence of POCD was lower in M group than those in T group （ 13.3% vs 23.3% ）. The concentration of the serum Aβ1-42 and p-Tan in M group was lower than that in T group at T2, T3 （P 〈 0.05 ）, there were no statistical significanees of the baseline rSO2, average rSO2 and the rSO2%max （P 〉 0.05 ）. Conclusion Methylprednisolone combined with transcutaneous acupiont electric stimulation could decrease the incidence of POCD in elederly patients under general anesthesia.