电针对老年患者颈动脉内膜剥脱术后认知功能的影响

Effect of electroacupuncture on postoperative cognitive function in elderly patients undergoing carotid endarterectomy

目的评价电针对老年患者颈动脉内膜剥脱术后认知功能的影响。 方法择期拟行单侧颈动脉内膜剥脱术患者50例，年龄≥65岁，性别不限，ASA分级Ⅱ或Ⅲ级，文化程度为小学以上（含小学），采用随机数字表法分为电针组（EA组）和对照组（C组），每组25例。EA组术前30 min行电针刺激，取穴百会、内关、足三里，波型为2/100 Hz疏密波，峰电流5～12 mA，然后行全身麻醉，电针刺激持续至手术结束。C组直接行全身麻醉。于术前（T0）、术毕（T1）和术后24 h（T2）时采集颈内静脉血样，采用ELISA法测定血浆S-100β蛋白、TNF-α及脑源性神经营养因子（BDNF）的浓度。于T0，2、术后3和7 d（T3，4）时运用蒙特利尔认知评估量表（MoCA）评价认知功能。 结果与C组比较，EA组T2～4时MoCA评分升高，T1，2时血浆S-100β蛋白和TNF-α浓度降低，T2时血浆BDNF浓度升高（P〈0.05）。 结论电针可改善老年患者颈动脉内膜剥脱术后认知功能，与抑制炎症反应和促进BDNF生成从而减轻脑损伤有关。

Objective To evaluate the effect of eleetroacupuncture on postoperative cognitive func- tion in elderly patients undergoing carotid endarterectomy. Methods Fifty patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ , with the educational level ≥ the level of primary school, scheduled for elective unilateral carotid endarterectomy, were divided into 2 groups （ n = 25 each） using a random number table： control group （group C） and electroacupuncture group （group EA）. In group EA, electroacupuncture （fi＇equency 2/100 Hz, intensity 5-12 mA） of Baihui （GV20）, Neiguan （PC6） and Zusanli （ST36） was performed throughout surgery starting from 30 rain before opera- tion, and then general anesthesia was performed. General anesthesia was performed directly in group C. Befure operation （ TO ） , at the end of operation （TI ） and at 24 h after operation （ T2 ） , blood samples were collected from the internal jugular vein for determination of plasma S-10013 protein, tumor necrosis factor-α and brain-derived neurotrophic factor （BDNF） concentrations by enzyme-linked immunosorbent assay. The cognitive function was assessed using Montreal Cognitive Assessment at T0-2 and at 3 and 7 days after opera- tion （T~.4）. Results Compared with group C, the Montreal Cognitive Assessment scores were significantly increased at T：4, the plasma S-100~ protein and tumor necrosis factor-α concentrations were significantly decreased at T1-2, and the plasma BDNF concentrations were significantly increased at T2 in group EA （ P〈 0. 05）. Conclusion Electroacupuncture can improve postoperative cognitive function in the elderly pa- tients undergoing carotid endarterectomy, which may be related to inhibition of inflammatory responses,promotion of BDNF production and reduction of brain injury.