电针对老年全麻手术患者术后早期认知功能障碍的影响

Effect of Electroacupuncture on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing General Anesthesia

目的观察电针对老年全麻手术患者早期术后认知功能障碍(POCD)的影响。方法将行择期腹腔镜胆囊摘除的老年患者80例(ASAⅠ~Ⅱ)按随机数字表法分为电针组(接受电刺处理)与对照组(未接受电针处理),各40例。两组均采用静吸复合全麻,术后患者均行静脉自控镇痛(PCIA)。麻醉诱导前30 min及术中持续于四神聪、神门、内关穴位经皮电刺激,直到手术结束后15 min结束刺激。对照组不作处理。观察记录术后24、72、120 h,两组患者认知的评分以及术后疼痛评分(VAS)。结果电针组患者术后24 h,有6例患者发生了认知功能障碍,术后72 h有4例发生认知功能障碍,术后120 h有1例发生认知功能障碍。对照组患者术后24 h有13例发生认知功能障碍,术后72 h有10例发生认知功能障碍,术后120 h有2例发生认知功能障碍。两组患者术后24、72 h认知功能障碍的发生率比较,差异有统计学意义(P<0.05)。术后120 h认知功能障碍发生率比较,差异无统计学意义(P>0.05)。两组间术后VAS评分比较,差异无统计学意义(P>0.05)。结论麻醉诱导前30 min及术中,直到手术结束后15 min进行穴位电针刺激,可以有效减少老年全麻患者POCD的发生率。电针改善老年全麻患者手后认知功能障碍的机制复杂,可能与电针具有脑保护作用,减少术中的应激水平,调节脑内神经递质,抗氧化自由基损伤,减少术中的炎症反应及术后并发症有等因素有关。

Objective： To observe the effect of electroacupuncture on postoperative cognitive dysfunction （POCD） in elderly patients undergoing general anesthesia. Methods： 80 cases （ASAⅠ~Ⅱ） were randomly di-vided into the electroacupuncture group （electro acupuncture treatment） and the control group （without elec-troacupuncture treatment）,40 cases in each. The two groups were treated with combined inhalation and general anesthesia,and all patients received intravenous patient-controlled analgesia （PCIA）. Early 30min in anesthesia induction and intraoperation,the electroacupuncture group received transcutaneous electrical stimulation on Sishencong,Shenmen and Neiguan till 15min after the operation. The control group was not treated. The cognitive score and postoperative pain score（VAS） of the two groups were recorded at 24th,72nd and 120th hour after op-eration. Results： After operation,there were 6 cases of cognitive dysfunction after 24 h,4 cases after 72 h,and 1 case after 120 h in the electroacupuncture group,while there were 13 cases of cognitive dysfunction after 24 h,10 cases after 72 h,and 2 cases after 120 h in the control group. The incidence of cognitive dysfunction after 24 h and 72 h in the two groups was statistically significant（P〈0.05）. The incidence of cognitive impairment after 120 h was not statistically significant （P〉0.05）. The difference of VAS score between the two groups was not statisti-cally significant after operation （P〉0.05）. Conclusion： Early 30min in anesthesia induction,intraoperation and 15min after operation,the electrical stimulation can effectively reduce the incidence of POCD in elderly patients undergoing general anesthesia. The mechanism of electroacupuncture in improving postoperative cognitive dys-function in elderly patients undergoing general anesthesia is complex. It may be related to some factors,such as electroacupuncture has brain protection,and can reduce the stress level during the operation,regulate the damage of neurotransmitter in the brain and anti-oxidation free radical,and reduce the inflammatory reaction and postop-erative complications.