经皮穴位电刺激辅助全麻对老年心脏手术患者术后免疫功能和认知功能的影响

Effects of transcutaneous acupoint electrical stimulation assisted with general anesthesia on postoperative immune function and cognitive function in elderly patients undergoing cardiac surgery

目的探究经皮穴位电刺激(TEAS)辅助全麻对老年心脏手术患者术后免疫功能和认知功能的影响。方法选取2016年4月~2018年3月上海中医药大学附属曙光医院84例行开胸心脏手术治疗的老年患者为研究对象,采用随机数字表法分为对照组和观察组,每组各42例。对照组给予全麻及常规镇痛完成手术,观察组则在对照组基础上予以TEAS干预。记录并比较两组术后8、12、24 h疼痛视觉模拟评分(VAS)及术后镇痛相关不良反应发生情况,并比较术前及术后3 d两组应激反应[皮质醇(COR)、β-内啡肽(β-EP)]、免疫功能[T淋巴细胞亚群(CD4^+、CD8^+)、CD4^+/CD8^+]、认知功能[简易精神状态检查量表(MMSE)]差异。结果两组组内术后8 h及12 h的VAS评分比较,差异无统计学意义(P> 0.05),但术后24 h的VAS评分明显高于术后8 h及12 h(P <0.05)。观察组术后各时间点VAS评分及术后镇痛相关不良反应总发生率均低于对照组(P <0.05)。术后3 d,两组COR、β-EP水平均较本组术前升高(P <0.05),CD4^+、CD8^+、CD4^+/CD8^+、MMSE评分均较本组术前降低(P <0.05),且对照组变化幅度均大于观察组(P <0.05)。结论 TEAS辅助全麻对老年心脏手术患者术后免疫功能及认知功能改善效果显著,且能有效镇痛,并减轻镇痛相关不良反应及手术应激反应,利于患者术后恢复。

Objective To explore the effects of transcutaneous acupoint electrical stimulation(TEAS)assisted with general anesthesia on postoperative immune function and cognitive function in elderly patients undergoing cardiac surgery.Methods A total of 84 elderly patients undergoing open heart surgery in Shuguang Hospital,Shanghai University of Traditional Chinese Medicine from April 2016 to March 2018 were selected as study subjects and they were divided into control group and observation group according to the random number table method,with 42 cases in each group.The control group was given general anesthesia and routine analgesia to complete the operation,and the observation group was given TEAS intervention on the basis of control group.The pain visual analogue scale(VAS)at 8,12 h and 24 h after operation and occurrence of postoperative analgesia-related adverse reactions were recorded and compared between the two groups,and the stress response[cortisol(COR),β-endorphin(β-EP)],immune function[T lymphocyte subsets(CD^4+,CD^8+),CD^4+/CD^8+]and cognitive function[mini-mental state examination(MMSE)]were compared before operation and at 3 d after operation between the two groups.Results There was no significant difference in VAS score at 8 h and 12 h after operation within the groups(P>0.05).However,the VAS score at 24 h after operation was significantly higher than that at 8 h and 12 h after operation(P<0.05).The VAS score at different time points after operation and the total incidence rate of postoperative analgesia-related adverse reactions in the observation group were lower than those in the control group(P<0.05).At 3 d after operation,the COR,β-EP levels were higher than those before operation(P<0.05)while CD^4+,CD^8+,CD^4+/CD^8+and MMSE score were lower than those before operation(P<0.05),and the changes in the control group were larger than those in the observation group(P<0.05).Conclusion TEAS assisted with general anesthesia has significant improvement effects on postoperative immune function and cognitive function in elderly patients undergoing cardiac surgery,and it can effectively relieve analgesia and alleviate analgesic-related adverse reactions and surgical stress response,and it is beneficial for postoperative recovery.