穴位电刺激对老年全麻患者术后认知功能障碍的干预效果

Effect of transcutaneous electrical acupoint stimulation on postoperative cognitive dysfunction in elderly patients

目的探讨经皮穴位电刺激(TEAS)对老年全麻患者术后认知功能障碍(POCD)及炎症因子的影响。方法选取陕西中医大学附属医院2016年1月至2017年10月拟在全身麻醉下行骨科髋关节置换术的老年患者80例,按照随机数表法分为对照组(A组)和TEAS组(T组),每组40例,两组均采取静吸复合麻醉,诱导和维持方法相同。T组在全麻诱导前30 min选取双侧合谷、内关行穴位电刺激至手术结束。观察两组患者术中一般情况和镇痛药的用量;分别于手术开始前24 h以及手术结束后24 h、72 h对每例患者由专人进行简易智能量表(MMSE)评分;并在相同的时间点采集静脉血样3 mL,采用酶联免疫吸附法(ELISA)测定血浆中白介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)的浓度。结果两组患者术中一般情况比较差异均无统计学意义(P>0.05);T组患者的瑞芬太尼用量为(290.8±33.3)μg,比A组的用量(272.6±37.6)μg明显减少,差异有统计学意义(P<0.05);T组患者术后24 h和72 h的MMSE评分分别为(22.14±1.66)分、(23.12±1.56)分,明显高于A组的(20.89±1.86)分、(21.23±1.98)分,差异均具有统计学意义(P<0.05);T组患者的POCD发生率为32.5%,明显低于A组的45.0%,差异具有统计学意义(P<0.05);两组患者血清IL-1β、TNF-α、IL-6在术后24 h、72 h水平均高于术前24 h,且T组与A组比较,同一时间血清炎症因子T组均比A组降低,差异均有统计学意义(P<0.05)。结论经皮穴位电刺激可以降低老年患者POCD的发生,其机制可能与抑制中枢神经系统神经炎症有关。

Objective To observe the effect of transcutaneous acupoint electrical stimulation(TEAS)on postoperative cognitive dysfunction(POCD)and inflammatory factors in elderly patients undergoing general anesthesia.Methods Eighty elderly patients undergoing orthopaedic hip replacement under general anesthesia in the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2016 to October 2017 were selected and divided into control group(group A)and TEAS group(group T)according to the random number table method,with 40 cases in each group.Combined intravenous-inhalation anesthesia was used in both groups,and the induction and maintenance methods were the same. In group T, patients received electrical stimulation at Hegu and Neiguan acupoints onboth sides from 30 minutes before induction of general anesthesia to the end of operation. Intraoperative general conditionsand analgesic dosage of patients in the two groups were observed. Each patient was scored by Mini-mental StateExamination (MMSE) at 24 hours before the operation and 24 hours and 72 hours after the operation. Venous blood samples(3 mL) were collected at the same time points to detect the serum concentrations of interleukin-1β (IL-1β), TNF-alpha(TNF-α) and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay (ELISA). Results There was no significantdifference in intraoperative general condition between the two groups (P>0.05). The dosage of remifentanil in groupT was (290.8±33.3) μg, which was significantly lower than (272.6±37.6) μg in group A (P<0.05). The MMSE scores ingroup T at 24 hours and 72 hours after operation were 22.14±1.66 and 23.12±1.56, respectively, which were significantlyhigher than 20.89±1.86 and 21.23±1.98 in group A (P<0.05). The incidence of POCD in group T was 32.5%, which wassignificantly lower than 45.0% in group A (P<0.05). Serum levels of IL-1β, TNF-α, IL-6 in the two groups 24 h and 72 hafter operation were higher than those 24 h before operation. Compared with group A, serum inflammatory cytokines ingroup T were lower at the same time than those in group A (P<0.05). Conclusion Transcuaneous electrical acupointstimulation can reduce the incidence of POCD in elderly patients, and its mechanism may be related to the inhibition ofneuroinflammation in the central nervous system.