经皮穴位电刺激联合右美托咪啶对老年患者术后谵妄的影响

Effect of transcutaneous electrical acupoint stimulation combined with Dexmedetomidine on postoperative delirium in elderly patients

目的研究经皮穴位电刺激(TEAS)联合右美托咪啶(DEX)对老年患者术后谵妄(POD)的影响。方法选择2017年1月~2018年11月首都医科大学附属北京中医医院择期全麻下行椎弓根钉内固定手术的老年患者96例,依据随机数字表法将其分为DEX组(D组)和联合组(T组),每组48例。D组麻醉诱导前静脉输注DEX;T组在D组的基础上,联合使用TEAS,且两组均在手术结束前30 min停止上述处理。比较两组术后5 d内POD的发生情况、术中丙泊酚用量及术前1 d、术后1、5d神经元特异性烯醇化酶(NSE)、血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超氧化物歧化酶(SOD)水平。结果两组谵妄发生率比较,差异无统计学意义(P>0.05)。T组丙泊酚用量低于D组,差异有统计学意义(P<0.05)。D组术后1、5 d NSE、TNF-α、IL-6水平高于术前1 d,SOD水平低于术前1 d,差异均有统计学意义(均P<0.05);术后5 d NSE、TNF-α、IL-6水平低于术后1 d,SOD水平高于术后1 d,差异均有统计学意义(均P<0.05)。T组术后1 d NSE、TNF-α、IL-6水平高于术前1 d,SOD水平低于术前1 d,差异均有统计学意义(均P<0.05);术后5 d IL-6水平高于术前1 d,差异有统计学意义,术后5 d NSE、TNF-α、SOD水平与术前1 d比较,差异均无统计学意义(均P>0.05)。术后5 d NSE、TNF-α、IL-6水平低于术后1 d,SOD水平高于术后1 d,差异均有统计学意义(均P<0.05)。结论TEAS联合DEX并未降低老年患者POD的发生率,但可以减少术中丙泊酚用量,抑制炎性反应,降低脑损伤。

Objective To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS)combined with Dexmedetomidine(DEX)on postoperative delirium(POD)in elderly patients.Methods From January 2017 to November 2018,96 cases with elderly patients underwent pedicle screw internal fixation under elective general anesthesia in Beijing Hospital of Traditional Chinese Medicine,Capital Medical University were selected.According to the random number table method,they were devided into DEX group(group D)and combination group(group T),with 48 cases in each group.Group D was used DEX before anesthesia induction,while group T was used TEAS in combination on the basis of group D,and both groups stopped the above treatment 30 min before the end of the operation.The incidence of POD was compared within 5 d after operation.The does of Propofol was compared.Neuron-specific enolase(NSE),serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and superoxide dismutase(SOD)levels in the two groups were compared within 1 d before operation and 1,5 d after operation.Results There was no significant difference in POD incidence between the two groups(P>0.05).The dose of Propofol in group T were lower than that in group D,and the differences were statistically significant(P<0.05).In group D,the levels of NSE,TNF-α,and IL-6 on 1,5 d after operation were higher than those on 1 d before operation,while the levels of SOD were lower than that on 1 d before operation,with statistically significant differences(all P<0.05).The levels of NSE,TNF-α,and IL-6 on 5 d after operation were lower than those on 1 d after operation,while the levels of SOD were higher than those on 1 d after operation,with statistically significant differences(all P<0.05).In group T,the levels of NSE,TNF-αand IL-6 on 1 d after operation were higher than those on 1 d before operation,while the levels of SOD were lower than those on 1 d before operation,with statistically significant differences(all P<0.05).The levels of IL-6 on 5 d after operation were higher than those on 1 d before operation,and the differences were statistically significant.The levels of NSE,TNF-α,and SOD on 5d after operation were not statistically significant compared with those on 1 d before operation(all P>0.05).The levels of NSE,TNF-α,and IL-6 on 5 d after operation were lower than those 1 d after operation,while the levels of SOD were higher than those 1 d after operation,with statistically significant differences(all P<0.05).Conclusion TEAS combined with DEX do not reduce the incidence of POD in elderly patients,but can reduce intraoperative Propofol dosages,inhibit inflammatory response and reduce brain injury.