经皮穴位电刺激对非体外循环下冠状动脉旁路移植术患者认知功能的影响

Influence of transcutaneous electrical acupoint stimulation on cognitive function in patients undergoing off-pump coronary artery bypass grafting

①目的探讨经皮穴位电刺激对非体外循环下冠状动脉旁路移植术患者认知功能的影响。②方法选取华北理工大学附属医院2015年8月~2018年7月非体外循环下冠状动脉旁路移植术患者72例,采用随机数字表法分为两组,各36例。对照组未实施经皮穴位电刺激,观察组实施经皮穴位电刺激,于手术前后行S100β、神经元特异性烯醇化酶检测,并行洛文斯顿认知功能评定测验评分(LOTCA)、蒙特利尔认知评估量表评分(MoCA)、日常生活活动能力评分(MBI),比较两组手术情况和并发症发生率。③结果两组手术后检测指标(S100β、神经元特异性烯醇化酶)、相关评分(LOTCA、MoCA、MBI)较手术前显著增加(P<0.05)。观察组手术后S100β和神经元特异性烯醇化酶低于对照组(P<0.05);LOTCA评分、MoCA评分、MBI评分高于对照组(P<0.05)。两组手术情况(手术持续时间、麻醉持续时间、丙泊酚用量、APACHEⅡ评分、机械通气时间、CCU停留时间、术后住院时间)、并发疾病(泌尿系统感染、肺部感染、胸腔积液、呼吸衰竭、失血性休克等)比较,差异无统计学意义(P>0.05);观察组舒芬太尼用量少于对照组,差异有统计学意义(P<0.05)。④结论经皮穴位电刺激可降低非体外循环下冠状动脉旁路移植术患者术后S100β和神经元特异性烯醇化酶的升高幅度,可改善患者的认知功能状况,麻醉药用量少且安全性高,值得临床推广使用。

Objective To explore influence of transcutaneous electrical acupoint stimulation on cognitive function in patients undergoing off-pump coronary artery bypass grafting.Methods A total of 72 patients undergoing off-pump coronary artery bypass grafting were selected in Affiliated Hospital of North China University of Science and Technology from August 2015 to July 2018,who were divided into two groups by random number table method.36 patients did not receive transcutaneous electrical acupoint stimulation as control group.36 patients received transcutaneous electrical acupoint stimulation as observation group.S100βand neuron specific enolase were detected before and after operation.LOTCA score,MoCA score and MBI score were evaluated.Operation and complications were compared between two groups.Results Detection indexes(S100β,neuron specific enolase)and related scores(LOTCA,MoCA,MBI)increased significantly in two groups after operation(P<0.05).S100βand neuron specific enolase in observation group were lower than control group after operation(P<0.05).LOTCA score,MoCA score,MBI score in observation group were higher than control group after operation(P<0.05).There were no significant differences on surgical conditions(operation time,anesthesia time,propofol dosage,APACHE II score,mechanical ventilation time,CCU stay time,postoperative hospitalization time),complications(urinary tract infection,pulmonary infection,pleural effusion,respiratory failure,hemorrhagic shock)between two groups(P>0.05).The dosage of sufentanil in observation group was less than control group(P<0.05).Conclusion Transcutaneous electrical acupoint stimulation can reduceelevation of postoperative S100βand neuron specific enolase inpatients undergoing off-pump coronary artery bypass grafting,which can improve patients’cognitive function.The dosage of anesthesia is low while safety is high.That is worthy of clinical application.