针刺联合硬膜外麻醉对老年腹部手术患者围术期应激及术后认知功能的影响

Effects of acupuncture combined with epidural anesthesia on perioperative stress and postoperative cognitive function in elderly patients undergoing abdominal surgery

目的探讨针刺联合硬膜外麻醉对老年腹部手术患者围术期应激及术后认知功能的影响。方法选取2018年1月至2019年8月空军军医大学唐都医院收治的84例择期行腹部手术的老年患者,按随机数表法分为观察组和对照组各42例。对照组采取硬膜外麻醉,观察组在对照组基础上联合针刺麻醉。比较两组患者在麻醉前、插管后和术毕3个时间点的皮质醇(Cor)、C反应蛋白(CRP)水平、心率(HR)和平均动脉压(MAP),记录两组患者在术前、术后1 d的视觉模拟评分(VAS)、简易智力状态量表(MMSE)评分,同时比较两组患者术后1 d、2 d、3 d的恶心程度。结果两组患者的Cor、CRP水平在麻醉前、插管后比较差异均无统计学意义(P>0.05),但观察组患者术毕时刻的Cor、CRP水平分别为(178.64±58.23)nmol/L、(76.29±20.34)mg/L,明显低于对照组的(264.51±79.57)nmol/L、(108.76±25.71)mg/L,差异均有统计学意义(P<0.05);两组患者围术期不同时刻的HR、MAP指标比较差异均无统计学意义(P>0.05),术前的VAS、MMSE评分比较两组间差异也均无统计学意义(P>0.05),但观察组患者术后的VAS评分为(3.95±1.27)分,明显低于对照组的(4.76±1.53)分,MMSE评分为(24.86±2.03)分,明显高于对照组的(20.31±1.59)分,差异均有统计学意义(P<0.05);观察组患者术后1 d、2 d、3 d的恶心情况均优于对照组,差异均有统计学意义(P<0.05)。结论针刺联合硬膜外麻醉能有效改善老年腹部手术患者术后围术期应激反应,减轻恶心、疼痛情况及对患者术后认知功能的影响。

Objective To explore effects of acupuncture combined with epidural anesthesia on perioperative stress and postoperative cognitive function in elderly patients undergoing abdominal surgery.Methods Eighty-four elderly patients who underwent elective abdominal surgery and were admitted to Tangdu Hospital of Air Force Military Medical University from January 2018 to August 2019 were enrolled.They were divided into observation group and control group by random number table,with 42 patients in each group.The control group was treated with epidural anesthesia,while the observation group was additionally treated with acupuncture for anesthesia.Before anesthesia,after intubation and at end of surgery,levels of cortisol(Cor)and C-reactive protein(CRP),heart rate(HR),and mean arterial pressure(MAP)were compared between the two groups.The scores of Visual Analogue Scale(VAS)and Mini-mental State Examination(MMSE)in both groups were recorded before surgery and at 1 d after surgery.The nausea degree at 1 d,2 d and 3 d after surgery was compared between the two groups.Results Before anesthesia and after intubation,there were no significant differences in levels of Cor and CRP between the two groups(P>0.05).At end of surgery,Cor,and CRP levels in observation group were(178.64±58.23)nmol/L,(76.29±20.34)mg/L,significantly lower than(264.51±79.57)nmol/L,(108.76±25.71)mg/L in the control group(P<0.05).There was no significant difference in perioperative HR or MAP between the two groups,as well as in scores of VAS and MMSE(P>0.05).After surgery,VAS in observation group was significantly lower than that in control group:(3.95±1.27)points vs(4.76±1.53)points,while MMSE score was significantly higher than that in control group:(24.86±2.03)points vs(20.31±1.59)points,with statistically significant difference(P<0.05).The nausea degree at 1 d,2 d and 3 d after surgery in observation group was better than that in control group(P<0.05).Conclusion Acupuncture combined with epidural anesthesia can effectively improve perioperative stress response of elderly patients undergoing abdominal surgery,alleviate nausea and pain,and reduce effects on their postoperative cognitive function.