耳穴揿针治疗对腹腔镜子宫切除术后认知功能障碍的影响

Effect of Intradermal Needling at Auricular Points on Postoperative Cognitive Dysfunction Following Laparoscopic Hysterectomy

目的观察耳穴揿针对术后认知功能障碍(POCD)的治疗效果。方法选择美国麻醉医师学会(ASA)1~2级,择期腹腔镜子宫切除术术后发生POCD的患者80例,随机分为对照组和治疗组,每组40例。治疗组揿针贴敷双侧耳穴心、肾、神门、交感、皮质下,对照组在治疗组相同穴位贴敷外观相同不含针体的假贴片。所有患者均进行3次治疗。分别在治疗开始后的7 d、15 d、30 d采用简易智能量表(MMSE)评估术后认知功能,采用焦虑自评量表(SAS)评估术后焦虑状态,采用日常生活能力量表(ADL)评估患者实际的自理能力,同时检测外周血S100β表达水平。结果治疗组治疗7 d、15 d及30 d MMSE评分高于对照组(P<0.05);治疗组治疗15 d及30 d SAS高于对照组(P<0.05),ADL高于对照组(P<0.05);相比对照组,治疗组外周血S100β水平在治疗第7天、第15天显著降低(P<0.05),第30天组间无显著差异(P>0.05)。结论耳穴揿针刺激可以显著促进POCD患者的认知功能恢复,减轻焦虑,提高自主生活能力;S100β水平的调节参与了早期认知功能的改善。

Objective To observe the treatment efficacy of intradermal needling at auricular points for postoperative cognitive dysfunction(POCD).Method Eighty patients graded 1-2 by the American Society of Anesthesiologists(ASA)who developed POCD after laparoscopic hysterectomy were randomized into a control group and a treatment group,with 40 cases in each group.The treatment group was intervened by intradermal needling at bilateral auricular points,including Heart(CO15),Kidney(CO10),Shenmen(TF4),Sympathetic(AH6 a)and Subcortex(AT4),while the control group received sham stickers with the same look but without needles applied to the same group of auricular points.The patients all received 3 sessions of treatment.The cognitive function was evaluated using the Mini-Mental State Examination(MMSE),the anxiety sate was assessed using the Self-rating Anxiety Scale(SAS)and the patients’actual self-care capability was estimated using the Activities of Daily Living(ADL)7 d,15 d and 30 d after the treatment commenced,and the expression level of S100βin peripheral blood was detected at the same time.Result The MMSE score was higher in the treatment group than in the control group at treatment days 7,15 and 30(P<0.05).The SAS score was higher in the treatment group than in the control group at treatment days 15 and 30(P<0.05),and the ADL score was higher in the treatment group than in the control group(P<0.05).Compared with the control group,the level of S100βin peripheral blood decreased significantly at treatment days 7 and 15 in the treatment group(P<0.05),while the between-group difference was statistically insignificant at day 30(P>0.05).Conclusion Intradermal needling at auricular points can notably promote the recovery of the cognitive function,reduce anxiety and improve the ADL in POCD patients;the regulation of S100βlevel should be involved in the improvement of cognitive function in early stage.