经皮穴位电刺激预处理对老年患者术后认知功能和炎症因子的影响

Effects of Transcutaneous Acupoint Electrical Stimulation Pretreatment on Postoperative Cognitive Dysfunction and Inflammatory Factors in Elderly Patients

目的通过经皮穴位电刺激(transcutaneous acupoint electrical stimulation,TEAS)对拟行全髋关节置换术的老年患者进行术前预刺激,探讨经皮穴位电刺激对术后认知功能障碍(POCD)发生率和炎症因子的影响。方法选取陕西中医药大学附属医院择期行髋关节置换术的老年患者80例,按照随机数字表法随机分为对照组和经皮穴位电刺激(TEAS)组,每组40例。TEAS组患者在麻醉诱导前30 min打开穴位电刺激治疗仪,进行电刺激。两组患者的麻醉诱导和维持方法相同,术中记录围术期情况及患者术后1、2 d疼痛视觉模拟评分(visual analogue score,VAS);分别于术前1 d,术后1、3 d对每例患者进行简易智力状态检查量表(MMSE)评分,并在麻醉诱导前30 min(电刺激前)、术后1、3 d分别采静脉血样,用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定血清中IL-1β、TNF-α、IL-6的水平。结果瑞芬太尼和丙泊酚在TEAS组比对照组低(P均<0.05);两组间患者术后1、2 d VAS评分比较差异均无统计学意义(P均>0.05);TEAS组术后1 d MMSE评分比对照组高(P<0.05);两组患者术后POCD的发生率比较差异无统计学意义(P>0.05)。TEAS组术后1 d血清促炎因子IL-1β、IL-6水平比对照组低(P<0.05);TNF-α水平在术后1、3 d两组间比较差异均无统计学意义(P均>0.05)。结论经皮穴位电刺激预处理对老年患者全髋关节置换术术后的应激反应有部分缓解作用,对术后POCD的发生率无显著影响,但增加了术后1 d的MMSE评分,是值得继续研究和推广的辅助麻醉方法。

Objective To investigate the effect of transcutaneous electrical stimulation(TEAS)on postoperative cognitive dysfunction(POCD) and inflammatory factors in elderly patients undergoing total hip replacement.Methods A total of 80 elderly patients undergoing hip replacement were selected from the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine.They were randomly divided into 2 groups according to the random number table method:control group and TEAS group,with 40 patients in each group. Patients in teas group were given electrical stimulation at acupoints 30 minutes before anesthesia induction. The anesthesia induction and maintenance methods of the two groups were the same. Perioperative conditions and visual analog score(VAS) were recorded during the operation. MMSE scores were performed on each patient 1 d before operation,1 and 3 d after operation,and 30 minutes before anesthesia induction(before electrical stimulation),1 and 3 d after operation Serum levels of IL-1 β,TNF-α and IL-6 were measured by enzyme-linked immunosorbent assay(ELISA). Results Remifentanil and propofol were lower in the TEAS group than in the control group(P all<0.05). There was no significant difference in VAS scores between the two groups on the first and second day after surgery(P all>0.05). The MMSE score in the TEAS group was significantly higher than that in the control group(P<0.05). The incidence of postoperative POCD in the two groups was not statistically significant(P>0.05). Serum levels of pro-inflammatory factor IL-1β and IL-6 were lower in the TEAS group 1 d after operation than in the control group(P<0.05). There was no significant difference in TNF-α level between the two groups 1 d and 3 d after surgery(P all>0.05). Conclusion TEAS can partially relieve the stress response after total hip replacement in elderly patients,and has no significant effect on the incidence of postoperative POCD,but it increases the MMSE score on the first day after operation,which is an assistant anesthesia method worthy of further study and promotion.