术前TEAS预保温策略对胸腔镜下肺叶切除术老年患者麻醉后恢复及术后认知功能的影响

Effects of preoperative TEAS prewarming strategy on postanesthesia recovery and cognitive function of elderly patients undergoing video-assisted thoracoscopic lobectomy

目的探讨术前经皮穴位电刺激(TEAS)预保温策略对胸腔镜下肺叶切除术老年患者麻醉后恢复及术后认知功能的影响。方法选择2018年1月至2019年12月在该院接受全身麻醉下行择期胸腔镜下肺叶切除术的老年患者150例为研究对象,分为穴位组(AW组)、充气加温毯预热组(PA组)和对照组(C组),每组50例。入麻醉准备间后,AW组采用穴位刺激仪对大椎及腰阳关穴进行电刺激30 min,PA组全身加盖充气加温毯30 min,C组在相应穴位贴电极,但不给予电刺激。观察并记录T0(入准备间)、T1(出准备间)、T2(麻醉诱导后)、T3(切皮后30 min)、T4(切皮后60 min)、T5(切皮后90 min)、T6(入PACU 10 min)时的核心体温;分析患者入准备间、术后24 h血清白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α水平。术前24 h、术后3 d,采用简易智力状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、术后恢复质量评估量表(PQRS)评估患者认知功能。结果T1时PA组、AW组患者体温明显高于C组(P<0.05),T2时AW组患者体温明显高于C组(P<0.05)。PA组、AW组苏醒时间均明显短于C组(P<0.01)。苏醒期寒战发生率AW组4.0%,PA组8.0%,C组32.0%,3组比较差异有统计学意义(P<0.01)。术后24 h PA组血清IL-6水平明显低于C组(P<0.01),AW组血清IL-6、TNF-α水平明显低于其他2组(P<0.01)。POCD发生率AW组4.0%,PA组6.0%,C组20.0%,3组比较差异有统计学意义(χ2=8.444,P=0.015)。结论术前TEAS预保温策略可减少胸腔镜肺叶切除老年患者围术期低体温的发生,缩短患者麻醉苏醒时间,降低炎症因子水平及POCD的发生率。

Objective To investigate the effects of the preoperative transcutaneous electrical acupoint stimulation(TEAS)and prewarming strategy on postanesthesia recovery and cognitive function of elderly patients undergoing video-assisted thoracoscopic lobectomy.Methods One hundred and fifty elderly patients undergoing elective video-assisted thoracoscopic lobectomy under general anesthesia in this hospital from January 2018 to December 2019 were selected as the study subjects and divided into the acupoint group(AW),inflatable warming blanket prewarming group(PA)and control group(C),50 cases in each group.After entering the anesthetic preparation room,the AW group adopted the acupoint stimulator to conduct the electric stimulation on Dazhui(GV14)and Yaoyangguan(GV3)for 30 min,the PA group was covered with the inflatable warming blanket for 30 min,and the group C was pasted with the electric pole at corresponding acupoints,but without giving the electric stimulation.Then the core temperature at entering the preparation room(T0),exiting from the preparation room(T1),after anesthesia and induction(T2),at 30 min after skin incision(T3),at 60 min after skin incision(T4),at 90 min after skin incision(T5)and at 10 min after entering PACU(T6)was observed and recorded.The levels of serum IL-1β,IL-6 and TNF-αat entering the preparation room and at postoperative 24 h were detected.The scores of Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and postoperative Quality Recovery Scale(PQRS)at preoperative 24 h and on postoperative 3 d were analyzed to evaluate the cognitive function of the patients.Results The body temperature at T1in the AW group and PA group was significantly higher than that in the group C(P<0.05).The body temperature at T2 in the AW group was significantly higher than that in the group C(P<0.05).The recovery time in the PA group and AW group was significantly shorter than that in the group C(P<0.01).The incidence rate of shivering during recovering period was 4.0%in the AW group,8.0%in the PA group and 32.0%in the group C,and the difference among 3 groups was statistically significant(P<0.01).The serum of IL-6 level at postoperative 24 h in the PA group was significantly lower than that in the C group(P<0.01).The serum IL-6 and TNF-αin the AW group were significantly lower than those in the other two groups(P<0.01).The occurrence rate of POCD was 4.0%in the AW group,6.0%in the PA group and 20.0%in the C group,and the difference among 3 groups was statistically significant(χ2=8.444,P=0.015).Conclusion Preoperative TEAS prewarming strategy can reduce the occurrence of perioperative hypothermia in elderly patients undergoing video-assisted thoracoscopic lobectomy,shorten the time of anesthesia recovery,decrease the levels of inflammatory factors and incidence rate of POCD.