三线放松功锻炼对防治老年前列腺手术术后早期认知损害的研究

Research on Prevention and Treatment of Triarchic Body-Pathway Relaxation Exercise on Early Cognitive Impairments Following Prostate Surgery in Elderly Patients

探索术前采用三线放松功进行锻炼是否能有效降低老年经尿道前列腺汽化电切术(TURP)患者术后认知功能障碍(POCD)的发病率和减轻认知损害。方法:60例被试随机分入治疗组(n=30)和对照组(n=30)。对照组仅接受围手术期常规护理,治疗组在此基础上于术前15 d开始每天练习三线放松功。所有被试于术前15 d(基线)、术后24 h及72 h,分别予以简易精神状态评价量表(MMSE)进行认知测试,并观察血清炎症因子IL-1β,TNF-α及S100-β蛋白表达水平的变化。术前15 d及术后72 h,被试同时接受3项神经心理学测试:Stroop色-词关联测验(SCWAT)、数字符号替代测试(DSST)及交替流畅性测验(ACAFFT)。考虑术前焦虑与POCD的潜在联系,被试还于术前15 d及术前1 d接受汉密尔顿焦虑量表(HAMA)测评。结果:1)练习三线放松功15 d后,治疗组HAMA总分显著下降(p<0.05),对照组HAMA总分则随手术日期的临近升高(p<0.05)。2)和基线相比,术后24~72 h,2组被试的MMSE总分均持续下降(p<0.05)。术后72 h,对照组MMSE总分下降比治疗组更显著(p<0.05)。3)和基线相比,术后72 h,2组患者的SCWAT测试耗时数均明显增加,且对照组患者在卡片C阶段耗时显著多于治疗组(p<0.05);2组患者在DSST测试中的正确率在术后均显著下降(p<0.05),且对照组正确率更低(p<0.05);在ACAFFT测试中,2组患者手术前后的正确率差异均不显著(p>0.05)。4)和基线相比,术后24 h,2组患者的IL-1β、TNF-α和S100-β指标均大幅上升(p<0.05)。无论术后24 h还是72 h,对照组IL-1β和TNF-α表达水平的涨幅均高于治疗组(p<0.05),尽管2组别间S100-β蛋白的表达差异不显著(p>0.05)。5)无论术后24 h还是72 h,2组被试的POCD发生率差异均不显著(p>0.05)。结论:术前连续15 d的三线放松功锻炼可减轻老年患者前列腺汽化电切术术后24 h及72 h的认知损害。术前焦虑情绪也可通过练习三线放松功得到缓解。但是,尚未有足够证据显示该锻炼可以有效降低术后24 h及72 h认知功能障碍的发生率。

To investigate if preoperative Triarchic Body-Pathway Relaxation Exercise(TBPRE)can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD)following Trans-Urethral Resection Prostate(TURP)among elderly.Methods:60 eligible participants were enrolled and randomized into either a treatment group(n=30)or a control group(n=30).The control group was intervened by routine perioperative care whereas the treatment group was required to practice TBPRE for consecutive 15 days before the surgery in addition to being intervened by the routine perioperative care.The Mini-Mental State Examination(MMSE),and expression levels of serum inflammatory cytokines including interleukin 1β(IL-1β)and tumor necrosis factor-α(TNF-α),and S100-βprotein were assessed at 15 days prior to the surgery(baseline),and postoperative 24 and 72 hours,respectively.Participants also underwent three neuropsychological tests:Stroop Color-Word Association Test,(SCWAT),Digit-Symbol Substitution Test(DSST),and Animal-City Alternating Form Fluency Test(ACAFFT),at baseline and postoperative 24 and 72 hours,respectively.Considering the potential correlation between preoperative anxiety and POCD,all patients were tested by Hamilton Anxiety Scale(HAMA)on preoperative 15 days and 1 day as well.Results:1)After 15-day practice of TBPRE,the HAMA global score of the treatment group decreased significantly(p<0.05),while that of the control group increased significantly with the approach of surgery(p<0.05).2)Compared with baseline,the MMSE global scores of both groups continuously decreased from postoperative 24 to 72 hours(p<0.05).It should be noted that the MMSE global scores of the control group decreased more significantly than that of the treat ment group at postoperative 72 hours(p<0.05).3)Compared with baseline,the time spent on SCWAT in both groups increased significantly at postoperative 72 hours,and the control group spent more time in the card C phase than that of the treatment group(p<0.05);in DSST,the correct rate of both groups significantly decreased after the surgery(p<0.05),and the correct rate of the control group was much lower(p<0.05);in ACAFFT,there was no significant difference of correct rate in both groups at pre-and post-surgery(p>0.05).4)Compared with baseline,IL-1β,TNF-αand S100-βlevels increased significantly in both groups at postoperative 24 hours(p<0.05).The increase of IL-1βand TNF-αlevels in the control group were higher than those in the treatment group at postoperative 24 hours(p<0.05)and at postoperative 72 hours(p<0.05),while the difference in expression of S100-βprotein between the two groups was not significant(p>0.05).5)There was no significant difference in the incidence of POCD between the two groups either at postoperative 24 hours(p>0.05)or at postoperative 72 hours(p>0.05).Conclusion:Preoperative and consecutive TBPRE can mitigate preoperative anxiety as well as the cognitive impairments in elderly undergoing TURP at postoperative 24 hours and 72 hours.However,there is insufficient evidence to support that TBPRE pretreatment reducing the incidence of POCD within postoperative 72 hours.