针药平衡麻醉对老年妇科肿瘤术后早期认知功能及短期临床预后的影响

Effect of acupuncture-drug balanced anesthesia on early cognitive function and short-term clinical prognosis after gynecological tumor surgery of elderly patients

目的初步探讨针药平衡麻醉(ADBA)对老年患者接受妇科肿瘤术后早期认知功能及短期临床预后的影响。方法选取2019年10月至2020年7月于河南大学人民医院接受诊断并确诊为妇科肿瘤的老年患者109例,年龄65~79岁,最终纳入择期行外科手术治疗的患者80例,术式为妇科肿瘤切除术。采用随机数字表法将其分为ADBA组(40例)和常规麻醉组(CA组,40例)。ADBA组于麻醉前10 min经皮电刺激内关穴(PC6)及合谷穴(L14)直至术毕;CA组行常规全凭静脉麻醉,并于相同穴位上贴电极片但不进行电刺激。留取患者中心静脉血,采用酶联免疫吸附法(ELISA)分别测定术前30 min(T_(0))、手术开始后30 min(T_(1))及术后60 min(T_(2))、24 h(T_(3))、3 d(T_(4))和5 d(T_(5))时的血浆白细胞介素6、8(IL-6、IL-8)和肿瘤坏死因子α(TNF-α)水平。患者认知功能分别于术前1 d、术后3 d及7 d时采用蒙特利尔认知评估量表(MoCA)和简易精神状态评价量表(MMSE)进行评估。记录住院时间及术后不良事件发生率。结果T_(1)~T_(5)时,ADBA组血浆IL-6、IL-8和TNF-α水平较CA组均明显降低[IL-6:(13.4±3.5)pg/ml比(17.2±4.4)pg/ml、(22.4±5.5)pg/ml比(28.6±5.6)pg/ml、(32.2±5.7)pg/ml比(40.7±6.2)pg/ml、(27.6±5.4)pg/ml比(35.2±6.6)pg/ml、(13.4±2.5)pg/ml比(19.5±3.6)pg/ml,均P<0.05;IL-8:(9.5±3.1)pg/ml比(13.5±3.4)pg/ml、(14.2±3.8)比(19.5±4.8)pg/ml、(24.6±4.5)pg/ml比(32.5±4.6)pg/ml、(18.6±3.3)pg/ml比(25.7±4.6)pg/ml、(13.7±3.3)pg/ml比(18.5±4.8)pg/ml,均P<0.05;TNF-α:(11.1±4.5)pg/ml比(18.8±5.3)pg/ml、(17.5±4.9)pg/ml比(32.2±6.4)pg/ml、(27.5±6.4)pg/ml比(45.7±7.9)pg/ml、(18.2±5.5)pg/ml比(35.7±6.3)pg/ml、(14.8±3.4)pg/ml比(25.4±4.3)pg/ml,均P<0.05]。术前1 d、术后3 d、术后7 d,CA组MMSE评分分别为(28.2±2.3)分、(22.4±0.9)分、(23.8±1.0)分,ADBA组MMSE评分分别为(28.5±2.2)分、(24.3±1.0)分、(25.7±1.2)分,CA组MoCA评分分别为(27.1±2.1)分、(22.2±1.2)分、(23.9±1.3)分,ADBA组MoCA评分分别为(26.9±1.9)分、(23.4±1.1)分、(25.3±1.4)分;与术前1 d比较,术后3 d两组MMSE和MoCA评分均降低(均P<0.05);与术后3 d比较,术后7 d两组MMSE和MoCA评分均升高(均P<0.05);术后3 d及术后7 d时ADBA组MMSE和MoCA评分均高于CA组(均P<0.05)。ADBA组术后肺部并发症发生率较CA组显著下降[5.0%(2/40)比22.5%(9/40),P<0.05],术后住院时间较CA组显著缩短[(11.4±2.6)d比(15.7±3.8)d,P<0.05]。结论ADBA可改善妇科肿瘤切除术老年患者术后早期认知功能及短期临床预后。

Objective To evaluate the effect of acupuncture-drug balanced anesthesia(ADBA)on postoperative early cognitive function and short-termclinical prognosis after gynecological tumor surgery in elderly patients.Methods A total of 109 patients who were 65-79 years old and were diagnosed with gynecological tumors at Henan University People's Hospital from October 2019 to July 2020 were selected.Finally,80 patients were selected for surgical treatment.The surgical procedure was gynecological tumor resection.The included patients were divided into an ADBA group and a conventional anesthesia group(CA group)by the random number table method,with 40 patients in each group.In the ADBA group,10 minutes before anesthesia,percutaneous electrical stimulation on Neiguan(PC6)and Hegu(L14)points was performed until the operation was completed.In CA group,the patients underwent routine intravenous anesthesia,and electrodes were attached to the same acupoints with no electrical stimulation.The patients'central venous blood was collected.The enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of plasma interleukin-6 and-8(IL-6 and IL-8)and tumor necrosis factor alpha(TNF-α)30 min before the surgery(T_(0)),30 min(T_(1))after the beginning of the operation,and 1 h(T_(2)),1 d(T_(3)),3 d(T_(4)),5 d(T_(5))after the end of the operation.Their cognitive function was evaluated by Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)1 day before and 3 and 7 days after the surgery.The hospital stays and the incidences of postoperative adverse events were recorded.Results The levels of plasma IL-6,IL-8,and TNFαat T_(1)-T_(5)were all lower in the ADBA group than those in the CA group[IL-6:(13.4±3.5)pg/ml vs.(17.2±4.4)pg/ml,(22.4±5.5)pg/ml vs.(28.6±5.6)pg/ml,(32.2±5.7)pg/ml vs.(40.7±6.2)pg/ml,(27.6±5.4)pg/ml vs.(35.2±6.6)pg/ml,and(13.4±2.5)pg/ml vs.(19.5±3.6)pg/ml,all P<0.05;IL-8:(9.5±3.1)pg/ml vs.(13.5±3.4)pg/ml,(14.2±3.8)pg/ml vs.(19.5±4.8)pg/ml,(24.6±4.5)pg/ml vs.(32.5±4.6)pg/ml,(18.6±3.3)pg/ml vs.(25.7±4.6)pg/ml,and(13.7±3.3)pg/ml vs.(18.5±4.8)pg/ml,all P<0.05;TNF-α:(11.1±4.5)pg/ml vs.(18.8±5.3)pg/ml,(17.5±4.9)pg/ml vs.(32.2±6.4)pg/ml,(27.5±6.4)pg/ml vs.(45.7±7.9)pg/ml,(18.2±5.5)pg/ml vs.(35.7±6.3)pg/ml,and(14.8±3.4)pg/ml vs.(25.4±4.3)pg/ml,all P<0.05].The scores of MMSE 1 day before and 3 and 7 days after the operation were(28.2±2.3),(22.4±0.9),and(23.8±1.0)in the CA group and were(28.5±2.2),(24.3±1.0),and(25.7±1.2)in the ADBA group,and the scores of MoCA 1 day before and 3 and 7 days after the operation were(27.1±2.1),(22.2±1.2),and(23.9±1.3)in the CA group and were(26.9±1.9),(23.4±1.1),and(25.3±1.4)in the ADBA group,with statistical differences between 1 day before and 3 days after the operation and between 3 and 7 days after the operation in both groups and between the CA group and the ADBA group 3 and 7 days after the treatment(all P<0.05).The incidence of postoperative pulmonary complications and the hospital stay in the ADBA group were significantly lower than those in the CA group[5.0%(2/40)vs.22.5%(9/40)and(11.4±2.6)vs.(15.7±3.8),both P<0.05].Conclusion ADBA can improve postoperative early cognitive function and short-term clinical prognosis in elderly patients after gynecological tumor surgery.