围术期经皮穴位电刺激对中老年患者电休克致中枢神经损伤及记忆能力的影响

Efficacy of perioperative transcutaneous electrical acupoint stimulation on central nervous system injury and memory ability in patients with modified electroconvulsive therapy

目的探讨围术期内行经皮穴位电刺激(TEAS)对无抽搐电休克治疗的中老年患者中枢神经损伤和记忆能力的影响。方法选择电休克治疗的中老年患者随机分为对照组和TEAS组,每次电休克前均在患者双侧内关穴、双侧合谷穴及大椎穴贴上电极片,连接穴位神经刺激仪。TEAS组采用疏密波,频率2/15 Hz,强度为10~30 m A调节至以患者疼痛不能耐受的最大水平,电刺激持续30 min。对照组不接通电源。于首次电休克前(T1)、和第6次电休克次日(T2)行简明精神状态量表(MMSE)和韦氏记忆量表(WMS)测评;静脉血检测中枢神经特异性蛋白(S100β蛋白)、神经元特异性烯醇化酶(NSE)浓度;记录围术期内不良反应(头痛、头晕、恶心呕吐、肌肉酸痛、发热)总例数。结果TEAS组与对照组T1时MMSE评分(26.92±1.98)分与(27.25±1.60)分,WMS评分为(87.33±17.86)分与(84.25±16.61)分,差异无统计学意义(P>0.05);T1时S100β蛋白浓度为(0.07±0.03)μg/L与(0.08±0.02)μg/L,NSE浓度(15.41±3.61)μg/L与(15.17±2.07)μg/L,差异无统计学意义(P>0.05);在T2时TEAS组MMSE评分为(23.58±4.23)分,高于对照组(19.58±4.80)分,WMS评分为(82.25±18.68)分,高于对照组(58.67±11.03)分,差异有统计学意义(P>0.05);T2时TEAS组S100β蛋白(0.04±0.01)μg/L低于对照组(0.09±0.03)μg/L、NSE(13.20±2.08)μg/L低于对照组(16.15±2.24)μg/L,差异有统计学意义(P<0.05);TEAS组围术期内头痛发生率(0%)与对照组(23.8%),头晕发生率(0%)与对照组(4.35%),比较均差异无统计学意义(P>0.05)。结论围术期应用经皮穴位电刺激技术可减轻中老年患者电休克术后中枢神经损伤,改善记忆能力。

Objective To investigate the efficacy of perioperative transcutaneous electrical acupoint stimulation(TEAS)on central nervous system injury and memory ability in patients treated with modified electroconvulsive therapy(ECT).Methods The elderly patients treated with ECT were randomly divided into control group and TEAS group.Before ECT,electrodes were pasted on bilateral Neiguan point,bilateral Hegu point and Dazhui point,and acupoint nerve stimulator was connected.The TEAS group was treated with a density wave with a frequency of 2/15 hz and an intensity of 10~30 mA,which was adjusted to the maximum level that the patient could not tolerate the pain,and the electrical stimulation lasted for 30 min.The control group was not powered on the device.The Mini-Mental State Examination(MMSE)and Wechsler Memory Scale(WMS)were used before the first ECT(T1)and the day after the sixth ECT(T2);central nervous system specific protein(S100βProtein)and neuron specific enolase(NSE)concentration were detected;the total number of adverse reactions(headache,dizziness,nausea and vomiting,muscle soreness,fever)during the perioperative period was recorded.Results The score of MMSE and WMS and S100βof the two groups measured at T1 showed no significant difference.At T2,MMSE score(23.58±4.23)and WMS score(82.25±18.68)in TEAS group were significantly higher than those in the control group;S100βProtein(0.04±0.01)μg/L and NSE(13.20±2.08)μg/L were significantly lower than those in the control group.The incidence of perioperative headache(0%vs.23.8%)and dizziness(0%vs.4.35%)in the bothgroups were not statistically significant.Conclusion TEAS during perioperative period helps to reduce the central nervous system injury and improve the memory decline in elderly patients treated with ECT.