电针对老年病人下肢骨科手术围术期认知功能及炎症因子的影响

Effects of electroacupuncture on cognitive function and inflammatory factors in elderly patients undergoing lower limb orthopedic surgery during the perioperative period

目的 观察术后电针治疗对全身麻醉下行下肢骨科手术老年病人围术期神经认知功能障碍(PND)和炎症因子表达水平的影响。方法 选取全身麻醉下行下肢骨科手术的老年病人80例,随机分为对照组和电针组,每组40例。2组病人采用相同的麻醉方法,对照组在术后给予常规治疗,针刺组在常规治疗基础上给予电针治疗。2组均在术前和术后第1、3、7天采用MMSE评估认知功能,并测定血清中炎症因子(TNF-α、IL-1β、IL-6)的水平。结果 针刺组在术后第1天和第3天PND发生率低于对照组,差异具有统计学意义(P<0.05),在术后第7天,2组间PND发生率差异没有统计学意义。术后第1、3、7天,针刺组血清中TNF-α和IL-6水平均显著低于对照组(P<0.05);针刺组IL-1β水平在术后第1天和第3天显著低于对照组(P<0.05),而在术后第7天差异没有统计学意义。在术后第1、3、7天,针刺组MMSE评分均与TNF-α、IL-1β、IL-6呈负相关。结论 电针治疗可以降低老年病人下肢骨科手术PND的发生率,这种作用可能与电针抑制炎症因子的表达有关。

Objective To observe the effects of postoperative electroacupuncture treatment on perioperative neurocognitive dysfunction(PND)and the levels of inflammatory factors in the elderly patients undergoing lower limb orthopedic surgery under general anaesthesia.Methods Eighty elderly patients undergoing lower limb orthopedic surgery under general anaesthesia were selected and randomly divided into the control group and the acupuncture group,with 40 cases in each group.Both groups were given the same anaesthetic method.The control group was given conventional treatment after surgery,and the acupuncture group was treated with electroacupuncture on the basis of conventional treatment.Cognitive function was assessed before and 1,3 and 7 days after surgery using the Mini Mental State Examination(MMSE),and the serum levels of the inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin(IL)-1βand IL-6 were measured in the two groups.Results The incidence rate of PND in the acupuncture group was lower than that in the control group on the first day and the third day after operation,with significant differences(P<0.05).In the acupuncture group,the serum levels of TNF-αand IL-6 were significantly lower than those in the control group on the first day,the third day and the seventh day after operation(P<0.05),and the level of IL-1βwas lower than that in the control group on the first day and the third day after operation.On the first,third and 7th day after operation,the MMSE score was negatively correlated with the levels of TNF-α,IL-1β,IL-6 in the acupucture group.Conclusions Electroacupuncture treatment can reduce the incidence of perioperative cognitive function in the elderly patients undergoing lower limb orthopedic surgery,and the effects can be related to the inhibition of inflammatory factors expression by electroacupuncture.