电针“四关”穴对老年患者髋关节置换术后认知功能的影响

Effect of electroacupuncture at “four close” points on cognitive function in elderly patients with hip replacement

关键词:  电针调节  “四关”穴  术后认知功能  S-100β蛋白  神经元特异性烯醇化酶

Key words:  electroacupuncture  Siguan acupoints  postoperative cognitive function  S-100β protein  neuron-specific enolase

摘要:

目的观察围术期电针“四关”穴对老年髋关节置换术患者术后认知功能影响。方法 择期行髋关节置换术的老年患者80例,年龄65～82岁,随机均分对照组(常规全身麻醉组)和电针组(围术期电针复合全身麻醉组),每组40例。电针组: 选取“四关”穴,于术前1～3d及术后1～3d每天1次,每次30min电针调节；手术当天,于术前30min开始电针调节至手术结束。对照组: 不予针刺干预。记录手术当天电针诱导前、电针诱导后30min、全身麻醉诱导后、插管即刻、插管后5min、拔管前5min、拔管时、拔管后5min的心率和动脉压的变化；记录术前电针诱导前、术毕、术后24h、术后48h及术后72h时血清S-100β、神经元特异性烯醇化酶(NSE)和炎症因子变化；术前3d、术后4d采用MMSE测定认知功能。结果 与对照组比较,电针组HR和MAP在插管即刻及拔管时均明显降低(P＜0.05)；电针组POCD的发生率较对照组明显下降(P＜0.05)。与电针诱导前相比,两组患者血清S-100β和NSE术毕及术后均明显增加,在24h达到最高峰,随后下降(P＜0.05)。与对照组比较,电针组术毕血清S-100β和NSE明显降低(P＜0.05)。与电针诱导前相比,两组患者血清炎症因子IL-1β和TNF-α均显著升高。与对照组相比,电针组血清IL-1β和TNF-α均显著降低(P＜0.05)。结论 围术期电针“四关”穴干预能改善老年髋关节置换术患者术后认知功能,可能与降低血清脑组织损伤蛋白S-100β和NSE,抑制炎症因子IL-1β和TNF-α相关。

Abstract:

Objective To evaluate the effects of perioperative electroacupuncture at “four close” points on postoperative cognitive function in elderly patients undergoing hip replacement. Methods Eighty elderly patients undergoing elective hip replacement, aged 65 to 82 years, were randomly divided into control group (routine general anesthesia) and acupuncture group (perioperative electroacupuncture plus general anesthesia) with 40 cases in each group. The acupuncture group received electroacupunctureat the “four close” pointfor 30min everyday in preoperative 1d to 3d and postoperative 1d to 3d. On the surgery day, theelectroacupuncture began 30 min before operationand through the surgery till the end. The control group received general anesthesia alone. The changes of heart rate (HR) and mean arterial pressure (MAP) were recorded before induction of electroacupuncture, 30min after electroacupuncture, after induction of anesthesia, intubation, 5min after intubation, 5min before extubation, at extubation, and 5min after extubation. The serum levels of S-100β, NSE, IL-1β and TNFα were measured before electroacupuncture, after surgery, on postoperative 24h, 48h and 72h. The cognitive function was measured using MMSE on preoperative d3 and postoperative d4. Results Compared with the control group, acupuncture group showed significantly lower HR and MAP on the intubation and extubation (P<0.05), and a decreased incidence of postoperative cognitive dysfunction(POCD) (P<0.05). After operation, the serum S-100β beta and NSE proteins were significantly increased (P<0.05). Compared with the control group, acupuncture group showed significantly decreased postoperative serum S-100β and NSE proteins (P<0.05) and serum inflammation cytokines IL-1β and TNF-α(P<0.05). Conclusion The perioperative electroacupuncture intervention at the “four close” points can improve the postoperative cognitive function in elderly patients with hip joint surgery, which may be associated with decrease of serum S-100β and NSE and the inhibition of inflammatory factors IL-1β and TNFα.