电针干预对老年患者全麻术后认知功能障碍的影响  

Effects of electroacupuncture on the elderly＇s postoperation cognitive dysfunction after general anesthesia

作　　者：周伟[1] 区锦燕[1] 陈耀雄[1] 罗富荣[1] 刘晓捷[1] 陈立成[1] 

机构地区：[1]广东省佛山市中医院麻醉科,佛山528000

出　　处：《中华物理医学与康复杂志》2014年第5期372-375,共4页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的研究电针干预对老年患者全麻术后认知功能障碍（POCD）的影响。方法将患有腰椎管狭窄症，行腰椎管切开减、复位内固定手术的患者60例按随机数字表法分为电针组和对照纰，每组30例。对照组仅接受常规静脉复合全麻术，电针组杠全麻前30min行电针干预，每干预30rain间歇10min，然后在患者手术体位调整完成后再次行电针干预30min，间歇10min，循环至手术结求。记录2组患者手术中内泊酚与瑞芬太尼的用量，分别于于术前24h和手术后72h使用简易智能状态检查量表（MMSE）评价2组患者的认知功能，并于术前30min、术毕拔除气管导管后10min（手术再10min）、手术后24h和手术后72h4个时间点测定2组患者血清白细胞介索（IL）-6、IL-10及S100β蛋白的水平。结果电针组患者手术中端芬太尼与丙泊酚的每小时用量分别为（6．54±3．27）μg／kg体重和（3．67±2．53）mg／kg体重，显著低于对照绀的（9．70±4．82）μg／kg体重和（5．624-1．73）mg／kg体重（P〈0．05）。手术后72h，电针组患者的POCD发生率为l例（3．3％），对照组发生率为8例（26．7％），组间差异有统计学意义（P〈0．05）；且电针组MMSE评分为（25．7±1．9）分，与对照组手术后72h的（23．2±2．1）分比较，差异有统计学意义（P〈0．05）。电针组术后各时间点的血清IL-6、IL-10和SIoo[3蛋白水平均显著低于对照组间时间点（P〈0．05）。结论电针干有利于改善老年患者于术后的认知功能，抑制其血清IL-6、IL-10、S100β蛋白的过发表达，减轻患者脑损伤的程度，有效降低患者POCD的发牛率。Objective To study the effects of electroacupuncture （ EA ） on the elderly＇s postoperation cog- nitive dysfunction （POCD） after general anesthesia. Methods Patients who need to have surgical operation done fur lumbar spinal stenosis were randomly divided into an observation group （ electroacupuncture and routine intraw,- nuus anesthesia） and a eontrol group （only routine intravenous anesthesia） , and EA was administered to thuse in the electroacupuncture group for 30 minutes at an interval of 10 minutes, beginning at 30 minutes prior to routine intrave- nons anesthesia and lasted till the end of the surgery. The differences regarding intraoperative propofol and remifcn- tanil dosage, cognitive function, the levels of serum interleukin-6（IL-6） , interleukin-10 （IL-10） and S100-β were compared. Results The inlraoperative propotol and remifentanil dosages in observation group were （6.54 ± 3.27） μg/（ kg. h） and （ 3.67 ± 2.53 ） mg/（ kg. h ） , respectively, while those in control group were （ 9.70 ± 4.82 ） μg/kg and （5.62 ±1.73 ） mg/kg. The intraoperative propofol and remifentanil dosages in observation group were significant- ly lower than those in control group （ P 〈 0.05 ）. At 72 hours post-operation the incidence of POCD in observation group was significantly lower than that in control group （ 1 case, 2.5% versus 8 cases, 20% ） , while the MMSE score was higher in observation group than that in control group （ 25.7 ± 1.9 versus 23.2 ± 2.1 ）. The post-operation level of serum IL-6, IL-10 and S100-β in observation group were significantly lower than that in control group （P 〈 O. 05）. Conclusion Electroacupuncture could significantly improve the ehterly＇s postoperation cognitive dysfunc- tion after general anesthesia. It could inhibit the excessive expressions of IL-6, IL-10 and S100-β, alleviate the brain damage and reduce the incidence of POCD.

关 键 词：老年患者 术后认知功能障碍 电针 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]