经皮穴位电刺激联合右美托咪定对老年患者髋部手术后认知功能的影响  

The effect of transcutaneous acupoint electrical stimulation combined with dexmedetomidine on the cognitive function of elderly patients after hip surgery

作　　者：杨涛[1] 刘勇[1] 曹兴华[1] YANG Tao;LIU Yong;CAO Xing-hua(The Affiliated Traditional Chinese Medicine Hospital,Xinjiang Medical University,Urumqi,830000,China)

机构地区：[1]新疆医科大学附属中医医院,乌鲁木齐830000

出　　处：《新疆医学》2021年第6期643-646,共4页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区自然科学基金(项目编号:2016D01C152)。

摘　　要：目的本研究旨在通过对行髋部手术的老年患者给予经皮穴位电刺激联合右美托咪定干预并观察其对术后认知功能的影响,从而对老年患者POCD的预防和临床治疗方面提供更进一步的指导作用。方法选取骨科就诊并择期行髋部手术的老年患者60名,根据入组前后顺序编写序号,基于随机数字表达法随机划分60例老年患者为两组,分别为穴位刺激联合右美托咪定组(E组)30例,单纯使用右美托咪定组(C组)30例。E组患者从麻醉前30min至手术结束在双侧鱼腰及双侧风池穴持续给予电刺激,并同时在麻醉前10min将剂量为0.5ug/kg×体重的右美托咪定在10min内持续泵注完毕。C组选取相同的穴位但不进行电刺激,其余麻醉方法均同E组。分别在开始手术和结束手术时采集患者的静脉血液标本,并对患者的白介素10(IL-10)、白介素6(IL-6)及中枢特异性蛋白(S100-β)水平进行检测,常用的检测方式为酶联免疫吸附试验。并采用精神状态简易量表(MMSE)对患者术前、术后24h的认知功能分别进行评估。结果研究结果表明,在开始手术与结束手术两个时间点,C组血清的IL-10、IL-6及S100-β水平高于E组,差异有统计学意义(P <0.05)。而对于术后24 hMMSE评分量表的对比发现,C组比E组降低更明显,差异有统计学意义(t=4.012,P<0.01)。结论经皮穴位电刺激联合右美托咪定与单纯使用右美托咪定干预相比,前者对术后认知功能的影响更有优势,这更有利于患者术后的康复。Objective To observe the effect of transcutaneous electrical acupoint stimulation combined with dexmedetomidine on postoperative cognitive function in elderly patients undergoing hip surgery, so as to provide further guidance for the prevention and clinical treatment of POCD in elderly patients. Methods Sixty elderly patients with hip surgery in orthopedics department were selected.According to the order before and after entering the group, sixty elderly patients were randomly divided into two groups, 30 cases in the acupoint stimulation combined with dexmedetomidine group(Group E), and 30 cases in the dexmedetomidine group(Group C). The patients in Group E were continuously given electrical stimulation at both Yuyao and Fengchi Points from 30 minutes before anesthesia to the end of operation. At the same time, dexmedetomidine with a dose of 0.5 ug/kg× weight was continuously pumped in 10 minutes before anesthesia. The same acupoints were selected in group C without electrical stimulation, and the other anesthesia methods were the same as those in group E. The peripheral venous blood samples were collected at two different time points, i.e. the beginning and the end of the operation. The levels of interleukin-10(IL-10), interleukin-6(IL-6)and central specific protein(S100-β)were detected. The common detection method was enzyme-linked immunosorbent assay(ELISA). The cognitive function was assessed by MMSE before and 24 hours after operation. Results The results showed that the serum levels of IL-10, IL-6 and S100-β in group C were higher than those in Group E(P<0.05). Compared with group E, the MMSE score of group C was significantly lower than that of group E(t=4.012, P<0.01).Conclusion Compared with dexmedetomidine alone, transcutaneous acupoint electrical stimulation combined with dexmedetomidine has more advantages on postoperative cognitive function, which is more conducive to postoperative rehabilitation.

关 键 词：经皮穴位电刺激 右美托咪定 术后认知功能 髋部手术 老年患者 

分 类 号：R614[医药卫生—麻醉学]