揿针治疗对老年髋部骨折术后认知功能障碍的影响  

Effect of Subcutaneous Thumb-tack Needle Embedding on Senile Cognitive Disorder After Hip Fracture Surgery

作　　者：李荣华 蒋蕴智 蒋兴燕 蔡靓羽[1] LI Ronghua;JIANG Yunzhi;JIANG Xingyan;CAI Liangyu(Jiangsu Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214000,China)

机构地区：[1]江苏省无锡市中医医院,无锡214000

出　　处：《上海针灸杂志》2022年第4期366-371,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：国家自然科学基金(81973878);江苏省自然科学基金(BK20180167);江苏中医药领军人才项目(SLJ0218)。

摘　　要：目的观察术前揿针治疗对老年髋部骨折患者术后认知功能障碍(POCD)的影响。方法选取将行髋部骨折手术(包括股骨头置换术、全髋关节置换术等)的老年患者80例,按随机数字表法分为试验组(40例)和对照组(40例)。试验组在术前行揿针治疗,对照组在术前行假揿针治疗。比较患者术前2 d(T0)、术后1 d(T1)、术后3 d(T2)以及术后5 d(T3)不同时间点的疼痛数字评价量表(NRS)和简易精神状态评价量表(MMSE)的评分,记录并统计术后补救镇痛的情况以及POCD的发生率。比较患者不同时间点的血清检测指标[神经元特异性烯醇化酶(NSE)、肿瘤坏死因子(TNF-α)、中枢神经特异性蛋白(S100β)和Tau蛋白水平的变化。结果术后T1、T2、T3时间点,两组NRS评分均低于同组术前T0时间点(P<0.05);试验组术后T1、T2时间点NRS评分明显低于对照组(P<0.05)。试验组术后T2、T3时间点补救镇痛事件次数明显少于对照组(P<0.05)。术后T1时间点,两组MMSE评分均为最低;试验组术后T1、T2、T3时间点MMSE评分均高于对照组(P<0.05)。试验组术后T2、T3时间点POCD发生率明显低于对照组(P<0.05)。试验组术后T2、T3时间点血清NSE、TNF-α、Tau蛋白水平均低于对照组(P<0.05)。试验组术后T1、T3时间点血清S100β蛋白水平低于对照组(P<0.05)。结论术前揿针治疗可缓解老年髋部骨折术后疼痛,降低疼痛相关认知功能障碍的发生率,下调神经损伤相关标记物的水平。Objective To observe the effect of preoperative subcutaneous thumb-tack needle embedding on postoperative cognitive dysfunction(POCD)in elderly patients with hip fracture.Method Eighty patients who would undergo hip fracture surgery(including femoral head replacement and total hip replacement)were enrolled and allocated,using a random number table,to an experimental group(40 cases)and a control group(40 cases).The experimental group received preoperative subcutaneous thumb-tack needle embedding and the control group received preoperative sham one.The numeric rating scale(NRS)for pain scores and the mini-mental state examination(MMSE)scores were compared between the two groups of patients two days(T0)before surgery and one day(T1),three days(T2)and five days(T3)after surgery and between different time points in the two groups of patients.Postoperative remedial analgesia and POCD incidence were recorded and statistically analyzed.Serum indicators[neuron-specific enolase(NSE),tumor necrosis factor(TNF-α),central nervous specific protein(S100β)and Tau protein]were compared between the two groups of patients at different time points and between different time points in the two groups of patients.Result The NRS score was lower in the two groups at T1,T2 and T3 than at T0(P<0.05)and significantly lower in the experimental group than in the control group at T1 and T2(P<0.05).The number of remedial analgesic events was significantly smaller in the experimental group than in the control group at T2 and T3(P<0.05).The MMSE score was lowest in the two groups at T1 and higher in the experimental group than in the control group at T1,T2 and T3(P<0.05).The incidence of POCD was significantly lower in the experimental group than in the control group at T2 and T3(P<0.05).Serum NSE,TNF-αand Tau protein levels were lower in the experimental group than in the control group at T2 and T3(P<0.05).Serum S100βprotein levels were lower in the experimental group than in the control group at T1 and T3(P<0.05).Conclusion Preoperative sub

关 键 词：皮内针疗法 揿针 骨折 疼痛 术后认知功能障碍 

分 类 号：R246.6[医药卫生—针灸推拿学]