头穴电针联合醒脑静对髋部骨折老年患者术后早期认知功能障碍的影响  

Effect of scalp electroacupuncture combined with Xingnaojing on early postoperative cognitive dysfunction in elderly patients with hip fracture

作　　者：徐知菲[1] 姚娟[1] 梁栋梁 刘颖 唐在荣 XU Zhifei;YAO Juan;LIANG Dongliang;LIU Ying;TANG Zairong(Department of Anesthesiology,Gaoyou Hospital of TCM,Jiangsu,Gaoyou 225600,China)

机构地区：[1]江苏省高邮市中医医院麻醉科,江苏高邮225600

出　　处：《中国医药科学》2024年第23期116-119,150,共5页China Medicine And Pharmacy

基　　金：江苏省高邮市卫生健康委员会医学科研立项项目(GY20221214)。

摘　　要：目的探讨头穴电针联合醒脑静干预对髋部骨折老年患者术后认知功能障碍(POCD)的影响。方法选择高邮市中医医院2022年6月至2023年12月美国麻醉医师协会(ASA)分级为Ⅰ~Ⅲ级,年龄70~86岁,80例择期拟行髋关节置换术(全髋或半髋)的老年患者,以随机数表法分为研究组和对照组,每组各40例,患者以0.5%重比重罗哌卡因2.5 ml行单次腰麻完成手术,研究组于单次腰麻操作完成后,即选取百会、神庭、内关、神门等头穴行电针刺激,并联合醒脑静注射液20 ml+生理盐水100 ml静脉滴注。术后两组患者以舒芬太尼2μg/kg+100 ml生理盐水,以2 ml/h背景量行患者术后静脉镇痛(PCIA)。术后第1、3、5天以简易精神状态量表(MMSE)及谵妄评定法(CAM)分别评定比较两组患者术后认知状态及术后谵妄(POD)发生率;并于术后第1天与第3天比较并记录两组外周静脉血中细胞因子如神经特异性烯醇化酶(NSE)、中枢特异性蛋白(S100-β)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)指标。结果术后第1、3、5天,研究组MMSE评分均高于对照组(P<0.05)。术后各时间点,对照组患者POD发生率均高于研究组,差异有统计学意义(P<0.05);术后第1、3天,研究组患者血清中细胞炎症因子水平低于对照组,差异有统计学意义(P<0.05)。结论围手术期头穴电针联合醒脑静注射液干预,可改善髋部手术老年患者术后早期的认知能力,降低术后谵妄的发生率;其机制或为抑制炎性细胞因子,减少脑组织损伤,改善与保护脑神经功能。Objective To explore the effect of scalp electroacupuncture combined with Xingnaojing intervention on postoperative cognitive dysfunction(POCD)in elderly patients with hip fracture.Methods From June 2022 to December 2023,80 elderly patients with American Society of Anesthesiologists(ASA)classification ofⅠ-Ⅲ,aged 70-86 years,who were scheduled to undergo hip replacement surgery(total hip or hemihip)at Gaoyou Hospital of TCM were selected.They were randomly divided into a study group and a control group,with 40 patients in each group.The patients underwent a single lumbar anesthesia with 2.5 ml of 0.5%specific weight ropivacaine.After the completion of the single lumbar anesthesia operation,the study group selected Baihui,Shenting,Neiguan,Shenmen and other acupoints for electroacupuncture stimulation,and combined with 20 ml of Xingnaojing Injection and 100 ml of physiological saline intravenous drip.Two groups of patient controlled intravenous analgesia(PCIA)with sufentanil 2μg/kg+100 ml normal saline and a background dose of 2 ml/h.On postoperative days 1,3,and 5,the mini mental state examination(MMSE)and confusion assessment method(CAM)were used to evaluate and compare the postoperative cognitive status and incidence of postoperative delirium(POD)between the two groups of patients;The indexes of cytokines such as neuron-specific enolase(NSE),central specific protein(S100-β),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)in the peripheral venous blood of two groups on postoperative day 1 and day 3 were compared and recorded.Results On postoperative days 1,3,and 5,the MMSE scores of the study group were higher than those of the control group(P<0.05).At various postoperative time points,the incidence of POD in the control group was higher than that in the study group,and the difference between the two was statistically significant(P<0.05).On postoperative days 1-3,the levels of cytokines in the serum of patients in the study group were lower than those in the control group,and the difference was stati

关 键 词：头穴电针 醒脑静 腰麻 髋关节置换术 术后认知功能障碍 

分 类 号：R246.6[医药卫生—针灸推拿学]