电针刺激对老年患者全麻术后认知障碍的作用研究
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摘要
目的探讨电针刺激对老年患者全麻术后认知功能的临床疗效,旨在进一步改善临床治疗方案。方法选取广东省人民医院自2013年9月—2014年8月收治老年全麻手术患者580例,年龄均为65岁以上,ASA分级Ⅱ~Ⅲ级,从中选取100例患者作为本次研究样本。采用前瞻性随机对照临床研究方法,随机分为A、B两组,全部患者均采取连续腰麻复合全身麻醉方式,其中A组于手术结束后连续3 d行电针刺激,B组空白对照。对比2组患者脑脊液血浆乙酰胆碱含量、术后MMSE评分以及最终POCD发病率。结果全麻手术后各组均有患者出现POCD症状,组间对比无显著差异(P>0.05);在认知功能上,2组患者术前MMSE评分无显著差异,在术后A组患者MMSE评分均高于B组(P<0.05);A组患者哮鸣音发生率较B组更低,存在显著差异(P<0.05);术后A组患者脑脊液乙酰胆碱明显高于B组(P<0.05),A组脑脊液胆碱酯酶活力低于B组(P<0.05);最终A组患者POCD发病率明显低于B组患者(P<0.01)。结论针对老年全麻手术患者采取电针刺激,可以有效控制患者术后认知功能障碍的发生,降低哮鸣音发生率,抑制患者脑内胆碱酯酶活性的同时增加脑内乙酰胆碱含量,恢复胆碱能神经功能,达到控制POCD发病率的目的。
Objective: To study the clinical efficacy of electro-acupuncture stimulation on postoperative cognitive disorder( POCD) of elderly patients after general anesthesia so as to further improve the clinical treatment plans. Methods: A total of 580 elderly patients undergoing general anesthesia were selected from September 2013 to August 2014 in Guangdong People's Hospital. The patients were all over the age of 65 and had ASA scores of II-III. 100 patients were randomly selected as samples for this study. A prospective randomized controlled clinical study was performed and the patients were randomly divided into A and B groups,as all of patients were received continuous spinal anesthesia plus general anesthesia. The group A received electro-acupuncture stimulation for 3 consecutive days,and the group B received nothing as blank control. The contents of plasma acetylcholine in the cerebrospinal fluid( CSF),the postoperative MMSE score,and the final POCD incidence were compared between the two groups. Results: The patients in each group had POCD symptoms after general anesthesia without any significant difference( P > 0. 05). In terms of cognitive function,there was no significant difference in preoperative MMSE scores between the two groups( P > 0. 05),while postoperative MMSE scores were higher than those in the group B( P < 0. 05). The incidence of wheezing in the group A was lower than that in the group B( P < 0. 05). The postoperative acetylcholine level in CSF was higher than that in the group B( P < 0. 05) and the cholinesterase activity of CSF in the group A was lower than that in the group B( P < 0. 05). Eventually,the group A showed a higher incidence of POCD than the group B( P < 0. 01). Conclusion: Electro-acupuncture stimulation for elderly patients undergoing general anesthesia can effectively control the occurrence of postoperative cognitive disorder,reduce the incidence of wheezing,inhibit the activity of cholinesterase in the brain,and increase the contents of acetylcholine in the brain,thus to recover cholinergic nerve function and achieve the goal of controlling the incidence of POCD.
Objective: To study the clinical efficacy of electro-acupuncture stimulation on postoperative cognitive disorder( POCD) of elderly patients after general anesthesia so as to further improve the clinical treatment plans. Methods: A total of 580 elderly patients undergoing general anesthesia were selected from September 2013 to August 2014 in Guangdong People's Hospital. The patients were all over the age of 65 and had ASA scores of II-III. 100 patients were randomly selected as samples for this study. A prospective randomized controlled clinical study was performed and the patients were randomly divided into A and B groups,as all of patients were received continuous spinal anesthesia plus general anesthesia. The group A received electro-acupuncture stimulation for 3 consecutive days,and the group B received nothing as blank control. The contents of plasma acetylcholine in the cerebrospinal fluid( CSF),the postoperative MMSE score,and the final POCD incidence were compared between the two groups. Results: The patients in each group had POCD symptoms after general anesthesia without any significant difference( P > 0. 05). In terms of cognitive function,there was no significant difference in preoperative MMSE scores between the two groups( P > 0. 05),while postoperative MMSE scores were higher than those in the group B( P < 0. 05). The incidence of wheezing in the group A was lower than that in the group B( P < 0. 05). The postoperative acetylcholine level in CSF was higher than that in the group B( P < 0. 05) and the cholinesterase activity of CSF in the group A was lower than that in the group B( P < 0. 05). Eventually,the group A showed a higher incidence of POCD than the group B( P < 0. 01). Conclusion: Electro-acupuncture stimulation for elderly patients undergoing general anesthesia can effectively control the occurrence of postoperative cognitive disorder,reduce the incidence of wheezing,inhibit the activity of cholinesterase in the brain,and increase the contents of acetylcholine in the brain,thus to recover cholinergic nerve function and achieve the goal of controlling the incidence of POCD.
引文
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[3]金君梅,张信岳.督脉配穴针刺对虚瘀互结型血管性痴呆大鼠学习记忆的影响及脑组织NO、NOS的调节作用[J].中国中医药科技,2013,20(2):108-109.
[4]张丽娟.石杉碱甲片对脑梗死后血管性认知功能障碍患者的临床研究[J].中西医结合心脑血管病杂志,2013,11(1):43-44.
[5]史清海,韩茹,伏建峰,等.石杉碱甲对急性低压低氧模型大鼠海马神经元凋亡的影响[J].解放军医学杂志,2013,38(2):103-106.
[2]舒细记,柳威,周红艳,等.GCSF对亚急性脑缺血老龄鼠认知障碍及海马损伤的修复作用[J].广东医学,2010,31(18):2343-2345.
[3]金君梅,张信岳.督脉配穴针刺对虚瘀互结型血管性痴呆大鼠学习记忆的影响及脑组织NO、NOS的调节作用[J].中国中医药科技,2013,20(2):108-109.
[4]张丽娟.石杉碱甲片对脑梗死后血管性认知功能障碍患者的临床研究[J].中西医结合心脑血管病杂志,2013,11(1):43-44.
[5]史清海,韩茹,伏建峰,等.石杉碱甲对急性低压低氧模型大鼠海马神经元凋亡的影响[J].解放军医学杂志,2013,38(2):103-106.