针刺预处理治疗前列腺增生TURP术后早期认知功能障碍临床研究
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摘要
目的:探讨针刺预处理治疗前列腺增生经尿道前列腺气化电切手术(TU RP)术后早期认知功能障碍(POCD)的临床疗效。方法:选取前列腺增生拟行TU RP手术治疗的男性患者90例,随机分为对照组和观察组各4 5例。对照组予术前常规处理,观察组在对照组基础上予针刺预处理百会穴,双侧内关和足三里穴。2组均在术前连续治疗3天。比较2组术后第1天、第3天POCD发病率和术前、术后第1天、第3天血清神经元特异性烯醇化酶(NSE)和S-10 0β蛋白含量。结果:术后第1天POCD发病率对照组为24.4 4%,观察组为13.3 3%,2组比较,差异有统计学意义(P<0.05);术后第3天POCD发病率对照组为11.11%,观察组为2.22%,2组比较,差异有统计学意义(P<0.05)。术后第1天,2组血清NSE和S-100β蛋白含量均较术前升高(P<0.05),对照组血清NSE和S-100β蛋白含量较观察组升高更明显(P<0.05)。术后第3天,对照组血清NSE和S-100β蛋白含量较术前升高(P<0.05),但较术后第1天降低(P<0.05);观察组血清NSE和S-100β蛋白含量与术前比较,差异无统计学意义(P>0.05),与对照组血清NSE和S-100β蛋白含量比较仍降低(P<0.05)。结论:针刺预处理治疗前列腺增生TU RP术后认知障碍,可有效降低患者术后认知障碍的发病率,降低术后血清NSE、S-100β蛋白水平,其机制可能与针刺预处理降低了围手术期麻醉手术等因素对脑组织的损害有关。
Objective: To discuss the clinical effect of acupuncture preconditioning for prostatic hypertrophy with postoperative congnitive dysfunction(POCD) in early stage after an operation of transurethral resection of the prostate(TURP). Methods:Selected 90 cases of male patients with prostatic hypertrophy who were planned to receive TURP operation randomly, and divided them into the control group and the observation group,45 cases in each group. The control group was given preoperative routine treatment,while the observation group was given acupuncture preconditioning at acupoints of Baihui,Neiguan and Zusanli of both sides. Both groups were treated consecutively for 3 days beforeoperation. Compared the incidence of POCD on the 1 st and 3 rd day after operation with the content of neuron-specific enolase(NSE) and S-100β protein in serum before operation and on the 1 st and 3 rd day after operation in the two groups. Results:One day after operation,the incidence of POCD was 24.44% in the control group and 13.33% in the observation group,difference being significant(P < 0.05). Three days after operation,the incidence of POCD was 11.11% in the control group and2.22% in the observation group, difference being significant(P < 0.05). One day after operation, the content of NSE and S-100βprotein in serum in the two groups were increased when compared with that before operation(P < 0.05). The contents of NSE and S-100β protein in serum in the control group were increased more obviously when compared with that in the observation group(P < 0.05). Three days after operation,the contents of NSE and S-100β protein in serum in the control group were higher than those before operation(P < 0.05),but lower than those on the 1 st day after operation(P < 0.05). There were no significant differences being found in the comparison of the contents of NSE and S-100β protein in serum in the observation group with those before operation(P > 0.05). But the contents of NSE and S-100β protein in serum in the observation group were lower when compared with those in the control group(P< 0.05). Conclusion:The application of acupuncture preconditioning for prostatic hypertrophy with POCD after TURP can effectively reduce the incidence of POCD and lower the levels of NSE and S-100β protein in serum after operation. Its mechanism may be relevant to the effect of acupuncture preconditioning in reducing the damage to brain tissues caused by perioperative anesthesia and other factors.
Objective: To discuss the clinical effect of acupuncture preconditioning for prostatic hypertrophy with postoperative congnitive dysfunction(POCD) in early stage after an operation of transurethral resection of the prostate(TURP). Methods:Selected 90 cases of male patients with prostatic hypertrophy who were planned to receive TURP operation randomly, and divided them into the control group and the observation group,45 cases in each group. The control group was given preoperative routine treatment,while the observation group was given acupuncture preconditioning at acupoints of Baihui,Neiguan and Zusanli of both sides. Both groups were treated consecutively for 3 days beforeoperation. Compared the incidence of POCD on the 1 st and 3 rd day after operation with the content of neuron-specific enolase(NSE) and S-100β protein in serum before operation and on the 1 st and 3 rd day after operation in the two groups. Results:One day after operation,the incidence of POCD was 24.44% in the control group and 13.33% in the observation group,difference being significant(P < 0.05). Three days after operation,the incidence of POCD was 11.11% in the control group and2.22% in the observation group, difference being significant(P < 0.05). One day after operation, the content of NSE and S-100βprotein in serum in the two groups were increased when compared with that before operation(P < 0.05). The contents of NSE and S-100β protein in serum in the control group were increased more obviously when compared with that in the observation group(P < 0.05). Three days after operation,the contents of NSE and S-100β protein in serum in the control group were higher than those before operation(P < 0.05),but lower than those on the 1 st day after operation(P < 0.05). There were no significant differences being found in the comparison of the contents of NSE and S-100β protein in serum in the observation group with those before operation(P > 0.05). But the contents of NSE and S-100β protein in serum in the observation group were lower when compared with those in the control group(P< 0.05). Conclusion:The application of acupuncture preconditioning for prostatic hypertrophy with POCD after TURP can effectively reduce the incidence of POCD and lower the levels of NSE and S-100β protein in serum after operation. Its mechanism may be relevant to the effect of acupuncture preconditioning in reducing the damage to brain tissues caused by perioperative anesthesia and other factors.
引文
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[7]董锡臣,岳红红,高寅秋,等.麻醉前电针干预对老年患者术后认知功能障碍的防治作用[J].中国医学前沿杂志:电子版,2016,8(9):82-85.
[8]刘智,滕永杰.针刺复合全麻对老年肿瘤切除术患者术后认知功能及相关炎症因子的影响[J].中国医药导报,2017,14(22):76-79.
[9]彭艺,熊华,董莉萍,等.老年患者血清NSE和S-100β蛋白水平变化与术后认知功能障碍的关系[J].南昌大学学报:医学版,2010,50(9):21-23.
[10]黎娜,艾琪,殷洁,等.针刺对术后认知功能障碍相关机制的研究进展[J].时珍国医国药,2017,28(1):180-182.
[2]孙书博.针刺会阴穴对脑卒中后中重度认知功能障碍的临床研究[D].福州:福建中医药大学,2017:1-5.
[3]那彦群.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2013:167-170.
[4]Folstein MF,Folstein SE,Mchugh PR.“Mini-mental state”.A practical method for grading the cognitive state of patients for the clinician.[J].Journal of Psychiatric Research,1975,12(3):189-198.
[5]袁力勇,戴体俊.认知功能障碍发病机制研究进展[J].现代生物医学进展,2007,7(1):126-130.
[6]胡江,闻大翔,杭燕南.术后认知功能障碍发病机制研究进展[J].国际麻醉学与复苏杂志,2011,32(4):470-473.
[7]董锡臣,岳红红,高寅秋,等.麻醉前电针干预对老年患者术后认知功能障碍的防治作用[J].中国医学前沿杂志:电子版,2016,8(9):82-85.
[8]刘智,滕永杰.针刺复合全麻对老年肿瘤切除术患者术后认知功能及相关炎症因子的影响[J].中国医药导报,2017,14(22):76-79.
[9]彭艺,熊华,董莉萍,等.老年患者血清NSE和S-100β蛋白水平变化与术后认知功能障碍的关系[J].南昌大学学报:医学版,2010,50(9):21-23.
[10]黎娜,艾琪,殷洁,等.针刺对术后认知功能障碍相关机制的研究进展[J].时珍国医国药,2017,28(1):180-182.