CAJ | 학술논문

目的研究电针干预对老年患者全麻术后认知功能障碍(POCD)的影响.方法将患有腰椎管狭窄症,行腰椎管切开减压、复位内固定手术的患者60例按随机数字表法分为电针组和对照组,每组30例.对照组仅接受常规静脉复合全麻术,电针组在全麻前30 min行电针干预,每干预30 min间歇10 min,然后在患者手术体位调整完成后再次行电针干预30 min,间歇10 min,循环至手术结束.记录2组患者手术中丙泊酚与瑞芬太尼的用量,分别于手术前24 h和手术后72 h使用简易智能状态检查量表(MMSE)评价2组患者的认知功能,并于术前30 min、术毕拔除气管导管后10 min(手术后10 min)、手术后24 h和手术后72h4个时间点测定2组患者血清白细胞介素(IL)-6、IL-10及S100β蛋白的水平.结果电针组患者手术中瑞芬太尼与丙泊酚的每小时用量分别为(6.54±3.27) μg/kg体重和(3.67±2.53) mg/kg体重,显著低于对照组的(9.70±4.82) μg/kg体重和(5.62±1.73) mg/kg体重(P＜0.05).手术后72 h,电针组患者的POCD发生率为1例(3.3％),对照组发生率为8例(26.7％),组间差异有统计学意义(P＜0.05);且电针组MMSE评分为(25.7±1.9)分,与对照组手术后72 h的(23.2 ±2.1)分比较,差异有统计学意义(P＜0.05).电针组术后各时间点的血清IL-6、IL-10和S100β蛋白水平均显著低于对照组同时间点(P＜0.05).结论电针干预有利于改善老年患者手术后的认知功能,抑制其血清IL-6、IL-10、S100β蛋白的过度表达,减轻患者脑损伤的程度,有效降低患者POCD的发生率.
목적 연구전침간예대노년환자전마술후인지공능장애(POCD)적영향.방법 장환유요추관협착증,행요추관절개감압、복위내고정수술적환자60례안수궤수자표법분위전침조화대조조,매조30례.대조조부접수상규정맥복합전마술,전침조재전마전30 min행전침간예,매간예30 min간헐10 min,연후재환자수술체위조정완성후재차행전침간예30 min,간헐10 min,순배지수술결속.기록2조환자수술중병박분여서분태니적용량,분별우수술전24 h화수술후72 h사용간역지능상태검사량표(MMSE)평개2조환자적인지공능,병우술전30 min、술필발제기관도관후10 min(수술후10 min)、수술후24 h화수술후72h4개시간점측정2조환자혈청백세포개소(IL)-6、IL-10급S100β단백적수평.결과 전침조환자수술중서분태니여병박분적매소시용량분별위(6.54±3.27) μg/kg체중화(3.67±2.53) mg/kg체중,현저저우대조조적(9.70±4.82) μg/kg체중화(5.62±1.73) mg/kg체중(P＜0.05).수술후72 h,전침조환자적POCD발생솔위1례(3.3％),대조조발생솔위8례(26.7％),조간차이유통계학의의(P＜0.05);차전침조MMSE평분위(25.7±1.9)분,여대조조수술후72 h적(23.2 ±2.1)분비교,차이유통계학의의(P＜0.05).전침조술후각시간점적혈청IL-6、IL-10화S100β단백수평균현저저우대조조동시간점(P＜0.05).결론 전침간예유리우개선노년환자수술후적인지공능,억제기혈청IL-6、IL-10、S100β단백적과도표체,감경환자뇌손상적정도,유효강저환자POCD적발생솔.
Objective To study the effects of electroacupuncture (EA) on the elderly's postoperation cognitive dysfunction (POCD) after general anesthesia.Methods Patients who need to have surgical operation done for lumbar spinal stenosis were randomly divided into an observation group (electroacupuncture and routine intravenous anesthesia) and a control group (only routine intravenous anesthesia),and EA was administered to those in the electroacupuncture group for 30 minutes at an interval of 10 minutes,beginning at 30 minutes prior to routine intravenous anesthesia and lasted till the end of the surgery.The differences regarding intraoperative propofol and remifentanil dosage,cognitive function,the levels of serum interleukin-6(IL-6),interleukin-10 (IL-10) and S100-β were compared.Results The intraoperative propofol and remifentanil dosages in observation group were (6.54 ± 3.27) μg/(kg· h) and (3.67 ± 2.53) mg/(kg· h),respectively,while those in control group were (9.70 ± 4.82) μg/kg and (5.62 ± 1.73) mg/kg.The intraoperative propofol and remifentanil dosages in observation group were significantly lower than those in control group (P ＜ 0.05).At 72 hours post-operation the incidence of POCD in observation group was significantly lower than that in control group (1 case,2.5％ versus 8 cases,20％),while the MMSE score was higher in observation group than that in control group (25.7 ± 1.9 versus 23.2 ± 2.1).The post-operation level of serum IL-6,IL-10 and S100-β in observation group were significantly lower than that in control group (P ＜ 0.05).Conclusion Electroacupuncture could significantly improve the elderly's postoperation cognitive dysfunction after general anesthesia.It could inhibit the excessive expressions of IL-6,IL-10 and S100-β,alleviate the brain damage and reduce the incidence of POCD.