新疆医科大学学报

目的观察经皮穴位电刺激在控制性降压期间对老年患者脑保护作用的临床效果。方法收集新疆医科大学附属中医医院2017年1月-2018年6月行髋关节置换术的患者60例。采用随机数字表法将60例患者随机分为单纯全麻组(C组)30例和全麻复合穴位电刺激组(T组)30例。T组患者从麻醉诱导前在双侧鱼腰、风池穴给予电刺激并持续至手术结束。C组选取相同的穴位但不进行电刺激,其余麻醉方法均同T组。分别于手术开始、降压30 min、手术结束3个时间点采集颈静脉血液标本,用酶联免疫吸附试验检测白细胞介素6(IL-6)、白细胞介素10(IL-10)、神经元特异性烯醇化酶(NSE)和中枢特异性蛋白(S100β)水平。并于术前、术后24 h、术后48 h采用精神状态简易量表(MMSE)评估患者的认知功能。结果降压30 min和手术结束时点,T组血清中IL-6、IL-10和S100β水平均低于C组,差异有统计学意义(P均<0.05);NSE水平在降压30 min时点低于C组,差异有统计学意义(t=7.035,P<0.05)。与T组比较,C组术后24 h MMSE评分降低,差异有统计学意义(t=4.753,P<0.01)。结论在双侧鱼腰、风池穴给予电刺激能够有效改善控制性降压带来的术后认知功能障碍,减轻炎症反应和脑细胞损伤可能是其机制之一。

Objective To observe the clinical effect of transcutaneous electrical acupuncture stimulation(TEAS) on cerebral protection in elderly patients during controlled hypotension. Methods Sixty patients with hip replacement from January 2017 to June 2018 in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University were collected. Sixty patients were randomly divided into simple general anesthesia group(group C) and combined acupoint electrical stimulation group(group T). Patients in group T received electrical stimulation at both sides of fish waist and Fengchi points before induction of anesthesia and lasted until the end of operation. Patients in group C were received the same acupoints without electrical stimulation, and the anesthesia methods were the same as group T. Jugular venous blood samples were collected at the beginning, 30 minutes after hypotension and the end of operation. The levels of interleukin-6(IL-6), interleukin-10(IL-10), neuron-specific enolase(NSE) and central specific protein(S100 beta) were detected by enzyme-linked immunosorbent assay(ELISA). Simple Mental State Scale(MMSE) was used to assess the cognitive function of patients before, 24 hours after and 48 hours after operation. Results The serum levels of IL-6, IL-10 and S100 beta in group T were lower than those in group C at 30 minutes of hypotension and at the end of operation(all P<0.05), and the levels of NSE in group T were lower than those in group C at 30 minutes of hypotension(t=7.035, P<0.05). Compared with group T, the MMSE score of group C was decreased at 24 hours after operation, with significant difference(t=4.753, P<0.01). Conclusion The electrical stimulation of bilateral Yuyao and Fengchi acupoints can effectively improve the postoperative cognitive dysfunction(POCD) caused by controlled hypotension, alleviating the inflammatory response and brain cell damage may be one of its mechanism.