目的

观察经皮穴位电刺激对高龄患者行髋关节置换术后认知功能及早期炎症因子的影响。

方法

选择2013年1月至2014年12月在苏北人民医院择期行全髋关节置换术的75岁以上老年患者53例，按照随机数字表法分为单纯全麻组（A 组，26例）和复合针麻组（B 组，27例）。B组于麻醉诱导前30 min至术毕持续应用G6805-2型电针仪行经皮穴位电刺激，取百会穴、内关穴、风池穴，电刺激参数：疏密波，波型2/100 Hz，峰电流8～12 mA，刺激强度以患者耐受最大电流为度，然后行气管内全身麻醉，针刺持续刺激至手术结束。A组选穴同B组，单纯贴电极片，不行电刺激，然后行气管内全身麻醉。两组患者均采用控制性降压以减少术中出血。对所有患者运用简易智能量表（MMSE）评定术前24 h、术后72 h的认知功能变化，若降低一个标准或以上者即为认知功能下降，诊断为术后认知功能障碍（POCD）。酶联免疫吸附法检测患者术前、术毕、术后24 h、术后72 h的肿瘤坏死因子α（TNF-α）、白细胞介素1β(IL-1β)、白细胞介素6（IL-6）水平。应用SPSS18.0统计软件对结果进行分析, 计量资料呈正态分布，以均数±标准差（）表示，组间比较采用独立样本t 检验，自身治疗后比较采用配对t检验，组间不同时间点的比较采用重复测量方差分析，计数资料采用χ²检验，以P<0.05为差异有统计学意义。

结果

A组POCD发生率为38.5%（10/26），高于B组的29.9%（7/27），有统计学意义（t=2.641，P<0.05）；两组患者血清IL-1β在术毕、术后24 h、术后72 h水平均高于术前，差异有统计学意义（t=7.968、10.038、12.652，均P<0.05）；两组患者血清IL-6在术毕、术后24 h、术后72 h水平均高于术前，差异有统计学意义（t=3.157、10.419、7.041，均P<0.05）；两组血清TNF-α术后24 h、术后72 h水平均高于术前，差异有统计学意义（t=4.294、5.354，均P<0.05）。B组与A组比较，血清TNF-α术后同时间点术后24 h、术后72 h水平均低于A组，差异有统计学意义（t=4.362、5.020，均P<0.05）；血清IL-1β术后同时间点术后24 h、术后72 h水平均低于A组，差异有统计学意义（t=5.756、8.268，均P<0.05）。

结论

经皮穴位电刺激可降低高龄患者髋关节置换术POCD发生，这可能与抑制术后早期炎性因子的释放有关。

Objective

To observe the influence of transcutanclus electrical acupoint stimulation(TEAS) on postoperative cognitive dysfunction (POCD) and inflammation cytokines in elderly patients undergoing hip-replacement surgery.

Methods

A total of 53 elderly patients (over 75 years), undergoing elective total hip replacement surgery, were selected from January 2013 to December 2014 in Jiangsu Northern People's Hospital. Patients were divided into general anesthesia group (group A, n=26) and composite acupuncture anesthesia group (group B, n=27) according to the random number table. In group B，TEAS (2 /100 Hz, 8～12 mA) was used 30 min before the endotracheal general anesthesia until completing operation, at Baihui (GV 20), Neiguan (PC 6), and Fengchi(GB 20), with G6805-2 electric acupuncture apparatus. Patients were treated with controlled hypotension for reducing blood loss in two groups during operation. In group A, the endotracheal general anesthesia was applied without TEAS. Mini-mental state examination (MMSE) was adopted to evaluate and record the changes in cognitive function 24 h before operation and 72 h after operation. Enzyme-linked immunosorbent method was used to measure tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6 before surgery，after surgery, 24 h and 72 h after surgery. SPSS18.0 statistical software was used to analyze data. The comparison between groups was analyzed using independent sample t test. The paired t test was used to compare results of treatment after itself. Data between groups at different time points were compared using repeated measures analysis of variance, and count data using χ² test. P<0.05 was considered statistically significant.

Results

The incidence rate of POCD was 38.5% (10/26) in A group, which was significantly higher than that of B group(29.9%, 7/27, t=2.641，P<0.05). There were significantly higher serum levels of IL-1β after operation,24h and 72h after operation than those before operation in two groups (t=7.968,10.038 and 12.652, P<0.05).The serum levels of IL-6 were significantly higher after surgery, 24h and 72h after surgery than those before operation in two groups (t=3.157,10.419 and 7.041，P<0.05). The serum levels of TNF-α were significantly higher 24 h and 72 h after surgery than those before operation in two groups (t=4.294 and 5.354, P<0.05). Compared with group A, the serum levels of TNF-α were significantly lower at 24 h and 72 h after operation in group B (t=4.362 and 5.020，P<0.05). The serum levels of IL-1β were significantly lower at 24 h and 72 h after operation in group B compared with those of group A (t=5.756 and 8.268,P<0.05).

Conclusion

TEAS can reduce the incidence rate of POCD in elderly patients undergoing hip-replacement surgery, which may be related to the inhibition of early postoperative inflammatory cytokine release.