Study on the effect of percutaneous acupoint electrical stimulation during perioperative period to prevent cognitive impairment after total knee arthroplasty in the elderly
Study on the effect of percutaneous acupoint electrical stimulation during perioperative period to prevent cognitive impairment after total knee arthroplasty in the elderly
金晓伟 1周森 1周奇韬 1蒋毅1
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 温州市中西医结合医院麻醉手术科,浙江温州 325000
折叠
摘要
目的 探索围手术期经皮穴位电刺激对老年全膝关节置换术(TKA)患者术后认知功能障碍(POCD)的预防作用.方法 纳入2020年1月-2023年6月158例于温州市中西医结合医院择期行单侧TKA的膝关节骨性关节炎老年患者,采用随机数表法将患者分为对照组(79例)和观察组(79例),对照组行全麻条件下TKA,观察组增加经皮穴位电刺激干预.记录手术及麻醉恢复指标,监测血流动力学变化,分析血清细胞因子及脑神经生化指标,随访术后5 d POCD的发生情况.结果 2组患者术中出血量、术中总输液量、手术持续时间、麻醉苏醒时间和拔除气管导管时间比较差异均无统计学意义(P＞0.05).2组切皮时和自体膝关节摘除后即刻心率、平均动脉压均低于麻醉诱导前30 min(P＜0.001).观察组术后5 d血清肿瘤坏死因子-α、白细胞介素6和白细胞介素1β均低于对照组(P＜0.001).观察组术后5 d血清S-100β蛋白和神经元特异性烯醇化酶均低于对照组,而脑源性神经营养因子高于对照组(P＜0.001).观察组术后5 d POCD发生率(11.39％,9/79)低于对照组(25.32％,20/79),差异有统计学意义(P＜0.05).结论 围手术期经皮穴位电刺激可抑制老年TKA患者神经细胞免疫反应,缓解神经细胞损伤,调节神经代谢功能,预防POCD的发生.
Abstract
Objective The purpose of this study is to explore the preventive effect of perioperative percutaneous acupoint electrical stimulation on postoperative cognitive dysfunction(POCD)in elderly patients undergoing total knee arthroplasty(TKA).Methods A total of 158 elderly patients with knee joint osteoarthritis who underwent elective unilateral TKA at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2020 to June 2023 were randomly assigned to a control group(79 cases)and an observation group(79 cases)by random number table method.The con-trol group received TKA under general anesthesia,and the observation group received additional perioperative percutane-ous acupoint electrical stimulation intervention.The surgical and anesthesia recovery indicators were recorded,periopera-tive hemodynamic changes were monitored,serum cytokines and brain neurobiochemical indicators were analyzed,and POCD occurrence was followed up 5 days after surgery.Results There was no statistically significant difference in intra-operative bleeding volume,total intraoperative infusion volume,surgical duration,anesthesia recovery time,and tracheal intubation time between the two groups(P＞O.05).The HR and MAP values of the two groups during skin resection and immediately after autologous knee joint removal were lower than those of 30 minutes before anesthesia induction(P＜0.001).The content of serum TNF-α,IL-6 and IL-1β in the observation group were lower than those in the control group 5 days after surgery(P＜0.001).The content of serum S-100β and NSE in the observation group were lower than those in the control group 5 days after surgery,while BDNF content was higher than that in the control group(P＜0.001).The incidence of POCD 5 days after surgery in the observation group(11.39％,9/79)was lower than that in the control group(25.32％,20/79),and the difference was statistically significant(P＜0.05).Conclusion Perioper-ative percutaneous acupoint electrical stimulation can inhibit neuroinflammatory response,alleviate brain tissue damage,regulate brain nerve metabolism function,and can prevent the occurrence of POCD.
维普
万方数据