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| 经皮穴位电刺激对不停跳冠状动脉搭桥术患者术后神经认知功能的影响 |
| Effect of transcutaneous electrical acupoint stimulationon on postoperative neurocognitive disorders in patients undergoing off-pump coronary artery bypass grafting |
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| DOI：10.12089/jca.2020.09.006 |
| 中文关键词: 经皮穴位电刺激 冠状动脉搭桥手术 术后神经认知障碍 炎症反应 |
| 英文关键词: Transcutaneous electrical acupoint stimulation Coronary artery bypass grafting Postoperative neurocognitive disorders Inflammatory responses |
| 基金项目:北京市医管局“青苗计划”（QML20190307）；北京市自然科学基金青年基金（7194270） |
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| 摘要点击次数: 2015 |
| 全文下载次数: 581 |
| 中文摘要: |
目的 探讨术中经皮穴位电刺激（TEAS）对不停跳冠状动脉搭桥术患者术后神经认知功能（PND）的影响。
方法 不停跳心脏冠状动脉搭桥术患者82例，男59例，女23例，年龄55~85岁，BMI 18~29 kg/m2，ASA Ⅱ或Ⅲ级，随机分为两组：对照组（n=42）和TEAS组（n=40）。所有患者均行全凭静脉麻醉。术前在患者的内关穴、合谷穴、大椎穴贴上特定电极片，连接韩式穴位神经刺激仪。对照组电流设置为0 mA，TEAS组电流设置为患者可以忍受但不致疼痛的最大水平，电刺激持续时间为手术开始至术毕。于术前1 d（T0）和术后7 d（T4）时行神经心理学测试，包括一套组合的测试量表，根据Z-计分法评估患者是否发生PND。于T0、术后5 min（T1）、术后1 d（T2）、术后3 d（T3）时抽取静脉血5 ml，测定血清肿瘤坏死因子（TNF-α）、白细胞介素1（IL-1）、白细胞介素6（IL-6）、S100β、丙二醛（MDA）和总抗氧化能力（T-AOC）浓度。记录电刺激相关不良反应的发生情况。
结果 T0时两组神经心理学测试差异无统计学意义，T4时TEAS组MMSE和HVLT明显高于对照组（P<0.05）。TEAS组PND发生率明显低于对照组[8例（20.0%）vs 17例（40.5%），P<0.05]。T0时两组血清TNF-α、IL-1、IL-6, S100β、MDA和T-AOC浓度差异无统计学意义，T1时TEAS组TNF-α，IL-1和MDA浓度明显低于对照组(P<0.05)，T1—T3时TEAS组IL-6和S100β浓度明显低于对照组 (P<0.05)。两组不同时点T-AOC浓度差异无统计学意义。两组均无一例电刺激相关不良反应。
结论 冠状动脉搭桥术患者术中应用经皮穴位电刺激可减少全身炎症反应，降低术后神经认知障碍发生率。 |
| 英文摘要: |
Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS) on postoperative neurocognitive disorders(PND) in patients undergoing off-pump coronary artery bypass grafting (CABG).
Methods Eighty-two elderly patients with off-pump CABG, 59 males and 23 females, aged 55-85 years, BMI 18-29 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into control group (n = 42) and TEAS group (n = 40). All patients underwent total intravenous anesthesia. Specific electrode pads were attached to Neiguan, Hegu and Dazhui acupoint of two groups before the surgery, then connected to a Korean acupoint nerve stimulator. The current in the control group was set to 0 mA, and in the TEAS group was set to the maximum level that the patient could tolerate without pain. The duration of electrical stimulation was the whole period of surgery. The neuropsychological test were performed at 1 d before surgery (T0) and 7 d after surgery (T4), including a set of combined test scales, according to the Z-score method to assess whether the patient developed PND, and calculate the occurrence rates of PND in the two groups. The serum concentration TNF-α, IL-1, IL-6, S100β, MDA, and T-AOC levels were measured at the baseline (T0), 5 min after surgery (T1), 1 d after surgery (T2) and 3 d after surgery (T3). The occurrence of adverse reactions related to electrical stimulation was recorded.
Results There were no significant difference in neuropsychological testing between the two groups at T0. The MMSE and HVLT in the control group were significantly lower than those in the TEAS group at T4(P < 0.05). The incidence of PND in the TEAS group was significantly lower than that in the control group [8 cases (20.0%) vs 17 cases (40.5%), P < 0.05]. There were no significant difference in serum concentrations of TNF-α, IL-1, IL-6, S100β, MDA and T-AOC between the two groups at T0. The concentrations of TNF-α, IL-1 and MDA in the TEAS group were significantly lower than those in the control group at T1(P < 0.05). The concentrations of IL-6 and S100β in TEAS group were significantly lower than those in control group at T1- T3(P < 0.05). There was no significant difference in T-AOC concentration between the two groups at different time points. There was no case of adverse effects related to electrical stimulation in either group.
Conclusion This study has proved that intraoperative use of transcutaneous electrical acupoint stimulation, can reduce postoperative inflammatory response and neurocognitive disorders in patients receiving CABG. |
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