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| 经皮穴位电刺激对改良电休克患者认知功能的影响 |
| Effects of transcutaneous electrical acupoint stimulation on cognitive function in patients with modified electroconvulsive therapy |
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| DOI：10.12089/jca.2021.02.011 |
| 中文关键词: 抑郁症 改良电休克 经皮穴位电刺激 认知功能 |
| 英文关键词: Depression Modified electroconvulsive therapy Transcutaneous electrical acupoint stimulation Cognitive function |
| 基金项目: |
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| 中文摘要: |
目的 评价经皮穴位电刺激（TEAS）对改良电休克（MECT）患者认知功能的影响。
方法 选择行MECT治疗的抑郁症患者40例，男23例，女17例，年龄18～60岁，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组：TEAS组（X组）和对照组（C组），每组20例。X组入室后先行TEAS 30 min，取百会、印堂、内关（双侧）和太冲（双侧），电针参数：疏密波2/100 Hz，峰电流5～12 mA。TEAS结束后行MECT。C组在相同穴位上粘贴电极片并连接治疗仪，但不进行电刺激，行MECT。于第1次MECT前24 h、第1次MECT后6 h、第6次MECT后6 h、第6次MECT后7 d、第6次MECT后30 d采用汉密尔顿抑郁量表（HAMD评分）、简易智力状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA评分）进行抑郁症状和认知功能的评定。分别在第1次MECT前、第1次MECT术毕、第1次MECT后24 h、第6次MECT术毕、第6次MECT后24 h抽取静脉血，采用荧光免疫法(FIA法)测定S100β浓度，ELISA法测定TNF-α和脑源性神经营养因子（BDNF）浓度。
结果 与第1次MECT前24 h比较，第1次MECT后6 h、第6次MECT后6 h、第6次MECT后7 d两组HAMD、MMSE、MoCA评分明显降低（P<0.05）。与第6次MECT后7 d比较，第6次MECT后30 d两组HAMD评分明显降低（P<0.05），MMSE、MoCA评分明显升高（P<0.05）。X组第1次MECT后6 h、第6次MECT后6 h、第6次MECT后7 d、第6次MECT后30 d HAMD评分明显低于C组（P<0.05），MMSE、MoCA评分明显高于C组（P<0.05）。与第1次MECT前比较，第1次MECT术毕、第1次MECT后24 h、第6次MECT术毕、第6次MECT后24 h两组S100β、TNF-α和BDNF浓度明显升高（P<0.05）。X组第1次MECT术毕、第1次MECT后24 h、第6次MECT术毕、第6次MECT后24 h S100β、TNF-α浓度明显低于C组（P<0.05），BDNF浓度明显高于C组（P<0.05）。
结论 与单纯静脉麻醉比较，经皮穴位电刺激预处理可以减轻抑郁症患者改良电休克治疗后的认知功能和记忆能力的损害程度，同时改善抑郁症患者的临床症状。 |
| 英文摘要: |
Objective To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAs) on cognitive function in patients with modified electroconvulsive therapy (MECT).
Methods Forty patients with depression selected for modified electroconvulsive therapy, 23 males and 17 females, aged 18-60 years, ASA physical status Ⅰ or Ⅱ, were divided into two groups using random number table method: TEAS group (group X) and control group (group C), with 20 patients in each group. Group X received transcutaneous electrical acupoint stimulation for 30 minutes after entry, and baihui, yitang, neiguan (both sides) and taichong (both sides) were selected. Electroacupuncture parameters were chosen as density wave 2/100 Hz, peak current 5-12 mA. MECT was performed after TEAS. Electrodes were pasted on the same points and connected to the therapeutic apparatus, but no electrical stimulation was given in group C. Depressive symptoms and cognitive function were assessed by the Hamilton depression scale (HAMD), the mini-mental state axamination (MMSE) and the Montreal cognitive assessment scale (MoCA) 24 hours before the first MECT, 6 hours after the first MECT, 6 hours after the sixth MECT, 7 days after the sixth MECT, and 30 days after the sixth MECT. Venous blood was extracted before the first MECT, 24 hours after the first MECT, 24 hours after the sixth MECT, and 24 hours after the sixth MECT. The concentrations of S100β were determined by FIA method, and the concentrations of TNF-α and brain-derived neurotrophic factor (BDNF) were determined by ELISA.
Results Compared with 24 hours before the first MECT, HAMD, MMSE and MoCA scores of the two groups were significantly decreased 6 hours after the first MECT, 6 hours after the sixth MECT, and 7 days after the sixth MECT (P < 0.05). Compared with 7 days after the sixth MECT, the HAMD scores of both groups were decreased 30 days after the sixth MECT (P < 0.05), and MMSE and MoCA scores were significantly increased (P < 0.05). The HAMD scores 6 hours after the first MECT, 6 hours after the sixth MECT, 7 days after the sixth MECT, and 30 days after the sixth MECT were significantly lower in group X than in group C (P < 0.05), and the MMSE and MoCA scores were significantly higher in group X than in group C (P < 0.05). Compared with before the first MECT, the concentrations of S100β, TNF-α and BDNF were significantly increased in the two groups after the first MECT, 24 hours after the first MECT, the sixth MECT, and the sixth MECT 24 hours after the first MECT (P < 0.05). Compared with group C, the concentrations of S100β and TNF-α were significantly decreased in group X after the first MECT, 24 hours after the first MECT, the sixth MECT, and the sixth MECT 24 hours after the sixth MECT (P < 0.05). Compared with group C, BDNF concentration in group X was significantly increased after the first MECT, 24 hours after the first MECT, the sixth MECT, and 24 hours after the sixth MECT (P < 0.05).
Conclusion Compared with intravenous anesthesia alone, transcutaneous electrical acupoint stimulation pretreatment can improve the cognitive function and reduce memory impairment of patients with depression after MECT treatment, as well as improve the clinical symptoms of patients with depression. |
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