穴位电刺激联合全身麻醉在老年腹腔镜结直肠癌根治术患者中的应用效果

李亚楠; 万政佐; 李岩岩; 阙斌; 于学来; 汪利凤

doi:10.16766/j.cnki.issn.1674-4152.002855

穴位电刺激联合全身麻醉在老年腹腔镜结直肠癌根治术患者中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.002855

杭州市中医院麻醉科，浙江杭州 321000

基金项目:

浙江省杭州市科技计划项目 20181228Y29

浙江省中医药科技计划项目 2020ZB155

浙江省杭州市科技发展计划项目 20201203B202

详细信息

通讯作者:
汪利凤，E-mail：13588820242@163.com

中图分类号: R614.2 R735.37
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出版历程
- 收稿日期: 2022-08-29
- 网络出版日期: 2023-04-20

Application effect of acupoint electrical stimulation combined with general anesthesia in elderly patients undergoing laparoscopic radical resection of colorectal cancer

Anesthesiology Department, Hangzhou Hospital of Traditional Chinese Medical, Hangzhou, Zhejiang 321000, China

摘要

摘要: 目的分析经皮穴位电刺激(TEAS)联合全身麻醉对患者胃肠激素及术后认知功能障碍(POCD)的影响，探讨TEAS联合全身麻醉在老年腹腔镜结直肠癌根治术中的应用效果。方法选取2020年1月—2022年1月于杭州市中医院行腹腔镜结直肠癌根治术的老年患者90例，使用随机数字表法将患者分为A组(45例)和B组(45例)。A组患者给予全身麻醉处理，B组患者在A组的基础上给予TEAS处理。比较2组患者围手术期指标、术中不同时间血流动力学改变情况、胃肠激素水平、中枢神经特异性(S100β)蛋白及脑源性神经营养因子(BDNF)水平、简易智力状态检查量表(MMSE)评分、POCD发生情况。结果 B组患者丙泊酚、瑞芬太尼用量、苏醒时间及拔管时间明显低于A组(P < 0.05)。B组中心静脉压(CVP)水平明显高于A组(P < 0.05)。2组胃泌素、胃动素水平较术前明显降低(均P < 0.05)，且B组明显高于A组(P < 0.05)。机体S100β蛋白水平先升高后降低(P < 0.05)、BDNF水平及MMSE评分先降低后升高(均P < 0.05)，且B组术后1、3、7 d时S100β蛋白水平均低于A组(均P < 0.05)，BDNF水平及MMSE评分均高于A组(均P < 0.05)。术后1、3 d，B组POCD发生率低于A组(37.78% vs. 68.89%，24.44% vs. 51.11%，均P < 0.05)。结论 TEAS联合全身麻醉可减轻老年腹腔镜结直肠癌根治术后患者手术及麻醉对胃肠激素分泌的抑制作用，保护中枢神经系统，改善认知功能，减少POCD的发生。
- 穴位电刺激 /
- 全身麻醉 /
- 腹腔镜结直肠癌根治术 /
- 胃肠激素 /
- 术后认知功能障碍
Abstract: Objective To analyze the effects of transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia on gastrointestinal hormones and postoperative cognitive dysfunction (POCD), and investigate the effect of TEAS combined with general anesthesia in elderly patients after laparoscopic radical resection of colorectal cancer. Methods A total of 90 elderly patients who underwent laparoscopic radical resection of colorectal cancer in Hangzhou Hospital of Traditional Chinese Medical from January 2020 to January 2022 were selected and divided into A and B group by random number table method, with 45 cases in each group. Patients in the group A were given general anesthesia treatment, and patients in the group B were given TEAS on the basis of the group A. The perioperative indicators, hemodynamic changes at different time during operation, gastrointestinal hormone levels, central nervous specific (S100β) protein and brain derived neurotrophic factor (BDNF) levels, mini-mental state examination (MMSE) scores, and the occurrence of POCD were compared between the two groups. Results The dosage of propofol and remifentanil, awakening time and extubation time of the group B were significantly lower than those in the group A (P < 0.05). The level of central venous pressure (CVP) in the group B was significantly higher than that in the group A (P < 0.05). The levels of gastrin (GAS) and motilin (MTL) in both groups were significantly lower than those before surgery (P < 0.05), and the group B was significantly higher than the group A (all P < 0.05). The S100β level protein was firstly increased and then decreased (P < 0.05), and BDNF level and MMSE score were firstly decreased and then increased (all P < 0.05). The levels of S100β protein in the group B were lower than those in the group A on 1 d, 3 d and 7 d after surgery (all P < 0.05), the levels of BDNF and MMSE score were higher than those in the group A (all P < 0.05). The occurrence of POCD in the group B on 1 d and 3 d after surgery were significantly lower than those in the group A (37.78% vs. 68.89%, 24.44% vs. 51.11%, all P < 0.05). Conclusion TEAS combined with general anesthesia can alleviate the inhibitory effect of surgery and anesthesia on gastrointestinal hormone secretion, protect the central nervous system, improve cognitive function, and reduce the occurrence of POCD in elderly patients after laparoscopic radical colorectal cancer surgery.
- Acupoint electrical stimulation /
- General anesthesia /
- Laparoscopic-assisted radical resection for colorectal cancer /
- Gastrointestinal hormones /
- Postoperative cognitive dysfunction

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表 1 2组腹腔镜结直肠癌根治术患者一般资料比较

Table 1. Comparison of general data between two groups of patients undergoing laparoscopic radical resection of colorectal cancer

组别	例数	性别(例)		年龄 (x±s，岁)	BMI (x±s)	病程 (x±s，年)	饮酒史 (例)	ASA分级(例)			高血压 (例)	糖尿病 (例)	冠心病 (例)	手术时间 (x±s，min)	疾病类型(例)
组别	例数	男性	女性	年龄 (x±s，岁)	BMI (x±s)	病程 (x±s，年)	饮酒史 (例)	Ⅰ级	Ⅱ级	Ⅲ级	高血压 (例)	糖尿病 (例)	冠心病 (例)	手术时间 (x±s，min)	结肠癌	直肠癌
A组	45	24	21	67.53±5.33	24.22±4.02	0.65±0.19	8	2	30	13	10	7	5	255.45±17.59	25	20
B组	45	23	22	68.40±5.56	25.10±4.11	0.69±0.21	9	3	31	11	12	8	6	258.66±18.24	22	23
统计量		0.045^a		0.758^b	1.027^b	0.948^b	0.073^a	0.383^a			0.241^a	0.08^a	0.104^a	0.850^b	0.401^a
P值		0.833		0.451	0.307	0.346	0.788	0.826			0.624	0.777	0.748	0.398	0.527
注：^a为χ²值，^b为t值。

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表 2 2组腹腔镜结直肠癌根治术患者围手术期指标比较(x±s)

Table 2. Comparison of perioperative indexes in two groups of patients undergoing laparoscopic radical resection of colorectal cancer (x±s)

组别	例数	丙泊酚 (mg)	瑞芬太尼 (mg)	苏醒时间 (min)	拔管时间 (min)
A组	45	810.58±81.23	1.61±0.25	16.20±5.25	25.68±9.64
B组	45	669.34±86.14	1.34±0.21	10.85±4.57	20.47±8.11
t值		8.002	5.547	5.156	2.774
P值		< 0.001	< 0.001	< 0.001	0.007

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表 3 2组腹腔镜结直肠癌根治术患者术中不同时间心率比较(x±s，次/min)

Table 3. Comparison of heart rate at different time during laparoscopic radical resection of colorectal cancer between 2 groups (x±s, times/min)

组别	例数	气腹前 (开腹前)	气腹后			放气腹(关腹)后30 min
组别	例数	气腹前 (开腹前)	30 min	60 min	120 min	放气腹(关腹)后30 min
A组	45	70.27±8.68	73.67±8.33	78.69±9.93	76.31±6.52	70.78±8.35
B组	45	70.44±8.68	72.44±8.54	76.38±9.15	74.36±6.2	72.33±7.95
t值		0.092	0.692	1.148	1.454	0.902
P值		0.926	0.491	0.254	0.150	0.370

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表 4 2组腹腔镜结直肠癌根治术患者术中不同时间MAP比较(x±s，mm Hg)

Table 4. Comparison of MAP at different time in two groups of patients undergoing laparoscopic radical resection of colorectal cancer (x±s, mmHg)

组别	例数	气腹前(开腹前)	气腹后			放气腹(关腹)后30 min
组别	例数	气腹前(开腹前)	30 min	60 min	120 min	放气腹(关腹)后30 min
A组	45	90.39±9.58	87.36±8.63	88.61±9.33	89.24±8.78	86.18±7.34
B组	45	89.41±9.33	85.46±8.94	90.34±9.18	92.19±8.39	86.47±7.15
t值		0.492	1.026	0.887	1.630	0.190
P值		0.624	0.308	0.378	0.107	0.950

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表 5 2组腹腔镜结直肠癌根治术患者术中不同时间CVP比较(x±s，cm H₂O)

Table 5. Comparison of CVP at different time during laparoscopic radical resection of colorectal cancer between 2 groups (x±s, cmH₂O)

组别	例数	气腹前(开腹前)	气腹后			放气腹(关腹)后30 min
组别	例数	气腹前(开腹前)	30 min	60 min	120 min	放气腹(关腹)后30 min
A组	45	11.68±1.24	12.06±1.17	12.47±1.15	12.36±1.21	11.56±1.19
B组	45	11.55±1.16	16.28±1.64	16.96±1.14	17.99±1.28	11.38±1.30
t值		0.514	14.05	18.60	21.44	0.685
P值		0.609	< 0.001	< 0.001	< 0.001	0.495

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表 6 2组腹腔镜结直肠癌根治术患者血清胃肠激素比较(x±s，pg/mL)

Table 6. Comparison of serum gastrointestinal hormones in two groups of patients undergoing laparoscopic radical resection of colorectal cancer (x±s, pg/mL)

组别	例数	GAS		MTL
组别	例数	手术前	手术后	手术前	手术后
A组	45	115.23±18.25	95.66±15.37^a	278.25±43.35	195.36±25.24^a
B组	45	116.45±18.51	103.28±17.94^a	279.47±45.28	241.57±29.67^a
t值		0.315	2.614	0.131	7.958
P值		0.754	0.033	0.896	< 0.001
注：与同组术前比较，^aP < 0.05。

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表 7 2组腹腔镜结直肠癌根治术患者S100β蛋白及BDNF水平比较(x±s)

Table 7. Comparison of S100β protein and BDNF levels in two groups of patients undergoing laparoscopic radical resection for colorectal cancer (x±s)

组别	例数	S100β蛋白(pg/mL)				BDNF(ng/mL)
组别	例数	术前	术后1 d	术后3 d	术后7 d	术前	术后1 d	术后3 d	术后7 d
A组	45	90.22±19.35	165.36±30.18^a	131.23±22.16^a	92.29±19.66	4.42±0.64	1.68±0.50^a	2.64±0.91^a	3.26±0.81^a
B组	45	85.36±20.17	130.22±24.14^a	115.28±16.84^a	85.69±21.38	4.58±0.69	2.23±0.98^a	3.41±1.07^a	4.01±1.11^a
t值		1.167	6.100	3.844	1.524	1.141	3.354	3.677	3.661
P值		0.247	< 0.001	< 0.001	0.131	0.257	0.001	< 0.001	< 0.001
注：与同组术前比较, ^aP < 0.05。

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表 8 2组腹腔镜结直肠癌根治术患者MMSE评分比较(x±s，分)

Table 8. Comparison of MMSE scores between two groups of patients undergoing laparoscopic radical resection of colorectal cancer (x±s, points)

组别	例数	术前	术后1 d	术后3 d	术后7 d
A组	45	29.20±0.24	25.96±0.26^a	27.23±0.29^ab	28.89±0.25^abbc
B组	45	29.24±0.23	26.89±0.22^a	28.04±0.26^ab	29.18±0.21^bc
t值		0.807	18.320	13.950	5.958
P值		0.422	< 0.001	< 0.001	< 0.001
注：与同组术前比较，^aP < 0.05；与同组术后1 d比较，^bP < 0.05；与同组术后3 d比较，^cP < 0.05。

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表 9 2组腹腔镜结直肠癌根治术患者术后POCD发生情况比较[例(%)]

Table 9. Comparison of postoperative POCD occurrence in patients with laparoscopic radical resection of colorectal cancer between two groups [cases (%)]

组别	例数	术后1 d	术后3 d	术后7 d
A组	45	31(68.89)	23(51.11)	5(11.11)
B组	45	17(37.78)	11(24.44)	4(8.89)
χ²值		8.750	6.807	0.123
P值		0.003	0.009	0.725

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