围手术期经皮穴位电刺激预防老年全膝关节置换术后认知功能障碍的临床研究

金晓伟; 周森; 周奇韬; 蒋毅

doi:10.16766/j.cnki.issn.1674-4152.003373

围手术期经皮穴位电刺激预防老年全膝关节置换术后认知功能障碍的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003373

温州市中西医结合医院麻醉手术科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2023KY1160

详细信息

通讯作者:
金晓伟，E-mail: xiaoweijinwz@163.com

中图分类号: R687.4 R614.2
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- 被引次数: 0
出版历程
- 收稿日期: 2023-10-07
- 网络出版日期: 2024-03-27

Study on the effect of percutaneous acupoint electrical stimulation during perioperative period to prevent cognitive impairment after total knee arthroplasty in the elderly

Department of Anesthesia and Surgery, Wenzhou Integrated Traditional Chinese and Western Medicine Hospital, Wenzhou, Zhejiang 325000, China

摘要

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。
- 全膝关节置换术 /
- 经皮穴位电刺激 /
- 老年 /
- 炎症反应 /
- 神经损伤 /
- 术后认知功能障碍
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 control group received TKA under general anesthesia, and the observation group received additional perioperative percutaneous acupoint electrical stimulation intervention. The surgical and anesthesia recovery indicators were recorded, perioperative 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 intraoperative bleeding volume, total intraoperative infusion volume, surgical duration, anesthesia recovery time, and tracheal intubation time between the two groups (P>0.05). 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 Perioperative percutaneous acupoint electrical stimulation can inhibit neuroinflammatory response, alleviate brain tissue damage, regulate brain nerve metabolism function, and can prevent the occurrence of POCD.
- Total knee arthroplasty /
- Transcutaneous acupoint electrical stimulation /
- Old age /
- Inflammatory response /
- Nerve injury /
- Postoperative cognitive dysfunction

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表 1 2组膝关节骨性关节炎患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with knee osteoarthritis

组别	例数	年龄 (x±s，岁)	性别(例)		ASA分级(例)		体重指数 (x±s)	术中出血量 (x±s，mL)	术中总输液量 (x±s，mL)	手术持续时间 (x±s，min)
组别	例数	年龄 (x±s，岁)	男性	女性	Ⅰ级	Ⅱ级	体重指数 (x±s)	术中出血量 (x±s，mL)	术中总输液量 (x±s，mL)	手术持续时间 (x±s，min)
对照组	79	73.09±4.86	38	41	36	43	22.41±1.59	169.82±12.91	1 782.64±253.71	121.39±10.57
观察组	79	73.27±5.03	36	43	37	42	22.26±1.46	172.45±13.36	1 749.57±249.03	119.68±10.14
统计量		0.229^a	0.102^b		0.025^b		0.618^a	1.258^a	0.827^a	1.038^a
P值		0.819	0.750		0.873		0.539	0.210	0.409	0.301
注：^a为t值，^b为χ²值。

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表 2 2组膝关节骨性关节炎患者围手术期血流动力学指标比较(x±s)

Table 2. Comparison of perioperative hemodynamic parameters between the two groups of knee osteoarthritis patients (x±s)

组别	例数	HR(次/min)
组别	例数	T1	T2	T3	T4	T5
对照组	79	82.68±5.91	71.23±5.83^a	77.64±5.46^a	80.73±5.72	83.16±5.68
观察组	79	83.14±5.76	70.89±5.69^a	78.35±5.72^a	81.09±5.58	82.65±5.79
F值		0.482	0.563	0.608	0.451	0.536
P值		0.574	0.491	0.443	0.618	0.519

组别	例数	MAP(mmHg)
组别	例数	T1	T2	T3	T4	T5
对照组	79	97.42±7.29	82.47±7.95^a	90.27±8.26^a	95.23±7.41	96.51±7.63
观察组	79	97.18±7.05	81.92±8.14^a	91.06±8.31^a	94.66±7.69	96.84±7.42
F值		0.362	0.419	0.627	0.491	0.381
P值		0.692	0.635	0.424	0.563	0.674

组别	例数	SPO₂(%)
组别	例数	T1	T2	T3	T4	T5
对照组	79	97.28±1.11	96.79±0.96	97.32±1.06	97.11±0.99	97.36±1.03
观察组	79	96.94±1.03	97.12±1.02	96.89±1.02	96.97±1.05	96.92±0.98
F值		0.591	0.537	0.639	0.452	0.503
P值		0.464	0.518	0.415	0.603	0.541
注：与T1时刻比较，^aP < 0.05。

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表 3 2组膝关节骨性关节炎患者麻醉恢复指标比较(x±s，min)

Table 3. Comparison of anesthesia recovery indexes between the two groups of patients with knee osteoarthritis (x±s, min)

组别	例数	麻醉苏醒时间	拔除气管导管时间
对照组	79	10.95±1.47	15.42±1.56
观察组	79	10.68±1.39	15.76±1.61
t值		1.186	1.348
P值		0.237	0.179

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表 4 2组膝关节骨性关节炎患者血清炎症因子水平比较(x±s，ng/L)

Table 4. Comparison of serum inflammatory factors between the two groups of patients with knee osteoarthritis (x±s, ng/L)

组别	例数	TNF-α		IL-6		IL-1β
组别	例数	麻醉诱导前30 min	术后5 d	麻醉诱导前30 min	术后5 d	麻醉诱导前30 min	术后5 d
对照组	79	24.96±5.37	35.84±6.17^a	16.85±2.43	27.91±3.26^a	20.65±2.97	29.42±3.74^a
观察组	79	25.34±5.48	27.62±5.59	17.24±2.61	18.37±2.74	19.94±2.81	21.28±3.15
t值		0.457	7.629	0.972	19.911	1.544	14.797
P值		0.598	< 0.001	0.332	< 0.001	0.125	< 0.001
注：与同组麻醉诱导前比较，^aP < 0.05。

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表 5 2组膝关节骨性关节炎患者血清脑神经生化指标比较(x±s，μg/L)

Table 5. Comparison of serum cranial nerve biochemical indexes between the two groups of patients with knee osteoarthritis (x±s, μg/L)

组别	例数	S-100β		NSE		BDNF
组别	例数	麻醉诱导前30 min	术后5 d	麻醉诱导前30 min	术后5 d	麻醉诱导前30 min	术后5 d
对照组	79	0.29±0.07	0.48±0.11^a	3.71±0.61	5.36±0.82^a	7.49±1.27	6.15±1.24^a
观察组	79	0.31±0.08	0.35±0.09	3.65±0.59	3.87±0.63	7.56±1.32	7.34±1.29
t值		1.672	8.614	0.628	12.527	0.347	5.963
P值		0.097	< 0.001	0.531	< 0.001	0.708	< 0.001
注：与同组麻醉诱导前比较，^aP < 0.05。

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