【摘要】 目的:调查电针预处理是否可以有效降低老年膝关节置换术后认知障碍(postoperative cognitive dysfunction,POCD)的发病率、减轻认知损害,观察其安全性。方法:将符合入组标准的60例受试者按1:1的比例随机分入治疗组和对照组,每组30例。治疗组的受试者接受真实电针治疗,而对照组的受试者则接受安慰电针治疗。两组均选择"头三神"穴(包括四神聪、神庭和双侧本神)作为主穴,百会、双侧合谷及双侧大冲作为配穴。两组受试者均在手术前5天开始接受治疗,每日1次,连续治疗5天。术前24小时、术后24小时以及术后72小时,分别予以简易精神状态评价量表(Mini-mental State Examination, MMSE)进行认知功能测试,并观察血清炎症因子IL-1β, TNF-α以及S100-β蛋白表达水平的变化,以此客观评价电针预处理对降低老年膝关节置换术后POCD发生率以及减轻术后认知损害的有效性,同时观察并记录不良反应事件。结果:(1)和基线相比,术后24小时,治疗组MMSE总分由29.43±0.97下降至27.10±1.95,对照组由29.27±1.01下降至26.83±2.25(均P<0.05),下降的趋势一直持续到术后72小时(术后72小时,治疗组MMSE总分为26.53±2.26,对照组为24.79±3.03)(均P<0.05);对照组MMSE评分下降比治疗组更显著(P<0.05)。(2)术后24小时及72小时,治疗组IL-1β在术后24小时由43.13±5.51升高至73.13±2.32,并在术后72小时达到83.17±5.95;对照组IL-1β在术后24小时由44.87±5.83升高至91.10±3.55,并在术后72小时达到111.93±9.18。治疗组TNF-α在术后24小时由5 1.27±6.48升高至88.80±3.55,并在术后72小时达到94.37±5.22;对照组TNF-α在术后24小时由52.07±7.48升高至116.37±3.14并在术后72小时达到121.40±3.68(P<0.05),且对照组比治疗组升高更明显(P<0.05)。两组间S100-β水平无统计学差异(P>0.05);(3)术后24小时,治疗组POCD发生率为26.67%,对照组POCD发生率为30.00%;术后72小时,治疗组POCD发生率为30.00%,对照组POCD发生率为46.67%,但两组相比差异无统计学意义(均P>0.05)。(4)研究过程中无明显不良反应事件,无受试者中途退出试验。结论:电针预处理可以在一定程度上减轻行膝关节置换术的老年患者术后24小时及72小时的认知损害的程度,其机制可能与抑制炎症表达相关,但尚无证据证明术前电针预处理可以有效降低POCD的发生率。更多还原

【Abstract】 Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety among elderly.Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy(Streitberger Placebo-needle). In both groups, Tou sanshen(头三神)acupoints, including Sìshéncōng(四神聪EX-HN1), Sh6 ntíng(神庭 GV24),and bilateral Běnsh6 n(本神GB13) were adopted as the main acupoints, while Bǎihui(百会GV20), bilateral Hégǔ(合谷Ll4), and bilateral Tàich6 ng(太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of MiniMental State Examination(MMSE), and levels of serum inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded.Results:(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ±0.97 to27.10 ±1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25(all ?P< 0.05), and this trend continued until postoperative 72 h(at postoperative 72 h, MMSE global scores in treatment group was 26.53 ±2.26 versus 24.79 ±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h(P<0.05).(2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ±5.51 to 73.13 ±2.32 at postoperative 24 h and reached 83.17 士 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 土 5.83 to91.10 ±3.55 at postoperative 24 h and reached 111.93 ±9.18 at postoperative 72 h; TNF-α in treatment group increased from 51.27 士 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ±7.48 to 116.37 ±3.14 at postoperative24 h and reached 121.40 ±3.68 at postoperative 72 h(both ?P< 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant(P<0.05). Statistical difference in level of S100-β was not observed(P>0.05).(3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups(P> 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h(POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00%in control group; POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group).(4) No serious adverse events were reported in this trial. No one dropped out from this trial.Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.更多还原