徐青果,蒋玲,何祥,陈定群
XU Qingguo,JIANG Ling,HE Xiang,CHEN Dingqun

• 1:宜昌市中心人民医院三峡大学第一临床医学院麻醉科
• 2:贵州省人民医院麻醉科
• 3:襄州区人民医院麻醉科

摘要(Abstract)：

目的:探讨电针"四关"穴对老年髋关节置换术患者术后认知功能及血清缺氧诱导因子-1α(HIF-1α)水平的影响。方法:选择在全身麻醉下行择期髋关节置换术的老年患者100例,随机分为对照组和电针组,给予相同的全麻方法,电针组于术前30 min至手术结束时进行"四关"穴电针,对照组不给予电针;于术前1 d和术后1、3、7 d采用简易智力状态评分(MMSE评分)评价2组患者认知功能,比较2组患者术后认知功能障碍(POCD)发生率,记录手术前(对照组)或电针前(电针组)、电针30 min、麻醉诱导后、插管即刻、插管后5 min、拔管时、拔管后5 min时的心率(HR)和平均动脉压(MAP),于手术或电针前及术后1、3、7 d时采用ELISA法测定血清HIF-1α水平,对电针组发生POCD患者的MMSE评分和血清HIF-1α水平进行Perason相关性分析。结果:电针组患者术后1、3 d的MMSE评分均高于对照组(P<0.05),POCD发生率低于对照组(P<0.05),在插管即刻和拔管时HR和MAP均低于对照组(P<0.05),术后1、3、7 d的血清HIF-1α水平也低于对照组(P<0.05);Perason相关性分析显示,术后1 d和术后3 d POCD患者MMSE评分与血清HIF-1α表达水平成负相关(r=-0.817 9、-0.935 9,P<0.05)。结论:电针"四关"穴可改善老年髋关节置换术患者术后认知功能,其机制可能与降低患者血清HIF-1α的水平有关。
Objective: To investigate the effect of electroacupuncture at "Siguan" points on postoperative cognitive function and serum hypoxia inducible factor-1α(HIF-1α) levels in elderly patients undergoing hip arthroplasty. Methods: 100 elderly patients who underwent general anesthesia hip arthroplasty were randomly divided into the control group and electroacupuncture group and received the same general anesthesia method. In the electroacupuncture group, electroacupuncture was performed 30 minutes before the operation and at the end of the operation, and the control group was not given electroacupuncture treatment. The patients were recorded with a simple intelligence status score(MMSE score) 1 day before surgery, and 1 day, 3 days, 7 days after surgery. Comparing occurrence rate of postoperative cognitive dysfunction(POCD). Recording heart rate(HR) and mean arterial pressure(MAP) of surgery(control group) or before electroacupuncture(electroacupuncture group), electroacupuncture for 30 min, induction of general anesthesia, immediate intubation, 5 min after intubation, extubation, and 5 min after extubation. The serum HIF-1α level was determined by ELISA before surgery or electroacupuncture and 1 day, 3 days, 7 days after surgery. Carrying out Perason correlation analysis between MMSE scores and serum HIF-1α level of electroacupuncture group. Results: Compared with the control group, MMSE scores of electroacupuncture group 1 d and 3 d after surgery were significantly higher than control group(P<0.05), incidence rate of POCD was significantly lower than that in the control group(P<0.05); the HR and MAP in the electroacupuncture group were significantly lower than that of control group(P<0.05). The levels of serum HIF-1α in the electroacupuncture group were significantly lower than that of the control group at 1 d, 3 d and 7 d after operation(P<0.05). Perason correlation analysis showed that MMSE scores 1 d and 3 d after surgery in POCD patients were negatively correlated with serum HIF-1α expression(r=-0.817 9,-0.935 9, P<0.05). Conclusion: Electroacupuncture at "Siguan" points can improve postoperative cognitive function in elderly patients undergoing hip replacement surgery, which may be related to lower the level of serum HIF-1α.

关键词(KeyWords)： 老年人;髋关节置换术;电针;穴位;全身麻醉;认知功能;缺氧诱导因子-1α
elders;hip replacement;electroacupuncture;acupoint;general anesthesia;cognitive dysfunction;hypoxia inducible factor-1α

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81860234);; 贵州省卫生计生委科学技术基金项目(gzwjkj2018-1-018)

作者(Author): 徐青果,蒋玲,何祥,陈定群
XU Qingguo,JIANG Ling,HE Xiang,CHEN Dingqun

DOI: 10.19367/j.cnki.1000-2707.2019.11.015

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