经皮穴位电刺激改善老年患者电视辅助胸腔镜手术后的认知功能：一项随机对照试验。
Transcutaneous Electrical Acupoint Stimulation Improves Postoperative Cognitive Function in Senior Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial.
机构信息
Department of Anesthesiology, Tangshan People's Hospital, Tangshan, Hebei Province, 063000, China.
Department of Anesthesiology, Tangshan Central Hospital, Tangshan, Hebei Province, 063000, China.
出版信息
Chin J Integr Med. 2022 Aug;28(8):730-735. doi: 10.1007/s11655-022-3516-1. Epub 2022 May 11.
OBJECTIVE
To evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) for improving postoperative cognitive function in senior patients undergoing video-assisted thoracoscopic surgical (VATS).
METHODS
From January to December 2020, 97 participants were randomly assigned to the TEAS group (49 cases) and the control group (48 cases) by a random number table. The patients in the TEAS group received TEAS, at the bilateral Neiguan (PC 6) and Zusanli (ST 36) acupoints. The control group received sham TEAS. The stimulation was started from 30 min before surgery until the end of the operation. The primary outcome was the incidence of pstoperative cognitive dysfunction (POCD), diagnosed based on the changes in the Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. The secondary outcomes were plasma levels of S100β protein and neuron-specific enolase (NSE).
RESULTS
The incidence of POCD on day 1 and 3 after surgery in the TEAS group was significantly lower than that in the control group [day 1 after surgery: 28.3% (13/46) vs. 52.3% (23/44), P=0.028; day 3 after surgery: 21.7% (10/46) vs. 40.9% (18/44), P=0.043]. Compared with baseline, the MMSE and MoCA scores decreased to various extents in both groups. The MMSE scores on day 1, 3, and 5 after surgery and MoCA scores on day 1, 3, 5, and 7 after surgery in the TEAS group were higher than those in the control group (all P<0.05) in both groups. Compared with baseline, the plasma levels of S100β and NSE were significantly increased at 4, 8, 12, 24 h after surgery (all P<0.05). Compared with the control group, the plasma levels of S100β and NSE were lower in the TEAS group at 4, 8, 12, and 24 h after surgery (all P<0.05). No obvious adverse events were found during the trial.
CONCLUSION
Application of TEAS in senior patients after VATS could reduce incidence of POCD and improve postoperative cognitive function.
目的
评估经皮穴位电刺激（TEAS）对改善接受电视辅助胸腔镜手术（VATS）的老年患者术后认知功能的有效性和安全性。
方法
2020 年 1 月至 12 月，采用随机数字表法将 97 例患者随机分为 TEAS 组（49 例）和对照组（48 例）。TEAS 组患者接受双侧内关（PC 6）和足三里（ST 36）穴位的 TEAS 治疗。对照组患者接受假 TEAS 治疗。刺激从手术前 30 分钟开始，持续到手术结束。主要结局是术后认知功能障碍（POCD）的发生率，根据简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）评分的变化来诊断。次要结局是 S100β 蛋白和神经元特异性烯醇化酶（NSE）的血浆水平。
结果
TEAS 组术后第 1 天和第 3 天的 POCD 发生率明显低于对照组[术后第 1 天：28.3%（13/46）比 52.3%（23/44），P=0.028；术后第 3 天：21.7%（10/46）比 40.9%（18/44），P=0.043]。与基线相比，两组的 MMSE 和 MoCA 评分均有所下降。TEAS 组术后第 1、3、5 天的 MMSE 评分和术后第 1、3、5、7 天的 MoCA 评分均高于对照组（均 P<0.05）。与基线相比，两组患者术后 4、8、12、24 h 时 S100β 和 NSE 血浆水平均显著升高（均 P<0.05）。与对照组相比，TEAS 组术后 4、8、12 和 24 h 时 S100β 和 NSE 血浆水平均较低（均 P<0.05）。试验过程中未发现明显不良事件。
结论
VATS 后老年患者应用 TEAS 可降低 POCD 的发生率，改善术后认知功能。
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