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

  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。 

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

  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.