经皮穴位电刺激对开颅术患者围术期脂质过氧化反应及认知功能的影响

目的:观察经皮穴位电刺激(TAES)对颅脑手术患者围术期脑损伤的保护作用及其可能的机制。方法:神经外科择期手术患者50例,随机分为TAES组(25例)和对照组(25例),两组均麻醉诱导后持续吸入七氟醚和间断静脉注射舒芬太尼、维库溴胺维持麻醉,TAES组加用经皮穴位电刺激干预(2~100 Hz,8~12 mA)。分别在麻醉诱导前、颅内操作1 h、术毕、术后24 h、术后48 h采用黄嘌呤酶氧化法和生物化学发光法测定血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量,采用酶联免疫吸附法检测S100β(一种酸性钙离子结合蛋白)水平;在麻醉前、术后1 h、术后24 h、术后48 h分别使用精神状态简易速检表对患者进行认知功能评分。结果:SOD在术后24 h组间比较,TAES组明显增高(P<0.05);MDA在术后24、48 h对照组比TAES组明显增高(P<0.01);S100β在颅内操作1 h、术后48 h对照组明显高于TAES组(P<0.05)。认知功能评分两组之间比较差异无统计学意义(P>0.05)。结论:TAES可以通过提高SOD、降低MDA而减少脂质过氧化损伤,起到脑保护作用,其对认知功能的影响有待进一步研究。

Effect of Transcutaneous Acupoint Electrical Stimulation on Lipid Peroxidation and Cognitive Function in Patients Experiencing Craniotomy

Objective To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on serum superox-ide dismutase (SOD) activity, malondialdehyde (MDA) and S100|3 contents in craniotomy patients for studying its cerebral protection mechanism. Methods Fifty patients scheduled for neurosurgery were randomly divided into TAES group (n = 25) and control group (n=25) with randomized block method. For patients of TAES group, TAES was applied to bilateral Hegu (LI 4) and Quchi (LI 11), Zusanli (ST 36) and Sanyinjiao (SP 6) from 30 minutes on before anesthesia to the end of operation. Patients of control group were anesthetized with sevoflurane inhalation and intermittent (i. v.) of sulfenany and vecurnium bromide. Blood samples were taken for assaying serum SOD activity, MDA and S100β contents with purinase oxydasis, biochemiluminescence and enzyme linked immunosorbent assay separately. Scores of cognitive ability were given by using Mini Mental State Examination (MMSE). Results In comparison with pre-anesthesia, serum SOD activity decreased significantly 1 h after craniotomy in control group, at the end of operation in both control and TAES groups (P<0. 05, P<0. 01), and increased markedly 48 h after operation in control group (P<0. 05). Serum MDA in control group increased significantly 48 h after operation, while that in TAES group reduced apparently 24 h after operation (P<0. 01). Serum S100β content in TAES group decreased remarkably 48 h after operation (P<0. 01). Serum SOD activity of TAES group was significantly higher than that of control group 24 h after operation (P<0. 05). Compared with control group, serum MDA contents of 24 h and 48 h after operation and serum S100β levels at 1 h after craniotomy and 48 h after operation were markedly lower in TAES group (P<0. 01, P<0. 05). No significant differences were found between two groups in the cognitive function scores (P>0. 05). Conclusion TAES can increase serum SOD activity and reduce MDA and S100|3 levels in patients undergoing craniotomy, which may contribute to its effect in reducing lipid peroxi-dation induced cerebral injury. But its impact on the patient's cognitive function needs study further.