及早经皮穴位电针刺激对高龄老年髋部骨折术后认知的影响

目的:研究经皮穴位电针刺激及早干预对老年髋部骨折术后认知功能及炎症因子的影响。方法:80岁以上髋部 骨折患者40例，随机分为对照组（A组, 20例）和电刺激组（B组，20例）。两组患者均采用腰-硬联合麻醉。B组患者术前 2 d选取百会穴和风池穴行经皮电针刺激，3次/d，30 min/次；麻醉操作完成后行穴位持续刺激至手术结束。A组患者仅在 相应穴位贴电极未行电针刺激。于入院时、术后24、72 h 3个时点对患者进行MMSE评定，若术后评分降低一个标准差或 以上者即认定发生术后认知功能障碍（POCD）。所有患者在入院时、术毕即刻、术后24 和72 h 抽取静脉血，测定血清 IL-6、IL-10 和S100β 蛋白水平。结果:A组术后24、72 h POCD 发生率分别为65%（13/20）和60%（12/20），高于B组的 35%（7/20）和25%（5/20），差异有统计学意义（P<0.05）；B组术后各时间点血清IL-6、IL-10和S100β蛋白水平均显著低于 对照组同时间点，差异有统计学意义（P<0.05）。结论:及早经皮穴位电针干预有利于改善高龄老年髋部骨折术后的认知 功能状态，有效降低患者POCD的发生率。这可能与抑制其血清IL-6、IL-10、S100B蛋白的过度表达、减轻患者脑损伤的 程度有关。

Effects of early transcutaneous acupoint electrical stimulation on postoperative cognition of elderly patients with hip fractures

Abstract: Objective To assess the effects of early transcutaneous acupoint electrical stimulation (TAES) on postoperative cognitive function and inflammatory factors of the elderly with hip fractures. Methods Forty patients aged over 80 years with hip fractures were randomly divided into control group (group A, 20 cases) and electrical stimulation group (group B, 20 cases). All patients were treated with spinal-epidural combined anesthesia. Patients in group B received TAES at Baihui (DU20) and fengchi (GB20) (3 times a day, 30 minutes a time) since 2 days before operation until the operation finished. In group A, the electrodes were only applied at the corresponding acupoints without electrical stimulation. At admission, and 24, 72 h after finishing operation, all patients were assessed with MMSE. If the postoperative score was reduced by one standard deviation or more, postoperative cognitive dysfunction (POCD) was identified. The levels of serum IL-6, IL-10 and S100β proteins were also measured at admission, the end of operation, and 24, 72 h after finishing operation. Results The incidence of POCD at 24 and 72 h after finishing operation was 65% (13/20) and 60% (12/20) in group A, higher than 35% (7/20) and 25% (5/20) in group B, with statistical significance (P<0.05). At all postoperative time points, the levels of serum IL-6, IL-10 and S100β proteins in group B were significantly lower than those in group A, with statistical significance (P<0.05). Conclusion Early TAES can improve the postoperative cognitive function of elderly patients with hip fractures and reduce the incidence of POCD, which may be related to inhibiting the over-expression of serum IL-6, IL-10 and S100β proteins, and reducing the degree of brain injury in patients.