| 高晓秋,张子银,马武华.电针辅助全身麻醉对老年患者术后认知功能的影响[J].,2012,32(5):591-593 |
| 电针辅助全身麻醉对老年患者术后认知功能的影响 |
| Effects of Electroacupuncture Assistant General Anesthesia on Postoperative Cognitive Dysfunction of Aged Patients |
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| DOI： |
| 中文关键词: 老年患者 术后认知功能障碍 针刺辅助麻醉 电针 全麻 |
| 英文关键词:aged patient postoperative cognitive dysfunction acupuncture-assisted anesthesia electroacupuncture general anesthesia |
| 基金项目:广东省中医药管理局资助项目(No.2008341) |
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| 中文摘要: |
| 目的观察电针辅助全身麻醉对老年患者术后认知功能的影响。方法选择美国麻醉医师学会(American Society of Anesthesiology,ASA)分级Ⅰ～Ⅲ级择期行非心脏手术的老年患者(年龄>65岁)120例,随机分为全身麻醉组(A组)和电针辅助全身麻醉组(B组),每组60例。在麻醉诱导开始前30min选取百会、合谷、内关、足三里4个穴位对B组患者进行电刺激并维持至术毕。两组患者均在依托咪酯0.2～0.3mg/kg,芬太尼3～5μg/kg,顺式阿曲库铵0.15mg/kg诱导下行气管插管,七氟烷吸入及瑞芬太尼持续输入下维持麻醉。手术结束前30min给予曲马多50mg。记录两组患者麻醉前1天及术后第2、4、6天简易智力状态检查(mini-mental state examination,MMSE)评分和术后恶心、呕吐情况,比较术后2、4、6天术后认知功能障碍(postoperative cognitivedys function,POCD)发生率。结果 B组患者术后第2、4天POCD发生率均明显低于A组同期(分别为40.0%vs66.7%,13.3%vs43.3%),差异有统计学意义(P<0.05)。两组患者麻醉前MMSE评分比较,差异无统计学意义(P>0.05);术后2、4天B组MMSE评分高于A组(分别为21.3±3.9vs18.3±3.8,26.4±2.9vs22.9±3.9),差异有统计学意义(P<0.05)。与本组麻醉前1天MMSE评分比较,A组患者术后第2、4天(18.3±3.8,22.9±3.9vs27.9±2.1)及B组术后第2天(21.3±3.9vs27.5±2.5)差异均有统计学意义(P<0.05)。B组患者术后恶心及呕吐的发生率为23.3%(14/60),低于A组(46.7%,28/60),差异有统计学意义(P<0.05)。结论电针辅助全身麻醉可减少老年患者POCD的发生率。 |
| 英文摘要: |
| Objective To observe the effects of electroacupuncture(EA)assistant general anesthesia on postoperative cognitive dysfunction(POCD)of aged patients.Methods One hundred and twenty senile American Society of Anesthesiology(ASA)grade Ⅰ-Ⅲ patients(more than 65 years old)with non-cardiac surgery were randomly assigned to two groups,Group A and Group B,60 cases in each group.Patients in Group A received general anesthesia,while those in Group B received EA assistant general anesthesia.Patients in Group B received EA at Baihui(DU20),Hegu(LI4),Neiguan(PC6),Zusanli(ST36)30 min before anesthesia induction to the end of operation.Anesthesia was induced by etomidate 0.2-0.3 mg/kg,fentanyl 3-5 μg/kg,cisatracurium 0.15 mg/kg in the two groups.Anesthesia maintenance was provided by sevoflurane and continuous pumping of remifentanil.Tramadol 50 mg was given 30 min before ending the operation.The scores of mini-mental state examination(MMSE),nausea and vomiting were recorded in the two groups one day before anesthesia,the 2nd,4th,and 6th day after operation.The occurrence of postoperative cognitive dysfunction(POCD)on day 2,4,and 6 was compared.ResultsThe occurrence of POCD on day 2 and 4 was obviously lower in Group B than in Group A at the same time period(40.0% vs 66.7%,13.3% vs 43.3%),showing statistical difference(P<0.05).There was no significant difference in the pre-anesthesia scores of MMSE between the two groups.The scores of MMSE on the 2nd and the 4th day were higher in Group B than in Group A(21.3±3.9 vs 18.3±3.8,26.4±2.9 vs 22.9±3.9,P<0.05).Compared with one day before anesthesia in the same group,the scores of MMSE were significantly different on the 2nd and the 4th day(Group A:18.3±3.8,22.9±3.9 vs 27.9±2.1;Group B:21.3±3.9 vs 27.5±2.5;P<0.05).The occurrence of post-aesthesia nausea and vomiting was lower in Group B(23.3%,14/60)than in Group A(46.7%,28/60)with statistical difference(P<0.05).Conclusion EA assistant general anesthesia could reduce the occurrence of POCD in aged patients. |
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