摘要
目的:探究针药复合麻醉对老年全髋关节置换术患者的应激状态及认知功能的影响。方法:收集行全髋关节置换术的患者89例,根据患者实施全髋关节置换手术时是否施用针刺麻醉分为针药复合麻醉组和单纯药物麻醉组。分别于术前未进行电刺激时和术后采集患者空腹静脉血3mL。采用放射免疫法检测皮质醇(Cor)、β-内啡肽(β-EP),采用电化学发光免疫法检测神经元特异性烯醇化酶(NSE)。采用酶联免疫吸附法测定S-100β蛋白(S-100β)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平。使用流式细胞仪测定血液中T细胞亚群(CD3+)及自然杀伤细胞(NK细胞)的比率。结果:术前未行电刺激时两组血清Cor、β-EP、NSE、S-100β、NK细胞、CD3+比率、CRP、TNF-α水平比较,差异无统计学意义(P>0.05)。术后两组血清Cor、β-EP、NSE、S-100β、CRP、TNF-α水平显著高于术前(P<0.05),且针药复合麻醉组显著低于单纯药物麻醉组(P<0.05)。术后针药复合麻醉组NK细胞、CD3+比率与术前比较,差异无统计学意义(P>0.05),而单纯药物麻醉组NK细胞、CD3+比率显著低于术前(P<0.05)。结论:针药复合麻醉可有效减轻行老年全髋关节置换术患者的炎症应激反应,解除手术及麻醉对机体产生的免疫抑制,降低对神经系统的损伤,改善患者的认知功能。
Objective: To investigate the effects of acupuncture combined with anesthesia on stress and cognitive function in seniorpatients with total hip arthroplasty. Methods: A total of 89 patients who underwent total hip replacement between January 2016 and May 2018 were collected. According to whether acupuncture anesthesia was applied during total hip replacement, the patients were divided into the acupuncture combined with anesthesia group and the single drug anesthesia group. Fasting venous blood (3 mL) was collected before the operation without electrical stimulation and after the operation. Cortisol (Cor) and β-endorphin (β-EP) were detected by radioimmunoassay, and neuron-specific enolase (NSE) was detected by electrochemical luminescence immunoassay. The levels of s-100β protein (s-100β), c-reactive protein (CRP) and tumor necrosis factor-α(TNF-α) were determined by ELISA. Flow cytometry was used to determine the ratio of T cell subsets (CD3 +) and natural killer cells (NK cells) in the blood. Results: The levels of Cor,β-EP, NSE, S-100β, CRP, TNF-α and the ratio of NK cell, CD3 + between the two groups hadno significant differences before operation ( P >0.05). Serum levels of Cor,β-EP, NSE, S-100β, CRP and TNF-α in patients in theacupuncture combined with drug anesthesia group and the single drug anesthesia group were significantly higher than those before surgery ( P <0.05). In addition, serum levels of Cor,β-EP, NSE, S-100β, CRP, TNF-α in the acupuncture combined with anesthesia group were significantly lower than those in the drug group alone ( P <0.05). There was no significant difference in NK cell and CD3 + ratio between post-operationand pre-operationin the acupuncture combined with drug anesthesia group ( P >0.05). The ratio of NK cells and CD3 + in the single drug anesthesia group was significantly lower than that before surgery ( P <0.05). Conclusion: Acupuncture combined with drug anesthesia can effectively reduce the inflammatory stress response of patients undergoing total hip arthroplasty, relieve the immune suppression caused by surgery and anesthesia, reduce the damage to the nervous system, and have a good influence in the cognitive function of the senior patients.
作者
魏林志
曲宁
WEI Lin-zhi;QU Ning(Department of Anesthesiology,Qinghai Traditional Chinese Medicine Hospital,Xining 810000,Qinghai,China)
出处
《海南医学院学报》
CAS
2019年第17期1342-1346,共5页
Journal of Hainan Medical University
基金
青海省科技计划项目(2018-ZJ-920)~~
关键词
针药复合麻醉
全髋关节置换术
应激反应
认知功能
Acupuncture combined anesthesia
Total hip arthroplasty
Stress response
Cognitive function
