刘智　滕永杰

[摘要] 目的 探討针刺复合全麻对老年肿瘤切除术患者术后认知功能及相关炎症因子的影响。 方法 选取2015年 6月～2016年12月湖南中医药大学第一附属医院收治的98例老年肿瘤切除术患者为研究对象，采用随机数字表法分为两组，各49例。对照组行单纯全麻，观察组行针刺复合全麻。术前1 d、术后1 d及术后3 d采用简易智力状态测试量表（MMSE）对所有患者进行评估，计算术后认知功能障碍（POCD）的发生率。术前、术毕、术后24 h和术后48 h采用酶联免疫吸附法（ELISA）测定患者血清肿瘤坏死因子（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）水平。 结果 术后1 d和术后3 d观察组MMSE评分高于对照组，POCD发生率低于对照组，差异有统计学意义（P < 0.05）。与术前比较，术毕、术后24 h及术后48 h两组TNF-α、IL-1β及IL-6水平升高，而观察组的升高幅度均低于对照组，差异有统计学意义（P < 0.05）。 结论 针刺复合全麻可以降低老年肿瘤切除术患者POCD发生率，其作用机制可能与降低患者体内TNF-α、IL-1β及IL-6水平有关。

[关键词] 针刺复合全麻；术后认知功能障碍；炎症因子

[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2017）08（a）-0076-04

[Abstract] Objective To investigate the effect of acupuncture combined with general anesthesia on cognitive function and related inflammatory factors in elderly patients underwent tumor resection. Methods A total of 98 elderly patients underwent tumor resection in the First Affiliated Hospital of Hu′nan University of Traditional Chinese Medicine from June 2015 to December 2016 were enrolled. The patients were divided into two groups according to the random number table method， each group had 49 cases. Patients in the control group were treated with general anesthesia. Patients in the observation group were treated with acupuncture combined with general anesthesia. All patients were scored by mini-mental state examination （MMSE） at 1 day before operation， 1 day after operation and 3 days after operation. The incidence of postoperative cognitive dysfunction （POCD） was calculated. The levels of serum TNF-α， IL-1β and IL-6 were measured by enzyme-linked immunosorbent assay （ELISA） before operation， at operation completed， 24 h and 48 h after operation. Results The MMSE scores of the observation group were significantly higher than those of the control group at 1 day and 3 days after operation， the incidence rates of POCD were lower than those of the control group， the differences were statistically significant （P < 0.05）. The levels of TNF-α， IL-1β and IL-6 in the two groups at operation completed， 24 h and 48 h after operation were significantly higher than those before operation， and the observation group were lower than those of the control group， the differences were statistically significant （P < 0.05）. Conclusion Acupuncture combined with general anesthesia can reduce the incidence of POCD in elderly patients underwent tumor resection. The mechanism may be related to the decrease of the levels of serum TNF-α， IL-1β and IL-6 in patients.

[Key words] Acupuncture combined with general anesthesia； Postoperative cognitive dysfunction； Inflammatory factorsendprint

术后认知功能障碍（postoperative cognitive dysfunction，POCD）是指老年患者在大手术后常见的一种中枢神经系统并发症，是一种认知功能、独立能力及技巧的变化，临床表现为精神错乱、焦虑、人格改变及记忆受损[1-3]。这种并发症不仅导致患者自身病情恶化、康复延迟、住院天数延长，还因医疗费用的增加对患者家庭乃至社会造成巨大负担。研究表明，手术作为一种创伤性治疗手段，可应激性地激活患者免疫系统，随之释放过量的促炎细胞因子，引发炎性反应，损伤大脑功能，最终对术后认知功能造成影响[4-5]。针刺麻醉是利用传统针刺镇痛方法部分或完全代替药物麻醉进行外科手术的麻醉方法，可通过刺激穴位降低患者体内肿瘤坏死因子（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）等促炎细胞因子的释放，抑制海马区神经元凋亡，解除长时间的神经抑制，降低并发症发生率[6]。……