赵娜 吴祥 吴秀青 张瑞

[摘要] 目的 觀察针刺醒神四穴对促进老年患者全麻术后认知恢复的疗效。 方法 选取2019年1—12月我院收治的老年全麻手术患者60例，随机分为观察组和对照组，每组各30例。对照组予常规处理，观察组在对照组基础上予针刺醒神四穴处理，比较两组炎症因子水平、疼痛评分（VAS）、社会功能评分（FAQ）、认知功能评分（MMSE）及认知障碍发生率。 结果 术后24 h两组IL-6、IL-10炎症因子水平均高于术前，但观察组低于对照组，差异有统计学意义（P<0.05）;术后5 d两组VAS评分、FAQ评分均低于术后24 h，且观察组低于对照组，差异有统计学意义（P<0.05）;术后3 d、5 d观察组MMSE评分高于对照组，差异有统计学意义（P<0.05）;术后3 d、5 d观察组认知功能障碍发生率低于对照组，差异有统计学意义（P<0.05）。 结论 针对老年全麻患者实施醒神四穴针刺，能够缓解炎症反应、缓解疼痛、改善社会功能，在促进患者术后认知功能恢复方面具有一定效果，可在临床广泛推广。

[关键词] 针刺;醒神四穴;全麻;认知恢复;认知功能评分;社会功能评分;炎症因子

[中图分类号] R614.2          [文献标识码] B          [文章编号] 1673-9701（2021）08-0107-04

Clinical effect of acupuncture at the Xingshen four points on promoting cognitive recovery of elderly patients after general anesthesia

ZHAO Na   WU Xiang   WU Xiuqing    ZHANG Rui

Department of Anesthesiology， the Affiliated Hospital of Medical School of Ningbo University， Ningbo   315020， China

[Abstract] Objective To observe the effect of acupuncture at the Xingshen four points on promoting cognitive recovery in elderly patients after general anesthesia. Methods The elderly patients undergoing general anesthesia were derived from the patients admitted to our hospital from January to December 2019. A total of 60 cases were randomly divided into observation group and control group with 30 cases in each group. The control group was given conventional treatment， the observation group was given acupuncture at Xingshen four points on the basis of the control group. The levels of inflammatory factors， pain score （VAS）， social function score （FAQ）， cognitive function score （MMSE） and the incidence of cognitive impairment were compared between the two groups. Results The levels of IL-6 and IL-10 inflammatory factors increased in both groups 24 hours after the operation than before the operation， but those of the observation group were statistically significant lower than those of the control group（P<0.05）. The scores of VAS and FAQ decreased in both groups 5 days after the operation than 24 hours after the operation， while those of the observation group were statistically significant lower than those of the control group（P<0.05）. The MMSE scores at 3 and 5 days after the operation of the observation group were significantly higher than those of the control group， and the differences were statistically significant（P<0.05）. The incidence of cognitive impairment at 3 and 5 days after the operation of the observation group were significantly lower than those of the control group， and the differences were statistically significant （P<0.05）. Conclusion Acupuncture at Xingshen four points for elderly patients with general anesthesia can relieve the inflammatory reaction， relieve pain， and improve the social function of patients. It has a certain effect in promoting the cognitive recovery of patients after surgery. It can be widely used in clinical practice.

[Key words] Acupuncture; Xingshen four points; General anesthesia; Cognitive recovery; Cognitive function score; Social function score; Inflammatory factor

作为手术常见并发症，术后认知功能障碍主要指手术麻醉当天或数天发生的急性精神紊乱综合征，患者表现为不同程度的认知功能变化、人格改变及精神活动异常等，部分表现为焦虑、精神错乱、记忆受损等[1]。有文献报道，术后认知功能障碍的诱发因素复杂多样，与高龄、长期药物依赖史及心理、手术创伤等具有密不可分的联系[2]，术后认知功能障碍不仅会延长患者的住院时间、增加医疗费用，而且会降低患者的预后、增加死亡风险。目前，临床针对老年全麻手术患者术后认知障碍的诊断及处理尚缺乏行之有效的干预手段，且麻醉方式不同、药物配伍不同，其认知障碍发生及治疗也会受到不同程度的影响。近年来，中医针刺疗法在全麻术后干预中的优势得以体现，本研究引入的针刺醒神四穴（百会、神门、内关及合谷穴）能够起到改善微循环、强化记忆力的效果，在临床中已被大量研究证实[3]，但关于其在防治老年全麻术后认知障碍中的作用研究甚少。……