目的：探讨经皮穴位电刺激（TAES）对老年患者腹腔镜直肠癌切除术后认知功能的影响及其可能的机制。方法选择2011年6月—2014年5月温州医科大学附属第一医院肿瘤外科收治的腹腔镜下直肠癌 Dixon 手术的老年患者60例，采用随机数字表法分为对照组30例和 TAES 组30例。两组患者均选择全凭静脉麻醉，TAES 组患者麻醉诱导前30 min 至术毕加用 TAES 进行干预。在围术期使用精神状态简易速检表（MMSE）对患者认知功能进行评分，并在不同时间点检测患者血清超氧化物歧化酶（SOD）、丙二醛（MDA）、S100β水平。结果 MMSE 评分治疗方法与时间无交互作用（ P ＞0.05）；组间比较，差异有统计学意义（ P ＜0.05）；时间间比较，差异有统计学意义（ P ＜0.05）。术后1、3、5 d TAES 组 MMSE 评分高于对照组（P ＜0.05）。术后1、3 d TAES 组患者 POCD 严重程度低于对照组（P ＜0.05），术后5、7 d 两组患者 POCD 严重程度比较，差异无统计学意义（P ＞0.05）。SOD、MDA、S100β水平治疗方法与时间无交互作用（P ＞0.05）；组间比较，差异有统计学意义（P ＜0.05）；时间间比较，差异有统计学意义（P ＜0.05）。术毕，术后2、6、24 h TAES 组 SOD 水平高于对照组（P ＜0.05）；术后2、6、24 h TAES 组 MDA、S100β水平低于对照组（P ＜0.05）。结论老年患者腹腔镜直肠癌切除导致术后认知功能障碍，TAES 通过增加 SOD水平、抑制 MDA 聚集、减少 S100β释放，保护脑功能，可以明显减少患者术后认知功能障碍的发生。%Objective To observe the effect of transcutaneous acupoint electrical stimulation(TAES)on postoperative cognitive function in elderly patients undergoing laparoscopic resection of rectal cancer and its possible mechanism. Methods Sixty elderly patients with rectal cancer who underwent laparoscopic Dixon surgery in Department of Surgical Oncology in the First Hospital Affiliated to Wenzhou Medical University from June 2011 to May 2014,were randomly divided into TAES group(group E,30 cases)and control group( group C,30 cases)by random number table method. Total intravenous anesthesia were selected for patients of two groups,group E were continually treated with TASE from 30 minutes before anesthesia to the end of operation. The mini - mental state examination( MMSE)was used to evaluate the changes of cognitive function during the perioperative period,serum levels of superoxide dismutase( SOD),malondialdehyde( MDA)and S100β were detected at different time points. Results There was no significant interaction between treatment method and time(P > 0. 05);there were significant differences in MMSE scores among groups( P < 0. 05);there were significant differences in MMSE scores among different time points(P < 0. 05);MMSE scores 1,3,5 days after operation in group E were significantly higher than those in group C respectively(P < 0. 05). The severity degree of POCD 1,3 days after operation of patients in group E were significantly lower than those in group C respectively(P < 0. 05). There was no significant difference in severity degree of POCD 5,7 days after operation between two groups(P > 0. 05). There was no significant interaction between treatment method and time(P >0. 05);there were significant differences in serum levels of SOD,MDA and S100β among groups( P < 0. 05);there were significant differences in serum levels of SOD,MDA and S100β among different time points(P < 0. 05). The levels of SOD in group E were higher than those in group C at the end of operation,and 2,6,24 h after operation respectively(P < 0. 05). The levels of MDA and S100β in group E were significantly lower than those in group C 2,6,24 h after opteration respectively (P < 0. 05). Conclusion Laparoscopic resection of rectal cancer in elderly patients can cause POCD,TAES has a protective effect on cerebral function by increasing SOD level,inhibiting the aggregation of MDA and reducing the release amount of S100β, thus can significantly reduce the incidence of POCD among patients.
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