Evaluation of Efficacy and Safety of Electro-acupuncture Precondition on Postoperative Cognitive Dysfunction (POCD) Following Knee Replacement in Elderly: A Randomized Controlled Trial
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摘要
OBJECTIVE: To investigate that whether electro-acupuncture(EA) precondition can reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety in elderly. METHODS: A total of 60 participants met the inclusion criteria were enrolled in a randomized controlled trial with the ratio of 1:1, with 30 cases in the treatment group and 30 cases in the control group. The participants in the treatment group were provided with realEA therapy whereas participants in control group were provided with placebo-EA therapy. Interventions were offered 5 days prior to the surgery, once daily, and for a total of 5 days. The scores of Mini-Mental State Examination(MMSE), and contents of serumal inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α) were observed at 24 hours prior-and posterior-to the surgery respectively for assessing the incidence of POCD among patients. Meanwhile, adverse effects were monitored and recorded. RESULTS:(1) After surgery, both treatment group and control group showed a significant decrease in MMSE global scores(P < 0.001, < 0.001, respectively), and the score in control group decreased more significantly than that in treatment group(P < 0.05);(2) Contents of serumal IL-1β and TNF-α were significantly increased in both groups after 24 hours posterior to the surgery(P < 0.001), and the contents in control group increased more significantly than that in treatment group(P < 0.001);(3) After surgery, the incidence of POCD was 20% in treatment group versus 36.67% in control group. There was no statistical difference between 2 groups(P > 0.05);(4) No serious adverse events were reported in this trial, except 1 patient from treatment group had a slight hematoma after receiving acupuncture. CONCLUSION: EA precondition might reduce cognitive impairments after 24 hours posterior to knee replacement surgery in elderly through inhibiting expression of inflammatory cytokines, including both IL-1β and TNF-α. However, there is insufficient evidence to support that EA precondition could reduce incidence of POCD.
OBJECTIVE: To investigate that whether electro-acupuncture(EA) precondition can reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety in elderly. METHODS: A total of 60 participants met the inclusion criteria were enrolled in a randomized controlled trial with the ratio of 1:1, with 30 cases in the treatment group and 30 cases in the control group. The participants in the treatment group were provided with realEA therapy whereas participants in control group were provided with placebo-EA therapy. Interventions were offered 5 days prior to the surgery, once daily, and for a total of 5 days. The scores of Mini-Mental State Examination(MMSE), and contents of serumal inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α) were observed at 24 hours prior-and posterior-to the surgery respectively for assessing the incidence of POCD among patients. Meanwhile, adverse effects were monitored and recorded. RESULTS:(1) After surgery, both treatment group and control group showed a significant decrease in MMSE global scores(P < 0.001, < 0.001, respectively), and the score in control group decreased more significantly than that in treatment group(P < 0.05);(2) Contents of serumal IL-1β and TNF-α were significantly increased in both groups after 24 hours posterior to the surgery(P < 0.001), and the contents in control group increased more significantly than that in treatment group(P < 0.001);(3) After surgery, the incidence of POCD was 20% in treatment group versus 36.67% in control group. There was no statistical difference between 2 groups(P > 0.05);(4) No serious adverse events were reported in this trial, except 1 patient from treatment group had a slight hematoma after receiving acupuncture. CONCLUSION: EA precondition might reduce cognitive impairments after 24 hours posterior to knee replacement surgery in elderly through inhibiting expression of inflammatory cytokines, including both IL-1β and TNF-α. However, there is insufficient evidence to support that EA precondition could reduce incidence of POCD.
OBJECTIVE: To investigate that whether electro-acupuncture(EA) precondition can reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety in elderly. METHODS: A total of 60 participants met the inclusion criteria were enrolled in a randomized controlled trial with the ratio of 1:1, with 30 cases in the treatment group and 30 cases in the control group. The participants in the treatment group were provided with realEA therapy whereas participants in control group were provided with placebo-EA therapy. Interventions were offered 5 days prior to the surgery, once daily, and for a total of 5 days. The scores of Mini-Mental State Examination(MMSE), and contents of serumal inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α) were observed at 24 hours prior-and posterior-to the surgery respectively for assessing the incidence of POCD among patients. Meanwhile, adverse effects were monitored and recorded. RESULTS:(1) After surgery, both treatment group and control group showed a significant decrease in MMSE global scores(P < 0.001, < 0.001, respectively), and the score in control group decreased more significantly than that in treatment group(P < 0.05);(2) Contents of serumal IL-1β and TNF-α were significantly increased in both groups after 24 hours posterior to the surgery(P < 0.001), and the contents in control group increased more significantly than that in treatment group(P < 0.001);(3) After surgery, the incidence of POCD was 20% in treatment group versus 36.67% in control group. There was no statistical difference between 2 groups(P > 0.05);(4) No serious adverse events were reported in this trial, except 1 patient from treatment group had a slight hematoma after receiving acupuncture. CONCLUSION: EA precondition might reduce cognitive impairments after 24 hours posterior to knee replacement surgery in elderly through inhibiting expression of inflammatory cytokines, including both IL-1β and TNF-α. However, there is insufficient evidence to support that EA precondition could reduce incidence of POCD.
引文
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2.Alcover L,Badenes R,Montero MJ,et al.Postoperative delirium and cognitive dysfunction.Trends in Anaesthesia and Critical Care.2013;3(4):199-204.
3.Tsai TL,Sands LP,Leung JM.An update on postoperative cognitive dysfunction.Advances Anesthesia,2010;28(1):269-284.
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5.Qiao Y,Feng H,Zhao T,et al.Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery:the influence of anesthetic technique,cerebral injury and systemic inflammation.BMCAnesthesiology,2015;15:154.
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8.Thompson SN.General Anaes the siaandcognitive functioning.Chinese Journal of Clinical Psychology,2003;11(1):71-72.
9.Evered LA,Silbert BS,Scott DA,et al.Plasma amyloid beta42 and amyloid beta40 levels are associated with early cognitive dysfunction after cardiac surgery.The Annals of Thoracic Surgery,2009;88(5):1426-1432.
10.Fodale V,Santamaria LB,Schifilliti D,et al.Anaesthetics and postoperative cognitive dysfunction:a pathological mechanism mimicking Alzheimer's disease.Anaesthesia,2010;65(4):388-395.
11.Hu Z,Ou YW,Duan KM,et al.Inflammation:A bridge between postoperative cognitive dysfunction and Alzheimer's disease.Medical Hypotheses,2010;74(4):722-724.
12.Jungwirth B,Eckel B,Blobner M,et al.The impact of cardiopulmonary bypass on systemic interleukin-6release,cerebral nuclear factor-kappa B expression,and neurocognitive outcome in rats.Anesthesia&Analgesia,2010;110:312-320.
13.Molnar T,Jakab L,Palinkas L,et al.Increased levels of baseline biomarkers reflecting platelet and endothelial activation predict early cognitive dysfunction after lung surgery.European Journal of Anaesthesiology,2009;26(8):708-710.
14.Yuan XM,Zhang Y,Liu q.The possible mechanisms of drugs to improve postoperative cognitive dysfunction.Chinese Journal of Gerontology,2017;9(37):4426-4428.
15.Zhang L.Research progress on drug safety of Dexmedetomidine.Chongqing Medicine,2013;42(9):1066-1069.
16.Li HL.Candesartan induced angioedema and sacroiliac joint pain.Chinese Journal of Aesthetic Medicine,2012;21(18):434-435.
17.Wang Z.Benefits and risks of edaravone in clinical application.The Chinese Journal of Clinical Pharmacology,2015;31(5):378-379.
18.Wang XB.Research of the intervention of acupuncture and moxibustion on cognitive disorders.Chinese Acupuncture&Moxibustion,2002(S1):165-166.
19.Wang JB.Research on the effect of eletro-acupuncture therapy of Traditional Chinese Medicine on the recovery of cognitive function in elderly patients after general anaesthesia.Chinese Medicine Modern Distance Education of China,2017;15(7):117-118.
20.Zhou J,Zhao YH,Wang XR.Effects of electroacupuncture on Neiguan on postoperative cognitive dysfunction in patients undergoing Off-pump coronary artery bypass grafting.Journal of Clinical Anesthesiology,2011;27(12):1188-1189.
21.Cockrell JR,Folstein MF.Mini-Mental State Examination(MMSE).Psychopharmacology Bulletin,1988;24(4):689-692.
22.O'Keeffe ST,Mulkerrin EC,Nayeem K,et al.Use of serial mini-mental state examinations to diagnose and monitor delirium in elderly hospital patients.Journal of the American Geriatrics Society,2005;53(5):867-870.
23.Norkien I,Samalavi ius R,Misiu-rien I,et al.Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting.Medicina,2010;46(7):460-464.
24.Liebert AD,Chow RT,Bicknell BT,et al.Neuroprotective effects against POCD by photobiomodulation:evidence from assembly/disassembly of the cytoskeleton,Journal of Experimental Neuroscience,2016;10(1):1.
25.Nelson PT,Alafuzoff I,Bigio EH,et al.Correlation of Alzheimer's disease neuropathologic changes with cognitive status:a review of the literature.Journal of Neuropathology&Experimental Neurology,2012;71(5):362-381.
26.Yu JC,Liu CZ,Zhang XZ,et al.Acupuncture improved cognitive impairment caused by multi-infarct dementia in rats.Physiology&Behavior,2005;86(4):434-441.
27.Ye GX,Ma J,Song NY,et al.Efficacy evaluation of acupuncture intervention on vascular dementia.Liaoning Journal of Traditional Chinese Medicine,2011;38(12):23-24.
28.Lu SM,Gui B,Dong HQ,et al.Prophylactic lithium alleviates splenectomy-induced cognitive dysfunction possibly by inhibiting hippocampal TLR4 activation in aged rats.Brain Research Bulletin,2015;114:31-41.
29.Sheeran P,Hall GM.Cytokines is an aesthesia.British Journal of Anaesthesia,1997;78(2):201-219.
30.Li MY,Li XR,Gao QJ,et al.Effect of electroacupuncture on content of serum EPCs and neurological deficitment in rats with focal cerebral ischemia and reperfusion.Traditional Chinese Medicine Journal,2017;16(3):39-42.
31.Ye JS,He YF,Peng HY,et al.Acupuncture at Siguan acupoint combined repetitive transcranial magnetic stimulation for depression of Parkinson's disease in 30 Cases.Journal of External Therapy of Traditional Chinese Medicine,2017;26(2):22-23.
2.Alcover L,Badenes R,Montero MJ,et al.Postoperative delirium and cognitive dysfunction.Trends in Anaesthesia and Critical Care.2013;3(4):199-204.
3.Tsai TL,Sands LP,Leung JM.An update on postoperative cognitive dysfunction.Advances Anesthesia,2010;28(1):269-284.
4.Newman M.Open heart surgery and cognitive decline.Cleveland Clinic Journal of Medicine,2007;74(1):S52-55.
5.Qiao Y,Feng H,Zhao T,et al.Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery:the influence of anesthetic technique,cerebral injury and systemic inflammation.BMCAnesthesiology,2015;15:154.
6.Wang W,Wang Y,Wu HB,et al.Postoperative cognitive dysfunction:current developments in mechanism and prevention.Medical Science Monitor,2014;20:1908-1912.
7.Steinmetz J,Christensen KB,Lund T,et al.Long-term consequences of postoperative cognitive dysfunction.Anesthesiology,2009;110:548-555.
8.Thompson SN.General Anaes the siaandcognitive functioning.Chinese Journal of Clinical Psychology,2003;11(1):71-72.
9.Evered LA,Silbert BS,Scott DA,et al.Plasma amyloid beta42 and amyloid beta40 levels are associated with early cognitive dysfunction after cardiac surgery.The Annals of Thoracic Surgery,2009;88(5):1426-1432.
10.Fodale V,Santamaria LB,Schifilliti D,et al.Anaesthetics and postoperative cognitive dysfunction:a pathological mechanism mimicking Alzheimer's disease.Anaesthesia,2010;65(4):388-395.
11.Hu Z,Ou YW,Duan KM,et al.Inflammation:A bridge between postoperative cognitive dysfunction and Alzheimer's disease.Medical Hypotheses,2010;74(4):722-724.
12.Jungwirth B,Eckel B,Blobner M,et al.The impact of cardiopulmonary bypass on systemic interleukin-6release,cerebral nuclear factor-kappa B expression,and neurocognitive outcome in rats.Anesthesia&Analgesia,2010;110:312-320.
13.Molnar T,Jakab L,Palinkas L,et al.Increased levels of baseline biomarkers reflecting platelet and endothelial activation predict early cognitive dysfunction after lung surgery.European Journal of Anaesthesiology,2009;26(8):708-710.
14.Yuan XM,Zhang Y,Liu q.The possible mechanisms of drugs to improve postoperative cognitive dysfunction.Chinese Journal of Gerontology,2017;9(37):4426-4428.
15.Zhang L.Research progress on drug safety of Dexmedetomidine.Chongqing Medicine,2013;42(9):1066-1069.
16.Li HL.Candesartan induced angioedema and sacroiliac joint pain.Chinese Journal of Aesthetic Medicine,2012;21(18):434-435.
17.Wang Z.Benefits and risks of edaravone in clinical application.The Chinese Journal of Clinical Pharmacology,2015;31(5):378-379.
18.Wang XB.Research of the intervention of acupuncture and moxibustion on cognitive disorders.Chinese Acupuncture&Moxibustion,2002(S1):165-166.
19.Wang JB.Research on the effect of eletro-acupuncture therapy of Traditional Chinese Medicine on the recovery of cognitive function in elderly patients after general anaesthesia.Chinese Medicine Modern Distance Education of China,2017;15(7):117-118.
20.Zhou J,Zhao YH,Wang XR.Effects of electroacupuncture on Neiguan on postoperative cognitive dysfunction in patients undergoing Off-pump coronary artery bypass grafting.Journal of Clinical Anesthesiology,2011;27(12):1188-1189.
21.Cockrell JR,Folstein MF.Mini-Mental State Examination(MMSE).Psychopharmacology Bulletin,1988;24(4):689-692.
22.O'Keeffe ST,Mulkerrin EC,Nayeem K,et al.Use of serial mini-mental state examinations to diagnose and monitor delirium in elderly hospital patients.Journal of the American Geriatrics Society,2005;53(5):867-870.
23.Norkien I,Samalavi ius R,Misiu-rien I,et al.Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting.Medicina,2010;46(7):460-464.
24.Liebert AD,Chow RT,Bicknell BT,et al.Neuroprotective effects against POCD by photobiomodulation:evidence from assembly/disassembly of the cytoskeleton,Journal of Experimental Neuroscience,2016;10(1):1.
25.Nelson PT,Alafuzoff I,Bigio EH,et al.Correlation of Alzheimer's disease neuropathologic changes with cognitive status:a review of the literature.Journal of Neuropathology&Experimental Neurology,2012;71(5):362-381.
26.Yu JC,Liu CZ,Zhang XZ,et al.Acupuncture improved cognitive impairment caused by multi-infarct dementia in rats.Physiology&Behavior,2005;86(4):434-441.
27.Ye GX,Ma J,Song NY,et al.Efficacy evaluation of acupuncture intervention on vascular dementia.Liaoning Journal of Traditional Chinese Medicine,2011;38(12):23-24.
28.Lu SM,Gui B,Dong HQ,et al.Prophylactic lithium alleviates splenectomy-induced cognitive dysfunction possibly by inhibiting hippocampal TLR4 activation in aged rats.Brain Research Bulletin,2015;114:31-41.
29.Sheeran P,Hall GM.Cytokines is an aesthesia.British Journal of Anaesthesia,1997;78(2):201-219.
30.Li MY,Li XR,Gao QJ,et al.Effect of electroacupuncture on content of serum EPCs and neurological deficitment in rats with focal cerebral ischemia and reperfusion.Traditional Chinese Medicine Journal,2017;16(3):39-42.
31.Ye JS,He YF,Peng HY,et al.Acupuncture at Siguan acupoint combined repetitive transcranial magnetic stimulation for depression of Parkinson's disease in 30 Cases.Journal of External Therapy of Traditional Chinese Medicine,2017;26(2):22-23.