Influence Of Electroacupuncture Before Operation On Post-operative Cognitive Dysfunction In Elderly Patients Undergoing Total Hip Joint Or Total Knee Replacement

Object:To observe the effects of electroacupuncture at baihui(DU20) and shenting(DU24) before operation on post-operative cognitive dysfunction in elderly patients undergoing total hip joint or total knee replacement.Methods:88 ASA physical statusⅠ-Ⅱpatients aged over 65 years were studied after elective total hip joint or total knee replacement under general anesthesia. Patients aged from 65 to 87 years and with weigh from 46 to 86Kg, were randomly divided into two groups: group E (n=41) and group C (n=47). Group E was treated with eletroacupuncture at DU20 and DU24 for 30min between anesthesia induction and operation. Two groups were intravenous patient-controlled analgesia (PCA) constantly until 48h after operation. MMSE (mini-mental state examination) scores were recorded before (T0),1 (T1 and 7 (T2) days after operation, respectively. Patients had cognitive dysfunction when postoperative MMSE score declined more than 2 score compared to the preoperative MMSE score. And S100βprotein levels in serum were measured by enzyme linked immunosorbent assay (ELISA) in 55 patients before anesthesia, at the end of operation and 1 day after operation. Age, sex, height, weigh, level of education, complications before operation, time of operation and anesthesia, perioperative hemorrhage, visual analogue scale pain scores and complications after operation were evaluated.Results:Cognitive deficit was present in 19 (40.40%) group C and in 8 (19.51%) group E at 1 day after operation. There was significant difference between group C and group E(p<0.05). At 7 days after operation, cognitive deficit was present in 7 (17.02%) group C and 4 (9.76%) group E (p>0.05). There was not significant difference between group C and group E. In high education patients, there was not significant difference in incidence of POCD between group C and group E(p>0.05). But in lower education patients, there was significant difference in incidence of POCD between group C and group E(p<0.05).MMSE scores at T1 were lower than those at To in group C. And MMSE scores at T1 were similar to those at To in group E. There were not significant differences in MMSE scores between T1 and To both in group C and group E(p>0.05). In lower education patients, there was significant difference in MMSE scores between T1 and To in group C(p<0.05). And at T1 there was significant difference in MMSE scores between group C and group E (p<0.05).S100βprotein levels in serum at the end of operation were higher than those before operation. S100pprotein levels in serum at 1 days after operation were silimar to those before operation.S100-βprotein levels in serums were similar in patients who did and did not POCD. S100-βprotein levels in serum were also similar in group C and group E at the end of operation. Conclusion:Although Electroacupuncture at baihui (DU20) and shenting (DU24) before operation can improve the cognitive function of elderly patients with lower education undergoing total hip joint or total knee replacement. But it can not reduce S100-βprotein levels in serum.