电针改善术后认知功能可能机制探讨

摘要/Abstract

摘要： 术后认知功能障碍（POCD）是一种术后发生的常见的临床现象，可引起术后康复延迟和生活质量的下降，增加术后一年内伤残率、死亡率的风险。目前POCD的发生机制、防治都尚未完全明确。电针（EA）是传统针灸与现代医学相结合的新型治疗方式，多种研究表明，电针可以改善POCD。本文就EA改善POCD的几种可能机制进行综述。

关键词: 术后认知功能障碍, 电针, 机制

Abstract: Postoperative cognitive dysfunction is a common clinical phenomenon after surgery.It refers to the delaying rehabilitation of patients and the declining quality of life, even increases the disability rate and mortality rate 1 year after operation.The mechanisms,prevention and cure of POCD are not clear yet. Electroacupuncture is a new type of treatment for the combination of traditional acupuncture and modern medicine.A variety of studies have indicated that electroacupuncture can improve POCD.The article reviewed several potential mechanisms that have been reported.

Key words: Postoperative cognitive dysfunction, Electroacupuncture, Mechanisms

刘昕. 电针改善术后认知功能可能机制探讨[J]. 外科研究与新技术, 2016, 5(1): 57-60.

参考文献

[1] Monk T G, Price C C. Postoperative cognitive disorders.[J]. Current Opinion in Critical Care, 2011, 17(4):376-381.
[2]周伟, 区锦燕, 陈耀雄,等. 电针干预对老年患者全麻术后认知功能障碍的影响[J]. 中华物理医学与康复杂志, 2014, 36(5).
[3]张陈麟, 朱玲丽, 严栋. 电针对老年患者全身麻醉术后认知功能恢复的影响[J]. 上海针灸杂志, 2015, 第2期:132-133.
[4]张芳芳, 郭小文, 徐永刚,等. 术前电针对老年关节置换患者术后认知功能障碍的影响[J]. 中国中医药科技, 2012, 05期(05):455-457.
[5]高晓秋, 张子银, 马武华. 电针辅助全身麻醉对老年患者术后认知功能的影响[J]. 中国中西医结合杂志, 2012, 32(05):591-593.
[6] Niccolò T, Eriksson L I, Jae K R, et al. Resolving postoperative neuroinflammation and cognitive decline.[J]. Annals of Neurology, 2011, 70(6):986-995.
[7] Fung A, Vizcaychipi M, Lloyd D, et al. Central nervous system inflammation in disease related conditions: mechanistic prospects.[J]. Brain Research, 2012, 1446(2):144-155.
[8] Zheng-Qian L, Xiao-Ying R, Ya-Jie L, et al. Activation of the canonical nuclear factor-κB pathway is involved in isoflurane-induced hippocampal interleukin-1β elevation and the resultant cognitive deficits in aged rats.[J]. Biochemical & Biophysical Research Communications, 2013, 438(4):628-634.
[9]陈妮. 不同电针频率对肺切除患者血清IL-1、IL-6的影响[J]. 中国针灸, 2012, 第6期:523-526.
[10] Ying X U, Zhang Z X, Shen R, et al. Effect of Electroacupuncture on Ethology and Cytokines of Hippocampus in Rats with Dysmnesy[J]. Acupuncture Research, 2007, 32(2):88-92.
[11]Qin L, Wu X, Block M L, et al. Systemic Lps Causes Chronic Neuroinflammation And Progressive Neurodegeneration[J]. Glia, 2007, 55(5):453–462.
[12] 闫醒予. 电针对脑缺血再灌注损伤大鼠脑组织中自由基及热休克蛋白70表达的影响[J]. 针刺研究, 2007, 02期:102-104.
[13]Yanjie W, Jing X, Fanzhen M, et al. Cognitive decline following major surgery is associated with gliosis, β-amyloid accumulation, and τ phosphorylation in old mice.[J]. Critical Care Medicine, 2010, 38(11):2190-2198.
[14]薛卫国, 葛桂玲, 张忠,等. 电针对转基因阿尔茨海默病小鼠海马CA1区超微结构的影响[J]. 针刺研究, 2009, 05期:309-314.
[15] 黄键, 刘忠锦, 刘丹阳,等. 电针对阿尔茨海默病模型大鼠学习记忆及tau蛋白磷酸化的影响[J]. 中国当代医药, 2013, 第15期:16-18.
[16] 吴羽楠, 陈吉祥, 陶静,等. 电针百会对APP/PS1转基因小鼠学习记忆能力及Tau蛋白磷酸化的影响[J]. 中国康复医学杂志, 2015, 第5期:432-436.
[17] 张敏, 徐桂华, 王维新,等. 电针调控p38MAPK通路降低AD大鼠海马磷酸化tau蛋白表达的研究[J]. 南京中医药大学学报, 2015, 第3期:261-264.
[18] Matthias R, Patricia O, Simone A, et al. Glial cell activation in a subgroup of patients with schizophrenia indicated by increased S100B serum concentrations and elevated myo-inositol[J]. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2007, 31(2):361–364.
[19] 林舜艳, 尹正录, 高巨,等. 针刺麻醉对老年患者肠癌切除术后认知功能障碍影响及其S-100β蛋白的变化[J]. 中国针灸, 2013, 第1期:63-66.
[20] 曹译匀, 李正迁, 等. 术后认知功能障碍发病机制的研究进展[J]. 临床麻醉学杂志, 2015, 第8期:826-829.
[21] 严洁, 樊凌, 常小荣,等. 电针不同穴组对急性脑缺血大鼠NO和ET-1的对比观察[C].中国针灸学会经络分会第十届学术会议. 2009:296-300.
[22] Zhou S, Huang J H, Fang B J. Effect of electroacupuncture on inducible nitric oxide synthase mRNA expression in hippocampus of the rats with cerebral ischemia-reperfusion injury[J]. Chinese Journal of Clinical Rehabilitation, 2005.
[23] 刘晓华. 电针对脑缺血再灌注模型大鼠NMDAR-NO-cGMP通路的影响[D]. 南京中医药大学, 2011.
[24] Guo Q ,Robinson N ,Mattson M P. Secreted beta-amyloid precursor protein counteracts the proapoptotic action of mutant presenilin-1 by activation of NF-kappaB and stabilization of calcium homeostasis.[J]. Journal of Biological Chemistry, 1998, 273(20):12341-12351.
[25] Javadzadeh A, Ghorbanihaghjo A, Bonyadi S, et al. Preventive effect of onion juice on selenite-induced experimental cataract. Indian J Ophthalmol[J]. Indian Journal of Ophthalmology, 2009, 57.
[26] Hasselmo M E. The role of acetylcholine in learning and memory.[J]. Current Opinion in Neurobiology, 2006, 16(6):710–715.
[27] 望庐山, 周丽莎, WANG,等. 电针治疗对阿尔茨海默病大鼠Ach、ChAT、AchE的影响[J]. 针灸临床杂志, 2009, 06期:40-42.
[28] 沈梅红, 刘晓华, 项晓人,等. 电针对脑缺血再灌注模型大鼠纹状体NMDA受体NR2亚基蛋白表达的影响[J]. 中国老年学杂志, 2012, 20期(20):4416-4418.
[29] 孟培燕, 孙国杰, 刘胜洪,等. 电针预处理对血管性痴呆大鼠神经细胞谷氨酸-NMDA受体信号转导通路的影响[J]. 针刺研究, 2008, 02期:103-106.
[30] Irvine E E, Danhiez A, Radwanska K, et al. Properties of Contextual Memory Formed in the Absence of αCaMKII Autophosphorylation[J]. Molecular Brain, 2011, 4(1):1-10.
[31] 王海英, 张秋玲, 李金国,等. 电针对局灶性脑缺血再灌注大鼠脑细胞凋亡及神经功能恢复的影响[J]. 中华行为医学与脑科学杂志, 2010, 第6期(6):510-512.
[32] 马玉侠, 王舒, 石学敏. 电针对脑缺血/再灌注损伤后大鼠海马CA1区神经元L型钙离子通道的调制作用[J]. 山东中医杂志, 2007, 06期:407-409.
[33] 梁慧英, 林阳阳, 燕铁斌,等. 电针对血管性痴呆大鼠海马组织GluA1和CaMKⅡ表达及其磷酸化的影响[J]. 中华物理医学与康复杂志, 2014, 36.
[34] 徐秋玲, 刘涛. 电针对老年痴呆症大鼠海马CaMKⅡ表达的影响[J]. 时珍国医国药, 2013, 01期:236-238.
[35] An L N, Yue Y, Guo W Z, et al. Surgical Trauma Induces Iron Accumulation and Oxidative Stress in a Rodent Model of Postoperative Cognitive Dysfunction[J]. Biological Trace Element Research, 2013, 151(2):277-283.
[36] Fang D, Qian Z M, Luo Q, et al. Hepcidin Suppresses Brain Iron Accumulation by Downregulating Iron Transport Proteins in Iron-Overloaded Rats[J]. Molecular Neurobiology, 2014, 52:1-14.
[37] 于永鹏, 丛海铭, 丛艳彬,等. 电针对6-羟多巴胺毁损大鼠黑质铁含量变化的影响[J]. 中华临床医师杂志(电子版), 2011, 08期(8):2309-2312.
[38] Lin D, Zuo Z. Isoflurane induces hippocampal cell injury and cognitive impairments in adult rats[J]. Neuropharmacology, 2011, 61(8):1354–1359.