目的 系统评价围术期电针干预对全麻手术患者术后谵妄(POD)的影响.方法 计算机检索PubMed、Embase、Cochrane、中国知网、万方和中国生物医学文献数据库(CBM),收集电针干预对全麻手术患者POD的随机对照试验(RCT),检索时间为建库至2022年3月.采用RevMan 5.3软件进行Meta分析.结果 共纳入11篇RCT研究,共计患者924例,电针组463例,对照组461例.与对照组比较,电针组POD发生率明显降低(RR=0.44,95％CI 0.35～0.54,P<0.001),术后1 d血清S100β蛋白(SMD=-1.83,95％CI-2.66～-1.01,P<0.001)和神经元特异性烯醇化酶(NSE)浓度(MD=-3.85 ng/ml,95％CI-4.39～-3.31 ng/ml,P<0.001)明显降低.结论 围术期使用电针可降低患者POD的发生率、降低患者术后1 d血清S100β蛋白和NSE浓度.

INTRODUCTION:Ventilator-induced lung injury (VILI) is the most common complication associated with mechanical ventilation. Electroacupuncture (EA) has shown potent anti-inflammatory effects. This study aimed to investigate the effects of EA on VILI and explore the underlying mechanisms. METHODS:Male C57BL/6 mice were subjected to high tidal volume ventilation to induce VILI. Prior to mechanical ventilation, mice received treatment with EA, nonacupoint EA, or EA combined with zinc protoporphyrin. RESULTS:EA treatment significantly improved oxygenation, as indicated by increased PaO2 levels in VILI mice. Moreover, EA reduced lung injury score, lung wet/dry weight ratio, and protein concentration in bronchoalveolar lavage fluid. EA also decreased the expression of pro-inflammatory cytokines including interleukin (IL)-1β, IL-6, tumor necrosis factor-α, IL-18, chemokine keratinocyte chemoattractant, macrophage inflammatory protein 2, and malondialdehyde. Furthermore, EA increased the activities of antioxidant enzymes superoxide dismutase, catalase, and glutathione peroxidase in VILI mice. At the molecular level, EA upregulated the expression of Nrf2 (nucleus) and heme oxygenase -1, while down-regulating the expression of p-NF-κB p65, NLR Family Pyrin Domain Containing 3, Cleaved Caspase-1, and ASC in VILI mice. Notably, the effects of EA were reversed by zinc protoporphyrin treatment, nonacupoint EA did not affect the aforementioned indicators of VILI. CONCLUSIONS:EA alleviates VILI by inhibiting the NLR Family Pyrin Domain Containing three inflammasome through activation of the Nrf2/HO-1 pathway.

Objective: This study aimed to evaluate the effect of electroacupuncture preconditioning on regional cerebral oxygen saturation (rSO(2)) levels in elderly patients with diabetes. Methods: Forty patients undergoing elective diabetic foot surgery were enrolled in this study. All patients were aged 65 years and above and weighed 45-75 kg. All were characterized as class II or III according to the American Society of Anesthesiologists' physical status classification system. Patients were divided randomly into an electroacupuncture group (group E) and a control group (group C); both groups comprised 20 patients. In group E, the DU20 (Baihui), DU24 (Shenting), and EX-HN1 (Sishencong) acupoints were selected for electroacupuncture 30 min prior to administering anesthesia, while in group C, patients underwent routine anesthesia without electro-acupuncture. The patients in both groups were anesthetized using a sciatic nerve block. The number of cases with increased or decreased regional oxygen saturation (rSO(2)) compared with the baseline as well as rSO(2) variability in the two groups were recorded and compared. Results: There was no significant difference in the preoperative rSO(2) values between the two groups (54.4 +/- 4.8 (L), 53.9 +/- 5.2 (R) [group C] vs 54.1 +/- 5.2 (L), 54.5 +/- 4.6 (R)[group E]). Compared with group C, the rSO(2) in group E increased (50.3 +/- 3.9 [group C] vs 58.4 +/- 3.2[group E]), and this difference was statistically significant (P < 0.001). Conclusion: Electroacupuncture stimulation can increase rSO(2) levels in patients with diabetes.

目的:探讨针刺对老年糖尿病患者局部脑氧饱和度(rSO2)的影响.方法:选取医院择期行糖尿病足手术的40例老年患者,采用随机数字表法将其分为针刺组和对照组,每组20例.针刺组采用针刺后常规静脉全身麻醉;对照组不行针刺,采用常规静脉麻醉.观察记录两组患者的基本情况、既往病史和术中指标,比较两组患者rSO2的基线值、最小值及最大值.结果:两组患者年龄、性别、体质量指数(BMI)、美国麻醉医师协会(ASA)分级、糖尿病病程、高血压病史、肺部慢性疾病病史、术前血红蛋白水平以及rSO2基线值的比较,差异均无统计学意义.针刺组rSO2最小值和最大值均高于对照组,其差异均有统计学意义(t=6.2813,t=9.4123;P<0.05).结论:手术前针刺预处理可以提升老年糖尿病手术患者rSO2.

Type 2 diabetes (T2DM) is a well known risk factor for Alzheimer's disease. Mitochondria are the center of intracellular energy metabolism and the main source of reactive oxygen species. Mitochondrial dysfunction has been identified as a key factor in diabetes-associated brain alterations contributing to neurodegenerative events. Defective insulin signaling may act in concert with neurodegenerative mechanisms leading to abnormalities in mitochondrial structure and function. Mitochondrial dysfunction triggers neuronal energy exhaustion and oxidative stress, leading to brain neuronal damage and cognitive impairment. The normality of mitochondrial function is basically maintained by mitochondrial quality control mechanisms. In T2DM, defects in the mitochondrial quality control pathway in the brain have been found to lead to mitochondrial dysfunction and cognitive impairment. Here, we discuss the association of mitochondrial dysfunction with T2DM and cognitive impairment. We also review the molecular mechanisms of mitochondrial quality control and impacts of mitochondrial quality control on the progression of cognitive impairment in T2DM.

目的 探讨七氟醚对外科腹腔镜气腹时肺动力学变化及术后肺并发症的影响.方法 选择2019年1月至2021年4月首都医科大学附属北京中医医院行腹腔镜下胃肠道手术患者125例,按术中是否使用七氟醚分为观察组86例(术中给予七氟醚)和对照组39例(术中不给予七氟醚).统计气腹后患者相关因素、肺动力学和循环参数与术后结局相关性.结果 两组患者术后死亡率、住院天数、肺部并发症发生率、入ICU率、ICU气管拔管天数比较,差异无显著性(P>0.05);观察组手术时间、接受术后雾化治疗率高于对照组,差异有显著性(P<0.05).年龄、美国麻醉师协会分级、手术时间、呼出潮气量与术后结局有相关性(P<0.05),分组、除呼出潮气量外其他术中肺动力学参数与结局不相关(P>0.05).肺动力学所有参数组内比较,差异有显著性(P<0.05).两组组间比较,潮气量、每分钟通气量、气道峰压、气道平台压、气道平均压、气道吸气阻力、呼气末正压差异无显著性(P>0.05);观察组呼吸频率、动态顺应性、静态顺应性、吸气最后20％阶段的顺应性与整个顺应性的比值(C20/C)、七氟醚变量值高于对照组,差异有显著性(P<0.05).结论 外科腹腔镜气腹时应用七氟醚,有更好的肺动态顺应性、静态顺应性、C20/C,虽接受更多的术后雾化治疗,但不影响术后结局;患者年龄、美国麻醉师协会分级、手术时间、呼出潮气量与术后结局有关,除呼出潮气量外其他肺动力学参数对结局无影响.

目的:探讨脑氧饱和度(rSO2)的基线水平监测及其影响因素.方法:选取医院收治的101例择期手术患者,101例患者存在4类并发症,按照并发症类型相对应的分为糖尿病组(46例)和非糖尿病组(55例);高血压组(57例)和非高血压组(44例);贫血组(25例)和非贫血组(76例);有糖尿病并发症的疮疡科组(46例)和无糖尿病并发症的非疮疡科组(55例).对101例患者的术前基本情况、既往病史及rSO2基线值进行相关分析,监测并比较糖尿病组与非糖尿病组(包括比较其中的糖尿病病史≤10年与>10年的患者)、疮疡科组与非疮疡科组、高血压组与非高血压组、贫血组与非贫血组以及年龄<60岁与≥60岁患者rSO2基值差异;对术前基本资料与rSO2基线进行相关分析和多元线性回归分析.结果:糖尿病组患者左、右侧rSO2基线值均小于非糖尿病组,差异有统计学意义(t=-4.251,t=-3.881;P<0.05),而其中糖尿病病程>10年患者左、右侧rSO2基线值均小于病程≤10年患者;有糖尿病并发症的疮疡科组患者左、右侧rSO2基线值均低于无糖尿病并发症的非疮疡科组,差异有统计学意义(t=-3.834,t=-3.566;P<0.05);高血压组患者左、右侧rSO2基线值均小于非高血压组,差异有统计学意义(t=-2.743,t=-2.008;P<0.05);年龄≥60岁老年患者左侧rSO2基线值小于年龄<60岁患者,差异有统计学意义(t=2.072,P<0.05).糖尿病、糖尿病病程、糖尿病并发症和年龄对左、右侧rSO2基线值影响的相关性显著(r=-0.4,r=-0.3,r=0.3,r=-0.2;P<0.05).结论:手术前合并糖尿病,糖尿病病史时间长,糖尿病并发症,高龄使患者rSO2明显降低.