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Article(id=1322926651536978553, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.09.044, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339892515, onlineDateStr=2026-10-30, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339892515, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339892515, creator=13701087609, updateTime=1793339892515, updator=13701087609, issue=Issue{id=1322926492627378659, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='9', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1757433600000', pubDateStr='2025-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339854628, creator='13701087609', updateTime=1793340762858, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930302095590169, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930302095590170, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=235, endPage=238, ext={EN=ArticleExt(id=1322926653197922938, articleId=1322926651536978553, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Postoperative Acupuncture Intervention on MMSE Score and Recovery Time in Elderly Patients Undergoing Lower Limb Surgery in Orthopedics Department, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the effect of postoperative acupuncture intervention on Mini-mental state examination（MMSE）score and recovery time in elderly patientswith lower extremity surgery in department of orthopedics.

Methods

A total of104 elderly patients undergoing lower limb surgery in orthopedics department of the hospital from January to December 2022 were selected as the research objects. They were divided into two groups according to the random number tablemethod，with 52 cases in each group. The control group was treated with surgery under combined spinal-epidural anesthesia，and the observation group was treated with postoperative acupuncture intervention on the basis of the control group. The vital signs，recovery time，MMSE score，hemorheology and adverse reactions of the two groupswere observed and compared.

Results

There was no significant difference in body temperature，heart rate or blood pressure between the observation group and the control group at1 and 3 days after operation（P>0.05）. The postoperative recovery time of the observation group was significantly shorter than thatof the control group（P<0.05）. After operation，the MMSE score of the control group decreased significantly，and there was no significant change in the observation group. The MMSE score of the observation group was significantly higher than that of the control group（P<0.05）. Before operation，there was no significant difference in high or low shear whole blood viscosity，plasma viscosity，hematocrit and erythrocyte aggregation indexes between the two groups（P>0.05）. After operation，the above hemorheology indexes of the two groups decreased significantly，and those in the observation group were lower than those in the control group（P<0.05）. The incidence of adverse reactions in the observation group and the control group was 3.85%（2/52）and 15.38%（8/52），and the incidence of the observation group was significantly lower than that of the control group（P<0.05）.

Conclusion

Postoperative acupuncture intervention is satisfactory for the elderly patients undergoing lower limb surgery in orthopedics. It can promote the recovery of patients，protect their cognitive function，improve the hemorheology，reduce the occurrence of adverse reactions，and facilitate the rehabilitation of the patients.

, authors=Miaoji WANG, Guoting XU, Xinmao LI, authorsList=Miaoji WANG, Guoting XU, Xinmao LI, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926654271664773, articleId=1322926651536978553, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=术后针灸干预对老年骨科下肢手术患者精神状态评价量表评分及苏醒时间的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

研究术后针灸干预对老年骨科下肢手术患者精神状态评价量表（Mini-mental state examination，MMSE）评分及苏醒时间的影响。

方法

选取老年骨科下肢手术患者104例为研究对象，按照随机数字表法均分为两组，每组52例，对照组腰硬联合麻醉下进行手术治疗，观察组在对照组基础上采用术后针灸干预。观察并比较两组患者的生命体征、恢复时间、MMSE评分、血液流变学以及不良反应情况。

结果

观察组和对照组术后1、3 d体温、心率、血压比较差异均无统计学意义（P>0.05）。观察组术后苏醒时间明显短于对照组（P<0.05），肛门排气时间及住院时间差异无统计学意义（P>0.05）。术前，两组患者的MMSE评分比较差异无统计学意义（P>0.05）；术后，对照组MMSE评分显著下降、观察组无明显变化，观察组MMSE评分显著高于对照组（P<0.05）。术前，两组患者的高切及低切全血黏度、血浆黏度、红细胞压积、红细胞聚集指数差异均无统计学意义（P>0.05）；术后两组患者以上各血液流变学指标均显著下降，并且观察组低于对照组（P<0.05）。观察组、对照组不良反应发生率分别为3.85%（2/52）、15.38%（8/52），观察组显著低于对照组（P<0.05）。

结论

术后针灸干预对老年骨科下肢手术患者效果满意，能够促进患者苏醒，保护其认知功能，改善血液流变学，减少不良反应的发生，利于患者康复。

, authors=王苗级, 徐国亭, 李新茂, authorsList=王苗级, 徐国亭, 李新茂, authorCompany=null, correspAuthors=null, authorNote=

王苗级（1984-），男，河南镇平人，副主任医师，硕士，研究方向：高龄患者的手术麻醉管理。

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王苗级（1984-），男，河南镇平人，副主任医师，硕士，研究方向：高龄患者的手术麻醉管理。

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王苗级（1984-），男，河南镇平人，副主任医师，硕士，研究方向：高龄患者的手术麻醉管理。

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福州：福建中医药大学，2022., articleTitle=梅花针强刺激叩刺风门、血海穴（双侧）配合拔罐放血治疗风热型慢性荨麻疹的临床疗效观察, refAbstract=null), Reference(id=1322926662295368395, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926651536978553, doi=null, pmid=null, pmcid=null, year=2019, volume=38, issue=12, pageStart=1419, pageEnd=1423, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=戴娇娇, 蔡慧, 邱洁, journalName=上海针灸杂志, refType=null, unstructuredReference=戴娇娇，蔡慧，邱洁，等. 基于古今文献和解剖数据考证箕门穴定位及其变革［J］. 上海针灸杂志，2019，38（12）：1419-1423., articleTitle=基于古今文献和解剖数据考证箕门穴定位及其变革, refAbstract=null)], funds=[Fund(id=1322926658847650478, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926651536978553, awardId=2019JDZX2178, language=CN, fundingSource=河南省中医药科学研究专项(2019JDZX2178), fundOrder=null, country=null), Fund(id=1322926658918953647, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926651536978553, awardId=KJGG075, language=CN, fundingSource=南阳市科技局项目(KJGG075), 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language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数体温/（℃）心率/（次/min）舒张压/（mm Hg）收缩压/（mm Hg）
术后1 d术后3 d术后1 d术后3 d术后1 d术后3 d术后1 d术后3 d
观察组5235.98±0.7236.48±0.4058.37±7.2663.49±6.7079.38±5.9183.29±6.11114.97±12.43118.49±10.25
对照组5235.86±0.6436.39±0.4459.30±8.0563.71±7.3378.95±6.4082.54±7.16115.62±11.40117.63±10.32
t值0.8981.0910.6190.1600.3560.5750.2780.426
P值0.3710.2780.5380.8730.7230.5670.7820.671
), ArticleFig(id=1322926658130424485, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926651536978553, language=CN, label=表1, caption=

两组复发性口腔溃疡患者体温、心率、血压比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数体温/（℃）心率/（次/min）舒张压/（mm Hg）收缩压/（mm Hg）
术后1 d术后3 d术后1 d术后3 d术后1 d术后3 d术后1 d术后3 d
观察组5235.98±0.7236.48±0.4058.37±7.2663.49±6.7079.38±5.9183.29±6.11114.97±12.43118.49±10.25
对照组5235.86±0.6436.39±0.4459.30±8.0563.71±7.3378.95±6.4082.54±7.16115.62±11.40117.63±10.32
t值0.8981.0910.6190.1600.3560.5750.2780.426
P值0.3710.2780.5380.8730.7230.5670.7820.671
), ArticleFig(id=1322926658201727654, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926651536978553, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数苏醒时间/（min）肛门排气时间/（h）住院时间/（d）
观察组5211.04±3.1222.87±4.2912.96±3.01
对照组5213.90±2.8723.11±3.8313.24±2.95
t值4.8650.3010.479
P值<0.001｀0.7640.633
), ArticleFig(id=1322926658302390951, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926651536978553, language=CN, label=表2, caption=

两组复发性口腔溃疡患者苏醒时间、肛门排气时间及住院时间比较（±s）

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组别例数苏醒时间/（min）肛门排气时间/（h）住院时间/（d）
观察组5211.04±3.1222.87±4.2912.96±3.01
对照组5213.90±2.8723.11±3.8313.24±2.95
t值4.8650.3010.479
P值<0.001｀0.7640.633
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组别例数术前术后t值P值
观察组5228.74±1.1528.28±1.391.8390.069
对照组5228.80±1.0726.03±2.148.349<0.001
t值0.2756.358--
P值0.784<0.001--
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两组复发性口腔溃疡患者MMSE评分比较（±s）

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组别例数术前术后t值P值
观察组5228.74±1.1528.28±1.391.8390.069
对照组5228.80±1.0726.03±2.148.349<0.001
t值0.2756.358--
P值0.784<0.001--
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组别例数高切全血黏度/（mPa·s）低切全血黏度/（mPa·s）血浆黏度/（mPa·s）红细胞压积/（%）红细胞聚集指数/（%）
术前术后术前术后术前术后术前术后术前术后
观察组527.26±0.395.89±0.30a9.34±1.057.19±1.36a1.80±0.091.40±0.26a54.38±0.7942.30±0.68a49.21±2.4029.13±8.32a
对照组527.31±0.426.62±0.51a9.40±1.228.24±1.18a1.78±0.111.58±0.19a54.12±0.8046.17±0.74a48.96±3.0533.64±7.37a
t值0.6298.8970.2694.2051.0154.0311.66827.7690.4652.926
P值0.531<0.0010.789<0.0010.313<0.0010.099<0.0010.6430.004
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两组复发性口腔溃疡患者患者血液流变学指标比较（±s）

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组别例数高切全血黏度/（mPa·s）低切全血黏度/（mPa·s）血浆黏度/（mPa·s）红细胞压积/（%）红细胞聚集指数/（%）
术前术后术前术后术前术后术前术后术前术后
观察组527.26±0.395.89±0.30a9.34±1.057.19±1.36a1.80±0.091.40±0.26a54.38±0.7942.30±0.68a49.21±2.4029.13±8.32a
对照组527.31±0.426.62±0.51a9.40±1.228.24±1.18a1.78±0.111.58±0.19a54.12±0.8046.17±0.74a48.96±3.0533.64±7.37a
t值0.6298.8970.2694.2051.0154.0311.66827.7690.4652.926
P值0.531<0.0010.789<0.0010.313<0.0010.099<0.0010.6430.004
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组别例数伤口感染下肢静脉血栓嗜睡头晕恶心合计
观察组521（1.92）0（0.00）0（0.00）1（1.92）0（0.00）2（3.85）
对照组522（3.85）1（1.92）2（3.85）1（1.92）2（3.85）8（15.38）
χ2值3.983
P值0.046
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两组复发性口腔溃疡患者不良反应情况比较

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组别例数伤口感染下肢静脉血栓嗜睡头晕恶心合计
观察组521（1.92）0（0.00）0（0.00）1（1.92）0（0.00）2（3.85）
对照组522（3.85）1（1.92）2（3.85）1（1.92）2（3.85）8（15.38）
χ2值3.983
P值0.046
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术后针灸干预对老年骨科下肢手术患者精神状态评价量表评分及苏醒时间的影响
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王苗级 , 徐国亭 , 李新茂
中华中医药学刊 | 省级项目平台 2025,43(9): 235-238
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中华中医药学刊 |省级项目平台 2025 , 43 (9) : 235 -238
术后针灸干预对老年骨科下肢手术患者精神状态评价量表评分及苏醒时间的影响
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王苗级（1984-），男，河南镇平人，副主任医师，硕士，研究方向：高龄患者的手术麻醉管理。

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王苗级（1984-），男，河南镇平人，副主任医师，硕士，研究方向：高龄患者的手术麻醉管理。

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王苗级, 徐国亭, 李新茂
作者信息
  • 南阳医学高等专科学校第一附属医院，河南 南阳 473000
作者简介:

王苗级（1984-），男，河南镇平人，副主任医师，硕士，研究方向：高龄患者的手术麻醉管理。

Effect of Postoperative Acupuncture Intervention on MMSE Score and Recovery Time in Elderly Patients Undergoing Lower Limb Surgery in Orthopedics Department
Miaoji WANG, Guoting XU, Xinmao LI
Affiliations
  • First Affiliated Hospital of Nanyang Medical College，Nanyang 473000，Henan，China
出版时间: 2025-09-10 doi: 10.13193/j.issn.1673-7717.2025.09.044
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摘要
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目的

研究术后针灸干预对老年骨科下肢手术患者精神状态评价量表（Mini-mental state examination，MMSE）评分及苏醒时间的影响。

方法

选取老年骨科下肢手术患者104例为研究对象，按照随机数字表法均分为两组，每组52例，对照组腰硬联合麻醉下进行手术治疗，观察组在对照组基础上采用术后针灸干预。观察并比较两组患者的生命体征、恢复时间、MMSE评分、血液流变学以及不良反应情况。

结果

观察组和对照组术后1、3 d体温、心率、血压比较差异均无统计学意义（P>0.05）。观察组术后苏醒时间明显短于对照组（P<0.05），肛门排气时间及住院时间差异无统计学意义（P>0.05）。术前，两组患者的MMSE评分比较差异无统计学意义（P>0.05）；术后，对照组MMSE评分显著下降、观察组无明显变化，观察组MMSE评分显著高于对照组（P<0.05）。术前，两组患者的高切及低切全血黏度、血浆黏度、红细胞压积、红细胞聚集指数差异均无统计学意义（P>0.05）；术后两组患者以上各血液流变学指标均显著下降，并且观察组低于对照组（P<0.05）。观察组、对照组不良反应发生率分别为3.85%（2/52）、15.38%（8/52），观察组显著低于对照组（P<0.05）。

结论

术后针灸干预对老年骨科下肢手术患者效果满意，能够促进患者苏醒，保护其认知功能，改善血液流变学，减少不良反应的发生，利于患者康复。

骨科  /  下肢手术  /  老年  /  针灸  /  腰硬联合麻醉  /  简易精神状态评价量表
Objective

To study the effect of postoperative acupuncture intervention on Mini-mental state examination（MMSE）score and recovery time in elderly patientswith lower extremity surgery in department of orthopedics.

Methods

A total of104 elderly patients undergoing lower limb surgery in orthopedics department of the hospital from January to December 2022 were selected as the research objects. They were divided into two groups according to the random number tablemethod，with 52 cases in each group. The control group was treated with surgery under combined spinal-epidural anesthesia，and the observation group was treated with postoperative acupuncture intervention on the basis of the control group. The vital signs，recovery time，MMSE score，hemorheology and adverse reactions of the two groupswere observed and compared.

Results

There was no significant difference in body temperature，heart rate or blood pressure between the observation group and the control group at1 and 3 days after operation（P>0.05）. The postoperative recovery time of the observation group was significantly shorter than thatof the control group（P<0.05）. After operation，the MMSE score of the control group decreased significantly，and there was no significant change in the observation group. The MMSE score of the observation group was significantly higher than that of the control group（P<0.05）. Before operation，there was no significant difference in high or low shear whole blood viscosity，plasma viscosity，hematocrit and erythrocyte aggregation indexes between the two groups（P>0.05）. After operation，the above hemorheology indexes of the two groups decreased significantly，and those in the observation group were lower than those in the control group（P<0.05）. The incidence of adverse reactions in the observation group and the control group was 3.85%（2/52）and 15.38%（8/52），and the incidence of the observation group was significantly lower than that of the control group（P<0.05）.

Conclusion

Postoperative acupuncture intervention is satisfactory for the elderly patients undergoing lower limb surgery in orthopedics. It can promote the recovery of patients，protect their cognitive function，improve the hemorheology，reduce the occurrence of adverse reactions，and facilitate the rehabilitation of the patients.

orthopedics  /  lower limbs surgery  /  old age  /  acupuncture  /  combined spinal epidural anesthesia  /  simple Mental State Assessment Scale
王苗级, 徐国亭, 李新茂. 术后针灸干预对老年骨科下肢手术患者精神状态评价量表评分及苏醒时间的影响. 中华中医药学刊, 2025 , 43 (9) : 235 -238 . DOI: 10.13193/j.issn.1673-7717.2025.09.044
Miaoji WANG, Guoting XU, Xinmao LI. Effect of Postoperative Acupuncture Intervention on MMSE Score and Recovery Time in Elderly Patients Undergoing Lower Limb Surgery in Orthopedics Department[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (9) : 235 -238 . DOI: 10.13193/j.issn.1673-7717.2025.09.044
正文
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骨科下肢手术是常见手术，近年来随着我国人口老龄化趋势加剧，老年骨科下肢手术患者也在不断增加，是较为特殊的群体。目前对于这类手术患者多选择腰硬联合麻醉方式，这是腰麻和硬膜外麻醉联合阻滞，由于它是两种麻醉方式，既有腰麻的麻醉起效快、肌肉松弛及镇痛效果确切等优点，又有硬膜外麻醉可满足长时间手术需要和维持术后镇痛的长处以取两者长处，有利于保持患者各个系统功能的稳定[1-3]。而且这种麻醉方法手术结束后保留硬膜外导管，还可以作为术后镇痛[4]。良好的术后镇痛还有利于老年下肢手术患者术后早期的下床活动，减少术后的一些相关的并发症，有利于患者快速地康复。但是在实际应用过程中，其在缓解机体应激反应的同时也对患者的精神状态产生了一定影响，需要引起关注[5-6]。有研究将中医穴位刺激应用于腰硬联合麻醉的老年骨科下肢手术患者尝试帮助其获得良好的镇痛镇静作用，并促进术后体温、精神状态等的恢复[7]。在此基础上，本研究探讨术后针灸干预对老年骨科下肢手术患者精神状态评价量表（Mini-Mental State Examination，MMSE）评分及苏醒时间的影响，现报道如下。
1　资料与方法
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1.1　一般资料
选取2022年1月—12月医院老年骨科下肢手术患者104例为研究对象，纳入标准：年龄≥60岁；均符合骨科下肢手术适应证并能够顺利完成手术者；患者及其家属知情同意研究内容。排除标准：凝血功能异常者；严重心肝肾功能不全患者；糖尿病、高血压等基础疾病患者；近2周服用过类固醇药物或接受过免疫功能治疗者。将所有患者按照随机数字表法均分为两组，每组52例。对照组中，男29例，女23例；年龄60～79岁，平均（65.9±4.9）岁；身体质量指数17.9～26.8 kg/m2，平均（22.7±2.4）kg/m2；胫腓骨骨折手术17例，股骨骨折手术15例，人工全膝置换术4例，髋关节置换术5例，人工股骨头置换术8例，其他3例。观察组中，男30例，女22例；年龄60～80岁，平均（66.1±5.2）岁；身体质量指数17.8～27.1 kg/m2，平均（22.9±2.1）kg/m2；胫腓骨骨折手术18例，股骨骨折手术14例，人工全膝置换术3例，髋关节置换术5例，人工股骨头置换术9例，其他3例。两组患者的一般资料进行比较，差异均无统计学意义（P>0.05），均衡可比。此次研究内容符合医学伦理学要求。
1.2　方法
对照组腰硬联合麻醉下进行手术治疗，患者取侧卧位，双手抱膝，大腿贴近腹壁，头尽量向胸部屈曲，使腰背部向后弓成弧形，根据患者情况在预定点做局麻皮丘，并在皮下及棘间韧带逐层进入，针尖穿刺黄韧带及蛛网膜时，各有一次落空感，随即拔出针芯，有脑脊液流出，穿刺成功，注入0.5%布比卡因3 mL，注药前后均应轻轻回抽脑脊液，确保药液全部注入蛛网膜下腔，留置硬膜外导管，辅助患者摆放术中所需体位，手术过程中根据手术需要可硬膜外注入0.5%罗哌卡因3～5 mL，手术后常规镇痛、抗感染。
观察组在对照组基础上采用术后针灸干预，取穴合谷穴、太冲、足三里、血海及箕门穴，常规消毒处理穴位处皮肤，以毫针刺，直刺合谷穴（0.5～1.0寸）、太冲（0.3～0.5寸）、足三里（1～2寸）、血海（1～2寸）及箕门穴（0.5～1.0寸），得气后留置30 min，出针稍微捻转，待针下轻松滑利时，捻针慢慢退出皮肤，消毒棉球按压针刺部位片刻，2次/d。7 d为1个疗程。
1.3　观察项目
（1）生命体征：体温、心率、血压。（2）恢复时间：苏醒时间、肛门排气时间及住院时间。（3）MMSE评分[8]：包括时间/地点定向力（10分）、即刻记忆（3分）、注意力和计算力（5分）、延迟记忆（3分）、语言功能（8分）、结构模仿视空间（1分）共计6个维度共计30分，总分≥27分为正常，否则分数越低、表明精神状态越差。（4）血液流变学：受检患者均取空腹静脉血，常规离心处理分离上清液获得样本，应用全自动血流变仪测定高切及低切全血黏度、血浆黏度、红细胞压积、红细胞聚集指数。（5）不良反应情况：包括伤口感染、下肢静脉血栓、嗜睡、头晕、恶心等。
1.4　统计学分析
所获数据资料应用SPSS 22.0统计软件包进行分析，计数资料以例（%）表示，采用χ2检验，计量资料呈正态分布、用表示、采用t检验，若P<0.05则差异有统计学意义。
2　结果
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2.1　生命体征比较
观察组和对照组术后1、3 d体温、心率、血压比较差异均无统计学意义（P>0.05），均逐渐恢复到了正常水平。见表1。
2.2　恢复时间比较
观察组术后苏醒时间明显短于对照组（P<0.05），肛门排气时间及住院时间差异无统计学意义（P>0.05）。见表2。
2.3　MMSE评分比较
术前，两组患者的MMSE评分比较差异无统计学意义（P>0.05）；术后，对照组MMSE评分显著下降、观察组无明显变化，观察组MMSE评分显著高于对照组（P<0.05）。见表3。
2.4　血液流变学指标比较
术前，两组患者的高切及低切全血黏度、血浆黏度、红细胞压积、红细胞聚集指数差异均无统计学意义（P>0.05）；术后，两组患者的以上各血液流变学指标均显著下降，并且观察组低于对照组（P<0.05）。见表4。
2.5　不良反应情况比较
观察组、对照组不良反应发生率分别为3.85%、15.38%，观察组显著低于对照组（P<0.05）。见表5。
3　讨论
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腰麻是把局麻药注入蛛网膜下腔，阻断神经功能的传导，使神经支配区域的运动感觉丧失，主要适用于下肢手术或者下腹部手术，特点是起效迅速、镇痛完善、肌肉松弛好[9]。硬膜外麻醉是将局麻药注入硬膜外腔，阻滞脊神经根，暂时使其支配区域产生麻痹，其特点是可以连续阻滞连续持续给药，手术时间多长就可以维持麻醉效果有多长，还可用于术后镇痛[10]。腰硬联合麻醉的优点在于既保留了腰麻起效快，镇痛与肌松完善的优点，也便于调节麻醉平面，防止麻醉平面过高[11-12]。研究提示将其应用于老年骨科下肢手术中能够充分考虑老年人的特殊性，进而使麻醉的安全性和有效性得到提高，保证手术顺利地实施，且对保障患者的生命安全也具有重要意义[13-14]。
腰硬联合麻醉过程中使用的麻醉药物会作用于神经系统，抑制大脑皮层对传入刺激的反应，老年手术患者因功能衰退、耐受力减弱等容易出现精神状态不佳、认知功能差[15]。近年来，中医药特色优势进一步彰显，服务能力不断提升，相关工作者将耳穴埋豆联合小掀针方法以及电针穴位刺激等方法引入到老年骨科手术患者获得了较为满意的效果[16-17]。本研究结合我院实际情况，对腰硬联合麻醉下进行老年骨科下肢手术的患者进行术后针灸干预，达到了更好的促醒、改善精神状态效果，血液流变学指标也达到更佳水平。分析考虑：合谷穴为全身反应的最大刺激点，可镇静止痛，通经活经，清热解表；太冲穴是肝经的原穴，是针灸中非常重要的一个穴位，有疏通下肢经络，行气止痛的功效，需要注意针灸时要取穴准确，且要在空隙处针尖方向要向涌泉[18]。足三里穴是“足阳明胃经”的主要穴位之一，具有调理脾胃、补中益气、通经活络、疏风化湿、扶正祛邪之功能。现代医学研究证实，针灸刺激足三里穴，可使胃肠蠕动有力而规律，并能提高多种消化酶的活力，增进食欲，帮助消化[19]；在神经系统方面，可促进脑细胞机能的恢复，提高大脑皮层细胞的工作能力[20]；在循环系统、血液系统方面，可以改善心功能，调节心律，增加红细胞、白细胞、血色素和血糖量[21]；在内分泌系统方面，对垂体-肾上腺皮质系统功能有双向性良性调节作用，提高机体防御疾病的能力[22]。血海为足太阴脾经腧穴，乃本经脉气所发，为脾血归聚之海，并善治血分病证，本穴具有祛风清热，调和气血，宣通下焦，行血活血之功[23-24]。《针灸甲乙经》曰：“箕门。在鱼腹上越两筋间，动脉应手，大阴内布，足太阴脉气所发，刺人三分，留六呼，灸三壮”。箕门穴有健脾利湿、舒筋通络的功效，《素问·刺禁论篇》曰：“刺阴股中大脉，血出不止死”。因此，针灸箕门穴时一定注意避开动脉[25]。
上述内容可见，术后针灸干预结合腰硬联合麻醉对老年骨科下肢手术患者效果满意，能够促进患者苏醒，保护其认知功能，改善血液流变学，减少不良反应的发生，利于患者康复。
基金
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  • 河南省中医药科学研究专项(2019JDZX2178)
  • 南阳市科技局项目(KJGG075)
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参考文献 引证文献
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2025年第43卷第9期
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doi: 10.13193/j.issn.1673-7717.2025.09.044
  • 首发时间：2026-10-30
  • 出版时间：2025-09-10
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河南省中医药科学研究专项(2019JDZX2178)
南阳市科技局项目(KJGG075)
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    南阳医学高等专科学校第一附属医院，河南 南阳 473000
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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