针药复合麻醉对老年术后认知的影响：系统评价及Meta分析

The Impact of Combined Acupuncture-Drug Anesthesia on Postoperative Cognition in the Elderly: Systematic Review and Meta-Analysis

摘要: 目的：系统评价针药复合麻醉对老年患者术后认知功能的影响及Meta分析。方法：检索中国知网(CNKI)、维普网(VIP)、万方数据库(Wanfang Data)、中国生物医学文献数据库(SinoMed)、PubMed、EMBASE、Cochrane Library、Web of Science (建库-2025年11月)，收集针药复合麻醉应用于老年患者手术的随机对照试验(RCT)。使用Cochrane偏倚风险评估工具Rob2.0对文献进行评估，并运用Revman 5.4进行Meta分析或描述性分析。结果：纳入36项研究，共3,387例患者。Meta分析显示：相较于传统麻醉，针药复合麻醉可降低患者术后认知功能障碍(POCD)的发生率[RR = 0.56, 95% CI: 0.47~0.66, P < 0.00001]，提高术后MMSE评分[MD = 2.32, 95% CI: 1.45, 3.19, P < 0.00001]，下调血清肿瘤坏死因子-α (TNF-α)、白细胞介素-1β (IL-1β)、白细胞介素-6 (IL-6)、中枢神经特异性蛋白(S-100β)、神经元特异烯醇化酶(NSE)水平(P < 0.05)，降低术后视觉模拟量尺(VAS)评分[MD = −0.34, 95% CI: −0.58, −0.09, P < 0.007]，术后并发症发生率低于传统麻醉[RR = 0.48, 95% CI: 0.34, 0.68, P < 0.0001]。敏感性分析表明结果稳健。GRADE评价显示术后并发症为中等质量证据，其余为低等或极低质量证据。Begg’s检验提示存在发表偏倚。结论：针药复合麻醉在降低老年患者术后认知功能障碍风险，以及改善围术期多项指标方面可能具有积极作用。但由于现有研究的异质性和方法学质量较低，以上发现需谨慎解读。未来还需进一步开展大样本、高质量的随机对照研究加以验证，以提供更可靠的证据。

Abstract: Objective: To systematically evaluate the impact of combined acupuncture-drug anesthesia on post-operative cognitive function in elderly patients and to synthesize the evidence by meta-analysis. Methods: The randomized controlled trials (RCTs) related to combined acupuncture-drug anesthesia on postoperative cognitive function in elderly patients were searched in CNKI, VIP databases, Wanfang databases, SinoMed, PubMed, EMBASE, Cochrane Library, and Web of Science (from database inception to November 2025). Methodological quality was assessed with the Cochrane RoB 2.0 tool, and Meta-analysis was conducted using RevMan 5.4. Results: 36 RCTs comprising 3,387 patients were included. Meta-analysis showed that combined acupuncture-drug anesthesia significantly reduced the incidence of postoperative cognitive dysfunction (POCD) [RR = 0.56, 95% CI: 0.47~0.66, P < 0.00001] and improved postoperative MMSE scores [MD = 2.32, 95% CI: 1.45, 3.19, P < 0.00001] compared to conventional anesthesia. For other outcomes, it significantly lowered serum levels of TNF-α, IL-1β, IL-6, S-100β and NSE (P < 0.05), reduced postoperative Visual Analog Scale scores [MD = −0.34, 95% CI: −0.58, −0.09, P < 0.007], and decreased postoperative complication rates [RR = 0.48, 95% CI: 0.34, 0.68, P < 0.0001]. Sensitivity analysis indicated that the results were robust. GRADE assessment showed that postoperative complications were supported by moderate-quality evidence, while the remaining outcomes were supported by low or very low-quality evidence. Begg’s test suggested the presence of publication bias. Conclusion: Combined acupuncture-drug anesthesia may have a positive effect in reducing the risk of postoperative cognitive dysfunction and improving multiple perioperative outcomes in elderly patients. However, due to the heterogeneity and low methodological quality of the existing studies, these findings should be interpreted with caution. Further large-scale, high-quality randomized controlled trials are needed to provide more reliable evidence.