穴位按摩干预围麻醉期对老年患者膝关节置换术后认知功能的影响

Effect of Acupoint Massage Intervention on Cognitive Function After Knee Arthroplasty in Elderly Patients During Perianesthesia

目的观察穴位按摩干预围麻醉期对老年患者膝关节置换术后认知功能的影响。方法选择期ASAI-III级,行膝关节置换术老年患者75例,随机分为穴位按摩组(X组39例)选择百会、内关、合谷、神门穴于术前1天、麻醉后手术开始前、术后1、2、3 d做穴位按摩治疗,4 d后指导患者每天行穴位按摩;对照组(N组36例)除穴位按摩各项治疗同X组。评价两组麻醉效果及术后认知情况。结果 MMSE评分术后3天与术前1天比较,X组和N组均明显降低(P<0.05),术后3天X组与N组比较明显升高(P<0.05),X组POCD发生率7.7%明显低于N组16.7%(P<0.05);术后1、2、3 d PCIA按压量X组与N组比较明显减少(P<0.05)。结论穴位按摩干预围麻醉期可改善老年患者膝关节置换术后认知功能,降低POCD发生,减少术后麻醉药用量,此方案值得临床推广应用。

Objective To observe the effect of acupoint massage intervention in perianesthesia on cognitive function of elderly patients after knee joint replacement.Methods Seventy-five elderly patients who underwent knee joint replacement were randomly divided into acupoint massage group(39cases in group X).Baihui,neiguan,hegu and shenmen points were selected for acupoint massage treatment1day before surgery,1day after anesthesia,1day after surgery,2days after surgery,and3days after surgery.Control group(N group:36cases)except acupoint massage,all treatments were the same as X group.To evaluate the effect of anesthesia and postoperative cognition of the two groups.Results Three days after surgery,the incidence of POCD in group X was significantly lower than that in group N(P<0.05).The incidence of POCD in group X was significantly higher than that in group N(P<0.05).The incidence of POCD in group X was7.7%lower than that in group N(P<0.05).The amount of PCIA compressions in group X and group N was significantly reduced(P<0.05).Conclusion Acupoint massage intervention during perianesthesia can improve the cognitive function of elderly patients after knee joint replacement,reduce the occurrence of POCD,and reduce the amount of postoperative anesthesia.This program is worthy of clinical application.