针刺疗法对高龄骨折患者围术期心率变异性的影响

Effect of Acupuncture on Perioperative Heart Rate Variability for Elderly Patients with Fracture

目的:观察针刺疗法对高龄骨折患者围术期心率变异的有效性。方法:选择我院年龄70岁以上,ASA≥Ⅱ级,纳入研究组者应至少合并以下一种基础疾病:高血压、糖尿病、冠心病、心肌缺血、心律失常的髋部或股骨骨折后择期行骨折切开复位内固定或关节置换术者120例,将纳入的患者,根据是否患有合并症分为两组(H组和N组),两组再按随机数字表分为HS组:有合并症研究组(n=30),HD组:有合并症对照组(n=30),NS组:无合并症研究组(n=30),ND组:无合并症对照组(n=30),HS组和NS组于麻醉前、术后第1天、术后第2天选择双侧内关和足三里进行针刺疗法,手术前和手术后第3天都做24小时动态心电图。记录患者针刺后的血压、心率、SPO2、心肌耗氧量。记录术前、术后两次动态心电图中心率变异性分析指标SDNN、Trianglar Index。结果:研究组与对照组、心率、SPO2无差异(P>0.05);而研究组收缩压、心肌耗氧量、均显著低于常规组(P<0.05)。HS组术后SDNN、Trianglar Index较术前均有升高,差异有统计学意义(P<0.05),组间比较,术前HS组和HD组SDNN、Trianglar Index低于NS组和ND组,差异有统计学意义(P<0.05),而术后HD组SDNN、Trianglar Index低于HS组、NS组和ND组,差异有统计学意义(P<0.05)。结论:初步研究发现围术期电针内关和足三里有效降低了患者收缩压和心肌耗氧量,提高心率变异性指标,降低了围手术期心血管不良反应发生率,提高围术期安全性。

Objective:Evaluating the effectiveness of acupuncture in improving the perioperative heart rate variability in elderly patients with fracture.Methods:Total 120 elderly inpatients who have Hip or Femur fracture followed by internal fixation or joint replacement were recruited.These patients were minimum 70 years old,ASA≥Ⅱlevel,and had at least one of the following basic diseases:Hypertension,diabetes,coronary heart disease,myocardial ischemia and arrhythmia.Based on if patients had basic diseases,they were divided into two groups(H group and N group).Next,patients with basic disease were randomly divided into HS study group(n=30)and HD controlled group(n=30).Patients without basic disease were randomly divided NS study group(n=30)and ND controlled group(n=30).Both the HS and the NS group had acupuncture therapy in Neiguan and Zusanli at the day before and the 1st and 2nd day after surgery.A 24-hour ambulatory electrocardiogram was performed before and on the 3rd day after surgery to record patient’s blood pressure,heart rate,SPO2 and myocardial oxygen consumption post acupuncture treatment.The SDNN and Trianglar Index were recorded from dynamic electrocardiograms before and after surgery.Results:Heart rate and SPO2 had no significant different between the study group and the controlled group(P>0.05).However,the study group had significant lower systolic blood pressure and myocardial oxygen consumption than that of the controlled group(P<0.05).After operation,the SDNN and Trianglar Index of the HS group were significantly higher than those before operation(P<0.05).Compared between groups,the SDNN and Trianglar Index of the HS and the HD group before operation were significantly lower than those of the NS group and the ND group(P<0.05),and the SDNN and Trianglar Index of the HD group were significantly lower than those of the HS,the NS and the ND group after operation(P<0.05).Conclusion:My study shows that electroacupuncture at Neiguan and Zusanli during the perioperative period can effectively reduce the patient’s systolic blood pressure and myocardial oxygen consumption,increase the heart rate variability index,reduce the incidence of perioperative cardiovascular adverse reactions and improve the perioperative safety.