菖蒲郁金汤联合耳穴压丸预防髋关节置换术的老年患者术后谵妄的作用

Effect of Changpu Yujin Decoction and Ear-Point Pressing Pills in Preventing Postoperative Delirium in the Elderly

目的观察菖蒲郁金汤(Changpu-yujin decoction)联合耳穴压丸(ear-point pressing pills)预防老年术后谵妄(Delirium)的效果及对患者睡眠质量和血清乙酰胆碱酯酶(acetyl cholinesterase AchE)的影响。方法选取2019年1月—2020年1月期间于广州中医药大学第三附属医院拟行髋关节置换术的老年患者120例,采用随机数字表法分为对照组、耳穴压丸组、菖蒲郁金汤组、联合组,各30例。在围手术期,对照组给予常规处理,耳穴压丸组术前实施耳穴压丸法,菖蒲郁金汤组手术前后给予菖蒲郁金汤服用,联合组给予耳穴压丸法联合菖蒲郁金汤,记录患者手术前后各时间点的简易精神状态量表(mini-mental state examination,MMSE)评分、谵妄量表分析系统(the confused assessment method,CAM-CR)、匹兹堡睡眠质量指数评分(Pittsburgh sleep quality index score,PSQI),并记录患者谵妄发生率,检测患者手术前后血清AchE水平。结果 (1)对照组耳穴压丸组和菖蒲郁金汤组术后1 d、术后3 d的MMSE评分均较术前显著降低(P<0.05),术后7 d恢复术前水平(P> 0.05),联合组术后无显著变化(P> 0.05);耳穴压丸组、菖蒲郁金汤组以及联合组术后1 d和术后3 d的MMSE评分均显著高于对照组(P<0.05),联合组术后1 d和术后3 d的MMSE评分显著高于耳穴压丸组、菖蒲郁金汤组(P<0.05),耳穴压丸组和菖蒲郁金汤组术后各时间点的MMSE评分比较,差异无统计学意义(P> 0.05)。(2)四组患者术后1 d和术后3 d的CAM评分均较术前显著升高(P<0.05),且对照组均高于其余三组(P<0.05),联合组低于耳穴压丸组和菖蒲郁金汤组(P<0.05),耳穴压丸组、菖蒲郁金汤组比较,差异无统计学意义(P> 0.05);四组患者术后7 d CAM-CR评分比较,差异无统计学意义(P> 0.05)。(3)联合组谵妄发生率10.00%(3/30)显著低于其他三组(P<0.05),对照组谵妄发生率46.67%(14/30)显著高于其他三组(P<0.05),耳穴压丸组与菖蒲郁金汤组谵妄发生率比较,差异无统计学意义(P> 0.05)。(4)耳穴压丸组、菖蒲郁金汤组以及联合组术后7 d的PSQI评分均较术前显著降低(P<0.05),且优于对照组(P<0.05);联合组低于耳穴压丸组和菖蒲郁金汤组(P<0.05),对照组手术前后PSQI评分无显著变化(P> 0.05)。(5)四组患者术后7 d血清AchE水平均较术前显著降低(P<0.05);术后7 d耳穴压丸组、菖蒲郁金汤组以及联合组血清AchE水平与对照组比较,差异无统计学意义(P>0.05)。结论菖蒲郁金汤联合耳穴压丸预防老年术后谵妄疗效确切,降低患者术后谵妄发生率,其作用机制可能与改善认知功能和患者睡眠质量有关,对患者血清AchE水平无明显影响。

Objective To observe the effect of Changpu Yujin decoction combined with ear-point pressing pills in preventing postoperative delirium in elderly patients and its effects on the sleep and serum acetyl cholinesterase(AchE).Methods From January 2019 to January 2020,120 elderly patients who were planned to undergo hip arthroplasty in the Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were selected and divided into the control group,the ear acupoint pressing pill group,and Changpuyu by a random number table method.Jintang group and combined group,30 cases in each group.During the perioperative period,the control group was given conventional treatment,the ear point pressing pill group was given ear point pressing pill before operation,Changpu Yujin Decoction group was given Changpu Yujin Decoction before and after the operation,and the combination group was given ear point pressing pill combined with Changpu Yujin Decoction,and the operation was recorded.Before and after each time point,the mini-mental state examination(MMSE) score,the delirium analysis system(the confused assessment method,CAM-CR),and the Pittsburgh sleep quality index score(PSQI)),and record the incidence of delirium in patients,and detect the level of serum AchE before and after surgery.Results(1) The MMSE scores of the control group,the auricular point pressing pill group and the Changpu Yujin Decoction group were significantly lower than those before the operation on the 1 st day and the 3 rd day after the operation(P <0.05),and the preoperative level was restored on the 7 th day after the operation(P>0.05),there was no significant change in the combined group(P> 0.05);the MMSE scores of the ear-point pressing pill group,Changpuyujin decoction group and the combined group were significantly higher than those of the control group at 1 and 3 days after surgery(P <0.05).The MMSE scores of the combined group at 1 and 3 days after operation were significantly higher than those of the ear point pressing pill group,Changpu Yujin decoction group(P <0.05),the ear point pressing pill group and Changpu Yujin decoction group at each postoperative time point Compared with the MMSE scores,the difference was not statistically significant(P> 0.05).(2) The CAM scores of the four groups of patients on the 1 st and3 rd days after the operation were significantly higher than those before the operation(P <0.05),and the control group was higher than the other three groups(P <0.05),and the combined group was lower There was no statistically significant difference between the ear point pressing pill group and the Changpu Yujin decoction group(P <0.05),the ear point pressing pill group and the Changpu Yujin decoction group(P> 0.05);the comparison of the CAM-CR scores of the four groups at 7 days after surgery,The difference was not statistically significant(P> 0.05).(3) The incidence of delirium 10.00%(3/30) in the combined group was significantly lower than the other three groups(P <0.05),and the incidence of delirium in the control group was 46.67%(14/30) significantly higher than the other three groups(P <0.05) There was no statistically significant difference in the incidence of delirium between the ear-point pressure pill group and the Changpuyujintang group(P> 0.05).(4) The PSQI scores of the ear acupoint pressing pill group,Changpu Yujin decoction group and the combination group were significantly lower than that of the preoperative 7 days after surgery(P <0.05),and were better than the control group(P <0.05);the combination group was lower than the ear acupoints The pressure pill group and Changpu Yujin Decoction group(P <0.05),the PSQI score of the control group before and after surgery did not change significantly(P> 0.05).(5) Serum AchE levels of the four groups of patients 7 days after operation were significantly lower than those before operation(P <0.05);7 days after operation,there were differences in serum AchE levels in the ear acupoint pill group,Changpu Yujin decoction group and the combination group compared with the control group No statistical significance(P> 0.05).Conclusion Changpu Yujin Decoction combined with Ear Point Pressing Pills has a definite curative effect on preventing postoperative delirium in elderly patients,and reduces the incidence of postoperative delirium in patients.Its mechanism may be related to improve cognitive function and sleep quality of patients,and has no significant effect on serum AchE levels.