经皮穴位电刺激对睡眠障碍老年患者全髋关节置换术后疲劳及谵妄的影响

Effect of transcutaneous electrical acupoint stimulation on postoperative fatigue and delirium in elderly patients with sleep disorder undergoing total hip arthroplasty

目的观察经皮穴位电刺激(TEAS)对睡眠障碍老年患者全髋关节置换术(THA)后疲劳及谵妄的影响。方法选择2020年5—12月择期行单侧THA且术前匹兹堡睡眠质量指数(PSQI)>5分的老年患者100例,男56例,女44例,年龄65-80岁,BMI 19-28 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法分为两组:经皮穴位电刺激组(TEAS组)和非电刺激组(NS组),每组50例。两组均采用超声引导下髂筋膜阻滞联合蛛网膜下隙阻滞,TEAS组在麻醉开始后30 min及术后1、2、3 d的8:00 PM于印堂穴、双侧合谷穴和内关穴行TEAS;NS组不予以电刺激。记录术前1 d、出院当日和术后1个月PSQI评分。记录术前1 d和术后1、2、3、4 d睡眠评分、快动眼(REM)睡眠比例和觉醒次数。记录术前1 d和术后1、3、5 d Christensen疲劳评分,术后1、3、5 d采用意识模糊评估法(CAM)评估谵妄,并于术前1 d和术后1、3、5 d检测C反应蛋白(CRP)浓度。记录术前1 d和术后1、2、3 d VAS疼痛评分、镇痛泵按压次数、首次下床活动时间、恶心呕吐的发生情况。结果出院当日和术后1个月TEAS组PSQI总分明显低于NS组(P<0.05)。术后1、2、3、4 d TEAS组睡眠评分、REM睡眠比例明显高于NS组,睡眠觉醒次数明显少于NS组(P<0.05)。术后1、3、5 d TEAS组CAM谵妄评分和CRP浓度明显低于NS组(P<0.05)。术后3、5 d TEAS组Christensen疲劳评分明显低于NS组(P<0.05)。两组不同时点VAS疼痛评分差异无统计学意义。两组镇痛泵按压次数和首次下床活动时间差异无统计学意义。两组均未发生恶心呕吐等不良反应。结论围术期经皮穴位电刺激可明显改善睡眠障碍老年患者全髋关节置换术后疲劳状态和谵妄的发生,可能与改善术后睡眠状态、降低术后炎症反应有关。

Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS)on postoperative fatigue and delirium in elderly patients with sleep disorder undergoing total hip arthroplasty(THA).Methods A total of 100 elderly patients with unilateral THA and preoperative Pittsburgh sleep quality index(PSQI)>5 scores were selected from May to December 2020,56 males and 44 females,aged 65-80 years,BMI 19-28 kg/m^(2),ASA physical statusⅡorⅢ.All patients were randomly divided into 2 groups(n=50):TEAS group(group TEAS)and non-electrical stimulation group(group NS).Both groups were treated with the combined ultrasound-guided fascia iliac block and spinal anesthesia.The patients in group TEAS received TEAS for 30 minutes after the anesthesia started,8:00 PM on the 1st,2nd,and 3rd day after operation,lasting 30 minutes at a time,and yintang,neiguan and hegu were selected.Group NS was not given electrical stimulation.PSQI scores were recorded 1 day before surgery,on discharge day,and 1 month after surgery.Sleep score,rapid eye movement(REM)sleep ratio,and awakening times were recorded 1 day before surgery and 1,2,3,and 4 days after surgery.Christensen fatigue scores were recorded 1 day before surgery and 1,3,and 5 days after surgery.Delirium was assessed by confusion assessment method(CAM)1,3,and 5 days after surgery.C-reactive protein(CRP)concentration was measured 1 day before surgery and 1,3,and 5 days after surgery.VAS pain score 1 day before surgery and 1,2,and 3 days after surgery,the times pressing analgesic pump and the time of getting out of bed for the first time,as well as the incidence of nausea and vomiting were recorded.Results On discharge day and 1 month after operation,PSQI score in group TEAS was significantly lower than that in group NS(P<0.05).The sleep score and REM sleep proportion in group TEAS were significantly higher than those in group NS 1,2,3,and 4 days after surgery,and the number of sleep and wake times were less than those in group NS(P<0.05).CAM delirium score and CRP concentration in group TEAS were significantly lower than those in group NS 1,3,and 5 days after surgery(P<0.05).Christensen fatigue score in TEAS group was significantly lower than that in group NS 3 and 5 days after surgery(P<0.05).There was no significant difference in VAS pain score between the two groups at different time points.There was no significant difference between the two groups in the number of analgesic pump pressing and the first time of getting out of bed.No adverse reactions such as nausea and vomiting occurred in the two groups.Conclusion Perioperative TEAS can significantly improve postoperative fatigue and delirium in elderly patients with sleep disorder undergoing total hip arthroplasty.