电刺激“鬼穴”复合气管内全麻对老年患者全膝关节置换术后谵妄的观察

Observation on the effect of electrical stimulation at ghost points combined with an endotracheal general anesthesia on delirium in elderly patients after a total knee arthroplasty

目的观察电刺激“鬼穴”复合气管内全麻对老年患者全膝关节置换术后谵妄的影响。方法选择行全膝关节置换手术的老年患者83例,随机分为观察组41例和对照组42例,观察组术前30 min采用经皮穴位电刺激方法,对印堂、内关、曲池、劳宫、大陵及百会以疏密波(2~6 Hz)、刺激强度6~12 mA,然后行气管内插管麻醉诱导,TEAS持续至手术结束。对照组单纯行气管内全身麻醉。对所有患者于手术前1天用简易智能量表(MMSE)进行认知功能评定筛选,低于24分者则不进入本研究观察。术后第1、3、7天用谵妄评定方法中文修订版(the Confusion Assessment Method--Chinese Revision,CAM-CR)量表评估患者术后谵妄,各项目的标准根据症状严重程度逐级评分,22分及以上诊断为谵妄。结果比较2组术后1、3、7天CAM-CR评分和谵妄发生例数及睡眠评分,结果显示,组间CAM-DR评分比较具有统计学意义(P<0.05),睡眠评分比较具有统计学意义(P<0.05)。结论电刺激“鬼穴”结合常规穴可以减少老年患者全膝关节置换术后谵妄的发生率并有可能改善睡眠。

Objective To observe the eff ect of electrical stimulation at ghost points combined with an endotracheal general anesthesia on delirium in elderly patients after a total knee arthroplasty.Methods A total of 83 elderly patients who underwent a total knee arthroplasty were selected and randomly divided into an observation group of 41 cases and a control group of 42 cases.In the observation group,a transcutaneous electrical stimulation was applied to Yintang(EX-HN3),Neiguan(P6),Quchi(LI11),Laogong(P8),Daling(P7),Baihui(GV20)with a density wave of 2~6 Hz and a stimulus intensity of 6~12 mA for 30 minutes before a surgery,then an endotracheal general anesthesia was performed and the TAES lasted until the end of the operation.While the control group only received an endotracheal general anesthesia.All the patients were assessed and screened for cognitive function with the mini-mental state examination(MMSE)scale one day before the operation and those with a score of less than 24 were excluded from the study.Postoperative delirium was assessed with the Confusion Assessment Method--Chinese Revision(CAM-CR)scale on the 1st,3^(rd) and 7th day after operation,whose criteria for each item were graded according to symptom severity,and delirium was diagnosed with a score of 22 or above.Results The CAM-CR scores,delirium cases and sleep scores were compared between the two groups on the 1st,3^(rd) and 7th day after operation,whose results showed there was a signifi cant diff erence in the CAM-CR score between the two groups(P<0.05),and there was a signifi cant diff erence in the sleep score(P<0.05).Conclusion The transcutaneous acupoint electrical stimulation at ghost points in combination with other conventional acupoints can reduce the incidence of delirium and may improve sleep in elderly patients after a total knee arthroplasty surgery.