电针与经皮穴位电刺激对老年患者术后谵妄的影响

Effect of Electroacupuncture and Transcutaneous Electrical Acupoint Stimulation on Postoperative Delirium in Elderly Patients

目的:探讨电针与经皮穴位电刺激对老年患者术后谵妄的影响。方法:择期全麻下行椎弓根钉内固定术老年患者276例,随机分为电针组(EA组)、经皮穴位电刺激组(TA组)及对照组(C组),每组92例。麻醉诱导前,EA组和TA组给予电针或经皮穴位电刺激。术后1 d、术后5 d进行谵妄评估;术前1 d、术后1 d、术后5 d检测神经元特异性烯醇化酶(NSE)、S-100β蛋白(S-100β)、超氧化物歧化酶(SOD)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β);记录并比较三组患者丙泊酚和瑞芬太尼用量、简易精神状态量表(MMSE)评分、术后视觉模拟评分(VAS)。结果:与C组比较,TA组和EA组谵妄发生率降低,差异有统计学意义(P<0.01);与C组相比,TA组、EA组术后1 d、术后5 d VAS评分降低,MMSE评分升高,差异有统计学意义(P<0.01);与术前1 d比较,三组患者术后1 d、5 d血清TNF-α、NSE、IL-1β、S-100β浓度升高,SOD浓度降低(P<0.01);与C组比较,TA组、EA组术后1 d、5 d血清TNF-α、NSE、IL-1β浓度降低,SOD浓度升高(P<0.01)。TA组、EA组丙泊酚用量低于C组,差异有统计学意义(P<0.05)。结论:电针、经皮穴位电刺激均可降低老年患者术后谵妄发生率,减轻术后疼痛,降低炎症和氧化应激反应。

Objective To investigate the effect of electroacupuncture and transcutaneous electrical acupoint stimulation on postoperative delirium in elderly patients.Methods A total of 276 elderly patients undergoing pedicle screw internal fixation under selective general anesthesia were randomly divided into electroacupuncture group(group EA),transcutaneous electrical acupoint stimulation group(group TA)and control group(group C),with 92 patients in each group.Before induction of anesthesia,group EA and group TA received electroacupuncture or transcutaneous electrical acupoint stimulation.Delirium was evaluated on the 1st and 5th day after operation.The neuron-specific enolase(NSE),S-100βprotein(S-100β),superoxide dismutase(SOD),tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)were detected on the 1st day before operation,the 1st day after operation and the 5th day after operation.Dosage of propofol and remifentanil,the scores of mini-mental state examination(MMSE)and visual analog scale(VAS)were recorded in three groups.Results Compared with group C,the incidence of delirium were decreased in group TA and EA(P<0.01).Compared with group C,the scores of VAS were decreased,and the scores of MMSE were increased on the 1st and 5th day after operation in group TA and EA(P<0.01).Compared with 1d before operation,the level of serum TNF-α,NSE,IL-1βand S-100βwere increased and SOD decreased on the 1st and 5th day after operation in three groups(P<0.01).Compared with group C,the level of serum TNF-α,NSE and IL-1βwere decreased and SOD were increased on the 1 st and 5 th day after operation in groups TA and EA(P<0.01).The dosage of propofol in groups TA and EA were lower than that in group C(P<0.05).Conclusion Electroacupuncture and transcutaneous electrical acupoint stimulation can reduce the incidence of postoperative delirium,postoperative pain,inflammation and oxidative stress response in elderly patients.