经皮穴位电刺激治疗肺癌术后早期睡眠障碍随机对照研究

Randomized Controlled Trial of Transcutaneous Electrical Acupoint Stimulation for Early Postoperative Sleep Disorders in Patients with Lung Cancer

目的探讨经皮穴位电刺激(TEAS)对肺癌患者术后早期睡眠障碍的影响。方法采用随机对照研究方法,筛选2023年3—7月期间空军军医大学唐都医院肺癌手术患者100例,纳入患者84例,采用随机数字表法分为电刺激组(TEAS组)与对照组(CON组),每组42例。TEAS组从麻醉诱导前30 min至手术结束给予经皮穴位电刺激,穴位选用双侧神门(HT7)、内关(PC6)、三阴交(SP6);对照组(CON组)只粘贴电极片连接电刺激仪,但不接通电源。通过记录两组术前24 h、术后24 h、术后72 h及出院前的匹兹堡睡眠指数量表(PSQI)和阿森斯失眠量表(AIS)评估睡眠情况,记录各时间点的疼痛视觉模拟评分(VAS)等;采用多因素Logistic回归方法,分析影响术后睡眠障碍的主要因素。结果TEAS组术后24 h、术后72 h及出院前PSQI、AIS总分及VAS评分均低于CON组(P<0.05);TEAS组术后24 h睡眠障碍发生率(58.8%)低于CON组(80.5%)。切口疼痛、不能翻身为术后睡眠障碍的危险因素(OR分别为19.584、9.745),TEAS为保护因素(OR 0.228),差异均有统计学意义(P<0.01,P<0.05)。结论TEAS可一定程度改善肺癌术后早期睡眠障碍。切口疼痛、不能翻身为术后睡眠障碍的危险因素,TEAS为术后睡眠障碍的保护因素。

Objective To investigate the effects of transcutaneous electrical acupoint stimulation(TEAS)on the early sleep disorder of patients with lung cancer after operation.Methods Purposive sampling of 100 patients that scheduled for lung cancer surgery in Tangdu Hospital of Air Force Military Medical University from March to July 2023 was conducted.Among them,84 patients were enrolled,and the participants were randomized into 2 groups(42 cases):transcutaneous electrical acupoint stimulation group(TEAS group)and control group(CON group).TEAS was applied to bilateral Shenmen(HT7),Neiguan(PC6)and Sanyinjiao(SP6)on TEAS group from 30 min before anesthesia induction to the end of surgery.In CON group,only electrodes were pasted to the electrical stimulator,but no power supply was connected.The Pittsburgh Sleep Quality Index(PSQI)and Athens Insomnia Scale(AIS)were performed to determine the sleep quality of at four time points:24 h before surgery,24 h and 72 h after surgery and before discharge.The Visual Analog Scale(VAS)was performed to evaluate pain scores after surgery.Multivariate regression analysis was used to analyze the main factors affecting postoperative sleep quality.Results The total scores of PSQI,AIS and VAS in TEAS group were lower than those in CON group at 24 h and 72 h after surgery and before discharge(P<0.05).The incidence of sleep disorders in the TEAS group(58.8%)was lower than that in the CON group(80.5%).Incision pain and inability to turn over were risk factors for postoperative sleep disorders(OR=19.584,9.745),and TEAS was a protective factor(OR=0.228).The incidence of sleep disorders in the TEAS group(58.8%)was lower than that in the CON group(80.5%),The difference was statistically significant(P<0.01,P<0.05).Conclusions TEAS treatment can improve early sleep disorders to a certain extent after lung cancer surgery.Incisional pain and inability to turn over are risk factors for postoperative sleep disorders,and TEAS is a protective factor for postoperative sleep disorders.