穴位电刺激联合快速康复外科理念在老年髋部骨折患者围术期中的应用

Perioperative Application of Acupoint Electrical Stimulation Combined with Concept of ERAS in Elderly Patients with Hip Fracture

目的分析穴位电刺激联合快速康复外科(enhanced recovery after surgery,ERAS)理念在老年髋部骨折患者围术期中的应用。方法2019年3月—2022年3月济南市中医医院骨科收治的老年髋部骨折患者120例,分为对照组与研究组,各60例,方法为随机数字表法。对照组给予ERAS理念的干预,研究组接受穴位电刺激联合ERAS理念干预,两组均干预至出院并随访2个月。分析两组围术期情况,术前、术后1 d、7 d疼痛及认知功能,术后7 d、14 d、1个月、2个月髋关节功能,术前、术后7 d骨代谢指标,住院期间并发症发生情况。结果研究组下床时间组间比较更短,平均每日行走时间组间比较更长(P<0.05)。与术前、术后1 d比较,术后7 d,两组视觉模拟评分法(visual analogue scale,VAS)评分降低,且研究组更低(P<0.05);与术前比较,术后1 d、7 d两组简易智力状态检查量表(mini-mental state examination,MMSE)评分均降低,且术后7 d高于术后1 d,术后1 d、7 d研究组MMSE评分更高(P<0.05)。术后7 d、14 d、1个月、2个月,两组Harris评分呈升高趋势,且研究组更高(P<0.05)。与术前比较,术后7 d,两组血清磷离子、钙离子、碱性磷酸酶水平升高,且研究组更高(P<0.05)。住院期间,研究组并发症发生率组间比较更低[8.33%(5/60)vs 21.67%(13/60),P<0.05]。结论穴位电刺激联合ERAS理念在老年髋部骨折患者围术期中的应用可改善围术期指标,减轻疼痛,改善患者认知功能,调节骨代谢,进而改善髋关节功能,安全性高。

Objective To analyze the perioperative application of acupoint electrical stimulation combined with the concept of enhanced recovery after surgery(ERAS)in elderly patients with hip fracture.Methods From March 2019 to March 2022,120 elderly patients with hip fracture admitted to the department of orthopedics of Jinan Hospital of Traditional Chinese Medicine were divided into the control group and the research group by the random number table method,with 60 cases in each group.The control group received the concept of ERAS intervention,while the research group received acupoint electrical stimulation combined with the concept of ERAS intervention.Both groups were intervened until discharge and were followed up for 2 months.The perioperative conditions,pain and cognitive function before operation,1 d and 7 d after operation,hip joint function at 7 d,14 d,1 and 2 months after operation,bone metabolism indexes before and 7 d after operation,the incidence of complications during hospitalization of two groups were analyzed.Results In the research group,the time to get out of bed was shorter,and the average daily walking time was longer(P<0.05).Compared with those before operation and 1 d after operation,the scores of visual analogue scale(VAS)in the two groups decreased on 7 d after operation,and the score of the research group was lower(P<0.05).Compared with those before operation,the scores of mini-mental state examination(MMSE)in the two groups decreased on 1 d and 7 d after operation,and the scores on 7 d after operation were higher than those on 1 d after operation,the score of MMSE the research group was higher on the 1 d and 7 d after operation(P<0.05).At 7 d,14 d,1 and 2 months after operation,the scores of Harris in the two groups showed an increasing trend,and the score of the research group was higher(P<0.05).Compared with those before operation,the serum levels of phosphorus ion and calcium ion and alkaline phosphatase in the two groups 7 d after operation increased,and the levels of the research group were higher(P<0.05).During the during hospitalization,the incidence of complication in the research group was lower[8.33%(5/60)vs 21.67%(13/60),P<0.05].Conclusion The application of acupoint electrical stimulation combined with the concept of ERAS in the perioperative period of elderly patients with hip fracture could improve perioperative indicators,reduce the pain,improve the cognitive function,regulate the bone metabolism,and then improve the hip joint function,with high safety.