耳穴贴压联合穴位按摩对老年股骨颈骨折患者术后谵妄及睡眠质量的影响

Influence of Auricular Point Sticking Combined with Acupoint Massage on Postoperative Delirium and Sleep Quality in Elderly Patients with Femoral Neck Fractures

目的:观察耳穴贴压联合穴位按摩对老年股骨颈骨折患者术后谵妄及睡眠质量的影响。方法:选择2020年7月—2023年7月南昌市人民医院收治的82例老年股骨颈骨折患者作为研究对象,根据数字编号信封法分为观察组、对照组,各41例。两组均行手术治疗,对照组给予术后常规护理干预,观察组给予术后常规护理+穴位按摩+耳穴贴压。比较两组谵妄发生情况[意识混乱评估量表(CAM)]、认知功能[简易智能量表(MMSE)]、意识状态(Glasgow昏迷量表,GCS)、疲劳程度(Christensen疲劳评分)、睡眠质量[匹兹堡睡眠质量指数(PSQI)]、睡眠情况、中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)、血小板/淋巴细胞比值(PLR)及睡眠中医症候评分。结果:干预7、14 d后,两组MMSE、GCS评分均高于干预前,且观察组均高于对照组;两组Christensen疲劳评分均明显低于干预前,且观察组低于对照组,差异均有统计学意义(P<0.05)。干预7、14 d后,两组总睡眠时间、快速动眼睡眠时间均明显高于干预前,且观察组均高于对照组;两组PSQI评分、入眠时间、觉醒次数均明显均低于干预前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。干预14 d后,两组睡眠中医症候评分和NLR、MLR、PLR水平均明显低于干预前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。结论:耳穴贴压联合穴位按摩可有效降低老年股骨颈骨折患者术后谵妄发生情况,改善睡眠质量、认知功能及意识状态,降低患者炎症反应和疲劳程度。

Objective:To observe the effects of auricular point sticking combined with acupoint massage on postoperative delirium and sleep quality in elderly patients with femoral neck fracture.Method:A total of 82 elderly patients with femoral neck fracture admitted to Nanchang People's Hospital from July 2020 to July 2023 were selected as the study objects,and they were divided into observation group and control group according to numbered envelope method,with 41 cases in each group.Both groups received surgical treatment,the control group received postoperative routine nursing intervention,the observation group received postoperative routine nursing+acupoint massage+auricular point sticking.The incidence of delirium[confusion assessment scale(CAM)],cognitive function[mini-mental state examination(MMSE)],state of consciousness(Glasgow coma scale,GCS),fatigue(Christensen fatigue score),sleep quality[Pittsburgh sleep quality index(PSQI)],sleep status,neutrophil/lymphocyte ratio(NLR),monocyte/lymphocyte ratio(MLR),platelet/lymphocyte ratio(PLR)and sleep traditional Chinese medicine symptom score were compared between two groups.Result:After 7 and 14 d of intervention,MMSE and GCS scores of two groups were higher than those before intervention,and those in the observation group were higher than those in the control group;the Christensen fatigue score of two groups was significantly lower than that before intervention,and that in the observation group was lower than that in the control group,the differences were statistically significant(P<0.05).After 7 and 14 d of intervention,total sleep time and rapid eye movement sleep time in two groups were significantly higher than those before intervention,and those in observation group were higher than those in control group;the PSQI score,sleep time and wake times of two groups were significantly lower than those before intervention,and those in the observation group were lower than those in control group,the differences were statistically significant(P<0.05).After 14 d of intervention,the sleep traditional Chinese medicine syndrome score and the levels of NLR,MLR and PLR in two groups were significantly lower than those before intervention,and those in observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Auricular point sticking combined with acupoint massage can effectively reduce postoperative delirium in elderly patients with femoral neck fracture,improve sleep quality,cognitive function and state of consciousness,and reduce inflammatory response and fatigue degree.