经皮穴位电刺激对心脏瓣膜手术患者术后神经认知功能的影响

Effect of transcutaneous acupoint electrical stimulation on postoperative neurocognitive function in patients with cardiac valve surgery

目的探讨经皮穴位电刺激(TEAS)对心脏瓣膜手术患者术后神经认知功能的影响。方法选取2018年1月至2019年10月在中南大学湘雅医院择期行心脏瓣膜手术的108例患者为研究对象,按照随机数字表法将患者分为对照组和TEAS组,每组54例。术前在患者的双侧中府穴、列缺穴、郗门穴、合谷穴、神门穴5个穴位贴上电极片,TEAS组行穴位电刺激,对照组无电刺激。收集患者一般资料和手术资料,术后数字评估量表(NRS)评分、简易精神状态检查量表(MMSE)评分、蒙特利尔认知功能评估量表(MoCA)评分,术后神经认知功能恢复延迟和谵妄发生率,以及术后并发症发生情况。结果两组麻醉时间、手术时间、主动脉阻断时间、体外循环时间、手术类型、术中出血量、术中尿量、拔管时间、ICU停留时间、住院时间,术后NRS评分、MMSE评分、MoCA评分,术后谵妄、房颤、肺部感染、急性肾损伤发生率比较差异无统计学意义(P>0.05)。TEAS组术后神经认知功能恢复延迟发生率较对照组明显降低,差异有统计学意义(P<0.05)。结论TEAS可改善心脏瓣膜手术患者术后神经认知功能,有利于围手术期管理。

Objective To investigate the effect of transcutaneous acupoint electrical stimulation(TAES)on postoperative neurocognitive function in the patients with cardiac valve surgery.Methods A total of 108 patients with elective cardiac valve surgery in Xiangya Hospital of Central South University from January 2018 to October 2019 were selected as the study subjects and divided into to the control group and TEAS group according to the random number table method,54 cases in each group.The patients were attached with the electrode slice at Zhongfu,Lieque,Ximen,Hegu and Shenmen acupoints on the bilateral sides.The TEAS group conducted the acupoint electrical stimulation,while the control group without the electric stimulation.The general data and intraoperative data of the patients were collected.The postoperative numerical rating scale(NRS),mini-mental state examination(MMSE)and Montreal cognitive assessment scale(MoCA)scores and incidence rates of postoperative neurocognitive function delayed recovery and delirium as well as the postoperative complications occurrence were recorded.Results There were no statistically differences in the introperative anesthetic time,operative time,aorta block time,extracorporeal circulation time,intraoperative bleeding volume,intraoperative urine volume,extubation time,ICU stay duration,hospitalization duration,postoperative NRS score,MMSE score,MoCA score and the incidence rates of postoperative delirium,atrial fibrillation,pulmonary infection and acute renal injury had no statistically significant differences between the two groups(P>0.05).The incidence rate of postoperative delayed neurocognitive recovery in the TEAS group was significantly decreased compared with the control group,and the difference was statistically significant(P<0.05).Conclusion Intraoperative TAES could improve the postoperative neurocognitive function recovery in the patients with cardiac valve surgery,which is conducive to perioperative management.