内关穴注射右美托咪定对老年人非心脏大手术后神经认知障碍和睡眠质量的影响

Effects of dexmedetomidine acupoint injection on neurocognitive disorderand sleep quality after non-cardiac major surgery in elderly people

目的探讨全身麻醉前内关穴注射右美托咪定对老年人非心脏大手术后神经认知障碍和睡眠质量的影响。方法选择该院2023年2月至2024年3月择期行胸、腹腔镜手术的老年患者,采用随机数字表法分为内关穴注射右美托咪定组(A)组、内关穴注射生理盐水组(B组)和静脉注射右美托咪定组(C组),每组40例,观察3组患者术后神经认知功能及睡眠相关情况。结果A组、C组术后第1天术后谵妄(POD)发生率较B组明显降低,差异有统计学意义(P<0.05);A组术后第2天POD发生率较B组明显降低(P<0.05)。A、C组术后第1天术后认知功能障碍(POCD)发生率较B组明显降低,且A组发生率低于C组,差异均有统计学意义(P<0.05);A组术后第3、5天POCD发生率低于B组(P<0.05)。B、C组术后第1、3、5天简易智能状态量表(MMSE)评分均较术前1天明显降低(P<0.05)。A、C组术后第1、3、5天MMSE评分均高于B组,且A组高于C组,差异均有统计学意义(P<0.05)。3组术后第1、3、5天匹兹堡睡眠质量指数(PSQI)评分均较术前1天升高(P<0.05);与B组比较,A、C组术后第1、3、5天PSQI评分均降低,且A组低于C组,差异有统计学意义(P<0.05)。A、C组心动过缓发生率均明显高于B组(P<0.05);A组恶心呕吐(PONV)发生率明显低于B、C组(P<0.05),B组、C组比较差异无统计学意义(P>0.05)。结论行胸、腹腔镜手术麻醉前内关穴注射右美托咪定可明显降低老年患者PND和改善睡眠质量,且同时具有预防PONV的作用。

Objective To investigate the effects of dexmedetomidine injection at the Neiguan acupoint before general anaesthesia on neurocognitive disorder and sleep quality after non-cardiac major surgery in elderly people.Methods Elderly patients undergoing elective thoracic and laparoscopic surgery in this hospital from February 2023 to March 2024 were selected and divided into the dexmedetomidine Neiguan acupoint injection group(A),saline Neiguan acupoint injection group(B)and dexmedetomidine intravenous injection group(C)by the randomised numerical table method,40 cases in each group.The postoperative neurocognitive function and sleep-related condition in the three groups were observed.Results The incidence rate of postoperative delirium(POD)on postoperative 1 d in the group A and C was significantly decreased compared with the group B,and the difference was statistically significant(P<0.05);the incidence rate of POD on postoperative 2 d in the group A was significantly decreased compared with the group B(P<0.05);the incidence rate of postoperative cognitive dysfunction(POCD)on postoperative 1 d in the group A and C was significantly decreased compared with the group B,moreover which in the group A was lower than that in the group C,and the differences were statistically significant(P<0.05);the incidence rate of POCD on postoperative 3,5 d in the group A was lower than that in the group B(P<0.05).The MMSE score on postoperative 1,3,5 d in the group B and C was significantly decreased compared with preoperative 1 d(P<0.05).The MMSE score on postoperative 1,3,5 d in the group A and C was higher than that in the group B.and the difference was statistically significant(P<0.05).The PSQI score on postoperative 1,3,5 d in the group A and C was increased compared with preoperative 1 d(P<0.05);compared with the group B,the PSQI score on postoperative 1,3,5 d in the group A and C was decreased,moreover the group A was lower the group C,and the differences were statistically significant(P<0.05).The incidence rate of bradycardia in the group A and C was significantly higher than that in the group B(P<0.05).The incidence rate of postoperative nausea and vomiting(PONV)in the group A was significantly lower than that in the group B and C(P<0.05),and the difference between the group B and C had no statistical significance(P>0.05).Conclusion Dexmedetomidine injection at the Neiguan acupoint before anaesthesia for minimally invasive surgery can significantly reduce perioperative neurocognitive dysfunction(PND)and improve the quality of sleep in elderly patients,moreover simultaneously has the effect for preventing PONV.