电针对老年脆弱脑功能病人髋关节置换术中脑氧饱和度及术后谵妄的影响  

Effect of electroacupuncture on intraoperative cerebral oxygen saturation and postoperative delirium in elderly patients with fragile brain function undergoing hip replacement

作　　者：李雪飞[1] 郑曼[1] 詹伟芳 王蔚 邹蓉[1] LI Xue-fei;ZHENG Man;ZHAN Wei-fang;WANG Wei;ZOU Rong(Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China)

机构地区：[1]江苏省中医院麻醉科,江苏省南京市210029

出　　处：《实用老年医学》2021年第7期676-679,共4页Practical Geriatrics

基　　金：江苏省中医院院级课题(Y19008)。

摘　　要：目的探讨电针对老年脆弱脑功能病人髋关节置换术中脑氧饱和度及术后谵妄(POD)的影响。方法选取全身麻醉下行髋关节置换术的老年脆弱脑功能病人60例,随机分为电针组(EA组)和非电针组(C组)各30例,EA组在麻醉诱导前30 min进行电针刺激至手术结束前30 min,C组不予干预。术中持续监测局部脑氧饱和度(rSO_(2)),并记录麻醉诱导前(T0)、气管插管后(T1)、手术开始时(T2)、手术开始后30 min(T3)、手术开始后1 h(T4)、术毕(T5)时的rSO_(2),并计算rSO_(2)的平均值(rSO_(2)_(mean))、术中最小值(rSO_(2)_(min))以及较基线值下降最大百分比(rSO_(2)%max)。记录病人的拔管时间、Ricker镇静和躁动(RSAS)评分及麻醉后监测治疗室(PACU)停留时间。分别于术后1、2、3 d进行POD评估及术后恢复质量问卷调查表(QoR-15)评估。结果与C组相比,EA组T1~T5的rSO_(2)、rSO_(2)_(mean)和rSO_(2)_(min)明显升高(P<0.05),rSO_(2)%_(max)明显降低(P<0.05);EA组术后1 d的POD发生率明显减低(P<0.05),术后2 d和3 d的POD发生率差异无统计学意义(P>0.05);EA组拔管时间和PACU停留时间明显缩短(P<0.05),RSAS评分明显降低(P<0.05)。EA组术后1、2、3 d,病人QoR-15评分明显增高(P<0.05)。结论电针可改善老年脆弱脑功能病人髋关节置换术中rSO_(2),降低术后1 d POD发生率,提高苏醒质量,加速病人术后恢复质量,其机制可能与改善脑氧代谢有关。Objective To investigate the effect of electroacupuncture on intraoperative cerebral oxygen saturation and postoperative delirium in the elderly patients with fragile brain function undergoing hip replacement.Methods A total of 60 elderly patients with fragile brain function receiving hip repalcement surgery under general anesthesia were randomly divided into electroacupuncture group(EA group)and non-electroacupuncture group(C group),with 30 cases in each group.EA group received electroacupuncture from 30 min before induction of anesthesia to 30 min before the end of surgery,while no intervention was performed on the C group.Regional cerebral oxygen saturation(rSO_(2))was recorded before anesthesia induction(T0),after tracheal intubation(T1),at the beginning of operation(T2),30 min and 1 h after beginning(T3,T4),and at the end of operation(T5).The mean rSO_(2)(rSO_(2)_(mean)),minimum rSO_(2)(rSO_(2)_(min))and maximum declining percentage compared with baseline values(rSO_(2)%max)was calculated.The extubation time,Ricker sedation-agitation scale(RSAS)score and the residence time of postanesthesia care unit(PACU)were recorded.Postoperative delirium and postoperative recovery quality questionnaire(QoR-15)were evaluated 1 d,2 d and 3 d after surgery.Results Compared with C group,rSO_(2) at T1-T5,rSO_(2)_(mean) and rSO_(2)_(min) was significantly increased in EA group(P<0.05),while rSO_(2)%_(max) was significantly decreased(P<0.05);The incidence of delirium in EA group was significantly decreased 1 d after surgery(P<0.05);The extubation time as well as the residence time of PACU was significantly shortened(P<0.05),and RSAS score was significantly reduced in EA group(P<0.05);QoR-15 score was significantly increased on 1 d,2 d and 3 d after surgery in EA group(P<0.05).Conclusions Electroacupuncture can improve intraoperative rSO_(2) in the elderly patients with fragile brain function undergoing hip replacement,reduce the incidence of postoperative delirium,improve the quality of recovery,and accelerate the quality of po

关 键 词：电针 老年人 脆弱脑功能 脑氧饱和度 术后谵妄 

分 类 号：R619[医药卫生—外科学]