经皮穴位电刺激对老年衰弱患者术后谵妄的影响  

Effect of transcutaneous electrical acupoint stimulation on postoperative delirium in frail elderly patients

作　　者：吴洪燕 高鸿 米智华[2] 林舜艳[2] 高巨[2] Wu Hongyan;Gao Hong;Mi Zhihua;Lin Shunyan;Gao Ju(Anesthesiology School of Guizhou Medical University,Guiyang 550025,China;Department of Anesthesiology,Northern Jiangsu People′s Hospital Institute of Anesthesia,Emergency and Critical Care,Yangzhou 225001,China)

机构地区：[1]贵州医科大学麻醉学院,贵阳550025 [2]江苏省苏北人民医院麻醉科江苏省苏北人民医院麻醉与急危重症研究所,扬州225001

出　　处：《中华麻醉学杂志》2021年第6期723-726,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(81571936);扬州市科技计划项目(YZ2014176)。

摘　　要：目的:评价经皮穴位电刺激对老年衰弱患者术后谵妄(POD)的影响。方法:择期全麻下拟行胃肠道肿瘤根治术老年衰弱患者60例,性别不限,年龄65~80岁,BMI 18.5~30.0 kg/m^(2),ASA分级Ⅱ或Ⅲ级,术前Fried衰弱量表评分≥3分,采用随机数字表法分为2组(n=30):对照组(C组)和经皮穴位电刺激组(TEAS组)。TEAS组于麻醉诱导前30 min至术毕刺激神门、内关和足三里穴,频率2/100 Hz,疏密波,波幅0.25 ms,根据患者可耐受程度维持电流强度1~30 mA,术后24、48和72 h时选择相同穴位持续刺激30 min;C组在相同穴位内侧4 cm的非穴位部位进行刺激。术后1~7 d采用意识模糊评估量表评估POD发生的情况,记录术中丙泊酚、瑞芬太尼及舒芬太尼用量,记录术后0~8 h(T_(1))、8~24 h(T_(2))和24~48 h(T_(3))时段PCIA泵有效按压次数及镇痛补救情况,记录POD、术后恶心呕吐及嗜睡发生的情况。结果:与C组比较,TEAS组术后补救镇痛率、POD、恶心呕吐和嗜睡发生率降低,术中丙泊酚、瑞芬太尼用量和术后T_(1)~3时段PCIA泵有效按压次数减少(P<0.05)。结论:经皮穴位电刺激可降低老年衰弱患者POD的发生。Objective To evaluate the effect of transcutaneous electrical acupoint stimulation(TEAS)on postoperative delirium(POD)in frail elderly patients.Methods Sixty frail elderly patients of both sexes,aged 65-80 yr,with body mass index of 18.5-30.0 kg/m^(2),of American Society of Anesthesiologists physical statusⅡorⅢ,with preoperative Fried frailty phenotype scale≥3,were divided into 2 groups(n=30 each)using a random number table method:control group(group C)and TEAS group.In group TEAS,patients received TEAS of Shenmen,Neiguan and Zusanli acupoints starting from 30 min before anesthesia induction until the end of surgery.The frequency was 2/100 Hz,wave length was 0.25 ms and the intensity was maintained at about 1-30 mA according to the current that could be tolerated.The same acupoints were continuously stimulated for 30 min at 24,48 and 72 h after operation.Electroacupuncture was performed for 30 min at the points 4 cm lateral to the same acupoints in group C.The occurrence of POD was evaluated by Confusion Assessment Method at 1-7 days after surgery.The intraoperative consumption of propofol,remifentanil and sufentanil,the effective pressing times of patient-controlled intravenous analgesia(PCIA)pump,the requirement for rescue analgesia at 0-8 h(T_(1)),8-24 h(T_(2))and 24-48 h(T_(3))after operation and the development of rescue analgesia,POD,postoperative nausea and vomiting(PONV)and somnolence after operation were recorded.Results Compared with group C,requirement for rescue analgesia and the incidence of POD,PONV and somnolence after operation were significantly decreased,and intraoperative consumption of propofol and remifentanil and the postoperative effective pressing times of PCIA at T_(1)-3 were decreased in group TEAS(P<0.05).Conclusion TEAS can reduce the occurrence of POD in frail elderly patients.

关 键 词：电刺激疗法 老年人 谵妄 

分 类 号：R619[医药卫生—外科学]