经皮穴位电刺激神门穴、内关穴对老年髋关节置换术患者睡眠质量及术后谵妄的影响  

The effect of transcutaneous electrical acupoint stimulation of Shenmen and Neiguan points on sleep quality and postoperative delirium in elderly patients undergoing hip replacement

作　　者：魏来[1,2] 罗雯 黄俊 谭思由 苏颖颖 唐轶珣 邹毅 孔高茵[1,2] 陈文雁[1] Wei Lai;Luo Wen;Huang Jun;Tan Siyou;Su Yingying;Tang Yixun;Zou Yi;Kong Gaoyin;Chen Wenyan(Department of Anesthesiology,Hunan Provincial People's Hospital(First Affiliated Hospital of Hunan Normal University),Changsha 410005,China;Clinical Research Center For Anesthesiology of ERAS in Hunan Province,Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)麻醉科,长沙410005 [2]湖南省围术期加速康复麻醉临床医学研究中心,长沙410005

出　　处：《国际麻醉学与复苏杂志》2021年第10期1056-1060,共5页International Journal of Anesthesiology and Resuscitation

基　　金：湖南省中医药管理局资助项目(201712);湖南省科技厅资助项目(2018SK7001)。

摘　　要：目的探讨经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)神门穴、内关穴对老年髋关节置换术患者睡眠质量及术后谵妄(postoperative delirium,POD)的影响。方法行髋关节置换术的老年患者102例,采用随机数字表法分为试验组(T组,50例)和对照组(C组,52例)。T组分别于术前30 min、手术当天、术后第1天、术后第2天18:00行TEAS双侧内关穴、神门穴,共4次,每次30 min;C组连接穴位电刺激仪,但不通电。记录两组患者性别、年龄、体重、ASA分级、麻醉方式、手术方式、出血量和手术时长等一般情况;记录两组患者术前1 d、术后当天、术后24 h、术后48 h VAS疼痛评分,术前1 d、术后72 h简易智力状态检查(Mini-Mental State Examination,MMSE)评分和匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI),术前1 d及术后24、48、72 h意识模糊评估法(Confusion Assessment Method,CAM)评分;手环监测术前1晚、术后当晚、术后第1晚、术后第2晚患者睡眠结构;记录两组患者POD发生情况。结果两组患者手术当天、术后24 h、术后48 h VAS疼痛评分低于术前1 d(P<0.05),两组患者术后24 h、术后48 h VAS疼痛评分低于手术当天(P<0.05),两组患者术后48 h VAS疼痛评分低于术后24 h(P<0.05)。两组患者术后72 h PSQI评分低于术前1 d(P<0.05),术后72 h T组PSQI评分低于C组(P<0.05)。C组术后当晚、术后第1晚、术后第2晚深睡眠时长少于术前1晚(P<0.05),睡眠时间长于术前1晚(P<0.05);T组术后当晚、术后第1晚、术后第2晚睡眠时间长于术前1晚(P<0.05);两组患者术后72 h MMSE评分低于术前1 d(P<0.05)。两组患者术后48、72 h CAM评分低于术前1 d和术后24 h(P<0.05)。T组POD发生率低于C组(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论围手术期应用TEAS双侧内关穴、神门穴可能改善老年髋关节置换术患者睡眠质量,降低POD发生率。Objective To explore the effects of transcutaneous electrical acupoint stimulation(TEAS)at Shenmen(HT7)and Neiguan(PC6)points on sleep quality and postoperative delirium(POD)in the elderly patients undergoing hip replacement surgery.Methods A total of 102 elderly patients undergoing hip arthroplasty surgery were divided into TEAS group(group T,50 cases)and control group(group C,52 cases)by random number table method.Patients in the group T received TEAS at bilateral HT7 points and PC6 points 30 min before surgery and at 18:00 on the surgery day and following two days after surgery,for a total of 4 times,30 min each time.The acupoints of patients in group C were connected to the electrical stimulator,but the stimulator was power off.General information such as gender,age,weight,American Society of Anesthesiologists(ASA)grade,anesthesia method,operation method,blood loss,and operation duration of patients in the two groups was recorded.Visual Analogue Scale(VAS)pain scores of both two groups were recorded at the time points of the day before surgery,the surgery day,24 h after surgery,and 48 h after surgery.The Mini-Mental State Examination(MMSE)scores and Pittsburgh Sleep Quality Indexes(PSQI)were recorded the day before surgery and 72 h after surgery.Confusion Assessment Method(CAM)scores were recorded on the day before surgery and 24,48,72 h after surgery.The sleep state of the patients was monitored by the bracelet on the first night before surgery,the night of the surgery day,the first night after surgery,and the second night after surgery.The occurrence of POD was also recorded in both groups.Results The VAS pain scores of group C and T on the day of operation,24 h and 48 h after operation were lower than the scores of 1 day before operation(P<0.05),the VAS pain scores of group C and T at 24 h and 48 h after operation were lower than the scores of the day of operation,the VAS pain scores of group C and T at 48 h after operation were lower than the scores at 24 h after operation.The PSQI scores of group C and T

关 键 词：经皮穴位电刺激 老年人 髋关节置换术 睡眠 术后谵妄 

分 类 号：R246.9[医药卫生—针灸推拿学]