头针透穴对全麻下老年全膝关节置换术患者苏醒期及术后谵妄的预防效果分析  

Preventive Effect of Scalp Acupuncture on Emergence Delirium and Postoperative Delirium in Elderly Patients undergoing Total Knee Arthroplasty under General Anesthesia

作　　者：熊昕[1] 王文军 阮文佳 李盼盼[1] 吴小飞 徐振华[1] 陈雁信 XIONG Xin;WANG Wen-jun;RUAN Wen-jia;LI Pan-pan;WU Xiao-fei;XU Zhen-hua;CHEN Yan-xin(Guangdong Provincial TCM Hospital,Guangzhou,Guangdong 510120;Guangdong Second Traditional Chinese Medicine Hospital(Guangdong Research Institute of Traditional Chinese Medicine Manuracturing Technology),Guangzhou,Guangdong 510095)

机构地区：[1]广东省中医院,广东广州510120 [2]广东省第二中医院(广东省中医药工程技术研究院),广东广州510095

出　　处：《按摩与康复医学》2022年第19期42-47,共6页Chinese Manipulation and Rehabilitation Medicine

基　　金：广东省中医药局科研项目,编号:20191130。

摘　　要：目的:观察头针透穴预防全麻下老年全膝关节置换术患者苏醒期及术后谵妄的效果。方法:将162例行全膝关节置换术老年患者随机分为试验一组、试验二组和对照组各54例,试验一组、试验二组分别于麻醉前、术毕30min时给予头针透穴治疗,对照组则全程不给予头针透穴治疗,在术后即时、术后第1天和第3天采用护理谵妄筛查量表(NUDESC)、谵妄诊断量表(CAM-CR)评估苏醒期、术后谵妄的发生情况,视觉模拟评分法(VAS)评价术后疼痛程度,并统计术后恶心、呕吐的发生率。结果:两试验组苏醒期、术后谵妄发生率及程度均低于对照组(P<0.05),两试验组间差异则无统计学意义(P>0.05);两试验组各时间点VAS评分均低于对照组(P<0.05),两试验组间差异则无统计学意义(P>0.05),但各时间点VAS评分与不同干预方案之间不存在交互效应(F=2.393,P>0.05);试验一组总体恶心发生情况少于试验二组和对照组(P<0.05),两试验组总体呕吐发生情况均少于对照组(P<0.05)。结论:不同时期施行头针透穴对全麻下老年全膝关节置换术患者苏醒期和术后谵妄均有预防作用,但麻醉前施行对术后不良反应的防治效果更好,可作为临床借鉴;不同时期施行头针透穴治疗的镇痛作用相当,但证据尚不充分。Objective:To observe the preventive effect of scalp acupuncture on emergence delirium and postoperative delirium in elderly patients undergoing total knee arthroplasty under general anesthesia.Methods:162 cases of elderly patients undergoing total knee arthroplasty were randomly divided into experimental group I(n=54),experimental group II(n=54)and control group(n=54),the experimental group I and experimental group II were received scalp acupuncture before anesthesia and 30min before the operation done respectively,while control group wasn't given scalp acupuncture throughout the whole process.At the time of immediate post-operation,1 day and 3 days after operation,the occurrence of emergence delirium and postoperative delirium was assessed by Nursing Delirium Screening Scale(NUDESC)and Confusion Assessment Method(CAM-CR),Visual Analogue Scale(VAS)was used to evaluate the degree of postoperative pain,and the incidence of postoperative nausea and vomiting was counted.Results:The incidence and degree of emergence delirium and postoperative delirium in the two experimental groups were lower than those in control group(P<0.05),but there was no significant difference between the two experimental groups(P>0.05).The VAS scores of the two experimental groups at each time point were lower than those of control group(P<0.05),but there was no significant difference between the two experimental groups(P>0.05),and there was no interaction effect between VAS scores at each time point and different intervention schemes(F=2.078,P>0.05).The overall incidence of nausea in experimental group I was less than that in experimental group II and control group(P<0.05),and the overall incidence of vomiting in both experimental groups was less than that in control group(P<0.05).Conclusion:Scalp acupuncture at different periods has preventive effect on emergence delirium and postoperative delirium in elderly patients undergoing total knee arthroplasty under general anesthesia,but the preventive effect of postoperative adverse reactions is b

关 键 词：苏醒期谵妄 术后谵妄 全膝关节置换术 全身麻醉 老年患者 头针疗法 透穴疗法 预防 

分 类 号：R246[医药卫生—针灸推拿学] R687.42[医药卫生—中医临床基础]