穴位刺激辅助麻醉对老年髋部骨折患者术后苏醒期躁动及血清阿片类物质、淀粉样蛋白A水平的影响  

Effect of acupoint stimulation assisted anesthetics on the agitation during recovery and the levels of serum opioids and amyloid A in elderly patients after hip fracture surgery

作　　者：王昌盛 张祝君 蔡璐[1] 周金萍[1] 陈公锦[1] Wang Changsheng;Zhang Zhujun;Cai Lu;Zhou Jinping;Chen Gongjin(Department of Anesthesiology,Shaoxing Second Hospital,Shaoxing 312000,China;Department of Anesthesiology,Shaoxing Maternal and Child Health Care Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴第二医院医共体总院麻醉科,绍兴312000 [2]绍兴市妇幼保健院麻醉科,绍兴312000

出　　处：《中国医师进修杂志》2023年第8期706-710,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨穴位刺激辅助麻醉对老年髋部骨折患者术后苏醒期躁动及血清阿片类物质(Opiorphin)、淀粉样蛋白A(SAA)水平的影响。方法采用前瞻性研究的方法,选择2020年2月至2021年9月在绍兴第二医院医共体总院行髋部骨折手术的患者86例,按随机数字表法分为常规组和研究组,每组43例,分别给予穴位假刺激、穴位刺激,观察两组手术一般指标、苏醒质量、认知功能及血清Opiorphin、SAA水平变化。结果两组患者手术时间、麻醉时间、苏醒时间和术中输血率比较差异无统计学意义(P>0.05)。研究组瑞芬太尼用量少于常规组[(270.64±17.62)μg比(291.82±23.34)μg],差异有统计学意义(P<0.05)。研究组苏醒期躁动发生率低于常规组[13.95%(6/43)比48.84%(21/43)],差异有统计学意义(P<0.05)。研究组术后12、24、48 h简易智力状态检查量表(MMSE)评分高于常规组[(22.80±2.04)分比(19.31±3.61)分、(24.92±2.44)分比(21.49±3.58)分、(26.73±2.57)分比(24.23±3.95)分],差异有统计学意义(P<0.05)。研究组术后24 h血清Opiorphin水平高于常规组[(32.74±8.57)mg/L比(25.40±6.36)mg/L],SAA水平低于常规组[(157.36±10.24)mg/L比(204.37±15.56)mg/L],差异有统计学意义(P<0.05)。结论穴位刺激辅助麻醉能减低老年髋部骨折手术患者苏醒期躁动发生率,减少麻醉药使用剂量,并减轻术后认知功能损伤,调节血清Opiorphin、SAA水平,有助于术后早期康复。Objective To investigate the effect of acupoint stimulation assisted anesthesia on the agitation during recovery and the levels of serum opioids(Opiorphin)and amyloid A(SAA)in elderly patients after hip fracture surgery.Methods Eighty-six older patients who underwent hip fracture surgery in Shaoxing Second Hospital from February 2020 to September 2021 were randomly divided into the routine group and the research group,each with 43 patients.They were given acupoint sham stimulation and acupoint stimulation respectively,and the general indexes of the two groups,recovery quality,cognitive function and changes in serum Opiorphin and SAA levels were compared.Results There were no differences in operation time,anesthesia time,recovery time and intraoperative blood transfusion between the two groups(P>0.05).The dosage of remifentanil in the research group was significantly lower than that in the routine group:(270.64±17.62)μg vs.(291.82±23.34)μg,P<0.05.The incidence of agitation during the recovery period in the research group was significantly lower than that in the routine group:13.95%(6/43)vs.48.84%(21/43),P<0.05.The mini-mental state examination(MMSE)scores in the research group at 12,24 and 48 h after operation were significantly higher than those in the routine group:(22.80±2.04)scores vs.(19.31±3.61)scores,(24.92±2.44)scores vs.(21.49±3.58)scores,(26.73±2.57)scores vs.(24.23±3.95)scores,there were statistical differences(P<0.05).The serum Opiorphin level at 24 h after operation in the research group was higher than that in the routine group:(32.74±8.57)mg/L vs.(25.40±6.36)mg/L;and the SAA level was lower than that in the routine group:(157.36±10.24)mg/L vs.(204.37±15.56)mg/L,there were statistical differences(P<0.05).Conclusions Acupoint stimulation adjuvant anesthesia can reduce the occurrence of agitation during the recovery period of elderly patients with hip fracture,reduce the dosage of anesthetics,reduce postoperative cognitive impairment,regulate serum Opiorphin and SAA levels,and help early

关 键 词：麻醉 全身 老年人 穴位刺激 髋部骨折 阿片类物质 淀粉样蛋白A 

分 类 号：R614[医药卫生—麻醉学]