经皮穴位电刺激对老年患者股骨近端仿生髓内钉内固定术后睡眠质量的影响  

Effects of transcutaneous electrical acupoint stimulation on postoperative sleep quality in elderly patients undergoing proximal femoral bionic nail fixation surgery

作　　者：卢飞飞 李言民 刘天伟 潘腾 刘静[1] 冯秀梅 龚广政 范从海 LU Feifei;LI Yanmin;LIU Tianwei;PAN Teng;LIU Jing;FENG Xiumei;GONG Guangzheng;FAN Conghai(Department of Anesthesiolog,Xuzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Xuzhou 221000,China)

机构地区：[1]南京中医药大学附属徐州市中医院麻醉科,221000 [2]南京中医药大学附属徐州市中医院康复科,221000 [3]南京中医药大学附属徐州市中医院信息科,221000 [4]南京中医药大学附属徐州市中医院骨伤科,221000

出　　处：《临床麻醉学杂志》2025年第1期19-24,共6页Journal of Clinical Anesthesiology

基　　金：徐州市科技创新项目(KC19023,KC22181)。

摘　　要：目的观察经皮穴位电刺激(TEAS)对老年患者股骨近端仿生髓内钉(PFBN)内固定术后睡眠质量的影响。方法选择行PFBN内固定术的老年患者78例,男17例,女61例,年龄≥65岁,BMI 18~28 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分成两组:TEAS组(T组)和对照组(C组),每组39例。T组麻醉诱导前30 min、术后第1~3天18:00予双侧内关穴、神门穴、合谷穴TEAS,选择疏密波,2/100 Hz,根据患者可耐受的刺激维持电流强度在6~15 mA;C组在相同时间、相同穴位处贴电极片,但不通电。手术结束后连接PCIA泵行术后镇痛。采用睡眠监测仪记录手术当晚、术后第1、3、5晚19:00至次日07:00的入睡时间、总睡眠时间、Stable持续时间、Stable占比、快速动眼睡眠(REM)占比、睡眠效率。记录术后24、48 h静息和活动(功能锻炼)时VAS疼痛评分。记录术前1 d、术后第1、3、5天hs-CRP浓度。记录术后谵妄、恶心呕吐、头痛头晕、肺部并发症等不良反应发生情况以及术后住院时间。结果与C组比较,T组手术当晚、术后第1、3、5晚入睡时间明显缩短(P<0.05),总睡眠时间、Stable持续时间明显延长(P<0.05),Stable占比、REM占比和睡眠效率明显升高(P<0.05),术后24、48 h活动时VAS疼痛评分明显降低(P<0.05),术后第1、3天hs-CRP浓度明显降低(P<0.05),术后谵妄、恶心呕吐发生率明显降低(P<0.05),术后住院时间明显缩短(P<0.05)。结论围术期应用TEAS双侧内关穴、神门穴、合谷穴可以改善老年患者PFBN内固定术后睡眠质量,能够抑制炎症反应,加速患者早期恢复。Objective To observe the effects of transcutaneous electrical acupoint stimulation(TEAS)on postoperative sleep quality in elderly patients after proximal femoral bionic nail(PFBN)fixation surgery.Methods Seventy-eight patients undergoing PFBN fixation surgery,17 males and 61 females,aged≥65 years,BMI 18-28 kg/m^(2),ASA physical status Ⅱ or Ⅲ,were selected.The patients were divided into two groups by random number table:the TEAS group(group T)and the control group(group C),39 patients in each group.In group T,TEAS was applied to bilateral Neiguan,Shenmen,and Hegu acupoints 30 minutes before anesthesia and at 18:00 on postoperative days 1-3.Dense-sparse waves with a frequency of 2/100 Hz were used,and the current intensity was maintained at 6-15 mA based on patient tolerance.In group C,electrode pads were applied to the same acupoints at the same times without electrical stimulation.Postoperative analgesia was administered using a patient-controlled intravenous analgesia(PCIA)pump.Sleep parameters including sleep onset time,total sleep time,stable sleep duration,stable sleep proportion,rapid eye movement(REM)sleep proportion,and sleep efficiency were recorded with a sleep monitor from 19:00 to 07:00 the next day on the night of surgery and postoperative days 1,3,and 5.Visual analog scale(VAS)pain scores at rest and during activity(functional exercises)were recorded at postoperative 24 and 48 hours.Plasma hs-CRP levels were measured 1 day before surgery and on postoperative days 1,3,and 5.The incidence of postoperative delirium,nausea and vomiting,headache and dizziness,pulmonary complications,and length of hospital stay were also recorded.Results Compared with group C,sleep onset time was significantly shorter in group T(P<0.05),total sleep time and stable sleep duration were significantly longer,and stable sleep proportion,REM sleep proportion,and sleep efficiency were significantly higher on the night of surgery and postoperative days 1,3,and 5 in group T(P<0.05).Compared with group C,VAS pain scores during

关 键 词：经皮穴位电刺激 老年 股骨近端仿生髓内钉 睡眠质量 超敏C反应蛋白 

分 类 号：R24[医药卫生—中医临床基础]