针刺百会、内关配伍足三里对全麻下行下肢全关节置换术老年患者术后谵妄的影响  

Effect of acupuncture at Baihui and Neiguan combined with Zusanli on postoperative delirium in elderly patients undergo⁃ing total joint arthroplasty of the lower limbs under general anesthesia

作　　者：戴冰舲 刘鹤 Dai Bingling;Liu He(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,Changzhou Hospital Affiliated to Nanjing University of Chinese Medicine,Changzhou 213000,China;Department of Anesthesiology,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]南京中医药大学常州附属医院麻醉科,常州213000 [3]湖州市中心医院麻醉科,湖州313000

出　　处：《国际麻醉学与复苏杂志》2025年第2期146-152,共7页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(82171227);浙江省自然科学基金(LY22H090019);神经信息教育部重点实验室开放课题(202311FKY00102);浙江省脑血管病诊治中医药多学科交叉创新团队项目;吴阶平医学基金会急性疼痛优化管理专项。

摘　　要：目的探讨针刺百会、内关配伍足三里对全麻下肢全关节置换术(TJA)老年患者术后谵妄(POD)发生率的影响。方法择期行全麻下肢TJA的老年患者130例,采用计算机生成随机序列法分为对照组(C组)与试验组(T组),每组65例。T组麻醉诱导前30 min针刺百会穴、内关穴和足三里三穴,C组麻醉诱导前30 min在上述三处穴位附近0.5 cm处做无效针刺。记录两组患者术后1、3、5 d(每日上午、下午各1次)及术后7 d的意识模糊评估法(CAM)评分,POD亚型及POD发生率。记录两组患者术前1 d、术后3 d的简易精神状态检查(MMSE)评分,术前1 d、术后1 d、术后2 d的视觉模拟评分法(VAS)疼痛评分及术后1 d、术后2 d的镇痛泵按压次数。记录两组患者拔管时间及脑梗死、肺栓塞发生率。结果T组各时点CAM评分低于C组(均P<0.05);两组患者CAM评分随着时间推移逐渐下降,C组、T组术后1 d下午、术后3 d上午、术后3 d下午、术后5 d上午、术后5 d下午、术后7 d的CAM评分较术后1 d上午降低(均P<0.05)。T组POD发生率低于C组(P<0.05),两组患者POD亚型差异无统计学意义(均P>0.05)。T组术后3 d MMSE评分高于C组(P<0.05),两组术后3 d MMSE评分低于术前1 d(均P<0.05)。C组、T组术后1 d、术后2 d的VAS疼痛评分低于术前1 d(均P<0.05),C组、T组术后2 d镇痛泵按压次数及VAS疼痛评分低于术后1 d(均P<0.05)。T组拔管时间短于C组(P<0.05);T组脑梗死、肺栓塞发生率小于C组,但差异无统计学意义(P>0.05)。结论应用针刺百会穴、内关穴配伍足三里穴的方式可降低全麻下肢TJA老年患者POD的发生率。Objective To explore the effect of acupuncture at Baihui and Neiguan combined with Zusanli on the incidence of postoperative delirium(POD)in elderly patients undergoing total joint arthroplasty(TJA)of the lower limbs under general anesthesia.Methods A total of 130 elderly patients who were scheduled for TJA of the lower limbs under general anesthesia were selected.According to the computer‑generated random sequence method,the patients were divided into two groups(n=65):a control group(group C)and an experimental group(group T).In group T,acupuncture was performed at Baihui,Neiguan and Zusanli 30 min before anesthesia induction.In contrast,ineffective acupuncture was performed 0.5 cm away from the points mentioned above 30 min before anesthesia induction.The Confusion Assessment Method(CAM)scores was recorded on postoperative days 1,3,5(once each in the morning and afternoon),and on postoperative day 7.Meanwhile,POD subtypes and POD incidence were also recorded.The Mini‑Mental State Examination(MMSE)scores were measured on the day before operation and on post‑operation day 3.The Visual Analog Scale(VAS)scores were recorded on the day before surgery and on post‑operation days 1 and 2.The number of analgesia pump pressing was also recorded on post‑operation days 1 and 2.The time to extubation and the incidence of brain infarction and pulmonary embolism were also documented.Results Group T showed lower CAM scores than group C at each time point(all P<0.05).CAM scores decreased over time in both groups,with lower scores on post‑operation day 1 afternoon,day 3 morning and afternoon,day 5 morning and afternoon,and day 7 than those on post‑operation day 1 morning(all P<0.05).The incidence of POD in group T was lower than that in group C(P<0.05),while there was no statistical difference in POD subtypes between the two groups(all P>0.05).MMSE scores on post‑operation day 3 in group T were higher than those in group C(P<0.05),and both groups showed decreased MMSE scores on day 3,compared with those the day b

关 键 词：针刺 术后谵妄 全关节置换术 老年人 

分 类 号：R246.2[医药卫生—针灸推拿学]