摘要
目的:比较术中电针刺治疗对老年患者术后谵妄发生率的影响及其机制。方法:筛选全身麻醉下老年患者186例,随机分成两组:针刺组,于麻醉诱导前30 min行双侧神门穴、内关穴、百会穴及印堂穴电针刺激治疗,留针通电刺激至术毕。对照组,浅刺激神门、内关、百会及印堂穴非穴位点,无有效电流输出,留针至手术结束。入组患者在连续3个时间点抽取静脉血检测S100β蛋白浓度。采用谵妄评定方法(CAM)或者CAM-ICU评定两组患者从入恢复室至术后5 d内是否发生谵妄,采用数字评分法(NRS)评估术后疼痛程度以及术后睡眠质量。结果:针刺组和对照组术后谵妄的发生率分别为7.0%和16.0%,组间差异无统计学意义(P>0.05)。两组患者术后5 d疼痛NRS评分无统计学意义(P>0.05)。针刺组术后连续5 d睡眠质量NRS评分低于对照组,有统计学意义(UDay1=4518.5,UDay2=4296,UDay3=4247.5,UDay4=4134,UDay5=4055.5,均P<0.05)。此外,对照组术后24 h S100β浓度显著上升。结论:虽然术中电针刺不能显著减少术后谵妄的发生率,但能明显改善术后5 d睡眠质量,这种改善可能与通过降低S100β蛋白介导的脑保护有关。
Objective:To evaluate the effect of intraoperative electro-acupuncture on the incidence of postoperative delirium in elderly patients and its mechanism.Methods:186 elderly patients under general anesthesia were randomly divided into two groups.In acupuncture group,the patients were stimulated with electroacupuncture at bilateral Shenmen,Neiguan,Baihui and Yintang point 30 min before anesthesia induction.As for control group,the patients were treated with superficial stimulation of non-acupoint sites and no effective current output,retained needles until the end of the operation.These participants were selected to detect the concentration of S100βin venous blood during continuous three time points.The Confusion Assessment Method(CAM)or CAM-ICU was used to assess whether delirium occurred from entering the recovery room to 5 days after operation.The Numerical Rating Scale(NRS)was used to assess the degree of pain and the quality of sleep after operation.Results:The incidence of delirium in acupuncture group and control group was 7.0%and 16.0%respectively,but there was no significant difference(P>0.05).No outstanding difference was observed in NRS score of pain between two groups(P>0.05).The NRS score of sleep quality in acupuncture group was lower than that in control group of 5 days after operation(UDay1=4518.5,UDay2=4296,UDay3=4247.5,UDay4=4134,UDay5=4055.5,all P<0.05).The concentration of S100βprotein in control group increased significantly 24 hours after operation.Conclusion:Although intraoperative acupuncture cannot significantly reduce the incidence of postoperative delirium,it can obviously improve the sleep quality of 5 days after operation,which may be related to brain protection mediated by reducing the concentration of S100β.
作者
吴建华
史佳
陈芋熹
胡欣欣
张圆
余剑波
WU Jian-hua;SHI Jia;CHEN Yu-xi;HU Xin-xin;ZHANG Yuan;YU Jian-bo(Tianjin Medical University NanKai Hospital,Tianjin 300041,China;Department of Anesthesiology,Tianjin Nankai Hospital,Tianjin 300041,China)
出处
《天津医科大学学报》
2020年第5期466-470,共5页
Journal of Tianjin Medical University
关键词
电针刺
谵妄
睡眠
老年
electroacupuncture
delirium
sleep
aged
