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| 电针治疗对老年患者髋部骨折术后谵妄的影响 |
| Effect of electroacupuncture therapy on postoperative delirium in elderly patients undergoing hip fracture surgery |
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| DOI：10.12089/jca.2025.07.005 |
| 中文关键词: 电针 术后谵妄 肠道菌群 脑-肠轴 全身麻醉 髋部骨折手术 老年 |
| 英文关键词: Electroacupuncture Postoperative delirium Gut microbiota Brain-gut axis General anesthesia Hip fracture surgery Aged |
| 基金项目:江苏省中医药管理局科研项目（MS2022057）；无锡市卫健委科研项目（Q202260）；南京中医药大学自然科学基金（XZR2023025）；无锡市中医药管理局科研项目（ZYYB02） |
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| 中文摘要: |
目的：探讨电针治疗对行髋部骨折手术的老年患者术后谵妄（POD）的影响。
方法：选择全麻下行择期髋部骨折手术老年患者96例，男35例，女61例，年龄≥65岁，BMI 18.5～25.5 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：电针治疗组（EA组,n=49）和对照组（C组,n=47）。EA组在围术期施加电针治疗，对照组以假电针治疗。采用意识模糊评估法（CAM）于术后1、3、5 d评估POD的发生情况。采用记忆谵妄评估量表（MDAS）评估谵妄程度。分别于术前2 d、术后1、3、5 d采集静脉血，检测血清C-反应蛋白（CRP）、白细胞介素-6（IL-6）、中枢神经特异性蛋白S100β、神经丝轻链蛋白（NfL）浓度。记录术后1、3、5 d NRS疼痛评分。记录镇痛泵总按压次数、镇痛泵有效按压次数和补救镇痛情况。采用16s rRNA测序技术对肠道菌群进行分析，ELISA法检测肠道分泌型免疫球蛋白A（sIgA）浓度。
结果：与C组比较，EA组术后1、3 d POD发生率、MDAS评分、血清IL-6浓度、NRS疼痛评分明显降低（P<0.05），术后1、3、5 d血清CRP、S100β浓度明显降低（P<0.05），术后3、5 d血清NfL浓度明显降低（P<0.05），镇痛泵总按压次数、镇痛泵有效按压次数明显减少（P<0.05），补救镇痛率明显降低（P<0.05），术后5 d血清sIgA浓度明显升高（P<0.05）。与C组比较，在门水平，术后EA组厚壁菌门和放线菌门丰度明显降低，变形菌门和拟杆菌门丰度明显升高（P<0.05）；在属水平，术后EA组拟杆菌属、海事成球杆菌属和普拉梭菌属丰度明显升高，埃希氏杆菌属和芽殖菌属丰度明显降低（P<0.05）。
结论：电针治疗能够显著降低老年患者全麻手术POD发生率，减轻其严重程度，术后还可提供有效的持续镇痛效应。电针治疗患者术后肠道相关菌群丰度改变明显，可能是电针治疗的关键机制之一。 |
| 英文摘要: |
Objective: To explore the effect of electroacupuncture therapy on postoperative delirium (POD) in elderly patients undergoing hip fracture surgery.
Methods: Ninety-six elderly patients undergoing elective hip fracture surgery under general anesthesia were selected, 35 males and 61 females, aged ≥ 65 years, BMI 18.5-25.5 kg/m2, ASA physical status Ⅱ or Ⅲ. They were divided into two groups using the random number table method: electroacupuncture therapy group (group EA, n = 49) and control group (group C, n = 47). The patients in group EA received electroacupuncture, while the patients in group C received sham electroacupuncture. The occurrence of POD was determined by using the confusion assessment method (CAM) 1 day, 3 and 5 days after the operation. The degree of delirium was evaluated using the memory delirium assessment scale (MDAS). The NRS pain scores 1 day, 3 and 5 days after the operation were recorded. Venous blood was collected 2 days before the operation, 1, 3, and 5 days after the operation respectively to detect the concentrations of serum C-reactive protein (CRP), interleukin-6 (IL-6), central nervous system specific protein S100β, and nerve filament light chain protein (NfL). The intestinal flora was analyzed by 16s rRNA sequencing technology, and the concentration of intestinal secretory immunoglobulin A (sIgA) was detected by ELISA.
Results: Compared with group C, the incidence of POD, MDAS score, serum IL-6 concentration and NRS pain score 1 day and 3 days after surgery in group EA were significantly decreased (P < 0.05), and the concentrations of serum CRP and S100β 1 day, 3 and 5 days after surgery were significantly decreased (P < 0.05), the serum NfL concentration was significantly decreased 3 and 5 days after the operation (P < 0.05), the total number of compressions of the analgesic pump and the effective number of compressions of the analgesic pump were significantly reduced (P < 0.05), the remedial analgesia rate was significantly decreased (P < 0.05), and the serum sIgA concentration was significantly increased 5 days after the operation (P < 0.05). Compared with group C, group EA showed a significant reduction in the abundance of Firmicutes and Actinobacteria at the phylum level, while the abundance of Proteobacteria and Bacteroidota increased significantly (P < 0.05), and group EA showed a significant increase in the abundance of Bacteroides, Faecalibacterium, and Phocaeicola at the genus level, while the abundance of Escherichia and Gemmiger decreased significantly (P < 0.05).
Conclusion: Electroacupuncture therapy can significantly reduce the incidence of POD in elderly patients undergoing hip fracture surgery under general anesthesia and alleviate its severity. It can also provide an effective and sustained analgesic effect postoperatively. The significant changes in the abundance of intestinal-related microbiota in patients receiving electroacupuncture may be one of the key mechanisms for its efficacy. |
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