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| 经皮穴位电刺激联合认知功能训练对老年骨科手术患者术后谵妄的影响 |
| Effect of transcutaneous electrical acupoint stimulation combined with cognitive function training on postoperative delirium in elderly patients undergoing orthopedic surgery |
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| DOI：10.12089/jca.2026.03.009 |
| 中文关键词: 经皮穴位电刺激 认知功能训练 术后谵妄 老年 骨科手术 |
| 英文关键词: Transcutaneous electrical acupoint stimulation Cognitive function training Postoperative delirium Aged Orthopedic surgery |
| 基金项目:江苏省卫生健康委医学科研重点项目（K2024021）；江苏省中医院科主任提升专项课题（Y2022ZR29） |
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| 中文摘要: |
目的： 探讨经皮穴位电刺激（TEAS）联合认知功能训练对老年骨科手术患者术后谵妄（POD）的预防效果及潜在机制。
方法： 选择择期在全麻下行全膝或全髋关节置换术的老年患者，年龄65～80岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为三组：对照组（C组）、术前认知训练组（O组）和TEAS联合术前认知训练组（TO组）。C组接受常规围术期护理；O组在常规围术期护理的基础上进行术前认知训练；TO组在O组的基础上进行TEAS。主要指标为术后1 d POD发生率。次要指标包括术后2、3、7 d POD发生率，术后1、3、7 d阿森斯失眠量表（AIS）评分，术前1 d、手术开始1 h和术后1 d的局部脑氧饱和度（rSO2），术前1 d和术后1 d血清IL-6和TNF-α浓度，镇痛泵有效按压次数、镇痛泵总按压次数和补救镇痛率，拔管时间，PACU停留时间和术后住院时间。不良反应包括术后恶心呕吐、腹胀和皮肤瘙痒。
结果： 共纳入患者105例，其中C组35例，O组36例，TO组34例。与C组比较，O组和TO组术后1、2、3 d POD发生率明显降低，术后1、3、7 d AIS评分明显降低，PACU停留时间和术后住院时间明显缩短（P＜0.05）；TO组手术开始后1 h和术后1 d rSO2明显降低，术后1 d血清IL-6和TNF-α浓度明显降低，镇痛泵有效按压次数和镇痛泵总按压次数明显减少，补救镇痛率明显降低，术后恶心呕吐发生率明显降低（P＜0.05）。与O组比较，TO组术后1、2、3 d POD发生率明显降低，术后1、3、7 d AIS评分明显降低，手术开始后1 h和术后1 d rSO2明显升高，术后1 d血清IL-6和TNF-α浓度明显降低，镇痛泵有效按压次数和镇痛泵总按压次数明显减少，补救镇痛率明显降低，术后住院时间明显缩短，术后恶心呕吐发生率明显降低（P＜0.05）。
结论： TEAS联合认知功能训练能够降低老年骨科手术患者POD发生率，改善rSO2和睡眠质量，缩短住院时间，促进患者术后康复。 |
| 英文摘要: |
Objective: To investigate the preventive effect and potential mechanism of transcutaneous electrical acupoint stimulation (TEAS) combined with cognitive function training on postoperative delirium (POD) in elderly patients undergoing orthopedic surgery.
Methods: Elderly patients scheduled for elective total knee or total hip arthroplasty under general anesthesia, aged 65-80 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into three groups using a random number table: the control group (group C), the preoperative cognitive training group (group O), and the TEAS combined with preoperative cognitive training group (group TO). Group C received conventional perioperative care, group O underwent preoperative cognitive training on the basis of conventional perioperative care, and group TO underwent TEAS on the basis of group O. The primary outcome was the incidence of POD on 1 day postoperatively. Secondary outcomes included the incidence of POD on 2, 3, and 7 days postoperatively, Asens insomnia scale (AIS) on 1 day, 3, and 7 days postoperatively, regional cerebral oxygen saturation (rSO2) on 1 day preoperatively, 1 hour after the start of surgery, and on 1 day postoperatively, the concentrations of serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) on 1 day preoperatively and on 1 day postoperatively, the total number of analgesie pump compressions, the number of effective compressions, and the incidence of requiring supplementary analgesia, the extubation time, PACU stay time, and postoperative hospitalization time. Adverse reactions included postoperative nausea and vomiting, abdominal distension, and skin itching.
Results: A total of 105 elderly patients were enrolled, 35 patients in group C, 36 patients in group O, and 34 patients in group TO. Compared with group C, the incidence of POD were significantly reduced on 1 day, 2, and 3 days postoperatively, the AIS scores were significantly reduced on 1 day, 3, and 7 days postoperatively, the PACU stay time and postoperative hospitalization time were significantly shortened in groups O and TO (P < 0.05). Compared with group C, the rSO2 levels were significantly reduced 1 hour after the start of surgery and on 1 day postoperatively, the concentrations of serum IL-6 and TNF-α were significantly decreased on 1 day postoperatively, the total number of analgesie pump compressions, the number of effective compressions, and the incidence of instances requiring supplementary analgesia were significantly reduced, the incidence of postoperative nausea and vomiting was significantly decreased in group TO (P < 0.05). Compared with group O, the incidence of POD were significantly reduced on 1 day, 2, and 3 days postoperatively, the AIS scores were significantly incidence on 1 day, 3, and 7 days postoperatively, the rSO2 levels were significantly increased 1 hour after the start of surgery and on 1 day postoperatively, the concentrations of serum IL-6 and TNF-α were significantly decreased on 1 day postoperatively, the total number of analgesie pump compressions, the number of effective compressions, and the incidence of instances requiring supplementary analgesia were significantly reduced, postoperative hospitalization time was significantly shortened, the incidence of postoperative nausea and vomiting was significantly decreased in group TO (P < 0.05).
Conclusion: TEAS combined with cognitive function training can reduce the incidence of postoperative delirium in elderly orthopedic patients, improve cerebral oxygen saturation and sleep quality, shorten hospitalization time, and promote patients' postoperative recovery. |
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