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| 40 Hz声光刺激对老年患者关节置换术后谵妄的影响 |
| Effect of 40 Hz audiovisual stimulation on postoperative delirium in elderly patients undergoing joint replacement surgery |
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| DOI：10.12089/jca.2026.03.010 |
| 中文关键词: 40 Hz声光刺激 术后谵妄 老年 关节置换术 |
| 英文关键词: 40 Hz audiovisual stimulation Postoperative delirium Aged Joint replacement surgery |
| 基金项目:国家自然科学基金青年科学基金项目（81701375） |
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| 中文摘要: |
目的： 探讨围术期应用40 Hz声光刺激对老年患者关节置换术后谵妄（POD）的影响。
方法： 选择2024年12月至2025年6月行关节置换术的老年患者，年龄65～85岁，BMI 18.5～40.0 kg/m2，ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组：对照组和干预组。干预组在麻醉前及术后恢复期各接受40 Hz声光刺激30 min，对照组接受自然白光和白噪声刺激。主要指标为术后3 d内POD发生率。次要指标包括POD严重程度和持续时间，手术当日和术后1、2、3 d 理查兹-坎贝尔睡眠问卷（RCSQ）评分，术后5 d焦虑自评量表（SAS）评分和抑郁自评量表（SDS）评分和补救镇痛率。不良反应包括术后恶心呕吐（PONV）、寒战和发热。
结果： 共纳入患者124例，每组62例。与对照组比较，干预组术后3 d内POD发生率和严重程度评分明显降低，POD持续时间明显缩短，术后1 d RCSQ评分明显升高（P<0.05）。两组补救镇痛率、PONV、寒战和发热发生率差异无统计学意义。
结论： 围术期应用40 Hz声光刺激可有效降低老年关节置换术患者术后3 d内POD发生率和严重程度，缩短POD持续时间，并改善术后早期睡眠质量，且具有良好安全性，为其在围术期神经认知功能保护中的临床应用提供了新思路。 |
| 英文摘要: |
Objective: To investigate the effect of perioperative 40 Hz audiovisual stimulation on the incidence of postoperative delirium (POD) in elderly patients undergoing joint replacement surgery.
Methods: Patients scheduled for joint replacement surgery between December 2024 and June 2025 were enrolled, aged 65-85 years, BMI 18.5-40.0 kg/m2, ASA physical status Ⅰ - Ⅲ. Patients were randomly assigned to two groups: the control group and the intervention group. The intervention group received 40 Hz audiovisual stimulation for 30 minutes before anesthesia induction and during the early postoperative recovery period, whereas the control group received neutral white light and white noise stimulation. The primary outcome was the incidence of POD within 3 days postoperatively. Secondary outcomes included POD severity, duration of POD, Richards-Campbell sleep questionnaire (RCSQ) scores on the surgery day, on 1 day, 2 and 3 days postoperatively, self-rating anxiety scale (SAS) scores and self-rating depression scale (SDS) scores on 5 days postoperatively, and the incidence of resuce analgesia. Adverse reactions included postoperative nausea and vomiting (PONV), shivering, and fever.
Results: A total of 124 elderly patients were enrolled, 62 patients in each group. Compared with the control group, the incidence of POD and POD severity were significantly decreased within 3 days postoperatively , the duration of POD was significantly shortened, RCSQ score on 1 day postoperatively was significantly increased in the intervention group (P < 0.05). There were no significantly differences in the incidences of rescue analgesia, PONV, shivering, and fever between the two groups.
Conclusion: Perioperative 40 Hz audiovisual stimulation can effectively reduce the incidence, severity, and duration of POD within 3 days postoperatively and improve early postoperative sleep quality in elderly patients undergoing joint replacement surgery, with a favorable safety profile. These findings provide a new approach for the clinical application of perioperative neurocognitive protection in this population. |
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