文章摘要
经皮穴位电刺激对老年衰弱患者全身麻醉手术后早期恢复质量的影响
Effect of transcutaneous electrical acupoint stimulation on early postoperative recovery quality in elderly frail patients undergoing surgery with general anesthesia
  
DOI：10.12089/jca.2026.05.004
中文关键词: 经皮穴位电刺激  衰弱  应激  炎症  恢复质量  老年
英文关键词: Transcutaneous electrical acupoint stimulation  Frailty  Stress  Inflammation  Recovery quality  Aged
基金项目:山西省中医药管理局科研课题（2023ZYYA024）
作者单位E-mail
刘华 030001,太原市,山西医科大学麻醉学院  
符炽冰 030001,太原市,山西医科大学麻醉学院  
彭宝田 030001,太原市,山西医科大学麻醉学院  
奥晋 030001,太原市,山西医科大学麻醉学院  
刘萌 030001,太原市,山西医科大学麻醉学院  
张林忠 山西医科大学第二医院麻醉科 Zlz1974@139.com 
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中文摘要:
      
目的：探讨经皮穴位电刺激（TEAS）对老年衰弱患者术后早期恢复质量的影响。
方法：选择择期行全身麻醉手术患者，年龄65～90岁，临床衰弱量表（CFS）评分≥4分，BMI 18.5～28.0 kg/m2，ASA Ⅱ—Ⅳ级。采用区组随机化将患者分为两组：TEAS组和对照组。TEAS组于术前1 d下午17：00、麻醉诱导前30 min、术后1 d上午09：00取单侧内关穴（PC6）、合谷穴（LI4）、足三里穴（ST36）、三阴交穴（SP6）行TEAS，选择频率为2/10 Hz的疏密波，每次持续30 min。对照组于相同穴位贴电极片但不给予电刺激。主要指标为术后1 d上午10：00的15项恢复质量（QoR-15）评分。次要指标包括术前1 d 下午16：00、术后3 d上午10：00的QoR-15评分，拔管时间，术后首次肛门排气时间，术后1 d上午10：00、术后3 d上午10：00的VAS疼痛评分，镇痛泵总按压次数、镇痛泵有效按压次数，止吐药使用率，术前1 d下午16：00、术后3 d上午10：00血清皮质醇（Cor）、C-反应蛋白（CRP）、白细胞介素-10（IL-10）、白细胞介素-6（IL-6）、前列腺素E2（PGE2）、前列腺素F2α（PGF2α）浓度以及中性粒细胞淋巴细胞比值（NLR）、血小板淋巴细胞比值（PLR）。不良反应为术后恶心呕吐（PONV）。
结果：共纳入患者156例，每组78例。术后1 d上午10：00两组QoR-15评分均数差值为6.1分。与对照组比较，TEAS组术后1 d上午10：00、术后3 d上午10：00的QoR-15评分明显升高，拔管时间、术后首次肛门排气时间明显缩短，术后1 d上午10：00、术后3 d上午10：00的VAS疼痛评分明显降低，镇痛泵总按压次数、镇痛泵有效按压次数明显减少，术后3 d上午10：00血清CRP、IL-10、IL-6、PGE2、PGF2α浓度以及NLR、PLR明显降低，PONV发生率、止吐药使用率明显降低（P＜0.05）。
结论：围术期TEAS可以有效提高老年衰弱患者术后早期恢复质量，减轻围术期炎症反应，同时还可缓解术后疼痛，促进胃肠功能的恢复。
英文摘要:
      
Objective: To investigate the effects of transcutaneous electrical acupoint stimulation (TEAS) on early postoperative recovery quality in elderly frail patients.
Methods: Patients scheduled for elective surgery under general anesthesia, aged 65-90 years, clinical frailty scale (CFS) score ≥ 4, BMI 18.5-28.0 kg/m2, ASA physical status Ⅱ-Ⅳ, were divided into two groups by block randomization: TEAS group and control group. The TEAS group received TEAS at unilateral Neiguan (PC6), Hegu (LI4), Zusanli (ST36), and Sanyinjiao (SP6) on preoperative day 1 (17:00), 30 minutes before induction, and on the morning of postoperative day 1 (09:00). A dense-disperse wave with a frequency of 2/10 Hz was selected, and each session lasted for 30 minutes. The control group had electrodes placed at identical acupoints without electrical stimulation. The primary outcome was the 15-item quality of recovery (QoR-15) scores on postoperative day 1 (10:00). Secondary outcomes included QoR-15 scores on preoperative day 1 (16:00) and postoperative day 3 (10:00), time to extubation at the end of surgery, time to first postoperative flatus, VAS pain scores on postoperative day 1 (10:00) and postoperative day 3 (10:00), requirement for rescue antiemetic medication, number of total and effective pressing of the analgesia pump, serum concentrations of cortisol (Cor), C-reactive protein (CRP), interleukin-10 (IL-10), interleukin-6 (IL-6), prostaglandin E2 (PGE2), and prostaglandin F2α (PGF2α), as well as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on preoperative day 1 (16:00) and postoperative day 3 (10:00). Adverse reactions was postoperative nausea and vomiting (PONV).
Results: A total of 156 patients were enrolled, 78 patients in each group. The mean difference in QoR-15 scores between the two groups after intervention on postoperative day 1 was 6.1 points. Compared with the control group, the TEAS group showed significantly higher QoR-15 scores on postoperative day 1 (10:00) and postoperative day 3 (10:00), significantly shorter time to extubation at the end of surgery, significantly shorter time to first postoperative flatus, significantly lower VAS pain scores on postoperative day 1 (10:00) and on postoperative day 3 (10:00), significantly fewer number of total and effective pressing of the analgesia pump, significantly lower serum concentrations of CRP, IL-10, IL-6, PGE2, and PGF2α, significantly reduced NLR and PLR on postoperatively day 3 (10:00), and significantly lower incidence of PONV and requirement for rescue antiemetic medication (P < 0.05).
Conclusion: The application of TEAS effectively enhances the quality of early postoperative recovery in frail patients, attenuates the perioperative inflammatory response, alleviates postoperative pain, and promotes the restoration of gastrointestinal function.
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