目的:目前尚无确切有效的术后谵妄(POD)治疗方法。目的观察经皮穴位电刺激(TEAS)术前及术中对老年POD患者的影响。材料与方法:将90例患者随机分为3组:术前TEAS组(E1组),术中TEAS组(E2组),对照组(C组)。在E1组中,在Shenting应用TEAS,百惠,双侧内关,手术前1天及麻醉诱导前30min和合谷穴。E2组术中应用TEAS。C组,电极被应用到刚才提到的点上,但是没有电刺激。术后5天内评估谵妄的发生率,记录丙泊酚在脑电双频指数(BIS)=50时的血浆浓度。收集血样以测量神经元特异性烯醇化(NSE),肿瘤坏死因子-α(TNF-α),术前1天和术后1、5天白细胞介素(IL)-1β。结果:E1组谵妄发生率较C组及E1组降低(均P<0.05)。与C组和E2组相比,E1组BIS=50时的丙泊酚血浆浓度也降低(均p<0.05)。与C组相比,NSE的浓度,TNF-α,E1组和E2组术后1、5天血浆IL-1β水平下降(P均<0.05),与E2组相比,E1组术后1天和5天血浆中NSE和IL-1β的浓度降低。结论:TEAS能减少术中丙泊酚用量,减少术后谵妄的发生。其机制可能与抑制炎症反应、减轻脑损伤有关。与术中应用相比,术前TEAS预处理效果较好。临床试验注册:ChiCTR-INR-17012501。注册日期:2017年8月29日。
Objectives: There is currently no exact and effective treatment for postoperative delirium (POD). The purpose of this
study was to observe the effect of transcutaneous electrical acupoint stimulation (TEAS) before surgery and during surgery in elderly patients with POD. Materials and Methods: A total of 90 patients were randomly divided into three groups: a preoperative TEAS group (group E1), an intraoperative TEAS group (group E2), and a control group (group C). In group E1, TEAS was applied at the Shenting, Baihui, bilateral Neiguan, and Hegu points for 30 min 1 day before surgery and before the induction of anesthesia. In group E2, TEAS was applied during surgery. In group C, electrodes were applied to the points just cited, but no electric stimulation was administered. The incidence of delirium was assessed within 5 days after surgery, and the plasma concentration of propofol at bispectral index (BIS) = 50 was recorded. Blood samples were collected to measure neuron-specific enolation (NSE), tumor necrosis factor-α (TNF-α), and interleukin (IL)-1β 1 day before surgery and 1 and 5 days after surgery. Results: The incidence of delirium in group E1 was decreased in comparison with group C and group E1 (both p < 0.05). The propofol plasma concentration at BIS = 50 in group E1 was also decreased in comparison with group C and group E2 (both p < 0.05). Compared with group C, the concentrations of NSE, TNF-α, and IL-1β in plasma were decreased in group E1 and group E2 1 and 5 days after surgery (both p < 0.05), and the concentrations of NSE and IL-1β in plasma in group E1 were decreased 1 and 5 days after surgery in comparison with group E2. Conclusion: The TEAS can reduce the dosage of propofol required during surgery and the occurrence of delirium after surgery. Its mechanism may be related to inhibiting inflammation response and alleviating brain injury. Compared with intraoperative application, the effect of preconditioning with TEAS before surgery is better. Clinical
Trial Registration: ChiCTR-INR-17012501. Date of registration: August 29, 2017.