经皮穴位电刺激对老年髋关节置换术患者脑氧代谢以及术后认知功能、镇痛效果的影响

目的:探讨经皮穴位电刺激(TEAS)对老年髋关节置换术患者脑氧代谢以及术后认知功能、镇痛效果的影响。方法:选取2016年1月～2018年7月期间我院收治的行髋关节置换术患者91例为研究对象,将研究对象根据随机数字表法分为对照组(n=45)和研究组(n=46),对照组给予常规麻醉处理,研究组在对照组基础上给予TEAS,比较两组脑氧代谢、术后认知功能以及镇痛效果,记录两组术后的不良反应发生情况。结果:在降压开始后20 min(T1)、降压开始后40 min(T2)、停止降压后20 min(T3)时间点时,两组静脉血氧含量(Cjv O2)较降压前即刻(T0)时间点升高,且研究组高于对照组(P0.05),两组脑动-静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)较T0时间点降低,且研究组低于对照组(P0.05)。两组患者术后72h简易智能量表(MMSE)评分均较术前24h降低,但研究组高于对照组(P0.05),研究组术后认知功能障碍(POCD)发生率低于对照组(P0.05)。与术前比较,两组患者术后8h、术后24h、术后48h视觉疼痛模拟量表(VAS)评分均升高(P0.05),但研究组术后8h、术后24h、术后48h等时间点VAS评分均低于对照组(P0.05)。两组患者不良反应总发生率比较无差异(P0.05)。结论:TEAS对老年髋关节置换术后患者的镇痛效果确切,可有效改善脑氧代谢情况,提高术后认知功能,临床应用价值较高。

Effect of Transcutaneous Electrical Acupoint Stimulation on Cerebral Oxygen Metabolism, Postoperative Cognitive Function and Analgesic Effect in Elderly Patients Undergoing Hip Replacement

ABSTRACT Objective: To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on cerebral oxygen metabolism,postoperative cognitive function and analgesic effect in elderly patients undergoing hip replacement. Methods: 91 patients who underwent hip replacement in our hospital from January 2016 to July 2018 were selected as the research subjects. The subjects were randomly divided into control group (n=45) and research group (n=46) according to the digital table method. The control group was given routine anesthesia and the research group was given TEAS on the basis of the control group. The cerebral oxygen metabolism, postoperative cognitive function and analgesic effect were compared between the two groups, and the occurrence of adverse reactions in the two groups was recorded. Results: The venous blood oxygen content (CjvO₂) increased at 20 minutes after the onset of hypotension (T₁), 40 minutes after the onset of hypotension (T₂) and 20 minutes after the cessation of hypotension (T₃), and the research group was higher than the control group (P<0.05). The cerebral arterial venous oxygen content difference (Da-CjvO₂) and cerebral extraction rate of oxygen (CERO₂) of the two groups was lower than that at T₀ time points, and that of the research group was lower than that of the control group (P<0.05). The Mini-Mental state examine (MMSE) scores at 72 hours after operation in both groups were lower than those at 24 hours before operation, but those in the research group were higher than those in the control group (P<0.05). Postoperative cognitive dysfunction(POCD) in the research group was lower than that in the control group (P<0.05). Compared with those before operation, the visual analogue scale (VAS) scores of the two groups increased at 8 hours, 24 hours and 48 hours after operation (P<0.05). However, the VAS scores of the research group at 8 hours, 24 hours and 48 hours after operation were lower than those of the control group (P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion: TEAS has a definite analgesic effect on elderly patients undergoing hip replacement. It can effectively improve cerebral oxygen metabolism and cognitive function, and it has a high clinical application value.