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摘要：
目的 探讨经皮穴位电刺激（transcutaneous electrical acupoint stimulation, TEAS）神门穴、内关穴对老年髋关节置换术患者睡眠质量及术后谵妄（postoperative delirium, POD）的影响。 方法 行髋关节置换术的老年患者102例，采用随机数字表法分为试验组（T组，50例）和对照组（C组，52例）。T组分别于术前30 min、手术当天、术后第1天、术后第2天18:00行TEAS双侧内关穴、神门穴，共4次，每次30 min；C组连接穴位电刺激仪，但不通电。记录两组患者性别、年龄、体重、ASA分级、麻醉方式、手术方式、出血量和手术时长等一般情况；记录两组患者术前1 d、术后当天、术后24 h、术后48 h VAS疼痛评分，术前1 d、术后72 h 简易智力状态检查（Mini‑Mental State Examination, MMSE）评分和匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI），术前1 d及术后24、48、72 h意识模糊评估法（Confusion Assessment Method, CAM）评分；手环监测术前1晚、术后当晚、术后第1晚、术后第2晚患者睡眠结构；记录两组患者POD发生情况。 结果 两组患者手术当天、术后24 h、术后48 h VAS疼痛评分低于术前1 d（P<0.05），两组患者术后24 h、术后48 h VAS疼痛评分低于手术当天（P<0.05），两组患者术后48 h VAS疼痛评分低于术后24 h（P<0.05）。两组患者术后72 h PSQI评分低于术前1 d（P<0.05），术后72 h T组PSQI评分低于C组（P<0.05）。C组术后当晚、术后第1晚、术后第2晚深睡眠时长少于术前1晚（P<0.05），睡眠时间长于术前1晚（P<0.05）；T组术后当晚、术后第1晚、术后第2晚睡眠时间长于术前1晚（P<0.05）；两组患者术后72 h MMSE评分低于术前1 d（P<0.05）。两组患者术后48、72 h CAM评分低于术前1 d和术后24 h（P<0.05）。T组POD发生率低于C组（P<0.05）。其余指标差异无统计学意义（P>0.05）。 结论 围手术期应用TEAS双侧内关穴、神门穴可能改善老年髋关节置换术患者睡眠质量，降低POD发生率。
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Abstract: Objective To explore the effects of transcutaneous electrical acupoint stimulation (TEAS) at Shenmen（HT7）and Neiguan（PC6）points on sleep quality and postoperative delirium (POD) in the elderly patients undergoing hip replacement surgery. Methods A total of 102 elderly patients undergoing hip arthroplasty surgery were divided into TEAS group (group T, 50 cases) and control group (group C, 52 cases) by random number table method. Patients in the group T received TEAS at bilateral HT7 points and PC6 points 30 min before surgery and at 18:00 on the surgery day and following two days after surgery, for a total of 4 times, 30 min each time. The acupoints of patients in group C were connected to the electrical stimulator, but the stimulator was power off. General information such as gender, age, weight, American Society of Anesthesiologists (ASA) grade, anesthesia method, operation method, blood loss, and operation duration of patients in the two groups was recorded. Visual Analogue Scale (VAS) pain scores of both two groups were recorded at the time points of the day before surgery, the surgery day, 24 h after surgery, and 48 h after surgery. The Mini‐Mental State Examination (MMSE) scores and Pittsburgh Sleep Quality Indexes (PSQI) were recorded the day before surgery and 72 h after surgery. Confusion Assessment Method (CAM) scores were recorded on the day before surgery and 24, 48, 72 h after surgery. The sleep state of the patients was monitored by the bracelet on the first night before surgery, the night of the surgery day, the first night after surgery, and the second night after surgery. The occurrence of POD was also recorded in both groups. Results The VAS pain scores of group C and T on the day of operation, 24 h and 48 h after operation were lower than the scores of 1 day before operation (P<0.05), the VAS pain scores of group C and T at 24 h and 48 h after operation were lower than the scores of the day of operation, the VAS pain scores of group C and T at 48 h after operation were lower than the scores at 24 h after operation. The PSQI scores of group C and T at 72 h after surgery were both lower than the scores of the first day before surgery (P<0.05), and the PSQI score of group T was lower than that of C group at 72 h after surgery (P<0.05). In group C, the duration of deep sleep on the night of surgery and following two nights after surgery was less than that before surgery (P<0.05), the sleep time was longer than that before surgery, the sleep time of group T on the night of surgery and the following two days was all longer than that before surgery (P<0.05). The MMSE scores of both two groups at 72 h after surgery were lower than those scores at the first day before surgery (P<0.05). CAM scores in groups C and T at 48 h and 72 h after surgery were lower than those scores on the first day before surgery and at 24 h after surgery (P<0.05). The incidence of POD in group T was lower than the incidence in group C (P<0.05). There was no significant difference in other indicators (P>0.05). Conclusions TEAS of bilateral HT7 and PC6 points during the perioperative period may improve sleep quality and reduce the incidence of POD in elderly patients undergoing hip arthroplasty surgery.
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