经皮穴位电刺激对老年脊柱术后睡眠的影响△

Effect of transcutaneous electrical acupoint stimulation on sleep after spinal surgery in elderly

摘要:

［目的］ 探讨围术期经皮穴位电刺激 （transcutaneous electrical acupoint stimulation, TEAS） 对老年全麻脊柱手术患者术后早期睡眠质量和谵妄发生率的影响。［方法］选择行脊柱手术老年患者 70 例，随机分为两组，每组 35 例。在术前 1 d、麻醉前和术后 1 d，TEAS 组在百会、安眠、神门、三阴交进行经皮电刺激治疗；对照组在相应的非穴位部位进行电刺激。记录患者术后 3 晚的睡眠情况；记录术后睡眠满意度；评定术后 7 d 内谵妄的发生率。［结果］ 最终资料完整者共 66 例，其中 TEAS 组 32 例，对照组 34 例。两组年龄、身高、BMI、手术时间、麻醉时间、术前 PSQI 的差异无统计学意义（P>0.05）。术后睡眠质量监测方面，术后第 1~3 晚，TEAS 组入眠时间、睡眠总时间、睡眠效率、稳定睡眠持续时间、稳定睡眠占比和快速睡眠占比均显著优于对照组 （P<0.05）。TEAS 组术后 3 d 睡眠总体满意度显著优于对照组 （P<0.05）。术后谵妄主要发生在术后 3 d 内，TEAS 组的总发生率 （6.25%） 低于对照组 （14.70%），但差异无统计学意义 （P>0.05）。［结论］ 围手术期在百会、安眠、 神门、三阴交等穴位应用经皮穴位电刺激可改善老年全麻脊柱手术患者术后睡眠质量、降低术后谵妄的发生率。

Abstract:

[Objective] To investigate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on early postop- erative sleep quality and incidence of delirium in elderly patients who received spinal surgery under general anesthesia. [Methods] A total of 70 elderly patients who were undergoing spinal surgery were randomly divided into two groups, with 35 cases in each group. The TEAS group received percutaneous electrical stimulation at Baihui, Anmian, Shenmen and Sanyinjiao 1 day before surgery, before anesthesia and 1 day after surgery, while the control group received electrical stimulation in the corresponding non-acupoint part. The sleep was continu- ously monitored for 3 nights after operation, additionally, satisfaction to postoperative sleep and occurrence of delirium within 7 days after operation was evaluated. [Results] Of them, only 66 patients were got complete data, including 32 patients in the TEAS group and 34 pa- tients in the control group. There were no significant differences in terms of age, height, BMI, operation time, anesthesia time and preopera- tive PSQI between the two groups (P>0.05) . Regarding postoperative sleep quality monitoring, the TEAS group proved significantly superi- or to the control group in terms of sleep initiation time, total sleep time, sleep efficiency, steady sleep duration, steady sleep proportion and proportion of rapid eye movement sleep on the 1^st to 3^rd night after surgery (P<0.05) . In addition, TEAS group was also significantly better than the control group in term of the overall sleep satisfaction postoperatively (P<0.05) . Postoperative delirium mainly occurred within 3 days after surgery, which in total incidence of TEAS group (6.25%) was lower than that of control group (14.70%) , but the difference was not statistically significant (P>0.05) . [Conclusion] Perioperative percutaneous electrical acupoint stimulation at Baihui, Anmian, Shenmen and Sanyinjiao acupoints do improve postoperative sleep quality and reduce the incidence of postoperative delirium in elderly patients in perioperative period of spinal surgery under general anesthesia.