国际麻醉学与复苏杂志   2025, Issue (2): 0-0
    
针刺百会、内关配伍足三里对全麻下行下肢全关节置换术老年患者术后谵妄的影响
戴冰舲, 刘鹤1()
1.徐州医学院江苏省麻醉学重点实验室&江苏省麻醉与镇痛应用技术重点实验室
Effect of acupuncture Baihui and Neiguan together with Zusanli points on the incidence of postoperative delirium in elderly patients undergoing total joint arthroplasty of lower limbs under general anesthesia
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摘要：

目的：探讨针刺百会、内关配伍足三里对全麻下行下肢全关节置换术老年患者术后谵妄（postoperative delirium，POD）发生率的影响。方法：选取南京中医药大学附属常州市中医医院择期行下肢全关节置换术130例老年患者作为研究对象，采用计算机生成随机序列法将患者分为对照组（C组）与试验组（T组）：麻醉诱导前30 min，T组患者针刺百会、内关和足三里三穴；C组患者在三处穴位附近0.5 cm处做无效针刺。术后第1、3、5日每日两次以及术后第7日进行意识模糊评分(the confusion assessment method，CAM)与Richmond躁动-镇静评分(Richmond agitation-sedation scale，RASS)，监测两组术前1d、术后第3d的简易智力状态检查量表（mini-mental state examination，MMSE）评分、麻醉时间、手术时间、术中出血量和尿量、术中是否发生循环波动、患者术后拔管时间、视觉模拟评分法（visual analogue scale，VAS）评定患者术前和术后疼痛情况、术后并发症（脑梗死、肺栓塞）发生率。结果：T组的POD发生率为4.6%，明显低于C组的16.9%，差异有统计学意义（P 0.05）。T组第1、3、5、7天各时间点的CAM评分（17.05±2.57，15.86±2.15，14.82±2.06，14.58±1.90，13.62±1.81，13.55±1.74，12.55±1.74）分与C组（18.75±3.35，18.14±3.14，16.82±2.81，16.43±2.39，15.31±2.24，14.91±2.06，13.94±2.02）分相比明显降低，差异有统计学意义（P 0.001）。两组患者谵妄分型分布大致相同，差异无统计学意义（P 0.05）。T组术后第3天MMSE评分为23.22±1.71分，高于C组的21.54±1.83分，差异有统计学意义（P 0.001）。T组拔管时间为14.62±2.95分钟，明显短于C组的20.26±3.76分钟，差异有统计学意义（P 0.001）。结论：应用针刺百会、内关配伍足三里的方式，可降低全麻下行下肢大关节置换术老年患者POD的发生率。
关键词： 针刺；术后谵妄；全关节置换
Abstract:

Objective: To evaluate the effect of acupuncture Baihui and Neiguan together with Zusanli points on the incidence of postoperative delirium in elderly patients undergoing total joint arthroplasty of lower limbs under general anesthesia. Methods: 130 elder patients at Changzhou Hospital Affiliated to Nanjing University of Chinese Medicine undergoing elective total joint arthroplasty were randomly assigned into two groups either the control group (group C) or the experimental group (group T) by computer generated random sequences. All patients received acupuncture for 30 min before anesthesia induction. Patients in the group T were acupunctured at points of Baihui, Neiguan and Zusanli, while ineffective acupuncture was inserted into the skin about 0.5 cm near three points of patients in the group C. The CAM was used to assess delirium on 1, 3, 5 and 7 day after surgery. The RASS was used to assess the classification of delirium. MMSE scores were recorded on 1 day before surgery and 3 days after surgery. Anesthesia time, operation time, intraoperative bleeding volume, urine volume, intraoperative circulation fluctuation and extubation time of patients were recorded. The VAS scores were used to evaluate preoperative and postoperative pain in these patients. Incidence of postoperative complications (cerebral infarction, pulmonary embolism) were also recorded. Results: The incidence of POD in the group T was 4.6%, which was significantly lower than that in the group C (16.9% ) (P 0.05). CAM scores in the group T (17.05±2.57，15.86±2.15，14.82±2.06，14.58±1.90，13.62±1.81，13.55±1.74，12.55±1.74) were significantly lower than those in the group C (18.75±3.35，18.14±3.14，16.82±2.81，16.43±2.39，15.31±2.24，14.91±2.06，13.94±2.02) on the day 1, 3, 5 and 7 after surgery (P 0.001). There was no significant difference in delirium classification between the two groups (P 0.05). The MMSE score of the group T (23.22±1.71) was higher than that of the group C (21.54±1.83) on the 3rd day after surgery, and the difference was statistically significant (P 0.001). The extubation time in the group T (14.62±2.95 min) was significantly shorter than that in the group C (20.26±3.76 min) (P 0.001). Conclusion: Acupuncture Baihui, Neiguan combined with Zusanli can reduce the incidence of POD in elderly patients undergoing total joint arthroplasty of lower limbs under general anesthesia.
Key words: acupuncture; postoperative delirium; total joint arthroplasty