Effect Of Transcutaneous Electrical Acupoint Stimulation On Postoperative Delirium In Geriatric Patients With Lacunar Infarction

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation on postoperative delirium（POD）in geriatric patients with lacunar infarction.Methods:Sixty-four patients with lacunar infarction of both sexes,aged65 years or older,of American Society of Anesthesiologists physical status I or II,scheduled for elective spinal surgery,were divided into 2 groups（n=32 each）using a random number table:control group（group C）and transcutaneous electrical acupoint stimulation group（group TEAS）.In group TEAS,the patients received TEAS（disperse-dense waves;frequency,2/100 Hz）on acupoints Hegu（LI4）and Neiguan（PC6）on both sides starting from 30minutes before induction of anesthesia until the end of the surgery,and the intensity was the maximum current that could be tolerated.In group C,electrodes were placed on the same acupoints before anesthesia induction,but no current was given.Before treatment of transcutaneous electrical acupoint stimulation（T₁）,at 30 minutes after skin incision（T₂）and surgery completed（T₃）,blood samples were collected from the jugular bulb for determination of serum interleukin-6（IL-6）,tumor necrosis factor-alpha（TNF-α）,S100βand matrix metalloproteinase-9（MMP-9）concentrations.The intraoperative consumption of propofol and remifentanil was recorded.Postoperative delirium was evaluated using Confusion Assessment Method on postoperative days 1-3.Results:Compared with the baseline value at T₁,the serum concentrations of IL-6,TNF-α,MMP-9,and S100βwere significantly increased at T_2-3-3 in both groups（P<0.05）.Compared with group C,serum levels of TNF-αand IL-6were lower at T_2-3 and serum levels of MMP-9 and S100βwere lower at T₃ in group TEAS（P<0.05）.The intraoperative consumption of propofol and remifentanil and the incidence of postoperative delirium were significantly lower in group TEAS than in group C（P<0.05）.Conclusion:TEAS can alleviate POD in older patients with lacunar infarction and may be related to reduce the neuroinflammation by lowering the permeability of blood-brain barrier.