The Effects Of Electroacupuncture Preconditioning Combined With α₂ Receptor Agonists On Perioperative Period In Elderly Orthopaedic Patients

Objective:In this study,elderly patients were selected as subjects,objective to evaluate the protective effect of electroacupuncturing at Baihui and Hegu combined with α₂ adrenergic receptor agonists.It provides theoretical and experimental basis for the application and promotion of electroacupuncture combined with α₂ receptor agonist in the operation of elderly patients.Methods: Experimental grouping and intervention: 56 elderly patients without preoperative cognitive impairment were selected for the lower limb fracture surgery.They were aged 65-80 years old and weighed 45-75 kg.They were randomly divided into four groups: "simple general anesthesia group","electroacupuncture-associated general anesthesia","α₂ adrenergic receptor agonist combined general anesthesia group" and " electroacupuncture pretreatment combined with α₂ adrenergic receptor agonist combined general anesthesia group"（combined acupuncture-drug general anesthesia group is the abbreviation for electroacupuncture pretreatment combined with α₂ adrenergic receptor agonist combined general anesthesia group）".The anesthesia method was the same in the four groups: intravenous anesthesia.1.In the simple general anesthesia group,sufentanil,propofol and cis-atracuride were intravenously injected in sequence by induction of intravenous anesthesia.Meanwhile,the mask absorbed pure oxygen,assisted artificial respiration,and mechanical ventilation were performed use of laryngoscope in endotracheal intubation.2.electroacupuncture-associated general anesthesia: patients’ baihui and hegu acupoints were taken,and the needle was inserted into the acupoints,connected with the peak current of G6805-2 type electroacupuncture instrument,which was stimulated to the end of the operation after the arrival of Qi.The wave type was density wave,sparse wave 4 Hz,dense wave 20 Hz,and peak current 5 m A.Induction of general anesthesia began after 20 min,and anesthesia induction and anesthesia,which is the same as those in the simple general anesthesia group.3.α₂ adrenergic agonist combined general anesthesia group: before anesthesia induction,a 0.5ug/kg of dexmedetomidine hydrochloride was infused with micro-pump.for 15min（0.9%Na Cl dilution,4ug/ml）,and anesthesia induction was uesd immediately after the completion of the pumping.The method was the same as that of general anesthesia group.After anesthesia induction,the infusion rate was maintained at 0.2-0.5ug/kg/h until the end of the operation,and the infusion rate was adjusted according to the changes of blood pressure and heart rate.4.Electroacupuncture pretreatment combined with α₂ adrenergic receptor agonist combined general anesthesia group: Patients’ baihui and hegu acupoints were taken,and the needle was inserted into the acupoints,connected with the peak current of G6805-2 type electroacupuncture instrument,which was stimulated to the end of the operation after the arrival of Qi,The wave type is sparse wave,sparse wave 4 Hz,dense wave 20 Hz,peak current 5 m A.After 20 min,0.5ug/kg of dexmedetomidine hydrochloride（diluted with 0.9%Na Cl,4ug/ml）was pumped with the micro pump for 15 min.Induction of anesthesia was performed immediately after the completion of pumping,in the same way as in the simple general anesthesia group.Observation Targets:The patients in the four groups were observed before intubation（T1）,immediately after intubation（T2）,immediately after extubation（T3）,and 60 min after extubation（T4）.Specimens were collected preoperatively（T0）,60 min postoperatively（T5）,one day postoperatively（T6）,and three days postoperatively（T7）.Specimens were collected.1.Intraoperative indicators: Saturation of peripheral oxygen（Sp O2）,heart rate（HR）,non-invasive arterial pressure（BP）,end-respiratory partial pressure of carbon dioxide（Pet CO2）,electrocardiogram（EKG）,bispectral index（BIS）,mean arterial pressure（MAP）and central venous pressure（CVP）,EKG-ST（II）.2.Neuropsychological indicators（main observation indicators）:Mini-mental State Examination,（MMSE）,Visual Analogue Scale/Score（VAS）.3.Length of stay.4 Intraoperative anesthesia effect: Intraoperative dosage of vasoactive drugs and Incidence of intraoperative cardiovascular accidents.Results:1.There was no significant difference in operation time and bleeding volume between the four groups（P > 0.05）.There was no significant difference in operation time and bleeding volume between the four groups（P > 0.05）.2.Comparisons of cognitive function in the four groups: Compared with T0,the MMSE values of T5（1 h after operation）and T6（24 h after operation）in the four groups decreased,with statistical significance（p < 0.05）.There was no difference between the four groups at the time point of T7（72 hours after operation）.group comparison: At T5 time point,there was significant difference between simple general anesthesia group and the combined acupuncture and medicine group（p < 0.05）.There was no significant difference among the three groups at T6 time point: combined electro-acupuncture group,combined dexmedetomidine group and combined acupuncture and medicine group（P > 0.05）.There was no significant difference among the four groups at T7 time point,but the average level was lower than that at the time point of T1.3.Comparisons of pain severity among the four groups: Compared with T0,the pain scores of the four groups at T5（1h after operation）,T6（24h after operation）and T7（72h after operation）decreased,and there was difference among the four groups（p < 0.05）.group comparison: at the time point of T5（1h after operation）and T6（24h after operation）there was no difference among the four groups（p > 0.05）.However,at the time point of T7（72h after operation）,there was a difference in pain scores between the four groups（p < 0.05）.4.Comparisons of hemodynamic indices in four groups: There was no significant difference in heart rate in T1（before operation）between the four groups（p > 0.05）.There were significant differences in heart rate between T2（immediate intubation）and T3（immediately extubation）.The heart rate changes of T4（1 hour after extubation）were different,but the difference was not obvious.Compared with T1,heart rate of simple general anesthesia group and combined electro-acupuncture group increased significantly in T2,while heart rate of combined dexmedetomidine group decreased significantly in T2.Heart rate at T3 in general anesthesia group was significantly higher than that at T1,while heart rate at T3 in combined electro-acupuncture group and combined dexamethasone group was significantly lower than that at T1.There was a significant difference in heart rate between T2 and T3 in the combined electro-acupuncture group.There was no significant difference in heart rate between T2 and T3 in combined dexmedetomidine group.There was no significant difference in T2,T3 and T4 in combined acupuncture-drug general anesthesia group.5.Comparison of blood glucose changes among the four groups: compared with preoperative（T0）,blood glucose increased in the three groups 1h after surgery（T5）,namely,the simple general anesthesia group,the combined electroacupuncture group and the combined dexmedetomidine group,and the difference was statistically significant（p < 0.05）;There was no significant difference in blood glucose of the combined acupuncture-drug general anesthesia group（p > 0.05）;Compared with preoperative（T0）,there was a statistically significant difference in blood glucose level of the combined dexmedetomidine group one day after surgery（T6）（p < 0.05）;There was no significant difference in blood glucose between the three groups（p > 0.05）;Compared with preoperative（T0）,there was no significant difference in blood glucose between the four groups 3 days after surgery（T7）and that before surgery（p > 0.05）.Comparison between groups: 1h after surgery（T5）,the blood glucose of the combined acupuncture-drug general anesthesia group was the lowest among the four groups,and the difference was statistically significant compared with the three groups of general anesthesia,combined electroacupuncture and dexamethanization group（p < 0.05）;There was no significant difference in blood glucose between the three groups（p > 0.05）;1 day after surgery（T6）,combined acupuncture-drug general anesthesia group level is the lowest in the four groups of patients,with simple general anesthesia group,electroacupuncture-associated general anesthesia group,compound dexmedetomidine group compared three groups,the difference was statistically significant（p < 0.05）;simple general anesthesia group,electroacupuncture-associated general anesthesia group and compound dexmedetomidine group,the blood sugar levels between groups was no significant difference（p > 0.05）.3 days after surgery（T7）,there was no significant difference in blood glucose between the four groups（p > 0.05）.6.Comparisons of the time of consciousness recovery and breathing recovery after operation in four groups: There was difference in the time of consciousness recovery between the simple general anesthesia group and in the combined acupuncture-drug general anesthesia group（p < 0.05）,There was difference in the time of consciousness recovery between the combined dexmedetomidine group and in the combined acupuncture-drug general anesthesia group（p < 0.05）,There was no difference in the time of consciousness recovery between the combined electro-acupuncture group and in the combined acupuncture-drug general anesthesia group（p > 0.05）.There was no difference in the simple general anesthesia group and in the combined dexmedetomidine group（p > 0.05）.There was no significant difference in breathing recovery time between the four groups（p > 0.05）.7.Comparisons of hospitalization days in the four groups: There was no difference in the number of hospitalization days between the four groups（P > 0.05）.Conclusion: 1.Electroacupuncture combined with hegu baihui point and α₂AR agonist can partially alleviate postoperative cognitivedysfunction.2.Electroacupuncture at hegu and baihui points combined with α₂AR has better postoperative analgesic effect,which is helpful for postoperative recovery of patients with orthopaedic injuries.It has a certain application value for clinical anesthesia and postoperative analgesia.3.Electroacupuncture at hegu and baihu points combined with α₂AR agonists can reduce the cardiovascular adverse reactions of perioperative α₂AR agonists and are helpful to make the patients’ hemodynamics in a clinically acceptable state.