Effect Of Transcutaneous Electrical Acupoint Stimulation On Postoperative Delirium In Elderly Patients With Hip Fracture

ObjectiveTo observe the effect of intraoperative transcutaneous electrical acupoint stimulation on Shenting(GV24),Yintang(GV29),Hegu(LI4)and Neiguan(PC6)on postoperative delirium in elderly patients with hip fracture combined with spinal epidural anesthesia,so as to provide reference for subsequent application of transcutaneous electrical acupoint stimulation to prevent postoperative delirium.MethodsThis prospective randomized controlled trial included 86 patients aged≥ 70 years who scheduled for elective hip fracture surgery with CSE anesthesia.Patients were randomly allocated into either the transcutaneous electrical acupoint stimulation group(group T,n=43)or the control group(group C,n=43).In group T,the patients received TEAS(disperse-dense waves;frequency,2/100Hz)on acupoints Shenting(GV24),Yintang(GV29),Hegu(LI4)and Neiguan(PC6)on both sides starting from 30 minutes before anesthesia until the end of the surgery,and the intensity was the maximum current that could be tolerated.While the electrodes were placed at the same acupoints before anesthesia in group C,but no current was given.Peripheral venous blood samples was collected before transcutaneous electrical acupoint stimulation(T0),after surgery(T1),and on the first day after surgery(T2).Serum IL-6,CRP,S100β,MMP-9 concentrations were determined by ELISA.The incidence of postoperative delirium,serum IL-6,CRP,S100β,MMP-9 concentrations at each time point,operation time,intraoperative dosage of analgesics and sedatives,postoperative dosage of analgesics,postoperative hospitalization,postoperative adverse reactions and complications in 2 groups were recorded.The onset of postoperative delirium was assessed 1-3 days after surgery using the assessment of confusion of consciousness(CAM scale).ResultsThe incidence of postoperative delirium in group C was 34.9%,and that in group T was 16.3%.The incidence of postoperative delirium in group T was significantly reduced(P < 0.05).Compared with T0,the serum concentrations of IL-6,CRP,S100β and MMP-9in two groups were significantly increased at T1 and T2(P < 0.05).Compared with group C,the concentrations of serum IL-6,CRP and S100β in group T decreased at T1 and T2(P< 0.05).There was no significant difference in serum MMP-9 concentration between the two groups after operation.Compared with group C,the amount of tramadol,flurbiprofen axetil and parecoxib in group T within 3 days after surgery was significantly decreased(P <0.05).The length of postoperative hospitalization,the amount of ropivacaine,ephedrine and atropine during operation,the VAS scores within 3 days after surgery,postoperative adverse reactions such as nausea and vomiting,low back pain and pneumonia were comparable.ConclusionIntraoperative transcutaneous electrical acupoint stimulation on Shenting(GV24),Yintang(GV29),Hegu(LI4)and Neiguan(PC6)can reduce the incidence of postoperative delirium in elderly patients with hip fracture,and the mechanism may be related to the inhibition of inflammatory response and the reduction of brain injury.