| Background:Perioperative neurocognitive dysfunction(PND)is a common central nervous system complication after anesthesia surgery,which is mainly reflected in cognitive abilities such as thinking,memory,orientation,and insight.In severe cases,personality and social behavior will decline.The frequent occurrence of PND in elderly patients after surgery should arouse great attention.Transcutanous electrical acupoint stimulation(TEAS)is a new type of acupuncture treatment method that combines transcutanous electrical nerve stimulation(TENS)and acupoint therapy.At present,there are few domestic and foreign studies on the influence of electrical acupoint stimulation on PND and perioperative adverse reactions.Therefore,this study selected elderly patients aged 60 to 90 who underwent open spinal surgery to explore the application of TEAS in open spinal surgery for the elderly,which is of great significance to the future application of anesthesia.Objective:To explore the effect of TEAS Hegu and Neiguan points assisted general anesthesia on perioperative neurocognitive impairment in elderly patients with open spinal surgery,as well as the effect of intraoperative anesthesia depth and postoperative complicationsMethods:The study adopted the randomized controlled principle and single-blind design study 64 elderly patients with open spinal surgery who met the criteria were included as the research objects.Using the random number table method,they were divided into 32 cases in the control group(only drug anesthesia group)and 32 cases in the experimental group(acupoint electrical stimulation combined with general anesthesia group).The experimental group:30 minutes before the anesthesia after entering the room.four bilateral Hegu and Neiguan were selected Electrical stimulation of the acupoints.with a frequency of 2-100 Hz.density waves.and stimulation intensity,without causing pain in the patient,select the maximum stimulation level that is acceptable in the awake state,and continue until the end of the operation;control group:connected to an electro-acupuncture instrument,Without electrical stimulation,I was the same as the experimental group.Two groups of patients underwent general anesthesia with drugs:TCI targets remifentanil and propofol.Remifentanil induced plasma concentrations of 3ng/ml and propofol 5μg/ml.After the consciousness disappeared,remifentanil.The plasma concentration of Nitraria was reduced to 3.2μg/ml.and propofol was reduced to 2.5ng/ml.At the same time.rocuronium was given 1 mg/kg.After muscle relaxation,tracheal intubation was performed Using mechanical ventilation,the tidal volume is 8ml/kg.the respiratory rate is 12 times/min,and the oxygen flow rate is 2L/min.Intermittently inject rocuronium 0.5 mg/kg to maintain muscle relaxation.Adjust the concentration of remifentanil to 0.2 ng/ml each time to maintain the MAP in the range of+10%to-20%of the basic value.The BIS value is maintained between 40-60.Observe the incidence of postoperative delirium(POD)on the 7th day after surgery,and the incidence of delayed neurocognitive recovery(DNR)on the 30th day after POD is excluded.Before anesthesia,during tracheal intubation,Changes in the patient’s BIS value during skin incision,pedicle screw placement,and after surgery,and the impact of postoperative complications(incision infection,nausea and vomiting)within 30 days,incidence of secondary hospitalization,and all-cause mortality within 30 days In order to explore the influence of acupoint electrical stimulation on perioperative neurocognitive impairment,depth of anesthesia,other complications and clinical prognosis in elderly patients with open spinal surgeryResults:This study included 64 elderly patients who underwent elective open spinal surgery,and all of them successfully completed the surgery.There was no statistically significant difference between the two groups in the general situation of ASA classification Ⅰ～Ⅲ,age,gender and education level(p>0.05);the operation time,anesthesia time,intraoperative blood loss,and total infusion volume of the two groups of patients There was no statistically significant difference in the comparison of MMSE(p>0.05);there was no statistically significant difference in the preoperative MMSE assessment(p>0.05);the two groups were in the room before anesthesia,tracheal intubation,skin incision,and placement There was no significant difference in the BIS value when the pedicle screw was inserted(p>0.05);but at the end of the operation.the BIS value of the experimental group was higher than that of the control group.and the difference was statistically significant(p<0.05).The incidence of suspicious POD in the two groups of patients was 7 days after surgery.The number of cases in the experimental group was lower than that in the control group.However.it was found that the two groups of patients were suspicious of delirium.and the difference was not statistically significant(p>0.05):the DNR of the two groups of patients within 30 days after surgery Incidence rate,the number of cases in the experimental group was lower than that in the control group,the difference was statistically significant(p<0.05).There was a statistically significant difference in the number of vomiting cases within 30 days after operation between the two groups(p<0.05);there was no significant difference in the number of incision infection cases within 30 days after operation between the two groups(p>0.05)Conclusion:Compared with simple general anesthesia,acupoint electrical stimulation combined with intravenous general anesthesia used in open spinal surgery for the elderly can reduce the incidence of PND.effectively reduce the incidence of postoperative vomiting,improve the prognosis of patients,and make acupuncture points Electrical stimulation is not only used as an anesthesia method to meet the needs of surgical operations,but also as a preventive and therapeutic method to improve the prognosis of patients undergoing spinal surgery.It has clinical application value. |
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