Preventive Effect Of Percutaneous Acupoint Electrical Stimulation Preconditioning On Postoperative Delirium In Elderly Patients Undergoing Total Hip Replacement

Objective:In this study,elderly patients undergoing total hip replacement were taken as subjects,and percutaneous acupoint electrical stimulation(TEAS)was used as treatment method to compare the changes of serum glial fibrillary acidic protein(GFAP)and neuron specific enolase(NSE)content in elderly patients undergoing total hip replacement treated as if in TEAS during the perioperative period.To explore the potential relationship between TEAS,postoperative delirium,GFAP and NSE expression levels,and reveal the possible mechanism by which TEAS can reduce the incidence of postoperative delirium.Methods:From March 2020 to March 2021,120 elderly patients undergoing hip replacement surgery in the Second Hospital of Shanxi Medical University were selected according to the previously established inclusion and exclusion criteria.In this study basic inclusion criteria were: age over 60 years old,ASA was classified as Ⅰ～Ⅱ,the preoperative MMSE score was greater than 24 and the education level is junior high school or above.As a result,the 120 patients were divided into 2 groups: control group(n=60)and TEAS group(n=60).In TEAS group,60 patients were stimulated by electroacupuncture at Neiguan and Hegu points of both upper limbs half an hour before anesthesia,and the stimulation lasted until the end of the operation,the waveform is dense wave,the frequency is 2/100 Hz,and the stimulation intensity current increases gradually from 1m A until the patient feels obvious shock but no pain.CAM-CR and VAS tests were performed 1 day before surgery,1 day after surgery and 3 days after surgery.TEAS before stimulation,1day after surgery and 3d after surgery,5ml blood sample was taken,and serum NSE and GFAP concentrations were detected by ELISA.Results:Compared with the control group,the occurrence rate of postoperative delirium in 3days after operation in TEAS group was significantly reduced and the concentrations of GFAP and NSE decreased significantly at 1 day and 3 days after operation(P < 0.05);Pearson correlation analysis showed that TEAS was negatively correlated with postoperative GFAP concentration on day 1(r =-0.711,P < 0.01),postoperative GFAP concentration on day 3(r =-0.791,P < 0.01),postoperative NSE concentration on day 1(r =-0.730,P < 0.01),postoperative NSE concentration on day 39(r =-0.500,P < 0.01),postoperative CAM-CR score on day 1(r =-0.194,P < 0.05),postoperative CAM-CR score on day 3(r =-0.545,P < 0.01),VAS score at 1 day after operation9(r =-0.622,P <0.01)and VAS score at 3 days after operation(r =-0.698,P < 0.01),and a positive correlation between GFAP concentration and NSE concentration(r = 0.464,P < 0.01 at 1day after operation;r = 0.428,P < 0.01 at 3 days after operation),the difference was statistically significant(P < 0.05);ROC curve analysis showed that the AUCs of postoperative delirium risk predicted by postoperative GFAP concentration on day 1,GFAP concentration on day 3 and NSE concentration on day 1 were 0.7290(P < 0.05),0.7900(P < 0.01)and 0.6930(P < 0.05),respectively.Conclusion:TEAS pretreatment can significantly prevent postoperative delirium in elderly patients undergoing total hip replacement,and its mechanism may be related to the decrease of GFAP concentration and NSE concentration.