| Purpose: A clinical investigation of the effect of applying percutaneous electrical acupoint stimulation pretreatment on the improvement of perioperative neurocognitive function in elderly hip fracture patients.Material and method: Sixty elderly patients who were admitted to the department of Bone Injury 1 and department of Bone Injury 2 of our hospital from January 2021 to december 2022 and required elective hip fracture surgery were selected.the preoperative score of Mini-Mental State Examination(MMSE)was above 24.American Society of Anesthesiologists(ASA)grade Ⅰ ~ Ⅲ,all anesthesia is combined with static and inhalation anesthesia.All enrolled patients were randomly divided into observation group(TEAS preconditioning group)and control group(routine general anesthesia group)by random numbers,with 30 patients in each group.In the observation group,30 min before induction of general anesthesia,adhesive electrodes(diameter 2-3 cm)were pasted on bilateral Neiguan points,bilateral Hegu points,bilateral taixi points,and Baihui points,respectively.the treatment instruments were connected,and the output frequency was selected as 2/100Hz(density wave),and the current intensity was slowly adjusted to the required intensity,as long as the patients had tingling and prickling sensation and could tolerate it.tetras were treated intermittently until the end of the suture;the control group was the same as the observation group except for no electrical stimulation of any intensity.The mean arterial pressure(MAP),heart rate(HR)level,and EEG dual-frequency index(BIS)at the immediate intubation(t0),at the beginning of surgery(t1),30 minutes after the start of surgery(t2),60 minutes after the start of surgery(t3),and at the end of surgery(t4)were compared between the two groups.the accumulative amount of related anesthetic drugs and the recovery time of anesthesia were carefully recorded in the two groups.MMSE scores 1 day before surgery,1 day after surgery,3 days after surgery and 7 days after surgery were recorded,and the incidence of Perioperative Neurocognitive disorders(PND)within 7 days after surgery were recorded in both groups.Venous blood samples were collected and S100-β protein levels were determined at various time points before and after TEAS.Results: 1.There was no statistical significance in perioperative general conditions and operation-related data between the two groups(P > 0.05),indicating comparability.2.Comparison of hemodynamics and anesthesia depth: There was no significant difference in BIS value,MAP and HR level at different time points during surgery between the two groups(P > 0.05).3.Comparison of anesthetic drug dosage: the intraoperative usage of propofol and remifentanil was compared between the two groups,and the observation group was significantly reduced compared with the control group(P < 0.01);the recovery time of the two groups was shorter in the observation group(P < 0.05).4.Comparison of MMSE scores: Compared with 1d before surgery,MMSE scores of patients in the two groups decreased with time to varying degrees,and the observation group had the smallest fluctuation,and the score of the observation group was significantly higher than that of the control group on 1d and 3d after surgery(P < 0.01).5.Comparison of the incidence of PND: the incidence of PND in the observation group and the control group within 7 days after surgery were 3.3% and 20%,respectively,with the lowest incidence in the observation group(P < 0.05).6.Comparison of serum S100-β protein level: Compared with t1 moment,the serum S-100β level of patients in 2 groups increased at different time points,the observation group increased the least,at t2 and t3 moment,the serum S100-β protein level of the control group was significantly higher than that of the control group(P < 0.05).Conclusion: Percutaneous acupoint electrical stimulation at bilateral Neiguan points,bilateral Hegu points,bilateral taixi points and Baihui points can reduce the amount of intraoperative anesthetics,accelerate the postoperative anesthesia recovery of patients,inhibit the release of inflammatory factor S100-β protein in the early postoperative period,significantly improve the perioperative cognitive function of elderly patients with hip fracture,and reduce the incidence of perioperative neurocognitive dysfunction. |
