Effect Of Transcutaneous Electrical Acupoint Stimulation On Perioperative Neurocognitive Dysfunction And Postoperative Rehabilitation In Elderly Patients Undergoing Total Knee Arthroplasty

Objective:To investigate the effects of transcutaneous electrical acupoint stimulation（TEAS）on perioperative neurocognitive dysfunction（PND）and postoperative rehabilitation in elderly patients undergoing elective total knee arthroplasty（TKA）.Methods:A total of 80 elderly patients who underwent elective unilateral TKA treatment in the Second Hospital of Shanxi Medical University from December 2018 to October 2019were selected and randomly divided into control group（group C）and TEAS group（group T）.In the end,66 people completed this study,including 32 cases in group C and34 cases in group T.Group T underwent TEAS at Fengchi point,bilateral Neiguan point and Hegu point 30 minutes before anesthesia until the end of operation.In group C,electrodes were attached to the same acupoints to connect the therapeutic apparatus,but no electrical stimulation was given.Neuropsychological test was used to evaluate the incidence of PND at 1d before surgery（t₀）,1d after surgery（t₁）,the day of discharge（t₂）,1 month after surgery（t₃）and 6 months after surgery（t₄）.30min before anesthesia（T₀）,6h after surgery（T₁）and 24h after surgery（T₂）,two m L of blood samples were collected.Serum concentrations of IL-1β,TNF-α,IL-6 and S100-βprotein were determined after centrifugation.The correlation between the three inflammatory factors and S100-βprotein and the occurrence of PND was analyzed.VAS scores at 6h,12h,24h and 48h,the time of the first field activity and VAS score,the use of PCIA pump within 48 hours after surgery,the incidence of nausea and vomiting and the QOR-15 score within 48h after operation were recorded in both groups.Results:There was no difference in preoperative and perioperative basic data between the two groups（P>0.05）.In T group,the incidence of PND was lower at t₁ and t₂（P<0.05）.Among them,12 cases（37.5%）of group C and 5 cases（14.7%）of group T developed PND at T₁（X²=4.479,P=0.034）.At T₂,9 patients in group C（28.1%）and 3patients in group T（8.8%）developed PND（X²=4.128,P=0.042）.The incidence of PND was no difference at t₃ and t₄（P>0.05）.Compared with T₀,the levels of IL-1β,IL-6,TNF-αand S-100βwere increased at T₁ and T₂（P<0.05）.Compared with group C,the serum levels were lower in group T at T₁ and T₂（P<0.05）.The above serological indicators were positively correlated with the occurrence of PND at T₁ and T₂ to varying degrees.VAS at resting time 12h and 24h after surgery,VAS score for the first time after surgery,the number of analgesia pump presses,and the people of nausea and vomiting48h after surgery in group T were lower（P<0.05）.QoR-15 score 48h after operation in group T was higher than that in group C（P<0.05）.VAS scores between the two groups at 6h and 48h after surgery,there was no difference（P>0.05）.Conclusion:Electrostimulation of Fengchi,Neiguan and Hegu acupoints at percutaneous acupoints can inhibit the release of inflammatory factors and S100-βprotein in the early stage after surgery,thus reducing the incidence of PND in elderly patients undergoing total knee arthroplasty.Transcutaneous electrical acupoint stimulation assisted anesthesia can enhance the effect of postoperative analgesia in elderly patients with TKA,reduce the incidence of adverse reactions,promote early postoperative functional exercise and overall recovery quality,shorten the length of hospital stay,and is conducive to postoperative rehabilitation of patients.