Effects Of Electroacupuncture Pretreatment On Postoperative Delirium And Early Recovery In Patients After Cardiac Valve Replacement With Cardiopulmonary Bypass

Objective:To investigate the effect of electroacupuncture pretreatment with acupoint GV20,EX-HN3 and DU26 on postoperative delirium?POD?and early recovery in patients after cardiac valve replacement with cardiopulmonary bypass.Methods:Sixty ASA physical status II or III patients without gender limitation,NYHA physical status II or III,aged 28 to 64 years,scheduled for cardiac valve replacement with cardiopulmonary bypass,were randomly divided into two groups by a random number table:control group?Group C,n=30?and electroacupuncture group?Group EA,n=30?.The diet was prohibited 8h before operation for all patients.the 0.2mg/kg morphine and the 0.02mg/kg penehyclidine hydrochloride were intramusculally injected30min before anesthesia induction.After enter into the operating room,the oxygen2L/min were inhaled by nasal catheter,and the electrocardiogram,blood pressure,pulse oxygen saturation and body temperature were routinely monitored by Philips multi-function monitor,the BIS index was monitored by anesthesia depth monitor,the regional cerebral oxygen saturation?rSO₂?was monitored by brain oxygen saturation monitor,and the central venous catheter and radial artery catheter were performed to monitor arterial blood pressure and CVP.The acupoint GV20,EX-HN3 and DU26 were stimulated 30 minutes with an electric stimulator?sparse-dense wave,frequency 2 to 15Hz,intensity 1 mA?after the induction of anesthesia and before surgery in group EA,whereas the same acupoint were acupunctured without electrical stimulation in group C at the same time.Intraoperative continuous monitoring of rSO₂ was performed and the surgery rSO₂ average(_rSO2),the minimal surgery rSO₂(rSO_2min)and the maximal percentage of the decreased rSO₂ compared to baseline values(rSO_2%max)were calculated in the both group.The concentration of serum TNF-?,IL-6,IL-10 and S100?protein,neuron-specific enolase?NSE?were determined by ELISA before the electroacupuncture pretreatment?T₀?,the end of surgery?T₁?,6 hours?T₂?,24 hours?T₃?and 72 hours?T₄?after surgery using venous blood samples.The CAM-ICU and qoR-40were used to evaluate the incidence of postoperative delirium and recovery at 24 hours before surgery and 72 hours after surgery.The incidence of POD,duration of stay in ICU and the length of hospital stay were also recorded.Results:Compared with the group C,the physical comfort score,emotional state score,psychological support score,pain score and the global qoR-40 scores were signifcant higher?P<0.05?,whereas the incidence of postoperative delirium,the duration of stay in ICU and the length of hospital stay were signifcant lower in group EA than that in group C?P<0.05?.Compared with the group C,the rSO_2minmin were increased significantly?P<0.05?,whereas the rSO_2%max%max was decreased significantly in group G?P<0.05?;Compared with the T₀,the concentration of serum TNF-?,IL-6 and IL-10 at T₁to T₄ were increased,and the concentration of NSE and S-100?at T₂ to T₄ were also increased with statistical significance?P<0.05?.Compared with the group C,the concentration of serum TNF-?,IL-6 was decreased,and IL-10 was increased significantly from T₁ to T₄?P<0.05?;and the concentration of serum NSE and S-100?was decreased significantly from T₂ to T₄?P<0.05?.Conclusion:Electroacupuncture pretreatment with the acupoint GV20,EX-HN3 and DU26 could improve the postoperative early recovery and reduce the incidence of postoperative delirium in patients after cardiac valve replacement with cardiopulmonary bypass,which may due to the improvement of cereral oxygen metabolism and the alleviation of inflammatory response and brain injury.