Effect Of Transcutanclus Electrical Acupoint Stimulation On Postoperative Delirium In Elderly Patients With Spinal Surgery

[Purpose]To study the effect of transcutanclus electrical acupoint stimulation(TEAS)on postoperative delirium(POD)of the operative aged patients with spinal surgery,discuss the action mechanism of TEAS on POD prevention,and provide the clinical evidence for its treatment promotion in the future.[Methods]90 cases of the elderly patients underwent the spinal surgery at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine during October,2016 to March,2017,were selected as the research objects.They were randomly divided into two groups.The patients in the treatment group were receiving TEAS receiving and general anesthesia,while the patients in the control group were receiving false electrical stimulation and general anesthesia.The incidence rate of POD,Richmond agitation-sedation scale(RASS),the levels of serum IL-1?,IL-6,TNF-? and high mobility group box-1 protein(HMGB1)at different postoperative times in two groups were statistically compared.[Results]The incidence rate of POD in the treatment group was lower than the control during different postoperative time periods,but there is no difference between the two groups.The RASS score of the treatment group was lower than that of the control group at different postoperative time periods(P<0.01).Moreover,the serum levels of IL-6,IL-1?,TNF-?and HMGB1 at the postoperative three days in the two groups were higher than the preoperative values(P<0.05).The serum levels of IL-6,IL-1? and HMGB1 in the treatment group were lower than those in the control group at the postoperative 2nd day(P<0.05).The serum levels of IL-6,IL-1?,TNF-? and HMGB1 in POD patients in the treatment group during the postoperative two days were significantly lower than those in the control group(P<0.05 or P<0.01).[Conclusion](1)For the elderly patients with spinal surgery,the TEAS pretreatment reduces the incidence rate of POD without statistical significance,but significantly reduces the severity of POD.(2)For the elderly patients with spinal surgery,the TEAS pretreatment significantly reduces the serum levels of the immune-related inflammatory cytokines including TNF-a,IL-1?,and high migration rate protein 1(HMGB1).Thus,inhibition of the release of serum HMGB1 and decreasing the release of immune-related inflammatory mediators such as TNF-a and IL-6 is proposed to be one possible action mechanism that TEAS can reduce the severity of POD.(3)Since TEAS has the obvious advantages such as smaller side-effects,simpler operation procedure,non-invasive and easier acceptance by the patients,it may provide a promising therapy to reduce the risk of POD of the operative aged patients with spinal surgery if it is promoted for the clinical prophylactic treatment in the future.