Effect Of Percutaneous Acupoint Electrical Stimulation On Postoperative Fatigue And Neurocognitive Disorders In Elderly Patients With Sleep Disorder Undergoing Total Hip Arthroplasty

Objective:To observe the effect of percutaneous acupoint electrical stimulation（TEAS）on postoperative fatigue and neurocognitive function in elderly patients with sleep disorder undergoing total hip arthroplasty.Methods:From May to October,2020,hundred patients of the elective TKA and the preoperative Pittsburgh Sleep Quality Index score was more than 5,sex unlimited,aged65-80 years,with body mass index of 19-28 kg/m^2,ASA physical statusⅡorⅢ,were randomly divided into 2 groups（n=50 each）using random number table:TEAS group（group TEAS）and non-electrical stimulation group（group NS）.After entering the room,both groups established venous channels,monitored basic vital signs such as BP,ECG,HR and Sp02,and measured invasive blood pressure by radial artery puncture.Both groups were treated with the combined ultrasound-guided fascia iliaca block and spinal anesthesia.The patients in group TEAS received percutaneous acupoint electrical stimulation（disperse-dense waves,frequency 2-100Hz,Current intensity was 6-10 m A）at the Yintang acupoints,both Neiguan and Hegu acupoints 30 minutes after the anesthesia started,PM8:00 on the 1st,2nd and 3rd day after operation,30 minutes at a time.In group NS,electrode plate were placed at the corresponding time points,but no electrical stimulation was applied.The Confusion assessment method（CAM）and Christensen’s Fatigue Scale scores were recorded at 1 day before operation and 1,3 and5 days after operation to evaluate the delirium and fatigue of patients,and the concentration of serum C-reactive protein（CRP）was detected at the same time.The Pittsburgh Sleep Quality Index（PSQI）was used to evaluate the patients’sleep state on the 1st day before operation,day of discharge and one month after operation,and used the Application of sleep monitoring ring to record the related sleep data of the patients at 1 day before operation and 1,2,3 and 4 days after operation.The neuropsychological test were performed at 1 day before operation、1 month after operation and 3 months after operation,including Mini-mental State Examination（MMSE）、Letter-Dight Coading（LDC）、Visual Verbal Learning（VVL）and Memory Scanning Task（MST）,the occurrence of postoperative neurocognitive impairment and delayed neurocognitive recovery were evaluated according to Z-scoring method.Results:（1）Compared with preoperative,the total score of PSQI in the two groups decreased significantly on the day of discharge and one month after operation;Compared with NS group,the total score of PSQI in TEAS group on the day of discharge and one month after operation was lower than that in NS group（P<0.05）.On the day of discharge,there were 23cases of sleep disorder in TEAS group and 31 cases of sleep disorder in NS group,the incidence rates were 56%and 75%respectively,and the incidence rates between the two groups were statistically significant（χ²=4.989,P<0.05）.One month after operation,there were 25 cases of sleep disorder in TEAS group and 29 cases of sleep disorder in NS group,the incidence rates were 61%and71%respectively,and the incidence rates between the two groups were no statistically significant（χ²=0.868,P>0.05）.（2）The sleep score and the rapid eye movement（REM）sleep ratio of patients in the two groups decreased from 1 to 4 days after operation（P<0.05）,and the above indexes in TEAS group were improved in different degrees compared with NS group（P<0.05）.Compared with preoperation,the the number of sleep awakenings in TEAS group increased at 1 and 2 days after operation,while those in NS group increased at 1-4 days after operation（P<0.05）.Compared with NS group,the the number of sleep awakenings in TEAS group decreased at 1-4days after operation（P<0.05）.（3）Compared with NS group,the total scores of Christensen’s Fatigue Scale scores of patients in TEAS group decreased significantly on the 3rd and 5th day after operation（P<0.05）.（4）The the concentration of serum C-reactive protein（CRP）in the two groups were significantly higher than the basic level before operation on the 1st,3rd and 5th day after operation（P<0.05）,and the concentration of serum C-reactive protein（CRP）of the patients in TEAS group decreased at 1d,3d and 5d after operation（p<0.05）.（5）Compared with NS group,the total scores of CAM of the patients in TEAS group decreased significantly at 1d,3d and5d after operation（p<0.05）.there was no significant difference in the incidence of delirium between the two groups（P>0.05）.（6）The scores of MMSE,Letter-Dight Coading and in TEAS group were lower than those before operation one month after operation,and the scores of four neuropsychological tests in NS group were lower than those before operation（P<0.05）,and the scores of MMSE and Letter-Dight Coading in two groups were still lower than those before operation three months after operation（P<0.05）.The MMSE scores and Visual Verbal Learning of TEAS group were higher than those of NS group at 1 month after operation,the MMSE score in 3 months was higher than that in NS group（P<0.05）,and there was no statistical difference（P>0.05）。（7）One month after operation,there were 4 cases in TEAS group and 6 cases in NS group with delayed recovery of postoperative neurocognition,,the incidence rates were 9%and 15%respectively（χ²=0.451,P>0.05）;Three months after operation,5 cases in TEAS group and 6 cases in NS group had postoperative neurocognitive impairment,the incidence rates were 11%and 15%respectively（χ²=0.105,P>0.05）,and there was no statistical difference（P>0.05）.Conclusion:（1）percutaneous acupoint electrical stimulation of Neiguan,Yintang and Hegu acupoint during perioperative period can significantly improve the postoperative sleep quality of elderly patients with sleep disorders after total hip arthroplasty,which is characterized by lower sleep awakening frequency and higher rapid eye movement（REM）sleep ratioin the early postoperative period,and lower PSQI score on the day of discharge and one month after operation;（2）percutaneous acupoint electrical stimulation of Neiguan,Yintang and Hegu acupoint during perioperative period can obviously relieve the postoperative fatigue of elderly patients with sleep disorder undergoing total hip replacement,reduce the postoperative CAM delirium score and improve some neuropsychological test scores in January and March after operation,which may be related to improving postoperative sleep and reducing postoperative inflammatory response.（3）percutaneous acupoint electrical stimulation of Neiguan,Yintang and Hegu acupoint during perioperative period has no obvious effect on the incidence of postoperative delirium,delayed recovery of postoperative neurocognition,of cognitive function in one month after operation and the incidence of cognitive impairment in three months after operation.