Effect of Perioperative Transcutaneous Electrical Acupoint Stimulation on the Early Postoperative Rehabilitation for Elderly Patients with Gastrointestinal Tumor
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摘要: 目的 探讨围手术期经皮穴位电刺激(TEAS)治疗对老年胃肠肿瘤患者术后康复的影响。方法 60例行全麻胃肠肿瘤根治术的患者随机分组。干预组进行TEAS治疗，选用双侧内关、足三里及印堂穴，对照组除不进行电刺激外其余均与干预组相同。观察患者围手术期认知(MMSE)、自理能力(ADL)、压疮、跌倒评分，术后排气排便、进食，术后发热、下床活动、拔除尿管、术后住院及总住院时间，患者围手术期的白细胞介素-6(IL-6)、C反应蛋白(CRP)、S100β及白细胞(WBC)水平。结果 干预组术后发热、下床活动、肛门排气排便及进食时间显著低于对照组(P < 0.05)。对照组术后认知功能总分，定向、记忆、回忆能力得分显著低于术前与干预组(P < 0.05)。与术前比较，2组患者手术当天ADL、压疮评分显著降低(P < 0.01)，跌倒评分明显升高(P < 0.01)；与手术当天比较，2组患者出院前ADL、压疮评分明显升高(P < 0.05~0.01)，跌倒评分显著降低(P < 0.01)，干预组优于对照组(P < 0.05~0.01)。与术前比较，2组患者术后第1天WBC、IL-6、CRP及S100β水平明显升高(P < 0.01)；与术后第1天比较，术后第3天2组患者WBC水平显著降低、CRP水平明显升高(P < 0.01)，IL-6水平干预组显著下降(P < 0.05)，2组比较，干预组优于对照组(P < 0.05~0.01)。结论 围手术期TEAS治疗可促进老年胃肠肿瘤患者术后胃肠功能及认知功能中定向、记忆及回忆能力的恢复，促进早期下床活动，减少压疮及跌倒风险，减轻术后炎症反应，加速早期康复。Abstract: OBJECTIVE To investigate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on the postoperative rehabilitation for elderly patients with gastrointestinal tumor.METHODS 60 cases of gastrointestinal tumor patients were randomly divided into the intervention group and the control group. Patients in the intervention group were given TEAS on PC6, ST36 and DU29 based on the treatment of the control group. The observed indexes were as following: mini-mental state examination (MMSE), ability of daily living (ADL), pressure and fall sores, postoperative break wind, defecation and eating, the duration of postoperative fever, off-bed activity, catheter removal, postoperative admission time and total admission time, along with the levels of interleukin-6 (IL-6), C-Reactive Protein (CRP), S100β and WBC.RESULTS The duration of fever, off-bed activity, break wind, defecation and recovery time in the intervention group was significantly lower than that in the control group (P < 0.05). The total score of postoperative cognitive function, scores of orientation, memory and recall ability in the control group were significantly lower than those before treatment and in the intervention group (P < 0.05). The scores of ADL and pressure sore in the two groups on the operation day were significantly lower than those before operation (P < 0.01), while the fall scores were significantly higher (P < 0.01). Compared with the operation day, the ADL scores and pressure sore in the two groups before discharge were significantly higher (P < 0.05, P < 0.01), while the fall scores were significantly lower (P < 0.05, P < 0.01), and the intervention group was better (P < 0.05, P < 0.01). Compared with those before operation, the levels of WBC, IL-6, CRP and S100β in the two groups were significantly increased on the first day after operation (P < 0.01). Compared with the first day after operation, the WBC levels in the two groups were significantly decreased on the third day after operation, while the CRP levels were significantly increased (P < 0.01). The IL-6 level in the intervention group was significantly decreased (P < 0.05), and the intervention group was improved better than that in the control group (P < 0.05, P < 0.01).CONCLUSION TEAS treatment in the perioperative stage can promote the recovery of gastrointestinal function and cognitive functions including orientation, memory and recall, promote early off-bed activity, reduce the risk of pressure and falls, relieve postoperative inflammatory reaction, and accelerate early recovery.
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图 4 2组患者围术期ADL、压疮、跌倒情况比较
注：与术前比较，#P<0.05，##P<0.01；与手术当天比较，△P<0.05，△△P<0.01；与对照组比较，*P<0.05，**P<0.01。
图 5 2组围手术期血液指标变化情况比较
注：与术前比较，#P<0.05，##P<0.01；与术后第1天比较，△P<0.05，△△P<0.01；与对照组比较，*P<0.05，**P<0.01。
表 1 2组患者术前一般情况比较(x±s，n=30)
组别 年龄/a 性别 BMI/(kg·m-2) 受教育年限/a MMSE评分 定向评分 记忆评分 注意和计算 男 女 干预组 70.03±6.17 20 10 21.97±3.23 6.47±3.88 24.77±1.91 9.17±0.70 2.90±0.31 3.83±1.21 对照组 71.00±6.19 22 8 22.91±3.02 6.87±3.67 25.17±1.86 9.13±0.73 2.87±0.35 4.00±1.08 组别 回忆评分 语言评分 手术史 术前用药量 饮酒 ASA 手术时长/h 麻醉时长/h 0次 1次 2次 是 否 Ⅱ Ⅲ 干预组 2.20±0.48 6.67±1.37 14 13 3 1.00±0.95 18 12 12 18 2.64±0.79 3.26±0.99 对照组 2.33±0.48 6.83±1.42 18 9 3 1.07±1.05 22 8 18 12 2.63±0.78 3.22±0.95 
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表 2 2组患者术前吸烟指数比较(n=30)
组别 吸烟指数=0 0 < 吸烟指数 < 200 200≤吸烟指数≤400 吸烟指数>400 干预组 11 8 8 3 对照组 9 10 8 3
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