经皮穴位电刺激对老年髋部骨折患者全髋关节置换术后免疫抑制状态的改善作用

Improvement of Transcutaneous Electrical Acupoint Stimulation on Postoperative Immunosuppression in Elderly Patients with Hip Fracture Undergoing Total Hip Replacement

摘要: 目的：探讨经皮穴位电刺激(TEAS)对老年髋部骨折患者全髋关节置换术后免疫抑制状态的改善作用。方法：选择2021年1月~2024年3月期间在北仑区人民医院初次行单侧全髋关节置换术的老年患者100例，随机分为经皮穴位电刺激组(TEAS组)和经皮穴位假电刺激组(SHAM组)，每组50例。TEAS组患者于术前、术中及术后给予TEAS干预，SHAM组患者相应给予假TEAS干预。分别于术前1d及术后1 d、4 d、7 d检测两组患者的白介素-6 (IL-6)、C反应蛋白(CRP)水平，并比较两组之间的术后继发感染情况及术后住院天数。结果：组内与术前比较，两组患者术后1d和4d的血清IL-6及CRP水平均明显上升(P < 0.01)，术后7 d则基本回落至术前水平(P > 0.05)；组间比较，术后1d和4d的TEAS组血清IL-6水平均明显低于SHAM组(P < 0.05)，术后4 d的TEAS组CRP水平也明显低于SHAM组(P = 0.026)。SHAM组的术后感染发生率显著高于TEAS组(P = 0.040)，但两组的术后住院天数比较未见统计学差异(P > 0.05)。结论：围术期TEAS能够明显改善老年髋部骨折患者全髋关节置换术后的免疫抑制状态，并降低术后感染的发生率。

Abstract: Objective: To observe the improvement of transcutaneous electrical acupoint stimulation (TEAS) on the postoperative immunosuppression in elderly patients with hip fracture undergoing total hip replacement. Methods: A total of 100 elderly patients with hip fracture scheduled for unilateral total hip replacement for the first time in Beilun District People’s Hospital from January 2021 to March 2024, were randomly divided into TEAS group and SHAM group, with 50 cases in each group. Patients in the TEAS group were given TEAS intervention before, during and after surgery, while patients in the SHAM group were treated with sham TEAS. The levels of interleukin-6 (IL-6) and C-reactive protein (CRP) were detected at 1 d before surgery, and 1 d, 4 d, 7 d after surgery respectively, and the incidence of postoperative infection and postoperative hospitalization days were compared between the two groups. Results: As compared with those before surgery, the serum levels of IL-6 and CRP in both groups were significantly increased at 1d and 4 d after surgery (P < 0.01), but dropped basically back to the preoperative level at 7 d after surgery (P < 0.05). Comparison between the two groups, serum IL-6 levels in the TEAS group were significantly lower than those in the SHAM group at 1 d and 4 d after surgery (P < 0.05), and the levels of CRP in the TEAS group was significantly lower than those in the SHAM group at 4 d after surgery (P = 0.026). The incidence of postoperative infection in the SHAM group was significantly higher than that in the TEAS group (P = 0.040), but there was no significant difference in postoperative hospitalization days between the two groups (P > 0.05). Conclusion: Perioperative TEAS intervention can significantly improve the postoperative immunosuppression status and reduce the incidence of infection in elderly patients with hip fracture undergoing total hip replacement.