Effect of electroacupuncture preconditioning on postoperative delirium and early outcomes in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Abstract

Objective To evaluate the effect of electroacupuncture preconditioning on postoperative delirium (POD) and early outcomes in the patients undergoing cardiac valve replacement with cardiopulmonary bypass. Methods Sixty American Society of Anesthesiologists physical status Ⅱor Ⅲ patients of both sexes, of New York Heart Association Ⅱ or Ⅲ, aged 28-64 yr, scheduled for elective cardiac valve replacement with cardiopulmonary bypass, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and electroacupuncture preconditioning group (group EA). In group EA, Baihui, Yintang and Renzhong acupoints were stimulated for 30 min with an electric stimulator (sparse-dense wave, frequency 2/15 Hz, intensity 1 mA) before skin incision.rSO2 was continuously monitored during operation, and the mean rSO2 (rSO2mean), the minimal rSO2 (rSO2min) and the maximal percentage of decrease from baseline in rSO2 (rSO2%max) were calculated.Blood samples were collected before the electroacupuncture, at the end of surgery, and at 6, 24 and 72 h after surgery for determination of serum tumor necrosis factor-alpha, interleukin-6 (IL-6), IL-10, neuron-specific enolase and S100β protein concentrations by enzyme-linked immunosorbent assay.POD was assessed by Confusion Assessment Method for Intensive Care Unit, and the postoperative recovery was evaluated by Quality of Recovery-40 Questionnaire.The occurrence of POD, duration of stay in intensive care unit and length of hospital stay were also recorded. Results Compared with group C, the rSO2%max, serum concentrations of tumor necrosis factor-alpha, IL-6, neuron-specific enolase and S100β protein and incidence of POD were significantly decreased, the rSO2min, serum IL-10 concentration and Quality of Recovery-40 Questionnaire score were increased, and the duration of stay in intensive care unit and length of hospital stay were shortened (P 0.05). Conclusion Electroacupuncture preconditioning decreases the occurrence of POD and improves early outcomes in the patients undergoing cardiac valve replacement with cardiopulmonary bypass. Key words: Electric stimulation therapy; Extracorporeal circulation; Delirium; Prognosis