医学
经颅直流电刺激
谵妄
关节置换术
随机对照试验
麻醉
焦虑
物理疗法
外科
内科学
刺激
精神科
重症监护医学
作者
Mingshu Tao,Song Zhang,Yuan Han,Chunyan Li,Qi Wei,Dexian Chen,Qiu Zhao,Jie Yang,Rongguang Liu,Jiaxing Fang,Xiang Li,Hongxing Zhang,He Liu,Jun-Li Cao
标识
DOI:10.1016/j.brs.2023.01.839
摘要
Abstract
Background
Postoperative delirium (POD) is a common and severe postoperative complication in elderly patients undergoing major surgery linked to increased morbidity and mortality. It is reported that transcranial direct current stimulation (tDCS) effectively enhances cognitive function and improves impaired consciousness. Objective
This study aimed to evaluate the efficacy of tDCS on POD in elderly patients undergoing lower limb major arthroplasty, including total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods
Patients aged ≥65 years scheduled for THA or TKA were randomly assigned to receive 2 mA tDCS for 20 min active-tDCS (n = 61) or sham-tDCS (n = 61). The primary outcome was the incidence of POD during the first 3 postoperative days. Results
All 122 patients (median age, 70 years; 80 women [65.6%]) completed the trial. The incident delirium risk was 4.9% (n = 3) vs. 19.7% (n = 12) in active-tDCS and sham-tDCS groups, respectively (relative risk, 0.250; 95% CI, 0.074 to 0.842; P = 0.013). Compared to the sham-tDCS group, the anxiety and depression scores of patients in the active-tDCS group were lower at 2 h and one day after surgery (P < 0.001 for each), and pain scores of patients in the active-tDCS group were lower during the first three days after surgery (P < 0.05). Conclusion
One session of anodal tDCS over the left dorsolateral prefrontal cortex may decrease the incidence of POD in elderly patients undergoing lower limb major arthroplasty.
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