Objective

2

To observe the effects of ear holographic scraping therapy combined with repetitive transcranial magnetic stimulation (rTMS) on postoperative delirium and cognitive function in elderly patients undergoing hip fracture surgery.

Methods

2

A total of 138 patients of

qi

deficiency and blood stagnation undergoing hip fracture surgery were randomly divided into a combined treatment group (46 cases

1 case dropped out)

an rTMS group (46 cases

1 case dropped out) and a conventional treatment group (46 cases

2 cases dropped out). The routine measure for delirium prevention was adopted in the conventional treatment group. On the basis of the intervention as the conventional treatment group

the rTMS at 10 Hz was delivered in the rTMS group. In the combined treatment group

the ear holographic scraping therapy was supplemented besides the intervention as the rTMS group. The auricular points included shenmen (TF

4

)

pizhixia (AT

4

)

gan (CO

12

) and Shen (CO

10

). The intervention was applied to the auricular points on one side

once daily

then alternated to the other side on the following day. In both the rTMS group and the combined treatment group

the interventions w

ere given on the day before surgery

on the day of surgery

and daily after surgery

for a total of 9 days. The scores of the confusion assessment method (CAM) and the visual analogue scale (VAS) of pain were recorded on the day before surgery and on days 1

4

and 7 postoperatively in each group. The incidence of postoperative delirium (POD) within 7 days after surgery was calculated

and the scores of delirium rating scale-revised-98 (DRS-R-98) on the delirium and suspected delirium

the length of hospital stay and the average sleep duration during hospitalization were recorded. On the day before surgery and on day 7 after surgery

the number of correct responses in the Stroop color word test

Part C (SCWT-C) and the scores in Montreal cognitive assessment scale (MoCA) were recorded; and the levels of serum C-reactive protein (CRP)

plasminogen activator inhibitor-1 (PAI-1)

and neuron specific enolase (NSE) were measured.

Results

2

The CAM scores at all postoperative time points were higher in all groups compared with preoperative ones (

P

<

0.05). In the combined treatment group

the CAM scores on days 4 and 7 after surgery

the incidence of POD within 7 days after surgery

DRS-R-98 score within 7 days after surgery in patients with delirium and suspected delirium were lower when compared with the other two groups (

P

<

0.05). On day 7 after surgery

the rTMS group showed the lower CAM score in comparison with the conventional treatment group (

P

<

0.05). On days 4 and 7 after surgery

the VAS scores in all groups were lower than those before surgery (

P

<

0.05)

and the score in the combined treatment group was lower than the other two groups (

P

<

0.05). On day 4 after surgery

the rTMS group exhibited lower VAS score compared with the conventional treatment group (

P

<

0.05). Both the combined treatment group and the rTMS group had shorter hospital stays when compared with the

conventional treatment group (

P

<

0.05). During hospitalization

the rTMS group demonstrated a longer average sleep duration than the conventional treatment group (

P

<

0.05)

while the combined treatment group showed a longer sleep duration when compared with the other two groups (

P

<

0.05). On day 7 after surgery

except for MoCA score in the conventional treatment group and NSE level in the combined treatment group

the number of correct responses on SCWT-C

MoCA score

as well as serum NSE and CRP levels in each group were all higher in comparison with the baseline (

P

<

0.05)

and PAI-1 level in the combined treatment group and rTMS group was higher when compared with the baseline (

P

<

0.05)

while the conventional group exhibited lower level (

P

<

0.05). The combined treatment group demonstrated the higher number of correct responses on SCWT-C and MoCA score in comparison with the conventional treatment group (

P

<

0.05)

while the serum CRP and NSE levels were lower and PAI-1 level was higher when compared with the other two groups (

P

<

0.05). In the rTMS group

the number of correct responses on SCWT-C

MoCA score

and serum PAI-1 level were higher than those in the conventional treatment group (

P

<

0.05)

while the serum NSE level was lower (

P

<

0.05).

Conclusion

2

The combination of ear holographic scraping therapy and rTMS can effectively reduce the incidence of POD and the duration of delirium. The mechanism may be related to the improvement of cognitive level

postoperative pain relief

circadian rhythms regulation

and neurotransmitter optimization.