耳部全息刮痧联合重复经颅磁刺激对气虚血瘀证老年髋部骨折手术患者术后谵妄和认知功能的影响

陈波; 陈汝艳; 郭亚雄; 王玲

doi:10.13703/j.0255-2930.20250618-0003

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耳部全息刮痧联合重复经颅磁刺激对气虚血瘀证老年髋部骨折手术患者术后谵妄和认知功能的影响

临床研究 | 更新时间：2026-07-09

- 耳部全息刮痧联合重复经颅磁刺激对气虚血瘀证老年髋部骨折手术患者术后谵妄和认知功能的影响
- Effects of ear holographic scraping therapy combined with repetitive transcranial magnetic stimulation on postoperative delirium and cognitive function in elderly patients undergoing hip fracture surgery
- 中国针灸 2026年46卷第7期页码：1090-1097
- 作者机构：
  
  西南医科大学附属医院康复医学科，四川泸州　646000
  康复医学与工程泸州市重点实验室，四川泸州　646000
  西南医科大学附属医院医院手术室，四川泸州　646000
- 作者简介：
  
  ✉王玲，副主任医师。E-mail：wyl012235@163.com
- 基金信息：
  
  四川科技计划资助项目(2023NSFSC1496);四川省医学青年创新科研课题计划项目(Q21100);四川省保健委员会保健科研课题项目(川干研2021-1506)
- DOI：10.13703/j.0255-2930.20250618-0003
  中图分类号：
- 收稿：2025-06-18，
  
  网络首发：2026-04-27，
  
  纸质出版：2026-07-12
- 稿件说明：
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陈波, 陈汝艳, 郭亚雄, 等. 耳部全息刮痧联合重复经颅磁刺激对气虚血瘀证老年髋部骨折手术患者术后谵妄和认知功能的影响[J]. 中国针灸, 2026,46(7):1090-1097.

CHEN Bo, CHEN Ruyan, GUO Yaxiong, et al. Effects of ear holographic scraping therapy combined with repetitive transcranial magnetic stimulation on postoperative delirium and cognitive function in elderly patients undergoing hip fracture surgery[J]. Chinese Acupuncture & Moxibustion, 2026, 46(7): 1090-1097.
陈波, 陈汝艳, 郭亚雄, 等. 耳部全息刮痧联合重复经颅磁刺激对气虚血瘀证老年髋部骨折手术患者术后谵妄和认知功能的影响[J]. 中国针灸, 2026,46(7):1090-1097. DOI： 10.13703/j.0255-2930.20250618-0003.

CHEN Bo, CHEN Ruyan, GUO Yaxiong, et al. Effects of ear holographic scraping therapy combined with repetitive transcranial magnetic stimulation on postoperative delirium and cognitive function in elderly patients undergoing hip fracture surgery[J]. Chinese Acupuncture & Moxibustion, 2026, 46(7): 1090-1097. DOI： 10.13703/j.0255-2930.20250618-0003.

摘要

目的：

观察耳部全息刮痧联合重复经颅磁刺激（rTMS）在改善气虚血瘀证老年髋部骨折手术患者术后谵妄状态及认知功能方面的作用。

方法：

将138例气虚血瘀证老年髋部骨折手术患者随机分为联合组（46例，脱落1例）、rTMS组（46例，脱落1例）和常规组（46例，脱落2例）。常规组采用常规谵妄预防；rTMS组在常规组基础上，进行10 Hz的rTMS刺激；联合组在rTMS组基础上，加用耳部全息刮痧，穴取神门、皮质下、肝、肾等，每日干预一侧耳穴，次日交替。rTMS组与联合组均于手术前1 d、手术当日以及术后每日进行干预，共干预9 d。于手术前1 d及术后1、4、7 d观察各组意识模糊评估法（CAM）、疼痛视觉模拟量表（VAS）评分，统计术后7 d内谵妄发生率，并记录各组谵妄和疑似谵妄者谵妄评定量表-98修订版（DRS-R-98）评分；记录各组患者住院时长、住院期间平均睡眠时长；于手术前1 d、术后7 d，观察各组Stroop色词干扰测验-C部分（SCWT-C）正确个数和蒙特利尔认知评估量表（MoCA）评分，检测血清C-反应蛋白（CRP）、纤溶酶原激活物抑制物-1（PAI-1）、神经元特异性烯醇化酶（NSE）水平。

结果：

各组术后各时点CAM评分高于手术前（

0.05）；联合组术后4、7 d CAM评分，术后7 d内谵妄发生率，以及术后7 d内谵妄和疑似谵妄者DRS-R-98评分均低于其余两组（

0.05）；术后7 d，rTMS组CAM评分低于常规组（

0.05）。术后4、7 d，各组疼痛VAS评分低于手术前（

0.05），联合组低于其余两组（

0.05）；术后4 d，rTMS组疼痛VAS评分低于常规

组（

0.05）。联合组和rTMS组住院时长均短于常规组（

0.05）；rTMS组住院期间平均睡眠时长较常规组延长（

0.05），联合组长于其余两组（

0.05）。术后7 d，除常规组MoCA评分和联合组NSE水平外，各组SCWT-C正确个数、MoCA评分及血清NSE、CRP水平均高于治疗前（

0.05），而在PAI-1水平，联合组和rTMS组高于治疗前（

0.05），常规组低于治疗前（

0.05）；联合组SCWT-C正确个数和MoCA评分高于常规组（

0.05），血清CRP、NSE水平低于其余两组，PAI-1高于其余两组（

0.05）；rTMS组SCWT-C正确个数、MoCA评分、血清PAI-1水平高于常规组（

0.05），血清NSE水平低于常规组（

0.05）。

结论：

耳部全息刮痧联合rTMS可以降低POD发生率，减少谵妄持续时间，其机制可能与改善认知功能、缓解术后疼痛、调节睡眠节律及优化神经递质水平有关。

Abstract

Objective

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

A total of 138 patients of

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

)

pizhixia (AT

)

gan (CO

) and Shen (CO

). 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

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

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

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 (

0.05). On day 7 after surgery

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

0.05). On days 4 and 7 after surgery

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

0.05)

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

0.05). On day 4 after surgery

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

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

conventional treatment group (

0.05). During hospitalization

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

0.05)

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

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 (

0.05)

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

0.05)

while the conventional group exhibited lower level (

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 (

0.05)

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

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 (

0.05)

while the serum NSE level was lower (

0.05).

Conclusion

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.

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