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Authors Gao F, Zhang Q, Li Y, Tai Y, Xin X, Wang X, Wang Q
Received 13 August 2018
Accepted for publication 25 September 2018
Published 24 October 2018 Volume 2018:13 Pages 2127—2134
DOI https://doi.org/10.2147/CIA.S183698
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Wu
Purpose: This study aims to investigate the effect of transcutaneous electrical
acupoint stimulation (TEAS) on postoperative delirium (POD) in elderly patients
with silent lacunar infarct and preliminarily to determine the relationship
among TEAS, blood–brain barrier (BBB), neuroinflammation, and POD.
Patients and
methods: Sixty-four-old patients with
silent lacunar infarct were randomly divided into two groups: group TEAS and
control group (group C). Patients in the group TEAS received TEAS
(disperse-dense waves; frequency, 2/100 Hz) on acupoints Hegu and Neiguan of
both sides starting from 30 minutes before induction of anesthesia until the
end of surgery, and the intensity was the maximum current that could be
tolerated. In group C, electrodes were placed on the same acupoints before
anesthesia induction, but no current was given. At 0 minute before the
treatment of TEAS, 30 minutes after skin incision, and after completion of
surgery (T1–3),
blood samples were extracted to detect the concentration of serum tumor
necrosis factor (TNF)-α, interleukin-6 (IL-6), matrix metalloproteinase-9
(MMP-9), and S100β. We assessed patients for delirium and coma twice daily in
the first 3 postoperative days using the Confusion Assessment Method for the
intensive care unit and the Richmond Agitation-Sedation Scale.
Results: This study preliminarily suggests that TEAS can reduce the
development of POD in elderly patients with silent lacunar infarction (6.3% vs
25.0%; P =0.039). Compared with the
baseline value at T1, the serum concentrations of IL-6, TNF-α, MMP-9, and S100β were
significantly increased at T2–3 in both the groups (P <0.05).
Compared with group TEAS, serum levels of TNF-α and IL-6 were higher at T2–3 and serum levels of MMP-9 and S100β were higher at T3 in group C (P <0.05). The
intraoperative anesthetic consumptions were less in group TEAS than group C.
Conclusion: TEAS can alleviate POD in older patients with silent lacunar
infarction and may be related to reduce the neuroinflammation by lowering the
permeability of BBB.
Keywords: delirium, geriatric, neuroinflammation, blood–brain barrier,
transcutaneous electrical acupoint stimulation, lacunar infarction