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| 经皮穴位电刺激联合耳迷走神经刺激对老年患者胃肠手术后谵妄的影响 |
| Effect of transcutaneous electrical acupoint stimulation combined with transcutaneous auricular vagus nerve stimulation on postoperative delirium in elderly patients undergoing gastrointestinal surgery |
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| DOI：10.12089/jca.2026.06.008 |
| 中文关键词: 经皮穴位电刺激 经皮耳迷走神经刺激 术后谵妄 胃肠手术 炎性因子 老年 |
| 英文关键词: Transcutaneous electrical acupoint stimulation Transcutaneous auricular vagus nerve stimulation Postoperative delirium Gastrointestinal surgery Inflammatory factor Aged |
| 基金项目:国家自然科学基金青年项目（82301388） |
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| 摘要点击次数: 300 |
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| 中文摘要: |
目的：评价单独实施经皮穴位电刺激（TEAS）与其联合耳迷走神经刺激（taVNS）对老年患者胃肠手术后谵妄（POD）的影响。
方法：选择择期行腹腔镜下胃肠手术的老年患者，年龄≥65岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者随机分为两组：TEAS组和联合组。TEAS组于麻醉诱导前在双侧合谷、内关、足三里穴实施TEAS，联合组在TEAS组的基础上加用taVNS，两组刺激时间均为30 min。主要指标为术后3 d内POD发生率。采用3分钟谵妄诊断量表（3D-CAM）评估术后1～3 d POD的发生情况。次要指标包括麻醉时间、手术时间、苏醒时间、丙泊酚用量、瑞芬太尼用量、舒芬太尼用量、总入量、总出量，入室时、气管插管时、手术开始时、手术结束时、拔管时HR和MAP，术后首次肛门排气时间、首次下床活动时间，术后24、48、72 h的VAS疼痛评分。采用酶联免疫吸附法（ELISA）分析术前（干预前）及术后（手术结束即刻）血清中白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的浓度。不良反应包括术后恶心呕吐、皮肤瘙痒、咽喉疼痛等。
结果：共纳入患者116例，每组58例。与TEAS组比较，联合组术后3 d内POD发生率明显降低，手术结束即刻IL-6、TNF-α浓度明显降低，气管插管时HR明显减慢，术后首次肛门排气时间明显缩短（P<0.05）。与术前比较，两组手术结束即刻IL-6、TNF-α浓度明显升高(P<0.05)。两组麻醉时间、手术时间、苏醒时间、丙泊酚、瑞芬太尼、舒芬太尼用量、总入量、总出量、术后首次下床活动时间、术后24、48、72 h VAS疼痛评分、不良反应发生率差异无统计学意义。
结论： 与单独使用TEAS相比，TEAS联合taVNS可能通过抑制IL-6、TNF-α的上调减少POD的发生。 |
| 英文摘要: |
Objective: To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) alone versus TEAS combined with transcutaneous auricular vagus nerve stimulation (taVNS) on the incidence of postoperative delirium (POD) in elderly patients undergoing gastrointestinal surgery.
Methods: Elderly patients aged ≥ 65 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, who scheduled for elective laparoscopic gastrointestinal surgery were enrolled. Patients were randomly assigned using a random number table to TEAS group and combined group. In the TEAS group, TEAS was administered bilaterally at Hegu (LI4), Neiguan (PC6), and Zusanli (ST36) for 30 minutes before anesthesia induction. In the combined group, taVNS was additionally administered based on TEAS, with the same stimulation duration. The primary outcome was the cumulative incidence of postoperative delirium (POD) within the first 3 days postoperatively. The incidence of POD within the first 3 days postoperatively was evaluated using the 3-minute delirium diagnostic scale (3D-CAM). Secondary outcomes included duration of anesthesia, duration of surgery, recovery time, dosage of propofol, dosage of remifentanil, dosage of sufentanil, total fluid intake volume, total fluid output volume, HR and MAP measured upon room entry, during tracheal intubation, at the commencement and conclusion of surgery, and at extubation, time to first postoperative flatus and time to first postoperative mobilization, and visual analog scale (VAS) pain scores 24, 48, and 72 hours postoperatively. Enzyme-linked immunosorbent assay (ELISA) was employed to quantify the serum concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) preoperatively (prior to trial intervention) and immediately postoperatively (at the conclusion of surgery). Adverse reactions comprised postoperative nausea and vomiting, pruritus, and sore throat.
Results: A total of 116 patients were included, with 58 patients in each group. Compared with TEAS group, combined group exhibited a significantly lower incidence of POD within the first 3 postoperative days, the concentrations of IL-6 and TNF-α immediately after the surgery in the combined group were significantly lower, the heart rate during tracheal intubation was significantly lower, and the time for the first postoperative rectal exhaust was significantly shorter (P < 0.05). There were no significantly differences in anesthesia duration, operation time, recovery time, propofol, remifentanil, sufentanil dosage, total input volume, total output volume, time of first postoperative ambulation, and VAS pain scores 24, 48, and 72 hours postoperatively between the two groups.
Conclusion: Compared with TEAS alone, the combination of TEAS and taVNS more effectively reduced the incidence of POD in elderly patients undergoing gastrointestinal surgery. This effect may be mediated through the attenuation of postoperative upregulation of IL-6 and TNF-α. |
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