文章摘要
经皮耳穴迷走神经刺激对非心肺转流冠状动脉旁路移植术后心律失常的影响
Effects of transcutaneous auricular vagus nerve stimulation on postoperative arrhythmias in patients undergoing off-pump coronary artery bypass grafting
  
DOI：10.12089/jca.2025.09.001
中文关键词: 经皮耳穴迷走神经刺激  冠状动脉旁路移植术  心律失常  炎症反应  心肌损伤
英文关键词: Transcutaneous auricular vagus nerve stimulation  Coronary artery bypass grafting  Arrhythmia  Inflammatory response  Myocardial injury
基金项目:河南省医学科技攻关计划联合共建项目（LHGJ20200596）
作者单位E-mail
马亚飞 471000,洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院麻醉科  
冯毅 471000,洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院儿科  
郭仲辉 471000,洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院麻醉科  
魏利娟 471000,洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院麻醉科 weilj66366@126.com 
陈小莉 471000,洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院麻醉科  
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中文摘要:
      
目的：探讨经皮耳穴迷走神经刺激（taVNS）对非心肺转流冠状动脉旁路移植术（CABG）患者术后心律失常、心肌损伤及炎症反应的影响。
方法：选择择期首次行CABG的患者95例，男63例，女32例，年龄46～74岁，BMI 20～33 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：taVNS组（T组，n=48）和对照组（C组，n=47）。T组术前1 d和术后3 d接受双耳taVNS治疗，手术当日术前2 h治疗1次，术中两耳交替刺激至术毕。C组操作同T组但不予以刺激。记录术中和术后抗心律失常药物使用情况，术后72 h内心律失常发生率。于术前1 d、术后入ICU后、术后24和72 h检测血清肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）、肿瘤坏死因子-α（TNF-α）和白细胞介素6（IL-6）浓度，并记录当日最大血管活性药物评分（VIS）。记录术后肺部感染、肾功能不全、胸腔积液、切口愈合不良等并发症发生情况。
结果：与C组比较，T组术后72 h内心律失常总发生率和房性或室性早搏发生率明显降低（P<0.05），术中兰地洛尔和利多卡因、术后胺碘酮和西地兰使用率明显降低（P<0.05），术后24 和72 h血清CK-MB、cTnI、TNF-α和IL-6浓度明显降低（P<0.05）。两组不同时点VIS以及术后肺部感染、肾功能不全、胸腔积液、切口愈合不良等并发症发生情况差异无统计学意义。
结论：taVNS可显著降低非心肺转流CABG患者术后心律失常发生率，减少抗心律失常药物使用，抑制炎症反应并减轻心肌损伤。
英文摘要:
      
Objective: To investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on postoperative arrhythmias, myocardial injury, and inflammatory response in patients undergoing off-pump coronary artery bypass grafting (CABG).
Methods: Ninety-five patients scheduled for elective off-pump CABG were enrolled, 63 males and 32 females, aged 46-74 years, BMI 20-33 kg/m2 and ASA physical status Ⅱ or Ⅲ. They were randomly divided into two groups: taVNS group (group T, n = 48) and control group (group C, n = 47). Group T received bilateral taVNS treatment 1 day preoperatively and postoperative days 1-3. An additional session was administered 2 hours preoperatively, with alternating bilateral stimulation during surgery until completion. Group C underwent identical procedures without electrical stimulation. Intraoperative and postoperative antiarrhythmic drug use and the incidence of arrhythmias within 72 hours postoperatively were recorded. Serum levels of creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured 1 day before surgery, upon ICU admission, and at 24 and 72 hours postoperatively, along with the maximum vasoactive-inotropic score (VIS) for the day. Postoperative complications, including pulmonary infection, renal dysfunction, pleural effusion, and poor wound healing were also documented.
Results: Compared with group C, group T exhibited significantly lower total incidence of arrhythmias and reduced frequency of atrial/ventricular premature contractions at 72 hours postoperatively (P < 0.05), the utilization rates of intraoperative landiolol and lidocaine, as well as postoperative amiodarone and cedilanid were significantly decreased in group T (P < 0.05), serum levels of CK-MB, cTnI, TNF-α, and IL-6 at 24 and 72 hours postoperatively were significantly lower in group T (P < 0.05). No significant differences were observed between the two groups in VIS at different time points, or the incidence of postoperative complications such as pulmonary infection, renal dysfunction, pleural effusion, and poor wound healing.
Conclusion: Transcutaneous auricular vagus nerve stimulation effectively reduces the incidence of postoperative arrhythmias, decreases antiarrhythmic drug requirements, suppresses inflammatory responses, and alleviates myocardial injury in patients undergoing off-pump CABG.
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