Strasser Eva Maria, Stättner Stefan, Karner Josef, Klimpfinger Martin, Freynhofer Matthias, Zaller Vera, Graf Alexandra, Wessner Barbara, Bachl Norbert, Roth Erich, Quittan Michael
Institute of Physical Medicine and Rehabilitation, Social Medical Centre South-Kaiser Franz Joseph Hospital, Vienna, Austria.
Ann Surg. 2009 May;249(5):738-43. doi: 10.1097/SLA.0b013e3181a38e71.
To investigate the effect of neuromuscular electrical stimulation (NMES) on skeletal muscle metabolism after major abdominal surgery.
Protein catabolism associated with surgical interventions leads to reduced muscle strength, increased clinical complications and prolonged convalescence. Immobilization is suggested as a major stimulus for muscle wasting. This study investigates the potency of NMES on skeletal muscle growth factors and degradation processes in surgical patients.
This observer blind study included 26 patients after major abdominal surgery mainly due to cancer aged 60 +/- 10 years. Starting on the first postoperative day, 1 randomly assigned thigh of each patient was treated on 4 consecutive days with NMES, whereas the other leg was used as sham-stimulated control. Thereafter, muscle biopsies from both legs were performed. Differences in mRNA level, protein expression, and enzyme activity between legs were analyzed by cross-over analysis of variance (Clinical Trial Registration Number: NCT00635440).
NMES significantly increased total RNA content and total sarcoplasmatic protein content. NMES significantly reduced ubiquitin-conjugated sarcoplasmatic proteins and proteasome activity. The mechano growth factor mRNA level correlated positively with the applied current and negatively with the body mass index of the patients. The increase in insulin like growth factor-1Ea mRNA after NMES correlated negatively with the age of the patients.
This study shows that NMES significantly increases total RNA content and reduces protein degradation in postoperative patients. Moreover, the induction of growth factors by NMES reveals dependency on body mass index, age, and applied current. We conclude that NMES is a useful clinical tool to reduce protein catabolism in postoperative patients.
探讨神经肌肉电刺激（NMES）对腹部大手术后骨骼肌代谢的影响。
与手术干预相关的蛋白质分解代谢会导致肌肉力量下降、临床并发症增加和康复期延长。制动被认为是肌肉萎缩的主要刺激因素。本研究调查了NMES对手术患者骨骼肌生长因子和降解过程的作用。
这项观察者盲法研究纳入了26例主要因癌症接受腹部大手术的患者，年龄为60±10岁。从术后第一天开始，对每位患者随机分配的一条大腿连续4天进行NMES治疗，而另一条腿作为假刺激对照。此后，对双腿进行肌肉活检。通过方差交叉分析比较双腿之间mRNA水平、蛋白质表达和酶活性的差异（临床试验注册号：NCT00635440）。
NMES显著增加了总RNA含量和总肌浆蛋白含量。NMES显著降低了泛素结合的肌浆蛋白和蛋白酶体活性。机械生长因子mRNA水平与施加的电流呈正相关，与患者的体重指数呈负相关。NMES后胰岛素样生长因子-1Ea mRNA的增加与患者年龄呈负相关。
本研究表明，NMES显著增加了术后患者的总RNA含量并减少了蛋白质降解。此外，NMES对生长因子的诱导显示出对体重指数、年龄和施加电流的依赖性。我们得出结论，NMES是减少术后患者蛋白质分解代谢的一种有用的临床工具。
