无针经皮电刺激：一项评估术后恢复改善的初步研究。
Needleless Transcutaneous Electrical Acustimulation: A Pilot Study Evaluating Improvement in Post-Operative Recovery.
机构信息
Department of Gastroenterology, Changzheng Hospital affiliated to Second Military Medical University, Shanghai, 200003, China. Ningbo Pace Translational Medical Research Center, Ningbo, Zhejiang, China. Division of Gastroenterology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, China. Gastroenterology Surgical Department, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, China. Department of Gastroenterology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China. Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, MD 21224, USA. These authors contributed equally: Bo Zhang, Feng Xu.
出版信息
Am J Gastroenterol. 2018 Jul;113(7):1026-1035. doi: 10.1038/s41395-018-0156-y. Epub 2018 Jun 21.
BACKGROUND
Functional gastrointestinal disturbance occurs after abdominal surgeries and could last for an extended period of time in some cases. This study was designed (1) to evaluate the effects of needleless transcutaneous electrical acustimulation (TEA) on postoperative recovery, and (2) to investigate the mechanisms involving autonomic function in postoperative patients after removal of gastrointestinal cancers.
METHODS
Forty-two patients (33 male, age: 69.5 ± 1.5 years) scheduled for abdominal surgical removal of gastrointestinal cancers were randomized to TEA (n = 21) and sham-TEA (n = 21). TEA was performed via acupoints ST36 and PC6 1 h twice daily from the postoperative day (POD) 1 to day 3. Sham-TEA was performed at non-acupoints.
RESULTS
(1) TEA improved major postoperative symptoms by about 30%, including a reduction in time to defecation by 31.7% (P < 0.01 vs. sham-TEA), time to first flatus by 35.9% (P < 0.001), time to ambulation by 42.8% (P < 0.01), time to resuming diet by 26.5% (P < 0.01) and hospital stay by 30% (P < 0.05) as well as pain score by 50% (P < 0.01). (2) TEA significantly increased vagal activity (P < 0.001) and decreased sympathetic activity on POD 4 (P < 0.001) compared with POD 1 as well as the serum level of NE (P < 0.05). (3) The vagal activity, high frequency assessed from the spectral analysis of heart rate variability, was negatively correlated with time to resuming diet, whereas the sympathetic measurement, serum norepinephrine was positively correlated with time to resuming diet and time to flatus. (4) TEA but not sham-TEA decreased TNF-α by 17.4% from POD 1 to POD 4. (5) TEA was an independent predictor of a shorter hospital stay.
CONCLUSIONS
Needleless TEA improves major postoperative symptoms by enhancing vagal and suppressing sympathetic activities.
背景
功能性胃肠紊乱发生在腹部手术后，在某些情况下可能会持续很长时间。本研究旨在：（1）评估无针经皮电刺激（TEA）对术后恢复的影响；（2）探讨胃肠道癌症切除术后患者自主神经功能的相关机制。
方法
42 例（男 33 例，年龄：69.5±1.5 岁）患者拟行腹部手术切除胃肠道肿瘤，随机分为 TEA 组（n=21）和假 TEA 组（n=21）。术后第 1 天至第 3 天，TEA 组每天两次经 ST36 和 PC6 穴位进行 1 小时 TEA。假 TEA 组在非穴位处进行。
结果
（1）TEA 可改善主要术后症状，改善程度约为 30%，包括排便时间减少 31.7%（与假 TEA 相比，P<0.01），首次排气时间减少 35.9%（P<0.001），活动时间增加 42.8%（P<0.01），恢复饮食时间减少 26.5%（P<0.01），住院时间减少 30%（P<0.05），疼痛评分降低 50%（P<0.01）。（2）与术后第 1 天相比，术后第 4 天 TEA 组的迷走神经活性显著增加（P<0.001），交感神经活性降低（P<0.001），血清去甲肾上腺素水平降低（P<0.05）。（3）心率变异性频谱分析中评估的高频（HF），即迷走神经活性与恢复饮食时间呈负相关，而交感神经测量指标，即血清去甲肾上腺素与恢复饮食时间和排气时间呈正相关。（4）与假 TEA 组相比，TEA 组可使 TNF-α水平从术后第 1 天至第 4 天降低 17.4%。（5）TEA 是缩短住院时间的独立预测因子。
结论
无针 TEA 通过增强迷走神经活动和抑制交感神经活动来改善主要术后症状。
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