Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.
Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, UK.
Br J Anaesth. 2022 Jan;128(1):135-149. doi: 10.1016/j.bja.2021.08.037. Epub 2021 Nov 18.
Autonomic dysfunction promotes organ injury after major surgery through numerous pathological mechanisms. Vagal withdrawal is a key feature of autonomic dysfunction, and it may increase the severity of pain. We systematically evaluated studies that examined whether vagal neuromodulation can reduce perioperative complications and pain.
Two independent reviewers searched PubMed, EMBASE, and the Cochrane Register of Controlled Clinical Trials for studies of vagal neuromodulation in humans. Risk of bias was assessed; I index quantified heterogeneity. Primary outcomes were organ dysfunction (assessed by measures of cognition, cardiovascular function, and inflammation) and pain. Secondary outcomes were autonomic measures. Standardised mean difference (SMD) using the inverse variance random-effects model with 95% confidence interval (CI) summarised effect sizes for continuous outcomes.
From 1258 records, 166 full-text articles were retrieved, of which 31 studies involving patients (n=721) or volunteers (n=679) met the inclusion criteria. Six studies involved interventional cardiology or surgical patients. Indirect stimulation modalities (auricular [n=23] or cervical transcutaneous [n=5]) were most common. Vagal neuromodulation reduced pain (n=10 studies; SMD=2.29 [95% CI, 1.08-3.50]; P=0.0002; I=97%) and inflammation (n=6 studies; SMD=1.31 [0.45-2.18]; P=0.003; I=91%), and improved cognition (n=11 studies; SMD=1.74 [0.96-2.52]; P<0.0001; I=94%) and cardiovascular function (n=6 studies; SMD=3.28 [1.96-4.59]; P<0.00001; I=96%). Five of six studies demonstrated autonomic changes after vagal neuromodulation by measuring heart rate variability, muscle sympathetic nerve activity, or both.
Indirect vagal neuromodulation improves physiological measures associated with limiting organ dysfunction, although studies are of low quality, are susceptible to bias and lack specific focus on perioperative patients.
自主神经功能障碍通过多种病理机制促进大手术后的器官损伤。迷走神经撤退是自主神经功能障碍的一个关键特征，它可能会增加疼痛的严重程度。我们系统地评估了研究迷走神经调节是否可以减少围手术期并发症和疼痛的研究。
两位独立的审查员搜索了 PubMed、EMBASE 和 Cochrane 对照临床试验登记册，以寻找人类迷走神经调节的研究。评估了风险偏倚；I 指数量化了异质性。主要结果是器官功能障碍（通过认知、心血管功能和炎症的测量来评估）和疼痛。次要结果是自主测量。使用逆方差随机效应模型，以标准化均数差值（SMD）和 95%置信区间（CI）总结连续结果的效应大小。
从 1258 条记录中，检索到 166 篇全文文章，其中 31 项研究涉及患者（n=721）或志愿者（n=679）符合纳入标准。6 项研究涉及介入心脏病学或外科患者。间接刺激方式（耳[ n=23]或颈皮[ n=5]）最常见。迷走神经调节降低了疼痛（n=10 项研究；SMD=2.29[95%CI，1.08-3.50]；P=0.0002；I=97%）和炎症（n=6 项研究；SMD=1.31[0.45-2.18]；P=0.003；I=91%），改善了认知（n=11 项研究；SMD=1.74[0.96-2.52]；P<0.0001；I=94%）和心血管功能（n=6 项研究；SMD=3.28[1.96-4.59]；P<0.00001；I=96%）。6 项研究中的 5 项通过测量心率变异性、肌肉交感神经活动或两者来证明迷走神经调节后的自主神经变化。
间接迷走神经调节改善了与限制器官功能障碍相关的生理指标，尽管这些研究质量较低，易受偏倚影响，且缺乏对围手术期患者的具体关注。
