Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, South Korea.
BMC Anesthesiol. 2022 Mar 9;22(1):68. doi: 10.1186/s12871-022-01611-x.
Cardiopulmonary bypass-related myocardial ischemia-reperfusion injury is a major contributor to postoperative morbidity. Although transcutaneous electrical nerve stimulation (TENS) has been found to have cardioprotective effects in animal studies and healthy volunteers, its effects on cardiac surgery under cardiopulmonary bypass patients have not been evaluated. We investigated the effects of TENS on myocardial protection in patients undergoing aortic valve replacement surgery using cardiopulmonary bypass.
Thirty patients were randomized to receive TENS or sham in three different anesthetic states - pre-anesthesia, sevoflurane, or propofol (each n = 5). TENS was applied with a pulse width of 385 μs and a frequency of 10 Hz using two surface electrodes at the upper arm for 30 min. Sham treatment was provided without stimulation. The primary outcome was the difference in myocardial infarct size following ischemia-reperfusion injury in rat hearts perfused with pre- and post-TENS plasma dialysate obtained from the patients using Langendorff perfusion system. The cardioprotective effects of TENS were determined by assessing reduction in infarct size following treatment.
There were no differences in myocardial infarct size between pre- and post-treatment in any group (41.4 ± 4.3% vs. 36.7 ± 5.3%, 39.8 ± 7.3% vs. 27.8 ± 12.0%, and 41.6 ± 2.2% vs. 37.8 ± 7.6%; p = 0.080, 0.152, and 0.353 in the pre-anesthesia, sevoflurane, and propofol groups, respectively).
In our study, TENS did not show a cardioprotective effect in patients undergoing aortic valve replacement surgery.
This study was registered at clinicaltrials.gov ( NCT03859115 , on March 1, 2019).
体外循环相关的心肌缺血再灌注损伤是术后发病率的主要原因。虽然经皮电神经刺激（TENS）已在动物研究和健康志愿者中被发现具有心脏保护作用，但它在体外循环下心内直视手术患者中的作用尚未得到评估。我们研究了 TENS 在体外循环下心主动脉瓣置换术患者中的心肌保护作用。
30 例患者随机分为 TENS 组或假刺激组，分别在麻醉前、七氟醚和丙泊酚三种不同麻醉状态下（每组 n = 5）接受 TENS 或假刺激。TENS 采用 385μs 脉冲宽度和 10Hz 频率，在上臂使用两个表面电极进行 30min。假刺激组不给予刺激。主要结局是采用 Langendorff 灌注系统，从患者中获得经 TENS 前后血浆透析液灌注大鼠心脏缺血再灌注损伤后心肌梗死面积的差异。通过评估治疗后梗死面积的减少来确定 TENS 的心脏保护作用。
在任何组中，治疗前后心肌梗死面积均无差异（麻醉前组：41.4±4.3% vs. 36.7±5.3%；七氟醚组：39.8±7.3% vs. 27.8±12.0%；丙泊酚组：41.6±2.2% vs. 37.8±7.6%；p=0.080、0.152 和 0.353）。
在我们的研究中，TENS 在心内直视主动脉瓣置换术患者中没有显示出心脏保护作用。
本研究于 2019 年 3 月 1 日在 clinicaltrials.gov 注册（NCT03859115）。
