Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, China.
Aging Clin Exp Res. 2022 Oct;34(10):2421-2429. doi: 10.1007/s40520-022-02177-x. Epub 2022 Jul 9.
The aim of this study was to investigate whether transauricular vagus nerve stimulation (taVNS) could decrease the incidence of delayed neurocognitive recovery (dNCR) in elderly adults after total joint arthroplasty (TJA).
A prospective, randomized, double-blind, sham-controlled trial was designed. In total, 124 elderly patients undergoing TJA were enrolled and randomly assigned to taVNS group (n = 62), who received taVNS at 1 h before anesthetic induction until the end of surgery, or sham stimulation (SS) group (n = 62), who received SS in the same manner. Neuropsychological batteries were performed before and at 1 week after surgery to assess the incidence of dNCR. Blood samples were collected before surgery and at 1 day after surgery to detect the activity of cholinesterase (AChE and BChE), as well as the levels of inflammatory factors (TNF-α, IL-1β, IL-6, and HMGB1) and brain damage factor S100β.
Of 124 patients, 119 completed 1 week neuropsychological tests. The incidence of dNCR was significantly decreased in taVNS group [10% (6/60)] compared with the SS group [27.1% (16/59)] (P < 0.05). Patients who received taVNS had lower blood levels of AChE, BChE, IL-6, HMGB1, and S100β after surgery (P < 0.05), as compared with those in the SS group. There was no difference in TNF-α between the two groups.
The taVNS can decrease the incidence of dNCR after TJA in elderly patients, which may be related to the inhibition of inflammatory cytokine production and the reduction of cholinesterase activity.
本研究旨在探讨经耳迷走神经刺激（taVNS）是否能降低老年全关节置换术后（TJA）患者发生延迟性神经认知恢复（dNCR）的发生率。
设计了一项前瞻性、随机、双盲、假刺激对照试验。共纳入 124 例接受 TJA 的老年患者，并随机分为 taVNS 组（n=62）和假刺激（SS）组（n=62）。taVNS 组于麻醉诱导前 1 小时开始至手术结束时接受 taVNS，SS 组以相同方式接受 SS。在术前和术后 1 周进行神经心理测试以评估 dNCR 的发生率。在术前和术后 1 天采集血样，以检测乙酰胆碱酯酶（AChE 和 BChE）的活性，以及炎症因子（TNF-α、IL-1β、IL-6 和 HMGB1）和脑损伤因子 S100β 的水平。
在 124 例患者中，有 119 例完成了 1 周的神经心理测试。与 SS 组（27.1%，16/59）相比，taVNS 组 dNCR 的发生率显著降低（10%，6/60）（P<0.05）。接受 taVNS 的患者术后血液中 AChE、BChE、IL-6、HMGB1 和 S100β 的水平均低于 SS 组（P<0.05），而 TNF-α 两组间无差异。
taVNS 可降低老年 TJA 患者术后 dNCR 的发生率，这可能与抑制炎症细胞因子的产生和降低乙酰胆碱酯酶的活性有关。
