经皮穴位电刺激改善腹腔镜胃肠肿瘤手术患者术后睡眠质量：一项前瞻性随机对照试验

Transcutaneous Electrical Acupoint Stimulation Improves Postoperative Sleep Quality in Patients Undergoing Laparoscopic Gastrointestinal Tumor Surgery: A Prospective, Randomized Controlled Trial.

作者信息

Wang Jun, Lu Fei-Fei, Ge Miao-Miao, Wang Li-Wen, Wang Gang, Gong Guan-Wen, Liu Xin-Xin, Zhang Wen-Zhuo, Ning Fei-Long, Chen Bao-He, Liu Yang, Quan Hong-Guang, Jiang Zhi-Wei

机构信息

Nanjing University of Chinese Medicine, Nanjing, China.

Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.

出版信息

Pain Ther. 2023 Jun;12(3):707-722. doi: 10.1007/s40122-023-00493-2. Epub 2023 Mar 14.

INTRODUCTION

This study was conducted to observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on the postoperative sleep quality of patients undergoing gastrointestinal tumor surgery and to verify the possible mechanism.

METHODS

Eighty-three patients were allocated to the TEAS or Sham group. Patients in the TEAS group received TEAS treatment (disperse-dense waves; frequency, 2/100 Hz) on bilateral Shenmen (HT7), Neiguan (PC6) and Zusanli (ST36) points for 30 min each time, total three times in the perioperative period. In the Sham group, electrodes were placed; however, no current was given. Sleep quality was assessed on the day before surgery (P1) and the first and third days after surgery (D1 and D3) using the Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS). Postoperative pain was assessed using visual analog scale (VAS) 72 h postoperatively. The incidences of abdominal distension, dizziness, postoperative nausea and vomiting (PONV) and pulmonary complications were recorded. Serum levels of inflammatory cytokines and the expression of key factors of oxidative stress and key molecules of the nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE) signal pathway were measured.

RESULTS

TEAS ameliorated sleep quality at D1 and D3 (PSQI P < 0.05, AIS P < 0.05) and decreased postoperative pain as demonstrated by lower VAS scores compared to the Sham group (P < 0.05). The incidences of abdominal distension and PONV were also lower in the TEAS group. Markers of oxidative stress were increased (P < 0.05), and the serum concentration of interleukin-6 (IL-6) was significantly lower in the TEAS group. The key mediators of the Nrf2/ARE pathway were enhanced after TEAS.

CONCLUSION

Perioperative TEAS improved postoperative sleep quality, reduced postoperative pain and alleviated postoperative adverse effects in patients undergoing laparoscopic gastrointestinal tumor surgery resection. This may be associated with activating Nrf2/ARE signal pathway and decreasing its inflammatory actions.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ), ChiCTR2100054971.

引言

本研究旨在观察经皮穴位电刺激（TEAS）对胃肠道肿瘤手术患者术后睡眠质量的影响，并验证其可能的机制。

方法

83例患者被分配到TEAS组或假刺激组。TEAS组患者在双侧神门（HT7）、内关（PC6）和足三里（ST36）穴位接受TEAS治疗（疏密波；频率，2/100Hz），每次30分钟，围手术期共三次。假刺激组放置电极，但不给予电流。使用匹兹堡睡眠质量指数（PSQI）和雅典失眠量表（AIS）评估手术前一天（P1）、手术后第一天和第三天（D1和D3）的睡眠质量。术后72小时使用视觉模拟量表（VAS）评估术后疼痛。记录腹胀、头晕、术后恶心呕吐（PONV）和肺部并发症的发生率。检测血清炎症细胞因子水平、氧化应激关键因子表达及核因子红细胞2相关因子2/抗氧化反应元件（Nrf2/ARE）信号通路关键分子表达。

结果

与假刺激组相比，TEAS改善了D1和D3时的睡眠质量（PSQI P<0.05，AIS P<0.05），并降低了术后疼痛，VAS评分更低（P<0.05）。TEAS组腹胀和PONV的发生率也更低。氧化应激标志物升高（P<0.05），TEAS组血清白细胞介素-6（IL-6）浓度显著降低。TEAS后Nrf2/ARE通路的关键介质增强。