冠状动脉搭桥术后接受神经肌肉电刺激治疗患者的认知结果。
Cognitive outcomes in patients treated with neuromuscular electrical stimulation after coronary artery bypass grafting.
作者信息
Lo Re Vincenzina, Russelli Giovanna, Lo Gerfo Emanuele, Alduino Rossella, Bulati Matteo, Iannolo Gioacchin, Terzo Danilo, Martucci Gennaro, Anzani Stefano, Panarello Giovanna, Sparacia Gianvincenzo, Parla Giuseppe, Avorio Federica, Raffa Giuseppe, Pilato Michele, Speciale Aurelio, Agnese Valentina, Mamone Giuseppe, Tuzzolino Fabio, Vizzini Giovan Battista, Conaldi Pier Giulio, Ambrosio Fabrisia
机构信息
Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy.
Department of Research, IRCCS ISMETT, UPMC, Palermo, Italy.
出版信息
Front Neurol. 2023 Aug 25;14:1209905. doi: 10.3389/fneur.2023.1209905. eCollection 2023.
OBJECTIVE
Mechanisms of neurocognitive injury as post-operative sequelae of coronary artery bypass grafting (CABG) are not understood. The systemic inflammatory response to surgical stress causes skeletal muscle impairment, and this is also worsened by immobility. Since evidence supports a link between muscle vitality and neuroprotection, there is a need to understand the mechanisms by which promotion of muscle activity counteracts the deleterious effects of surgery on long-term cognition.
METHODS
We performed a clinical trial to test the hypothesis that adding neuromuscular electrical stimulation (NMES) to standard rehabilitation care in post-CABG patients promotes the maintenance of skeletal muscle strength and the expression of circulating neuroprotective myokines.
RESULTS
We did not find higher serum levels of neuroprotective myokines, except for interleukin-6, nor better long-term cognitive performance in our intervention group. However, a greater increase in functional connectivity at brain magnetic resonance was seen between seed regions within the default mode, frontoparietal, salience, and sensorimotor networks in the NMES group. Regardless of the treatment protocol, patients with a Klotho increase 3 months after hospital discharge compared to baseline Klotho values showed better scores in delayed memory tests.
SIGNIFICANCE
We confirm the potential neuroprotective effect of Klotho in a clinical setting and for the first time post-CABG.
目的
冠状动脉旁路移植术（CABG）术后神经认知损伤的机制尚不清楚。手术应激引起的全身炎症反应会导致骨骼肌损伤，而制动也会使这种损伤加剧。由于有证据支持肌肉活力与神经保护之间存在联系，因此有必要了解促进肌肉活动抵消手术对长期认知有害影响的机制。
方法
我们进行了一项临床试验，以检验以下假设：在CABG术后患者的标准康复护理中添加神经肌肉电刺激（NMES）可促进骨骼肌力量的维持和循环中神经保护性肌动蛋白的表达。
结果
除白细胞介素-6外，我们未在干预组中发现神经保护性肌动蛋白的血清水平升高，也未发现更好的长期认知表现。然而，在NMES组中，默认模式、额顶叶、突显和感觉运动网络内种子区域之间的脑磁共振功能连接增加更为明显。无论治疗方案如何，出院3个月后与基线Klotho值相比Klotho增加的患者在延迟记忆测试中得分更高。
意义
我们首次在CABG术后的临床环境中证实了Klotho的潜在神经保护作用。
Zotero 插件