Zhou Can, Gao Ya-Nan, Qiao Qiao, Yang Zhi, Zhou Wei-Wei, Ding Jing-Jing, Xu Xing-Guo, Qin Yi-Bin, Zhong Chao-Chao
Department of Anesthesiology, The Affiliated Hospital of Nantong University, Nantong, 226001, China.
Department of Gastroenterology, The Affiliated Hospital of Nantong University, Nantong, 226001, China.
Brain Stimul. 2025 Jan-Feb;18(1):52-60. doi: 10.1016/j.brs.2024.12.1475. Epub 2024 Dec 26.
Postoperative delirium (POD) is a serious complication in elderly patients after major surgery, associated with high morbidity and mortality. Treatment and prevention methods are limited. Repetitive transcranial magnetic stimulation (rTMS) shows potential in enhancing cognitive function and improving consciousness.
To evaluate whether early postoperative rTMS has a protective effect against POD and to explore its potential mechanisms.
Patients aged 60 years or older, scheduled for major abdominal surgery, were randomly assigned to receive rTMS at 100 % RMT, 10 Hz, with 2000 pulses targeting the DLPFC after extubation in PACU, either as active rTMS(n = 61) or sham rTMS (n = 61). The primary outcome was the incidence of POD during the first 3 postoperative days.
In the modified intention-to-treat analysis of 122 patients (mean [SD] age, 70.2 [4.1] years; 53.3 % women), POD incidence was lower in the rTMS group (11.5 %) compared to the sham rTMS group (29.5 %) (relative risk, .39; 95 % CI, .18 to .86; P = .01). rTMS patients had higher BDNF (8.47 [2.68] vs. 5.76 [1.42] ng/mL; P < .001) and lower NfL (.05 [.04] vs. .06 [.04] ng/mL; P = .02) levels. Mediation analysis suggests that rTMS may reduce POD by increasing brain-derived neurotrophic factor (z = -3.72, P < .001) rather than decreasing neurofilament light (z = 1.92, P = .06).
Immediate postoperative rTMS can reduce the incidence of POD in elderly patients undergoing major abdominal surgery, probably by upregulating brain-derived neurotrophic factor levels.
术后谵妄（POD）是老年患者大手术后的一种严重并发症，与高发病率和死亡率相关。治疗和预防方法有限。重复经颅磁刺激（rTMS）在增强认知功能和改善意识方面显示出潜力。
评估术后早期rTMS对POD是否具有保护作用，并探讨其潜在机制。
年龄60岁及以上、计划进行腹部大手术的患者，在麻醉后监护室（PACU）拔管后，随机分为接受100%静息运动阈值（RMT）、10Hz、2000个脉冲靶向背外侧前额叶皮质（DLPFC）的rTMS组（n = 61）或假rTMS组（n = 61）。主要结局是术后前3天内POD的发生率。
在对122例患者（平均[标准差]年龄，70.2[4.1]岁；53.3%为女性）的改良意向性分析中，rTMS组的POD发生率（11.5%）低于假rTMS组（29.5%）（相对风险，0.39；95%置信区间，0.18至0.86；P = 0.01）。rTMS组患者的脑源性神经营养因子（BDNF）水平较高（8.47[2.68]对5.76[1.42]ng/mL；P < 0.001），神经丝轻链（NfL）水平较低（0.05[0.04]对0.06[0.04]ng/mL；P = 0.02）。中介分析表明，rTMS可能通过增加脑源性神经营养因子来降低POD（z = -3.72，P < 0.001），而不是通过降低神经丝轻链水平（z = 1.92，P = 0.06）。
术后立即进行rTMS可降低老年腹部大手术患者的POD发生率，可能是通过上调脑源性神经营养因子水平实现的。
