术中经皮穴位电刺激联合麻醉预防术后认知功能障碍：一项系统评价和Meta分析
Intraoperative transcutaneous electrical acupoint stimulation combined with anesthesia to prevent postoperative cognitive dysfunction: A systematic review and meta-analysis.
作者信息
Gan Lin, Qian Kecheng, Yang Jinding, Cai Qian, Ye Qinyu, Dai Mengyuan, Jia Zhaoxing, Jiang Tianxiang, Ma Congcong, Lin Xianming
机构信息
The Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China.
出版信息
PLoS One. 2025 Jan 9;20(1):e0313622. doi: 10.1371/journal.pone.0313622. eCollection 2025.
BACKGROUND
Postoperative cognitive dysfunction (POCD) is associated with an increased risk of dementia and may lead to chronic neurodegeneration. The utilization of intraoperative Transcutaneous Electrical Acupoint Stimulation (TEAS) in conjunction with anesthesia is expected to become an effective preventive measure for POCD in clinical practice.
METHODS
We conducted a comprehensive literature review focusing on the use of TEAS in the prevention of POCD during surgical anesthesia. We searched various databases for relevant literature, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The synthesis of data was performed using RevMan version 5.4.
RESULTS
Our meta-analysis incorporated data from 20 Randomized Controlled Trials (RCTs) involving 1549 patients. The findings revealed that intraoperative TEAS significantly reduced the incidence of POCD when compared to the control group [Odds Ratio (OR) 0.29, 95% Confidence Interval (CI) 0.22-0.39, p < 0.00001]. Moreover, patients receiving intraoperative TEAS exhibited a significant increase in MMSE scores (MD 1.21, 95% CI 0.53-1.89, p = 0.0005). Additionally, intraoperative TEAS demonstrated efficacy in reducing the contents of perioperative serum S100β protein (S100β), neuron-specific enolase (NSE), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in patients, and the improvement of these indexes may be the potential mechanism of TEAS in preventing POCD.
CONCLUSION
Our results suggest that intraoperative TEAS combined with anesthesia prevents cognitive dysfunction in the immediate postoperative period, however we need additional evidence of its utility in preventing long-term cognitive dysfunction. We advocate for the broader promotion and application of this approach in clinical surgical settings.
TRIAL REGISTRATION
PROSPERO (CRD42023457910).
背景
术后认知功能障碍（POCD）与痴呆风险增加相关，可能导致慢性神经退行性变。术中经皮穴位电刺激（TEAS）联合麻醉有望成为临床实践中预防POCD的有效措施。
方法
我们进行了一项全面的文献综述，重点关注TEAS在手术麻醉期间预防POCD的应用。我们在多个数据库中检索相关文献，包括PubMed、Embase、Cochrane图书馆、Web of Science、中国知网（CNKI）和万方数据。使用RevMan 5.4进行数据合成。
结果
我们的荟萃分析纳入了来自20项随机对照试验（RCT）的数据，涉及1549例患者。结果显示，与对照组相比，术中TEAS显著降低了POCD的发生率[优势比（OR）0.29，95%置信区间（CI）0.22 - 0.39，p < 0.00001]。此外，接受术中TEAS的患者简易精神状态检查表（MMSE）评分显著提高（平均差1.21，95% CI 0.53 - 1.89，p = 0.0005）。另外，术中TEAS在降低患者围手术期血清S100β蛋白（S100β）、神经元特异性烯醇化酶（NSE）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）含量方面显示出疗效，这些指标的改善可能是TEAS预防POCD的潜在机制。
结论
我们的结果表明，术中TEAS联合麻醉可预防术后即刻的认知功能障碍，然而我们需要更多证据证明其在预防长期认知功能障碍方面的效用。我们主张在临床手术环境中更广泛地推广和应用这种方法。
试验注册
PROSPERO（CRD42023457910）
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