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经皮耳迷走神经刺激对肝部分切除术患者术后肝功能的影响:一项前瞻性、双盲、随机对照试验的研究方案

Effect of transcutaneous auricular vagus nerve stimulation on postoperative liver function in patients undergoing partial hepatectomy: a study protocol for a prospective, double-blind, randomized controlled trial.

作者信息

Wang Yuanyuan, Sun Zhengxiu, Lin Yongao, Tao Mingshu, Zhao Wenxin, Liu Jinling, Guo Xiaoqin, Hang Chuyu, Wang Mingyuan, Tan Wen, Xiong Xingyu, Cao Jun-Li, Liu He

机构信息

Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.

NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs and Jiangsu Province Key Laboratory of Anesthesiology and Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China.

出版信息

Front Med (Lausanne). 2025 Aug 12;12:1603543. doi: 10.3389/fmed.2025.1603543. eCollection 2025.


DOI:10.3389/fmed.2025.1603543
PMID:40873804
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12378827/
Abstract

BACKGROUND: Partial hepatectomy remains a primary therapeutic intervention for various hepatic diseases. However, several intraoperative factors, including surgical manipulation, substantial blood loss, the need for blood transfusions, and hypoxic stress, can significantly impair liver function. Current perioperative strategies aimed at protecting the liver exhibit certain limitations. Transcutaneous auricular vagus nerve stimulation (taVNS), an emerging non-invasive neuromodulation technique, has demonstrated potential in preserving organ function through vagus nerve-mediated anti-inflammatory mechanisms. This study is designed to evaluate the hepatoprotective effects of taVNS on liver function in patients undergoing elective partial hepatectomy under general anesthesia. METHODS/DESIGN: In this single-center, prospective, double-blind, randomized controlled trial, 140 patients scheduled for partial hepatectomy will be randomly allocated in a 1:1 ratio to either the transcutaneous auricular active-taVNS or sham taVNS groups. Both groups will receive 60-min stimulation sessions at four predefined time points: (1) at the onset of the first hepatic portal occlusion, (2) post-extubation, (3) on postoperative day 1 (6:00-7:00 a.m.), and (4) on postoperative day 2 (6:00-7:00 a.m.). The primary outcome is alanine aminotransferase (ALT) level measured in venous blood samples collected at 7:00 a.m. on postoperative day 2. Secondary outcomes include postoperative levels of inflammatory markers, renal function indicators, quality of recovery, gastrointestinal function recovery, pain, fatigue, anxiety, incidence of postoperative delirium, and time to first flatus, bowel movement, and oral intake, all of which will be assessed using validated instruments. DISCUSSION: Postoperative liver function dysfunction following partial hepatectomy remains a significant clinical complication that negatively impacts patient prognosis and long-term survival outcomes. TaVNS, an emerging non-invasive neuromodulation technique, has demonstrated considerable potential for perioperative organ protection in preclinical studies. This study aims to provide robust evidence regarding the therapeutic efficacy of taVNS in reducing hepatic injury after partial hepatectomy. By introducing a novel approach to perioperative hepatic protection, taVNS may contribute valuable insights into the development of multimodal hepatoprotective strategies.

摘要

背景:肝部分切除术仍然是治疗各种肝脏疾病的主要治疗手段。然而,包括手术操作、大量失血、输血需求和缺氧应激在内的几个术中因素,会显著损害肝功能。目前旨在保护肝脏的围手术期策略存在一定局限性。经皮耳迷走神经刺激(taVNS)是一种新兴的非侵入性神经调节技术,已通过迷走神经介导的抗炎机制在保护器官功能方面显示出潜力。本研究旨在评估taVNS对全身麻醉下接受择期肝部分切除术患者肝功能的保护作用。 方法/设计:在这项单中心、前瞻性、双盲、随机对照试验中,计划接受肝部分切除术的140例患者将按1:1的比例随机分配至经皮耳主动taVNS组或假taVNS组。两组将在四个预定义时间点接受60分钟的刺激:(1)在首次肝门阻断开始时,(2)拔管后,(3)术后第1天(上午6:00 - 7:00),以及(4)术后第2天(上午6:00 - 7:00)。主要结局是术后第2天上午7:00采集的静脉血样本中测得的丙氨酸转氨酶(ALT)水平。次要结局包括术后炎症标志物水平、肾功能指标、恢复质量、胃肠功能恢复、疼痛、疲劳、焦虑、术后谵妄发生率,以及首次排气、排便和经口进食的时间,所有这些都将使用经过验证的工具进行评估。 讨论:肝部分切除术后的肝功能障碍仍然是一种严重的临床并发症,对患者的预后和长期生存结局产生负面影响。TaVNS是一种新兴的非侵入性神经调节技术,在临床前研究中已显示出围手术期器官保护的巨大潜力。本研究旨在提供有力证据,证明taVNS在减少肝部分切除术后肝损伤方面的治疗效果。通过引入一种新的围手术期肝脏保护方法,taVNS可能为多模式肝脏保护策略的发展提供有价值的见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab9/12378827/dded5b7276b6/fmed-12-1603543-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab9/12378827/0286bc0ce69b/fmed-12-1603543-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab9/12378827/dded5b7276b6/fmed-12-1603543-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab9/12378827/0286bc0ce69b/fmed-12-1603543-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ab9/12378827/dded5b7276b6/fmed-12-1603543-g002.jpg

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本文引用的文献

[1]
Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis.

Braz J Anesthesiol. 2025

[2]
A pooled analysis of the side effects of non-invasive Transcutaneous Auricular Vagus Nerve Stimulation (taVNS).

Front Hum Neurosci. 2025-2-5

[3]
A brain-to-liver signal mediates the inhibition of liver regeneration under chronic stress in mice.

Nat Commun. 2024-11-28

[4]
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Cancer Epidemiol Biomarkers Prev. 2024-10-2

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Vagal nerve stimulation in myocardial ischemia/reperfusion injury: from bench to bedside.

Bioelectron Med. 2024-9-13

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Electroacupuncture Promotes Liver Regeneration by Activating DMV Acetylcholinergic Neurons-Vagus-Macrophage Axis in 70% Partial Hepatectomy of Mice.

Adv Sci (Weinh). 2024-8

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Clin Gastroenterol Hepatol. 2024-11

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Transcutaneous auricular vagus nerve stimulation as a novel therapy connecting the central and peripheral systems: a review.

Int J Surg. 2024-8-1

[9]
Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.

CA Cancer J Clin. 2024

[10]
Clinical application of transcutaneous auricular vagus nerve stimulation: a scoping review.

Disabil Rehabil. 2024-12

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