经皮耳迷走神经刺激对患者术后早期认知功能的影响

Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Patients’Early-stage Post-operative Cognitive Function

目的观察经皮耳迷走神经刺激对老年患者术后早期认知功能障碍的影响。方法选择拟全麻下手术的老年患者120例,随机分为经皮耳迷走神经刺激组(TAVNS组)、假刺激组和空白对照组,每组40例。TAVNS组于耳甲迷走神经分布区采用低频脉冲治疗仪经皮刺激;假刺激组予以相同参数的电刺激,但刺激位置为耳郭非迷走神经分布区域;空白对照组不做任何刺激处理。分别于术前1 d、术后1 d、术后3 d、术后7 d用蒙特利尔认知评估量表(MoCA)测定认知功能,并同时于术前、术毕、术后1 d、术后3 d检测外周血血清神经元特异性烯醇酶(NSE)、S100β蛋白、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6及IL-1β水平。结果术后1 d、3 d、7 d,TAVNS组的MoCA评分高于假刺激组和空白对照组(P<0.05),假刺激组和空白对照组比较差异无统计学意义(P>0.05)。TAVNS组在术后1 d、术后3 d的NSE、S100β、TNF-α、IL-6、IL-1β的表达均显著低于假刺激组和空白对照组(P<0.05),假刺激组和空白对照组比较差异无统计学意义(P>0.05)。结论围术期经皮耳迷走神经刺激可以抑制老年患者术后早期认知功能下降。

Objective To observe the effect of transcutaneous auricular vagus nerve stimulation(TAVNS)on the early-stage post-operative cognitive function in elderly patients.Method A total of 120 elderly patient who were going to receive a general-anesthesia operation were randomized into a TAVNS group,a sham stimulation group,and a blank control group,with 40 cases in each group.The TAVNS group received transcutaneous stimulation to the distribution area of the vagus nerve on the auricular concha using a low-frequency pulse therapeutic apparatus.The sham stimulation group received electronic stimulation with the same parameters to auricle away from the distribution area of the vagus nerve.The blank control group did not receive any stimulation.The Montreal cognitive assessment(MoCA)was adopted to assess the patients’cognitive function 1 d prior to the operation,and at post-operation days 1,3,and 7.The levels of serum neuron-specific enolase(NSE),S100βprotein,tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-1βin the peripheral blood were detected before and after the operation and at post-operation days 1 and 3.Result At post-operation days 1,3,and 7,the MoCA score was higher in the TAVNS group than in the sham stimulation group and blank control group(P<0.05)and the differences between the latter two groups were statistically insignificant(P>0.05).At post-operation days 1 and 3,the expression levels of NSE,S100β,TNF-α,IL-6,and IL-1βwere significantly lower in the TAVNS group than in the sham stimulation and blank control groups(P<0.05),and the differences between the latter two groups were statistically insignificant(P>0.05).Conclusion TAVNS during the peri-operation period can inhibit the decline of the early-stage post-operation cognitive function in elderly patients.