经皮穴位电刺激对髋关节置换术患者术后转归的meta分析

Meta-analysis of postoperative outcomes of patients undergoing hip arthroplasty with transcutaneous electrical acupoint stimulation

目的系统评价经皮穴位电刺激(TEAS)对髋关节置换术(HA)患者术后转归的影响。方法计算机检索中国知网、万方数据库、维普网、中国生物文献数据库、PubMed、Embase、the Cochrane Library、Web of Science、Medline和Ovid数据库中有关TEAS对HA治疗效果的随机对照试验,检索时限为建库至2021年7月。使用Revman 5.3软件进行meta分析,比较试验组和对照组术后疼痛、炎症因子、认知功能、脑部代谢相关指标和不良反应发生情况。结果共纳入16篇文献,涉及患者1039例。meta分析结果显示,试验组术后12、24、48 h的VAS评分低于对照组(P<0.05)。试验组术后24、72 h的白细胞介素(IL)-1β低于对照组,术后24 h的肿瘤坏死因子-α低于对照组,术后2 h以内及术后24、72 h的IL-6、IL-10低于对照组(P<0.05)。试验组术后72 h简易精神状况检查评分高于对照组,术后24、72 h认知功能障碍发生率低于对照组,术后S100β蛋白低于对照组,降压开始后20、40 min及停止降压后20 min的颈内静脉血氧含量高于对照组,降压开始后20 min动脉动混合静脉血氧含量差低于对照组(P<0.05)。试验组恶心呕吐和眩晕的发生率低于对照组(P<0.05)。漏斗图显示无发表偏倚。结论TEAS能缓解HA患者术后疼痛,控制炎症因子水平,改善认知功能,降低术后恶心呕吐和眩晕的发生率,值得临床进一步推广。

Objective To systematically evaluate the effect of transcutaneous electrical acupoint stimulation(TEAS)on postoperative regression of patients undergoing hip arthroplasty(HA).Methods Randomized controlled trials of TEAS in the treatment of HA were searched by computer in CNKI,Wanfang Data,VIP,CBM,PubMed,Embase,the Cochrane Library,Web of Science,Medline,and Ovid databases.The retrieval time limit was from the inception to July 2021.Meta-analysis of pain,inflammatory factors,cognitive function,related indicators of brain metabolism,and the incidence of adverse reactions after surgery were compared between the experimental group and control group by Revman 5.3 software.Results A total of 16 literatures were included,involving 1039 patients.The results of meta-analysis showed that VAS scores of experimental group at 12,24,and 48 h after surgery were lower than those in control group(P<0.05).Interleukin(IL)-1βof experimental group at 24 and 72 h after surgery were lower than those in control group,tumor necrosis factor-αat 24 h after surgery was lower than that in control group,and IL-6 and IL-10 within 2 h after surgery,and at 24,72 h after surgery were lower than those in control group(P<0.05).The mini mental status examination score of experimental group at 72 h after surgery was higher than that in control group,the incidence of cognitive dysfunction at 24 and 72 h after surgery were lower than those in control group,S100βprotein after surgery was lower than that in control group,and the cervical venous oxygen contents at 20and 40 min after hypotension and 20 min after hypotension stopped were higher than those in control group,arterio-mixed venous oxygen content differences at 20 min after hypotension was lower than that in control group(P<0.05).The incidence of nausea and vomiting,vertigo in experimental group was lower than that in control group(P<0.05).Funnel plot showed no publication bias.Conclusion TEAS can relieve postoperative pain in HA patients,control the level of inflammatory factors,improve cognitive function,reduce the incidence of postoperative nausea and vomiting,vertigo,and further promote clinical value.