经皮迷走神经刺激治疗老年难治性高血压的临床研究

Clinical study of transcutaneous vagus nerve stimulation in the treatment of elderly patients with refractory hypertension

目的观察和评价外配式经皮迷走神经刺激仪联合降压药物治疗老年患者难治性高血压的临床疗效。方法选取2019年5月—2020年8月于复旦大学附属金山医院门诊及病房收治的52例老年难治性高血压患者,采用数字表法随机分为试验组(n=26)和对照组(n=26)。对照组采取药物治疗,试验组在与对照组相同药物治疗的基础上,加用耳屏迷走神经刺激治疗。试验组于耳屏使用外配式耳迷走神经刺激仪(TENS-200A型)治疗,每次40min,2次/d,5d/周,持续治疗12周,治疗第12周时进行随访,评估并比较2组的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率变异性(HRV);检测并比较2组血清乙酰胆碱(Ach)、去甲肾上腺素(NE)、血管紧张素Ⅱ(ANGⅡ)水平;观察并比较2组不良反应发生情况。结果治疗12周,试验组患者的舒张压及收缩压均有显著低于对照组(P<0.05);试验组总有效率明显高于对照组(92.3%vs76.9%,P<0.05);试验组平均心率低于对照组(P<0.05);试验组HRV明显低于对照组(P<0.05);试验组血清ANGⅡ和Ach水平均显著低于对照组(P<0.05),血清Ach在试验组显著升高(P<0.05),均提示试验组患者的迷走神经活性增强,自主神经活性趋于平衡;试验组出现不良反应1例,2组不良反应率差异无统计学意义(P>0.05)。结论老年难治性高血压患者在服用药物基础上联合迷走刺激治疗,可辅助降低血压,有效且安全。

Objective To observe and evaluate the clinical efficacy of externally worn ear vagus nerve stimulator combined with antihypertensive drugs in the treatment of elderly patients with refractory hypertension.Methods A total of52elderly patients with refractory hypertension who were admitted to the outpatient and ward of Jinshan Hospital Affiliated to Fudan University from May2019to August2020were selected and divided into experimental group(n=26)and control group(n=26)by random number table method.The control group was treated with antihypertensive drugs.On the basis of the same drug treatment as the control group,the experimental group was treated with tragus vagus nerve stimulation.The experimental group was treated with an externally worn ear vagus nerve stimulator(TENS-200A)in the tragus,40minutes each time,twice a day,5days a week,for12weeks.The patients were followed up at the12th week of treatment.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and heart rate variability(HRV)of the two groupswere evaluated and compared;the levels of serum acetylcholine(Ach),norepinephrine(NE)and angiotensinⅡ(AngⅡ)were detected and compared between the two groups;the adverse reactions of the two groups were observed and compared.Results After12weeks of treatment,the DBP and SBP of the experimental group were significantly lower than those of the control group(P<0.05);the total effective rate of the experimental group was significantly higher than that of the control group(92.3%vs76.9%,P<0.05);the average HR of the experimental group was lower than that of the control group(P<0.05);the HRV of the experimental group was significantly lower than that of the control group(P<0.05);the levels of serum ANGⅡand Ach of the experimental group were significantly lower than those of the control group(P<0.05).The above all suggested that the vagus nerve activity in the experimental group was increased,and the autonomic nerve activity tended to be balanced.There was one case of adverse reaction in the experimental group,and there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion On the basis of drug therapy,vagal nervestimulation therapy is helpful to reduce blood pressure in elderly patients with refractory hypertension,and it is safe and effective.