术中迷走神经刺激对胃肠手术后康复的影响研究

Effects of intraoperative vagus nerve stimulation on recovery after gastrointestinal surgery

目的研究术中迷走神经刺激(iVNS)对大鼠胃底折叠术后康复的影响及其机制。方法将20只大鼠随机分为试验组(iVNS组)和对照组(即空白-iVNS),对2组大鼠进行完全胃底折叠手术(Nissen胃底折叠术)。试验组术中进行短暂(30 min)迷走神经刺激,对照组完成与试验组完全一样的迷走神经分离并电极接通,但未进行电刺激。在术后规定期限内观察动物的行为、进食量、饮水量和粪便等情况,同时在不同时段记录胃慢波(GSWs)以评估胃蠕动;在不同时间段采集血样本以评估炎症反应。结果(1)iVNS缩短开始进食水时间(P<0.05),增加粪便量(P<0.05)和增加粪便中水的含量(P<0.05)。(2)iVNS改善了术后6h的胃电活动,与空白组相比,实验组正常GSWs的百分比更高(P<0.05)。(3)与对照组相比,iVNS组术后24 h炎症细胞因子明显被抑制(P<0.05)。(4)与空iVNS组相比,iVNS术后6和24 h迷走神经张力明显增加(P<0.05)。迷走神经张力的增加与术后更快开始饮水(r=-0.635,P<0.05)和进食相关(r=-0.647,P<0.05)。所有实验大鼠未出现腹泻。结论短暂iVNS通过改善术后动物行为、改善胃肠道运动和抑制炎症细胞因子、增强的迷走神经张力来加速术后康复。

Objective Restoration of gastrointestinal motility is an important indication of postoperative recovery.This study investigated the effects and mechanisms of vagus nerve stimulation(VNS)on postoperative recovery from Nissen fundoplication in rats.Methods 20 rats were undergone Nissen fundoplication and separated to two groups which were iVNS group(brief 30 minutes VNS was performed during surgery)and sham-iVNS group(same surgical procedure without conducting electricity to VNS lead).at specific postoperative periods,Animal's behaviors were monitored.Electrocardiogram(ECG)and gastric slow waves(GSWs)were recorded;Inflammatory cytokines were assessed in blood samples.Results(1)iVNS shortened the time to start eating and drinking(P<0.05),increased the amount of feces(P<0.05)and increased the content of water in the feces(P<0.05).(2)iVNS improved gastric electrical activity 6 hours after operation,and the percentage of normal gastric slow waves in the experimental group was higher than that in the sham group(P<0.05).(3)Compared with the sham group,the inflammatory cytokines in the iVNS group were significantly inhibited 24 hours after operation(P<0.05).(4)Compared with the sham-iVNS group,the vagal tone was significantly increased 6 hours and 24 hours after iVNS(P<0.05).Increased vagal tone was associated with faster postoperative initiation of drinking(r=-0.635,P<0.05)and eating(r=-0.647,P<0.05).Diarrhea did not occur in all experimental rats.Conclusion Transient iVNS accelerates postoperative recovery by improving postoperative animal behavior,improving gastrointestinal motility and inhibiting inflammatory cytokines,enhancing vagal tone.