经皮耳迷走神经电刺激对老年胃肠手术患者术后谵妄的影响

doi:10.3969/j.issn.1003-9198.2026.10.008

摘要/Abstract

摘要： 目的探讨经皮耳迷走神经电刺激(taVNS)对老年胃肠手术患者术后谵妄(POD)的影响。方法选择择期于南京市第一医院行胃肠手术的老年患者436例,随机分成taVNS组和对照组。2组于术前1 d、麻醉诱导前30 min和术后1~3 d分别接受taVNS刺激和假刺激。收集2组一般资料、术前MMSE评分及血红蛋白、白蛋白、中性粒细胞、淋巴细胞、白细胞计数水平,并计算中性粒细胞／淋巴细胞比值(NLR)和预后营养指数(PNI);观察2组患者术后24、48 h的数字评定量表(NRS)疼痛评分,麻醉前(T₀)、麻醉诱导后5 min(T₁)、切皮时(T₂)、手术结束时(T₃)的平均动脉压(MAP)和心率(HR), 比较2组术后7 d 内POD发生率及不良反应发生情况。结果与对照组比较,taVNS组术后7 d 内POD发生率和术后24、48 h NRS疼痛评分(静息、运动)均明显降低(P<0.05)。2组不同时间点MAP和HR水平比较,差异均无统计学意义(P>0.05)。与非POD组相比,POD组患者受教育程度、术前MMSE评分、术前白蛋白水平、PNI较低,年龄、NLR和术后中重度疼痛发生率较高(P<0.05)。Logistic 回归分析显示,年龄大、术后中重度疼痛是老年胃肠手术患者POD发生的危险因素,受教育程度高、PNI高和taVNS干预是保护因素(P<0.05)。结论 taVNS是预防老年胃肠手术患者发生POD的有效手段,年龄、术后疼痛程度、受教育程度和PNI是老年胃肠手术患者发生POD的影响因素。

关键词: 经皮耳迷走神经电刺激, 老年人, 术后谵妄, 胃肠手术

Abstract: Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on postoperative delirium (POD) in elderly patients undergoing gastrointestinal surgery. Methods A total of 436 elderly patients scheduled for elective gastrointestinal surgery were randomly divided into the taVNS group and the control group. Patients in both groups received taVNS stimulation or sham stimulation 1 day before surgery, 30 min before anesthesia induction, and 1-3 days after operation. General data, preoperative Mini-Mental State Examination (MMSE) score and the levels of hemoglobin, albumin, neutrophil count, lymphocyte count, white blood cell count, neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) were recorded. Numeric Rating Scale (NRS) scores 24 h and 48 h after surgery, mean arterial pressure (MAP) and heart rate (HR) before anesthesia (T₀), 5 min after anesthesia induction (T₁), at the time of skin incision (T₂), and at the end of surgery (T₃) were observed. The incidence of POD within 7 days after surgery and adverse reactions were compared. Results Compared with the control group, the taVNS group showed significantly lower incidence of POD within 7 days after surgery and lower NRS pain scores (at rest and during movement) 24 h and 48 h after surgery (P<0.05). No significant differences were observed in MAP and HR at any time points between the two groups (P>0.05). Compared with the non-POD group, the level of education, preoperative MMSE score, preoperative albumin level and PNI were significantly lower, while the age, NLR, and incidence of moderate-to-severe postoperative pain were higher in the POD group (P<0.05). Logistic regression analysis showed that older age and moderate-to-severe postoperative pain were risk factors, while high educational level, high PNI, and taVNS intervention were protective factors for POD (P<0.05). Conclusions taVNS is an effective intervention for preventing POD, and age, postoperative pain level, educational level and PNI are influencing factors for POD in elderly patients undergoing gastrointestinal surgery.

Key words: transcutaneous auricular vagus nerve stimulation, aged, postoperative delirium, gastrointestinal surgery

中图分类号:

R749.2

林海威, 周潇, 韩流, 史宏伟, 谭其莲, 张媛. 经皮耳迷走神经电刺激对老年胃肠手术患者术后谵妄的影响[J]. 实用老年医学, 2026, 40(10): 1018-1023.

LIN Haiwei, ZHOU Xiao, HAN Liu, SHI Hongwei, TAN Qilian, ZHANG Yuan. Effect of transcutaneous auricular vagus nerve stimulation on postoperative delirium in elderly patients undergoing gastrointestinal surgery[J]. Practical Geriatrics, 2026, 40(10): 1018-1023.

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