经皮穴位电刺激对活体供肾者围术期血浆褪黑素水平及术后睡眠质量的影响

Effect of transcutaneous electrical acupoint stimulation on the perioperative plasma melatonin levels and postoperative sleep quality in living kidney donors

中文关键词: 活体肾移植术  经皮穴位电刺激  睡眠质量  炎症反应  术后康复

英文关键词: Living kidney transplantation  Transcutaneous electrical acupoint stimulation  Sleep quality  Inflammatory response  Postoperative recovery

中文摘要:

      
目的 分析经皮穴位电刺激（TEAS）对活体供肾者（LKD）围术期血浆褪黑素水平和术后睡眠质量的影响。
方法 选择2020年3月至2021年5月择期行活体肾移植术的LKD 60例，男19例，女41例，年龄18～64岁，BMI 18.5～28.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将LKD分为两组：TEAS组（T组）和对照组（C组），每组30例。T组分别于术前1 d、麻醉诱导前30 min、术后1 d在双侧神门穴、三阴交穴与内关穴行30 min TEAS，频率为2/100 Hz，刺激强度以LKD的最大耐受力为宜；C组仅在相同时点及穴位贴电极片，但不给予电流刺激。分别于术前1 d、麻醉诱导前、术后1 d采集静脉血3 ml，检测血浆褪黑素、白细胞介素-1β（IL-1β）及肿瘤坏死因子-α（TNF-α）浓度。分别于术前1 d、术后1、3、5 d行失眠严重指数（ISI）量表及15项恢复质量评分量表（QoR-15）评估，记录术后1、3、5 d术后睡眠障碍（POSD）例数。记录PACU停留时间、术后补救镇痛例数、术后发热例数及住院时间。
结果 与C组比较，T组麻醉诱导前和术后1 d血浆褪黑素浓度明显升高（P<0.05），术后1 d血浆IL-1β和TNF-α浓度明显降低（P<0.05）；术后1、3、5 d ISI总分及POSD发生率明显降低，QoR-15评分明显升高；PACU停留时间、住院时间明显缩短，术后补救镇痛率及术后发热率明显降低（P<0.05）。
结论 围术期TEAS可提高LKD血浆褪黑素水平，改善围术期睡眠质量，促进术后康复。

英文摘要:

      
Objective To analyze the effect of transcutaneous electrical acupoint stimulation (TEAS) on perioperative plasma melatonin levels and postoperative sleep quality in living kidney donors(LKD).
Methods Sixty LKD, 19 males and 41 females, aged 18-64 years, BMI 18.5-28.0 kg/m², ASA physical status Ⅰ or Ⅱ, who were electively proposed for living kidney transplantation from March 2020 to May 2021 were recruited. The LKD were randomly allocated into two groups using the randomised number table: TEAS group (group T) and control group (group C), 30 patients in each group. In group T, TEAS was applied 30 minutes at bilateral Shenmen, San Yinjiao, and Neiguan on the day before surgery, before induction, and the first day after surgery, with a frequency of 2/100 Hz, and the stimulation intensity was appropriate for the LKD’s maximum tolerance. In group C, electrodes were applied at the same times and acupoints, but no current stimulation was given. In both groups, 3 ml of venous blood was collected before each stimulation, and the plasma levels of melatonin, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were measured. The scores of insomnia severity index (ISI) and quality of recovery-15 (QoR-15) were evaluated 1 day before operation and 1, 3, 5 days after operation. Postoperative sleep disturbance (POSD) was recorded 1, 3, 5 days after operation. The duration of anesthesia and surgery, post-anesthesia care unit (PACU) stay, the incidence of postoperative sleep disturbance, postoperative fever, postoperative analgesic remedy, and length of hospital stay were recorded.
Results Compared with group C, melatonin levels in plasma were significantly higher in group T before induction of anesthesia and 1 day postoperatively, and IL-1β and TNF-α levels in plasma were significantly lower in group T 1 day postoperatively (P < 0.05). Compared with group C, LKD in group T had significantly lower ISI scores and rate of POSD and higher QoR-15 scores 1, 3, and 5 days after surgery (P < 0.05). The PACU stay and hospital stay were significantly shorter, and the rates of postoperative fever and postoperative analgesic remedy were significantly lower in group T than in group C (P < 0.05).
Conclusion TEAS can increase plasma melatonin levels, improve perioperative sleep, and promote postoperative recovery in LKD.