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中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2023, Vol. 10 ›› Issue (03) : 125 -129. doi: 10.3877/cma.j.issn.2095-8765.2023.03.003

论著

术中迷走神经刺激对胃肠手术后康复的影响研究
阿力木江·麦斯依提1, 买买提·依斯热依力2, 开丽比努尔·阿布来提3, 阿丽叶古丽·艾皮热2, 李义亮1, 克力木·阿不都热依木1,†()   
  1. 1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院微创、疝和腹壁外科;830001　乌鲁木齐，新疆维吾尔自治区人民医院胃食管反流病及减重代谢外科临床研究中心;830001　乌鲁木齐，新疆维吾尔自治区人民医院自治区普外微创研究所
    2. 830001　乌鲁木齐，新疆维吾尔自治区人民医院胃食管反流病及减重代谢外科临床研究中心;830001　乌鲁木齐，新疆维吾尔自治区人民医院自治区普外微创研究所
    3. 830054　乌鲁木齐，新疆医科大学研究生学院
  • 收稿日期:2023-03-20 出版日期:2023-08-15
  • 通信作者: 克力木·阿不都热依木
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2019D01C148)

Effects of intraoperative vagus nerve stimulation on recovery after gastrointestinal surgery

Maisiyiti Alimujiang·1, Yisireyili Maimaiti·2, Abulaiti Kailibinuer·3, Aipire Aliyeguli·2, Yiliang Li1, Abudureyimu Kelimu·1,†()   

  1. 1. Department of Minimally invasive, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China;Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China;Research Institute of General and Minimally Invasive Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    2. Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China;Research Institute of General and Minimally Invasive Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    3. Xinjiang Medical University Graduate School of Medicine, Urumqi 830054, China
  • Received:2023-03-20 Published:2023-08-15
  • Corresponding author: Abudureyimu Kelimu·
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阿力木江·麦斯依提, 买买提·依斯热依力, 开丽比努尔·阿布来提, 阿丽叶古丽·艾皮热, 李义亮, 克力木·阿不都热依木. 术中迷走神经刺激对胃肠手术后康复的影响研究[J]. 中华胃食管反流病电子杂志, 2023, 10(03): 125-129.

Maisiyiti Alimujiang·, Yisireyili Maimaiti·, Abulaiti Kailibinuer·, Aipire Aliyeguli·, Yiliang Li, Abudureyimu Kelimu·. Effects of intraoperative vagus nerve stimulation on recovery after gastrointestinal surgery[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2023, 10(03): 125-129.

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6 h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。

关键词: 迷走神经刺激, 术后恢复, 胃肠道运动, 神经调节
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.

Key words: Vagus nerve stimulation, Postoperative recovery, Gastrointestinal motility, Neuromodulation
图1 技术路线图 注：NF为Nissen胃底折叠术；iVNS为植入式迷走神经刺激术
表1 iVNS对术后动物行为的影响（）
组别 例数 首次饮水时间（min） 首次进食时间（min） 水的摄入量（ml） 进食量（g）
iVNS 10 25.3±9.8 47.6±10.5 93.2±9.4 8.6±2.4
空白-iVNS 10 45.2±11.9 66.2±13.1 68.4±12.8 4.1±1.9
P值 0.001 0.002 0.002 0.001
表2 iVNS对术后疼痛的影响（分，）
组别 组别 术后15 min 术后30 min 术后45 min 术后60 min 术后90 min 术后120 min 术后150 min 术后180 min
iVNS 10 0.81±0.12 1.18±0.19 1.39±0.14 1.53±0.32 1.48±0.22 1.18±0.17 1.03±0.18 1.04±0.16
空白-iVNS 10 0.96±0.14 1.450.21 1.87±0.19 1.85±0.25 1.81±0.19 1.36±0.15 1.09±0.19 1.01±0.14
P值 0.089 0.013 0.001 0.016 0.003 0.027 0.483 0.663
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