Effects Of Transcutaneous Electrical Acupoint Stimulation On Intestinal Barrier Function In Patients With Sepsis

Objective:To explore the effect of transcutaneous electrical acupoint stimulation on intestinal barrier function in patients with sepsis and its possible mechanism.Methods:44 patients diagnosed with gut origin sepsis were admitted to the department of critical care medicine after operation were randomized divided into the transcutaneous acupoint electrical stimulation group（TEAS group）and the control group,22 cases in each group.Both groups received conventional anti-infection and fluid resuscitation treatment.On the basis of conventional treatment,TEAS group additionally received transcutaneous acupoint electrical stimulation at Zusanli and Neiguan treatment with dense wave and 4-6Hz electrical stimulation,30 minutes each time,three times a day,for a total of 3 days.The control group received conventional treatment and connected with electrodes,without electrical stimulation.The heart rate variability（HRV）of 30 minutes before and after each electrical stimulation in TEAS group was continuously monitored.Intestinal barrier indexes（I-FABP,D-lactic acid,DAO,endotoxin）and inflammatory reaction indexes（CRP and PCT,IL-6,TNF-α）were detected before treatment（T₀）and on the first day（T₁）and the third day（T₃）after treatment,and the scores of APACHE II,SOFA,duration of mechanical ventilation and 28 day mortality were assessed and recorded.Results:（1）There was no significant difference in age,gender,APACHE II scores and operation type between TEAS group and control group（P>0.05）.（2）There was no significant difference in I-FABP,D-lactic acid,DAO and endotoxin between the two groups before treatment（T₀）（P>0.05）.Compared with the control group,the concentrations of I-FABP and D-lactic acid in the TEAS group were significantly decreased after treatment（F=4.580,P=0.038 and F=4.934,P=0.032）.Compared with T₀point treatment,the concentration of I-FABP and D-lactic acid in the two groups were significantly decreased at each time point after treatment（P<0.01）,and T₃was better than T₁after treatment（P<0.05）.Compared with the control group at the same period,the concentrations of I-FABP and D-lactic acid at T₁and T₃in teas group were significantly decreased（P<0.05）.There was no significant difference in DAO and endotoxin at T₁and T₃between the two groups（P>0.05）.（3）Before treatment（T₀）,there was no significant difference in CRP,PCT,IL-6 and TNF-αbetween the two groups（P>0.05）.Compared with the control group,the IL-6 index of TEAS group was significantly lower（F=4.73,P=0.034）.Compared with before treatment,the IL-6 index of T₁and T₃in the two groups was significantly lower（P<0.01）,and T₃was better than T₁（P<0.05）.Compared with the control group,the IL-6 index at T₁and T₃in TEAS group were significantly decreased after treatment（P<0.05）.CRP,PCT,and TNF-αat T₁and T₃in both groups were significantly decreased after treatment（P<0.05）.Compared with the control group,there was no significant difference in CRP,PCT,IL-6 and TNF-αat T1and T₃in teas group（P>0.05）;（4）The HF value of the TEAS group were increased on the first day,the second day and the third day after electrical stimulation（P<0.05）,and the LF/HF change on the first day was statistically significant（P<0.05）.There was no significant difference in the concentration ofα7n ACh R between the two groups before treatment,but the concentration ofα7n ACh R in the TEAS group was higher than that in the control group after treatment（P<0.05）.Compared with the control group,the APACHE II and sofa scores of TEAS group was significantly decreased after treatment（P=0.024 and P=0.015）,and there was no significant difference in mechanical ventilation time and 28 day mortality between the two groups（P>0.05）.Conclusion:Transcutaneous acupoint electrical stimulation has a protective effect on intestinal barrier in patients diagnosed with sepsis,and its mechanism may be related to increasing the activity of vagus nerve,activating cholinergic anti-inflammatory pathway and reducing the release of inflammatory factors.