| BackgroundPostoperative gastrointestinal dysfunction(POGD)is characterized by nausea,vomiting,abdominal distention,and abnormal anal discharge and defecation,and has a high incidence after various surgical procedures worldwide,especially after abdominal and spinal surgery.Lumbar internal fixation(LIF)is a commonly used treatment in spine surgery,which is prone to POGD,and if not prevented and treated early,it is likely to persist and increase the risk of various postoperative complications.However,the current treatment has shortcomings,such as single drug efficacy is not ideal,the combination of drugs significantly increases the risk of side effects,non-pharmacological therapies such as postoperative pseudo-feeding and early feeding have limited efficacy,and operations such as enema may also stimulate the gastrointestinal tract and increase the risk of electrolyte disturbance and aggravate the patient’s pain.Therefore,exploring safer and more effective prevention and treatment options for POGD is a key step in promoting postoperative recovery of LIF patients,and is also a hot medical issue that needs to be addressed in current clinical practice.At present,there is no definite and uniform conclusion on the pathogenesis,diagnostic criteria and prevention measures of POGD,and more higher-grade research evidence is needed to guide clinical practice.The current research on POGD is mostly focused on abdominal surgery such as gastrointestinal surgery,and there are significantly fewer research results in other types of surgery,especially in orthopedic spine surgery,where there is a clear lack of relevant clinical evidence.Chinese medicine has a unique understanding of the etiology and treatment of POGD.In previous clinical practice and research,acupuncture and moxibustion have been shown to regulate gastrointestinal function and systemic qi and blood through meridian responses,and can be an effective supplement and adjunct to conventional prevention and treatment methods.However,in current practice and research,there are various external treatments such as acupuncture,electroacupuncture,moxibustion,and intradermal acupuncture,which are complicated in operation and have mixed results.Transcutaneous electrical acupoint stimulation(TEAS)is a new type of therapy that combines the theory of Chinese acupuncture with the theory of Western transcutaneous electrical nerve stimulation,which is non-invasive,painless,with controllable parameters and stable efficacy,and is easier for patients to accept,physicians to operate and programs to promote.It has more significant perioperative application advantages than traditional acupuncture and electroacupuncture.In recent years,studies on TEAS to improve postoperative gastrointestinal function have been gradually enriched,and its prevention and treatment potential has been gradually discovered,which has a good application prospect as an important supplement to the integrated prevention and treatment strategy of POGD.However,there is no definite and uniform conclusion on its efficacy,safety and specific mechanism of action,which needs to be verified by in-depth studies.Therefore,this study is intended to investigate the clinical efficacy of TEAS in the prevention and treatment of POGD in patients with LIF through a prospective,randomized controlled clinical trial,in an attempt to clarify its efficacy,safety and effect on postoperative neuroendocrine-immune regulation,and to provide some ideas and evidence for the clinical use of TEAS in the prevention and treatment of POGD in spinal surgery.Objective1.To clarify the effectiveness and safety of TEAS in preventing and treating POGD in patients with LIF.2.To observe the effects of TEAS on postoperative neuro-endocrine-immune regulation in patients with LIF.MethodsThis study was a prospective,randomized controlled clinical trial.Seventy-two patients who underwent LIF surgery under general anesthesia,from January 2022 to December 2022 were selected and randomly divided into a test group and a control group of 36 patients each.The patients in the experimental group were treated with TEAS with a parameter of 2/100Hz dispersed-dense wave for 3 0min(the current intensity was the maximum current that the patients could tolerate)2 hours after extubation.The rats in the control group were treated with sham-TEAS.The treatment points were:Tianshu,Zhongguancun,Neiguan,Sansili,Shangjiuxu,and Guangyuan.The time to first anal discharge,time to first bowel movement,time to recovery of bowel sounds,time to start eating solid food by mouth(and no intolerance)after surgery,number of bowel sounds within 48 hours,occurrence of postoperative nausea and vomiting and abdominal distension,occurrence of TEAS adverse effects,and postoperative hospitalization time were observed and compared between the two groups.The follow-up points were 2h,4h,6h,12h,24h,and 48h after extubation,.Serological tests were collected after admission and 24h after extubation to compare the following indicators:gastrin(MTL),gastrin(GAS),vasoactive intestinal peptide(VIP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6).Results1.A total of 72 patients were enrolled in the two groups,36 in the test group and 36 in the control group.In the test group,2 cases were excluded due to overtime of surgery.In the control group,2 cases were excluded due to lack of serum collection and 2 cases were excluded due to overtime of surgery.There were no patients who violated the trial protocol,were lost to follow-up,withdrew voluntarily,or were transferred to another hospital.Finally,66 patients completed the trial as required,including 34 patients in the test group and 32 patients in the control group.2.All patients included 32 males and 34 females,with an overall age distribution of 21-66 years.There was no statistical difference in the baseline values of gender,age,BMI,basic vital signs,and past medical history between the two groups(P>0.05).3.The time to first postoperative anal evacuation of patients in the test group was 21.71 ± 11.40 h,which was significantly lower than that of the control group(33.52 ±11.35 h),and the differences were statistically significant(P<0.05).The time to first postoperative anal evacuation of patients in the test group was 3.90±1.08 d,which was lower than that of the control group(4.42±1.09 d),and the differences were not statistically significant(P(P>0.05).The time to return to normal bowel sounds in the test group was 6.12±4.23 h,which was significantly lower than that in the control group(13.81±11.26 h),and the difference was statistically significant(P<0.05).The time to start eating solid food by mouth(without intolerance)in the test group was 23.35±6.98 h,which was significantly lower than that in the control group(30.38±8.48 h),and the difference was statistically significant(P<0.05).The number of bowel sounds in the test group was 15.65±2.41 in 48 hours after surgery,which was significantly higher than that of the control group(12.66±2.70),and the difference was statistically significant(P<0.05).2 cases(0.06%)of postoperative nausea occurred in the test group,which was lower than 7 cases(0.22%)in the control group,and the differences were not statistically significant(P>0.05).1 case(0.03%)of postoperative vomiting occurred in the test group,which was lower than 2 cases(0.06%)in the control group,and the differences were not statistically significant(P>0.05).6 cases(0.18%)of postoperative bloating occurred in the test group,which was lower than 14 cases(0.43%)in the control group,and the difference was statistically significant(P<0.05).4.The GAS and IL-6 levels in the test group were lower than those in the control group 24 h after surgery,and the differences were statistically significant(P<0.05);the changes of VIP,MTL and TNF-α levels in the test group 24 h after surgery were not statistically significant compared with those in the control group(P>0.05).5.The effective rate of POGD prevention and treatment in the test group was 82.35%,which was significantly higher than that of the control group,which was 50.00%,and the difference was statistically significant(P<0.05).6.Various adverse events such as patch allergy,electrical stimulation intolerance and case shedding did not occur in both groups.ConclusionIn this study,the percutaneous acupoint electrical stimulation treatment protocol can effectively shorten the time to first postoperative anal discharge,the time to recovery of bowel sounds and the time to start eating solid food by mouth(and no intolerance performance),reduce the incidence of postoperative abdominal distension,and have a better safety profile,which can effectively prevent and treat gastrointestinal dysfunction in patients after lumbar internal fixation.This efficacy may be correlated with the reduction of postoperative serum inflammatory factor IL-6 release and the reduction of GAS secretion. |
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