The Application Of Transcutaneous Electrical Acupoint Stimulation On Improving Postoperative Cognitive Function In Older Patients With Lung Cancer

Background: Perioperative Neurocognitive Disorders(PND)including Postoperative delirium(POD)and Postoperative Cognitive Dysfunction(POCD),is a common postoperative complication in elderly patients with lung cancer,which could hamper patients’ prognosis and increase the economic burden on their families and the consumption of social medical resources.However,there are no current effective and safe measures for prevention.Transcutaneous electrical acupoint stimulation(TEAS)had shown some advantages in assisting anesthesia and analgesia in surgical patients during the perioperative period,but limited studies explored the effect of TEAS on the cognitive function and quality of life among old patients with lung cancer.Objective: Firstly,this study was to investigate the cognitive function and influencing factors among older patients with lung cancer,which could help improve the intervention strategies.Secondly,this study was to evaluate the effect of TEAS on POD in various kinds of surgical patients,which could provide evidence-based medicine for TEAS.Lastly,this study was to explore the efficacy and safety of TEAS on improving postoperative cognitive function in elderly patients with lung cancer,which could provide theoretical support for the application of TEAS in this population.Methods:1)Retrospective investigation and analysis: The clinical data of older patients who underwent thoracoscopic pulmonary resection at the Second Affiliated Hospital of Air Force Medical University between January 2019 and June 2020,were retrospectively analyzed and investigated by a telephone interview.Their socio-demographic characteristics,surgical information,postoperative sleep,pain and therapy,and scores of Telephone Interview for Cognitive Status-Modified were collected.Univariate analysis was conducted to examine the differences between normal group and POCD group.Multivariate logistic regression analyses were used for identifying influencing factors for POCD.2)Systematic review and meta-analysis: Randomized controlled trials(RCTs)studied TEAS for the prevention of POD were searched in Wanfang,China National Knowledge Infrastructure,VIP,Chinese Biology Medicine,Pub Med,Cochrane Library,and Web of Science database.The methodological qualities of the included trials was evaluated by the Cochrane risk of bias tool.The application experience of TEAS was also reviewed.Review Manager(Rev Man 5.3)software was used for meta-analysis of the incidence of POD,Confusion Assessment Method(CAM)scores,Visual Analogue Scale(VAS)scores,and the intraoperative consumption of anesthetics.3)Randomized controlled trial: From August 2020 to 2021 January,128 patients scheduled for surgery were randomly assigned to the TEAS group and sham-TEAS group.From 30 min before anesthesia induction until the end of the surgery,a standardized intervention of TEAS or sham-TEAS combined with a general anesthetic protocol was performed in the two groups.Patients’ cognition was tested by the Montreal Cognitive Assessment(Mo CA)scale,the Mini-Mental State Examination(MMSE)scale,and the Numerical Rating Scale(NRS)on pain and sleep at postoperative 1 day,7 days,and 30 days.Patients’ life quality was tested by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC-QLQ-C30)at postoperative 6and 12 months,and the chronic pain questionnaire at postoperative 12 months.Results:1.The long-term postoperative cognitive function and influencing factors among elderly patients with lung cancer: 1)In this part,a total of 442 patients completed the investigation,of which 89(20.14%)patients were diagnosed with POCD.2)Univariate analysis showed that there were significant differences in gender,education,frequency of social activities,living alone,surgical history,anesthetic drugs,postoperative pulmonary function,sleep quality,and chronic pain between the POCD group and the normal group(P < 0.05).3)Multivariate regression analysis showed that patients with higher education,such as a college degree(OR = 0.014,95%CI: 0.003-0.069)and intraoperative use of propofol-based anesthesia(OR = 0.153,95% CI: 0.076-0.311)had a lower risk for POCD,while the risk of POCD was increased in patients who had the older age such as more than80 years(OR = 6.974,95%CI: 1.129-43.081),or suffered chronic pain(OR = 2.219,95%CI: 1.046-4.704)and the worse postoperative pulmonary function(OR = 5.465,95%CI: 1.705-17.514).2.The efficacy of TEAS on preventing POD: 1)A meta-analysis containing 715 experimental and 717 control participants from 12 RCTs was performed.2)The results of the risk of bias assessment showed that the quality of included RCTs was moderate,and the main problems were randomization,allocation concealment,and blinding.3)The most commonly used parameters of TEAS were 2/100 Hz,disperse-dense wave,intraoperative intervention(30 minutes before anesthesia induction until the end of the operation),and the acupoints of Neiguan,Hegu,and Baihui were frequently selected.4)The overall results showed that the incidence of the POD in the TEAS group was significantly lower than that in the control group on postoperative 1st day,2nd day,and within 3,5,or 7 days(P < 0.05).The CAM score of the TEAS group was significantly lower than the control group on the 3rd postoperative day(MD =-0.52,95%CI:-1.02--0.03,P = 0.04).The VAS score of the TEAS group was better than the control group on the 1st postoperative day(MD =-0.19,95%CI:-0.36-0.02,P = 0.03).The consumption of propofol and remifentanil were both significantly lower in the TEAS group compared with the control group(MD =-23.1,95%CI:-37.27--8.94,P = 0.001;MD =-105.69,95%CI:-174.20--37.19,P = 0.002).3.Effect of TEAS on postoperative cognitive function in elderly patients with lung cancer: 1)Participants who completed the 12-month trial of the TEAS group and the sham-TEAS group were well-matched in baseline demographic and clinical parameters.2)Compared with the sham-TEAS group,the consumption of remifentanil was significantly reduced in the TEAS group(P = 0.04).3)At postoperative day 30,the incidence of POCD in the TEAS group was significantly lower than in the sham-TEAS group(P < 0.001).In addition,the TEAS group exhibited better scores of Mo CA,MMSE,pain,and sleep compared with the sham-TEAS group(P < 0.001).At 6 and 12 months points,the global health scores of EORTC-QLQ-C30 in the TEAS group were still significantly higher than the sham-TEAS group,and the prevalence of chronic pain was significantly lower than the sham-TEAS group(P < 0.05).Conclusions: 1.Currently,the long-term postoperative cognitive function of elderly patients with lung cancer is serious,which has a great influence on the survival and prognosis of lung cancer patients.2.Existing studies have shown that TEAS is effective in reducing the incidence of POD in various surgical patients.This technique could assist in reducing the consumption of anesthetics during surgery.3.TEAS could effectively prevent and treat PND in elderly patients who underwent thoracoscopic radical resection,and positively affect their quality of life.