Effect of Transcutaneous Electrical Acupoint Stimulation on Extubation-Related Stress Response in Noncardiac Surgery Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

IF 1.6 4区医学 Q2 NURSING

Journal of Perianesthesia Nursing Pub Date : 2024-12-01 DOI:10.1016/j.jopan.2024.01.015

Mengchao Jiang MMed , Bei Wang MD , Meinv Liu MMed , Huanhuan Zhang MMed , Jianli Li MD

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引用次数: 0

Abstract

Purpose

Stress response is a common complication during extubation, mainly manifested by dramatic hemodynamic fluctuations. Transcutaneous electrical acupoint stimulation (TEAS) is widely applied in the perioperative period. We performed this meta-analysis to evaluate whether the TEAS could relieve the stress response during extubation in noncardiac surgery patients.

Design

A systematic review and meta-analysis of randomized controlled trials.

Methods

We searched six databases (PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, CNKI, and Wan Fang) for relevant literature. A risk of bias assessment was executed based on the Cochrane Criteria. We applied RevMan5.4.1 software to analyze data. When the χ² test did not show heterogeneity, we adopted the fixed-effect model. Otherwise, the random-effect model was used.

Findings

ln total, 12 randomized controlled trials with 1,347 participants were enrolled in this meta-analysis. Meta-analysis showed the heart rate and mean arterial pressure of the intervention group were significantly lower than the control group at immediately, 5 minutes, and 10 minutes after extubation. The occurrence rate of emergency agitation (RR 0.39, 95% CI [0.26,0.60]) and postoperative delirium (RR 0.40, 95% CI [0.22, 0.72] were also lower in the TEAS group. The consumption of propofol (standardized mean difference (SMD) 0.47, 95% CI [−0.77, −0.18]) and remifentanil (SMD 1.49, 95% CI [−2.01, −0.96]) of the intervention group were also significantly reduced compared with the control group.

Conclusions

TEAS was beneficial for improving stress response during extubation, emergence agitation, postoperative delirium, and reduced the consumption of intraoperative propofol and remifentanil, but it was necessary to note the limitations of the current evidence.

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经皮穴位电刺激对非心脏手术患者拔管相关应激反应的影响：随机对照试验的系统回顾和元分析》。

目的：应激反应是拔管过程中常见的并发症，主要表现为血流动力学的剧烈波动。经皮穴位电刺激（TEAS）被广泛应用于围手术期。我们进行了这项荟萃分析，以评估经皮穴位电刺激是否能缓解非心脏手术患者拔管时的应激反应：设计：对随机对照试验进行系统回顾和荟萃分析：我们检索了六个数据库（PubMed、Web of Science、Embase、Cochrane Library、China National Knowledge Infrastructure、CNKI 和 Wan Fang）中的相关文献。根据 Cochrane 标准进行了偏倚风险评估。我们使用RevMan5.4.1软件分析数据。当χ2检验未显示异质性时，我们采用固定效应模型。结果：本次荟萃分析共纳入了 12 项随机对照试验，共有 1 347 名参与者。荟萃分析表明，干预组在拔管后立即、5 分钟和 10 分钟的心率和平均动脉压均显著低于对照组。TEAS 组的急诊躁动（RR 0.39，95% CI [0.26,0.60]）和术后谵妄（RR 0.40，95% CI [0.22,0.72]）发生率也较低。与对照组相比，干预组的异丙酚用量（标准化平均差（SMD）0.47，95% CI [-0.77，-0.18]）和瑞芬太尼用量（SMD 1.49，95% CI [-2.01，-0.96]）也显著减少：TEAS有利于改善拔管时的应激反应、出现躁动、术后谵妄，并减少术中丙泊酚和瑞芬太尼的用量，但有必要注意目前证据的局限性。

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来源期刊

Journal of Perianesthesia Nursing NURSING-

CiteScore

2.20

自引率

17.60%

发文量

279

审稿时长

90 days

期刊介绍： The Journal of PeriAnesthesia Nursing provides original, peer-reviewed research for a primary audience that includes nurses in perianesthesia settings, including ambulatory surgery, preadmission testing, postanesthesia care (Phases I and II), extended observation, and pain management. The Journal provides a forum for sharing professional knowledge and experience relating to management, ethics, legislation, research, and other aspects of perianesthesia nursing.