经皮耳迷走神经刺激与脓毒症急性胃肠道损伤患者胃窦运动增高有关：一项随机、假对照、盲法结果评估的先导试验

IF 9.7 1区医学 Q1 CLINICAL NEUROLOGY

Brain Stimulation Pub Date : 2026-07-01 Epub Date: 2026-07-02 DOI:10.1016/j.brs.2026.103154

Zhiyang Wu, Xin Zhang, Yankun Li, Xi Guo, Jian Yu

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引用次数: 0

摘要

背景：经皮耳迷走神经刺激（taVNS）是一种无创神经调节方法，涉及自主神经、胃肠道和免疫调节的迷走神经传入通路；它对危重病人胃运动功能的影响尚不清楚。目的：评价taVNS对脓毒症合并急性胃肠损伤（AGI）患者胃运动的可行性、安全性及初步生理信号。方法：在这项单中心、随机、假对照、盲法结局评估的试点试验中，脓毒症相关AGI的成年ICU患者在标准治疗的基础上，按1:1的比例随机分为每日1次taVNS或假刺激7天。主要观察指标为第7天床边超声测量的胃窦运动指数（MI）。次要结局包括肠内营养达标、炎症因子、胃肠激素、肠屏障损伤标志物、临床结局和不良事件；这些都是探索性的。结果：66例患者被随机分配（33例taVNS， 33例假手术），基线特征相似。经基线调整后，taVNS组第7天心肌梗死高于假手术组。更多接受tavns治疗的患者在第7天达到预定的肠内营养目标。细胞因子、胃肠激素和肠道屏障标志物的探索性变化方向与taVNS可能的生理作用一致。无呼吸机天数、ICU和住院时间、28天死亡率无差异。未发生与刺激相关的严重不良事件。结论：TaVNS是可行的，耐受性良好，在脓毒症相关AGI中显示出较高的胃窦运动的初步信号，并伴有肠道相关生理指标的探索性变化。这些发现只是假设。需要更大规模的试验来证实这些观察结果并确定临床疗效。

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Transcutaneous auricular vagus nerve stimulation is associated with higher gastric antral motility in septic patients with acute gastrointestinal injury: A randomized, sham-controlled pilot trial with blinded outcome assessment

Background

Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive neuromodulation approach engaging vagal afferent pathways involved in autonomic, gastrointestinal, and immune regulation; its effects on gastric motor function in critical illness remain uncertain.

Objective

To assess feasibility, safety, and preliminary physiological signals of taVNS on gastric motility in septic patients with acute gastrointestinal injury (AGI).

Methods

In this single-center, randomized, sham-controlled pilot trial with blinded outcome assessment, adult ICU patients with sepsis-associated AGI were randomized 1:1 to once-daily taVNS or sham stimulation for 7 days in addition to standard care. The primary outcome was gastric antral motility index (MI) measured by bedside ultrasonography on day 7. Secondary outcomes included enteral nutrition target attainment, inflammatory cytokines, gastrointestinal hormones, intestinal barrier injury markers, clinical outcomes, and adverse events; these were exploratory.

Results

Sixty-six patients were randomized (33 taVNS, 33 sham) with comparable baseline characteristics. Baseline-adjusted Day-7 MI was higher with taVNS than sham. More taVNS-treated patients achieved prespecified enteral nutrition targets by day 7. Exploratory changes in cytokines, gastrointestinal hormones, and intestinal barrier markers were directionally consistent with possible physiological effects of taVNS. Ventilator-free days, ICU and hospital length of stay, and 28-day mortality did not differ. No serious stimulation-related adverse events occurred.

Conclusions

TaVNS was feasible and well tolerated and showed preliminary signals of higher gastric antral motility in sepsis-associated AGI, with exploratory changes in gut-related physiological markers. These findings are hypothesis-generating. Larger trials are needed to confirm these observations and determine clinical efficacy.

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来源期刊

Brain Stimulation 医学-临床神经学

CiteScore

13.10

自引率

9.10%

发文量

256

审稿时长

72 days

期刊介绍： Brain Stimulation publishes on the entire field of brain stimulation, including noninvasive and invasive techniques and technologies that alter brain function through the use of electrical, magnetic, radiowave, or focally targeted pharmacologic stimulation. Brain Stimulation aims to be the premier journal for publication of original research in the field of neuromodulation. The journal includes: a) Original articles; b) Short Communications; c) Invited and original reviews; d) Technology and methodological perspectives (reviews of new devices, description of new methods, etc.); and e) Letters to the Editor. Special issues of the journal will be considered based on scientific merit.