Effect Of Transcutaneous Electrical Acupoint Stimulation On Gastrointestinal Motility In Patients With Brain Injury

Objective: To evaluate the clinical effect of percutaneous electrical acupoint stimulation on gastrointestinal motility in critically ill patients and explore possible mechanisms.Methods: Thirty-two patients with traumatic brain injury undergoing mechanical ventilation in the intensive care unit(ICU)were randomly divided into two groups: the transcutaneous electrical acupoint stimulation group(TEAS)and the control group,with16 in each group.The two groups were continuously observed and treated for 5 days,and the daily enteral nutrition was recorded.Patients in the TEAS group received dense waves and 100 Hz electrical stimulation,and were treated twice a day for 30 minutes each time.The control group used gastric prokinetic agents according to the clinical experience of the bed doctor.Enteral nutrition(EN)is started within 24-48 hours after the patient stays in the ICU.The caloric target is 25-30 kcal / kg / d,and the goal is to reach the 80% target amount within 2-3 days.Simultaneously,the gastric remnant volume was calculated daily by using the ultrasonic sinusectomy area method,and then the emptying time of 300 ml warm water was observed in the two groups.Finally,the relevant gastrointestinal hormones(MTL,GAS,CCK,VIP,SP,BDNF)were detected before treatment(D0),on day 1(D1),and on day 5(D4).Results: There were no significant differences in age,gender,BMI,APACHE II score,GCS score,RASS score,and underlying disease between the TEAS group and theC group.There was no significant difference in gastric residual volume at various time points in the TEAS group(P> 0.05).The gastric emptying time was shorter at D2,D3,and D4 than at D0(P <0.05),while the gastric residual volume and gastric emptying time were significantly increased at D4 in the control group.Compared with the control group,the gastric emptying time of patients in the TEAS group was significantly shorter at D3 and D4(P <0.05),and the gastric residual volume was significantly reduced at D1,D2,D3,and D4(P <0.05).The nutrition balance of patients in the TEAS group improved significantly on each day of treatment.Compared with the control group,the average feeding balance of patients in the TEAS group increased significantly at D2,D3,and D4.The number of bowel sounds in the TEAS group increased gradually during treatment.The TEAS group significantly increased compared with the control group at D2,D3,and D4.There was no significant difference in MTL,GAS,and VIP at each time point in each group(P> 0.05),while CCK and VIP decreased,and SP and BDNF increased(P <0.05)at the time point of D4 in the TEAS group.Compared with the control group,there was no significant difference in GAS,CCK,VIP,BDNF and SP between the two groups at D0 and D1(P> 0.05),while GAS increased,CCK and VIP decreased,and BNDF and SP increased(P <0.05)at D4 in the TEAS group.Conclusion: TEAS can improve gastric emptying,reduce residual gastric volume,and increase the rate of enteral nutrition in ICU patients with Brain injury.The mechanism may be related to lowering blood CCK and VIP levels,increasing BDNF,P substance,and GAS.