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已发表论文
耳迷走神经刺激可减少老年患者非心脏大手术后的术后谵妄
Authors Shi J, Gao D , Hu X, Zhang Y , Guo T, Mao Q, Liu Q , Ji M
Received 6 August 2025
Accepted for publication 11 December 2025
Published 6 January 2026 Volume 2026:21 558395
DOI https://doi.org/10.2147/CIA.S558395
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Maddalena Illario
Jinyun Shi,1,2 Dapeng Gao,3 Xiaoyi Hu,4 Yue Zhang,1,2 Ting Guo,4 Qinghong Mao,1,2 Qingren Liu,5 Muhuo Ji4
1Department of Anesthesiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China; 2Department of Anesthesiology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, People’s Republic of China; 3Department of Anesthesiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210018, People’s Republic of China; 4Department of Anesthesiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, People’s Republic of China; 5Department of Anesthesiology, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
Correspondence: Muhuo Ji, Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, People’s Republic of China, Email jimuhuo2009@sina.com
Background: Postoperative delirium (POD) is a prevalent and devastating complication in elderly patients undergoing major surgery, marked by substantial increases in morbidity, mortality, and long-term cognitive decline. However, treatment and prevention methods are limited. Accumulating evidence suggests that vagus nerve stimulation effectively enhances cognitive function.
Objective: To evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) on POD in elderly patients undergoing major non-cardiac surgery.
Methods: Patients aged ≥ 65 years scheduled for major non-cardiac surgery were randomly assigned to either the active taVNS group or the sham taVNS group, with stimulation targeting the cymba conchae or earlobe, respectively. In both groups, stimulation was initiated 5 minutes prior to anesthesia induction and continued until the end of surgery. The only difference between the two groups was the stimulation site. The primary outcome was the incidence of POD during the first 3 postoperative days.
Results: A total of 150 patients (median age, 73 years; 96 women [64%]) completed this trial. The incident POD risk was 12% (n = 9) vs 25.3% (n = 19) in active-taVNS and sham-taVNS groups, respectively (relative risk, 0.47; 95% CI, 0.23– 0.98; P = 0.036). The mediation analysis revealed that postoperative sleep quality played a significant mediating role in the effect of taVNS on POD (z = − 2.30, P = 0.02).
Conclusion: In this study, taVNS reduces the incidence of POD in elderly patients undergoing major non-cardiac surgery, possibly by improving postoperative sleep quality. We suggest that this non-invasive neuromodulation technique could be considered as a potential preventive strategy for POD. Further validation in future large-scale randomized controlled trials is warranted.
Keywords: taVNS, postoperative delirium, sleep quality, mediation effects
1Department of Anesthesiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China; 2Department of Anesthesiology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, People’s Republic of China; 3Department of Anesthesiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210018, People’s Republic of China; 4Department of Anesthesiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, People’s Republic of China; 5Department of Anesthesiology, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
Correspondence: Muhuo Ji, Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, People’s Republic of China, Email jimuhuo2009@sina.com
Background: Postoperative delirium (POD) is a prevalent and devastating complication in elderly patients undergoing major surgery, marked by substantial increases in morbidity, mortality, and long-term cognitive decline. However, treatment and prevention methods are limited. Accumulating evidence suggests that vagus nerve stimulation effectively enhances cognitive function.
Objective: To evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) on POD in elderly patients undergoing major non-cardiac surgery.
Methods: Patients aged ≥ 65 years scheduled for major non-cardiac surgery were randomly assigned to either the active taVNS group or the sham taVNS group, with stimulation targeting the cymba conchae or earlobe, respectively. In both groups, stimulation was initiated 5 minutes prior to anesthesia induction and continued until the end of surgery. The only difference between the two groups was the stimulation site. The primary outcome was the incidence of POD during the first 3 postoperative days.
Results: A total of 150 patients (median age, 73 years; 96 women [64%]) completed this trial. The incident POD risk was 12% (n = 9) vs 25.3% (n = 19) in active-taVNS and sham-taVNS groups, respectively (relative risk, 0.47; 95% CI, 0.23– 0.98; P = 0.036). The mediation analysis revealed that postoperative sleep quality played a significant mediating role in the effect of taVNS on POD (z = − 2.30, P = 0.02).
Conclusion: In this study, taVNS reduces the incidence of POD in elderly patients undergoing major non-cardiac surgery, possibly by improving postoperative sleep quality. We suggest that this non-invasive neuromodulation technique could be considered as a potential preventive strategy for POD. Further validation in future large-scale randomized controlled trials is warranted.
Keywords: taVNS, postoperative delirium, sleep quality, mediation effects