EFFECTS OF TEAS USING DIFFERENT ACUPOINT COMBINATIONS ON PERIOPERATIVE VENTRICULAR REPOLARIZATION IN NEUROSURGERY

Abstract

Objective: To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) delivered using different acupoint combinations on perioperative ventricular repolarization and indices of depolarization-repolarization balance in patients undergoing neurosurgery. Methods: Sixty patients scheduled for elective neurosurgery were randomized in a 1:1:1 ratio to a control group (C), a Governor Vessel-based acupoint combination group (EAA), or a Pericardium Meridian-based acupoint combination group (EAB), with 20 patients per group. The EAA protocol included Lingtai (GV10), Shendao (GV11), bilateral Neiguan (PC6), and bilateral Shenmen (HT7); the EAB protocol included bilateral Neiguan (PC6), Ximen (PC4), Daling (PC7), and Shenmen (HT7). In the control group, identical electrodes were applied to the corresponding acupoints without effective electrical stimulation. TEAS was delivered continuously from induction of anesthesia until the end of surgery. Standard 12-lead electrocardiograms were obtained before anesthesia induction (T0), after completion of the principal lesion-related surgical step (T1), at the end of surgery (T2), and 24 h postoperatively (T3). QT interval, QRS duration, and the Tpeak-to-Tend (Tp-e) interval were measured in lead V5. The corrected QT interval (QTc) was calculated using Bazett's formula, and the Tp-e/QT ratio and index of cardio-electrophysiological balance (iCEB) were derived. Arrhythmias occurring during the study observation period were also recorded. Complete data were available for 50 patients and were included in the complete-case analysis (C, n=18; EAA, n=16; EAB, n=16). Results: At T0, QTc, Tp-e, Tp-e/QT, and iCEB did not differ among groups (all P>0.05). For QTc, the overall group effect was not significant (P=0.529), whereas the time effect (P=0.010) and group-by-time interaction (P=0.040) were significant. QTc increased from baseline at T1 and T2 in the control group, while the corresponding changes were smaller in both TEAS groups. For Tp-e, the overall group effect, time effect, and group-by-time interaction were all significant (P=0.002, P<0.001, and P=0.020, respectively); the EAB group showed comparatively limited fluctuations across time points. No significant group, time, or interaction effects were observed for Tp-e/QT (P=0.072, P=0.366, and P=0.057, respectively). For iCEB, the overall group effect and interaction were not significant (P=0.138 and P=0.373), whereas the time effect was significant (P=0.029). During the observation period, arrhythmias were recorded in 3 patients in the control group, 1 patient in the EAA group, and no patients in the EAB group. Conclusions: Different TEAS acupoint combinations were associated with distinct perioperative trajectories of QTc and Tp-e in patients undergoing neurosurgery, with comparatively smaller Tp-e fluctuations observed in the EAB group. No consistent between-group dynamic differences were demonstrated for Tp-e/QT or iCEB. The specific effects and clinical relevance of different acupoint combinations on perioperative ventricular repolarization and depolarization-repolarization balance require confirmation in larger, rigorously monitored studies.