针刺超前镇痛对开胸手术患者围术期镇痛效果的影响  

Influence of Advanced Acupuncture Analgesia on Perioperative Analgesic Effect in Thoracotomy Patients

作　　者：朱余明[1] 周红[1] 闵屹华[1] 施伶俐[1] 

机构地区：[1]上海市肺科医院针麻研究室,上海200433

出　　处：《上海针灸杂志》2010年第10期620-622,共3页Shanghai Journal of Acupuncture and Moxibustion

基　　金：上海市卫生局中医药科研项目(2006L012A)

摘　　要：目的观察针刺超前镇痛对于开胸手术患者围术期镇痛效果的影响,对针刺具有超前镇痛效应提供临床依据。方法选择开胸肺癌手术患者120例,随机分为四组,每组30例。A组、B组术前3d予以针刺超前镇痛,每日1次,连续3d。A组、C组予以术后针刺镇痛。D组为全麻对照组。选取与镇痛相关的β-内啡肽和与应激相关的皮质醇为观察指标,检测四组患者手术前后的水平变化,统计四组患者术后镇痛药物芬太尼的具体用量。四组患者均控制疼痛指数在3以下。结果 A组术前一天β-内啡肽与C组和D组比较,均P<0.05。B组术前一天与C组和D组比较,均P<0.05。皮质醇数据自身比较,A组、B组、D组入院与拔管后一天比较,术前一天与拔管后一天比较,均P<0.05;C组入院与拔管后一天比较,P<0.05。四组患者术后镇痛泵的芬太尼含量经单因素方差分析P<0.05,差异有统计学意义。结论超前镇痛在开胸手术患者应用中,具有提高镇痛指标β-内啡肽的效应,与传统的术后镇痛比较有明显优势。对于应激指标皮质醇则无明显差异,手术和拔管等刺激对机体产生较大的即时应激,针刺无明显优势。术后针刺可在一定程度上替代镇痛药物的使用量,此次配比减少20%。Objective To investigate the influence of advanced acupuncture analgesia on perioperative analgesic effect in thoracotomy patients and provide clinical evidence for the advanced analgesic effect of acupuncture.Methods One hundred and twenty patients subjected to lung cancer thoracotomy were recruited and randomly allocated to four groups,30 cases each.Group A and B were given advanced acupuncture analgesia 3 days preoperatively,once daily,for 3 consecutive days.Group A and C were given acupuncture analgesia postoperatively.Group D was a general anesthesia control group.Analgesia-related β-endorphin and stress-related cortisol were selected as observation indices.Their levels were measured in the four groups of patients before and after the operation.The postoperative dosage of analgesic fentanyl was examined in the four groups of patients.Pain index was controlled below 3 in all the four groups of patients.Results At one day before the operation,there was a significant difference in β-endorphin content between group A and C（P0.05） or D（P0.05） and between group B and C（P0.05） or D（P0.05）.There was a significant difference in cortisol content between the admission day and one day after the decannulation and between one day before the operation and one day after the decannulation in group A,B and D（all P0.05）.There was a significant difference in cortisol content between the admission day and one day after the decannulationin in group C（P0.05）.A single factor analysis of variance showed a significant difference in postoperative PCIA fentanyl dosage among the four groups of patients（P0.05）.Conclusion Advanced acupuncture analgesia produces an increasing effect on analgesia index β-endorphin in thoracotomy patients and has an obvious advantage compared with conventional postoperative analgesia.It does not produce a significant effect on stress index cortisol.Acupuncture has not an obvious advantage in treating an immediate greater stress caused by surgery and decannulation.Postoperative

关 键 词：针刺镇痛 肺切除术 Β内啡肽 皮质醇 芬太尼 

分 类 号：R246.2[医药卫生—针灸推拿学]