针药复合麻醉对胸腔镜肺癌根治术患者术后镇痛效果的影响  

EFFICACY OF TRANSCUTANEOUS ELECTRICAL ACUPOINT STIMULATION COMBINED WITH GENERAL ANESTHESIA FOR POSTOPERATIVE ANALGESIA IN LUNG CANCER PATIENTS UNDERGOING THORACOSCOPIC RADICAL RESECTION OF PULMONARY CARCINOMA

作　　者：张云霄[1] 陈冀衡[1] 万有[2] 王祥瑞[3] 范志毅[1] 黄川[4] 陈克能[4] 孔国华[1] 李晓曦[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所麻醉科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学神经科学研究所基础医学院神经生物学系,教育部和卫生部神经科学重点实验室,北京100191 [3]上海交通大学医学院附属仁济医院麻醉科,上海200127 [4]北京大学肿瘤医院暨北京市肿瘤防治研究所胸外一科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国疼痛医学杂志》2015年第3期206-209,共4页Chinese Journal of Pain Medicine

基　　金：科技部国家重点基础研究发展计划“973”资助项目(2013CB531900)

摘　　要：目的：观察针药复合麻醉对胸腔镜肺癌根治术患者术后镇痛效果的影响。方法：选取择期行肺癌根治术的肺癌患者64例,年龄18-75岁,采用随机数字表法,将其分成两组,每组32例。针药复合组（A组）32例,对照组（C组）32例。A组于麻醉诱导前30 min、术中持续及术后3次（术后6 h、24 h、48 h）经皮穴位电刺激,频率为2/100 Hz,术前、术后电刺激强度为引起感觉阈强度2-3倍即10-15 m A,术中麻醉期间刺激强度为30 m A,刺激部位是患者双侧合谷、内关、后溪及支沟穴,30 min/次;C组也以相同的装置和时间点连接在患者双侧合谷、内关、后溪及支沟穴处但以较小电刺激强度4 m A进行电刺激,频率为2/100 Hz。两组均采用全凭静脉麻醉,术后行静脉患者自控镇痛（Patient Controlled Analgesia,PCIA）。术后6 h、24 h、48 h随访,观察记录两组患者疼痛视觉模拟评分（Visual Analogue Scale,VAS）、镇痛药物的用药量及镇痛泵按压次数。结果：A组患者术后6 h、24 h、48 h镇痛泵用药量及术后6h、24 h VAS评分明显低于C组（P〈0.05）;A组术后镇痛泵总按压次数明显低于C组（P〈0.05）,A组术后有效按压率明显高于C组（P〈0.05,）。结论：针药复合麻醉可以有效减轻胸腔镜肺癌根治术患者术后疼痛程度并减少术后镇痛药物用量。Objective： To observe the efficacy of transcutaneous electrical acupoint stimulation（TEAS）combined with general anesthesia for postoperative analgesa in lung cancer patients undergoing thoracoscopic radical resection of pulmonary carcinoma. Methods： 64 lung cancer patients, aged 18-75, undergoing thoracoscopic radical resection of pulmonary carcinoma,were enrolled and randomly allocated into 2 groups, 32 cases each. Patients in TEAS combined with general anesthesia group（group A） were given transcutaneous electrical acupoint stimulation at 5 timepoints, 30 min before induction（2/100 Hz, 10-15 m A, 30 min）, intraoperation（2/100 Hz, 30 m A, continuously）, postoperation 6 h（2/100 Hz, 10-15 m A, 30 min）, postoperation 24 h（2/100 Hz, 10-15 m A, 30 min） and postoperation 48 h（2/100 Hz, 10-15 m A）, patients were treated with TEAS at bilateral Hegu（ LI 4）, Neiguan（ PC 6）, Houxi（SI 3） and Zhigou（TE 6）, while patients in control group（group C） were stimulated at the same TEAS points, timepoints and stimulation time with smaller stimulus intensity（2/100 Hz, 4 m A） except intraoperation. Both groups received total introvenous anesthesia during intraoperation and intravenous patient-controlled analgesia（PCIA） during postoperation. The Visual Analogue Scale（VAS） score were counted at 6, 24 and 48 h postoperatively in the two groups. The analgesic dosage, the number of attempts were also recorded. Results： Compared with group C,the analgesic dosage was significantly lower in group A 6 h、24 h and 48 h after operation, and the VAS score was significantly lower in group A 6h and 24 h postoperative（P 0.05）. Compared with group C, The number of PCIA attempts of the patients was significantly lower in group A（P 0.05）. Conclusion： Transcutaneous electrical acupoint stimulation combined with general anesthesia provided less pain score and lower consumption of sufentanyl in patients undergoing thoracoscopic radical resection of pulmonary carcinoma.

关 键 词：全身麻醉 肺癌 针刺 镇痛 

分 类 号：R734.2[医药卫生—肿瘤]