腕踝针联合自控镇痛泵治疗全髋关节置换术后髋关节疼痛的临床研究  

Clinical study on wrist-ankle acupuncture analgesia combined with patient-controlled analgesia for treatment of hip pain after total hip arthroplasty

作　　者：李文龙[1] 李阳阳[1] 张海龙[1] 刘又文[2] 

机构地区：[1]河南中医药大学,河南郑州450008 [2]河南省洛阳正骨医院/河南省骨科医院,河南洛阳471002

出　　处：《中医正骨》2016年第10期24-28,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：河南省研究生教育创新培养基地2015年度研究生创新基金项目

摘　　要：目的：观察腕踝针联合自控镇痛泵（patient controlled analgesia，PCA）治疗全髋关节置换术（total hip arthroplasty，THA）后髋关节疼痛的临床疗效和安全性。方法：68例接受单侧THA手术的患者随机分为2组，腕踝针联合PCA组35例、PCA组33例。2组患者术前均接受疼痛知识宣教，术后均采用PCA镇痛48h。腕踝针联合PCA组在此基础上从术前3d开始行腕踝针针刺镇痛治疗，每日1次，10d为1个疗程，共治疗1个疗程。记录术后48h内2组患者每12h的PCA镇痛药使用量；分别在术后12、24、36、48h及术后3、4、5d采用疼痛视觉模拟量表（visual analogue scale，VAS）对2组患者髋关节疼痛情况进行评估；观察术后48h内2组患者不良反应发生情况；术后2周，依据髋关节Harris评分标准评价髋关节功能。结果：2组患者髋关节疼痛VAS评分术后不同时间点问的差异具有统计学意义，即存在时间效应（F=220．239，P=0．000）；术后12、24、36、48h时，2组髋关节疼痛VAS评分的组间差异均无统计学意义[（6．22±1．01）分，（6．15±1．13）分，t=0．273，P=0．786；（5．32±0．99）分，（5．17±1．27）分，t=0．513，P=0．610；（3．83±0．26）分，（3．92±0．34）分，t=-1．667，P=0．098；（3．06±0．28）分，（2．99±0．23）分，t=0．954，P=0．344]；术后3、4、5d时，腕踝针联合PCA组髋关节疼痛VAS评分低于PCA组[（3．68±0．25）分，（4．17±0．32）分，t=-7．528，P=0．000；（3．58±0．35）分，（4．03±0．26）分，t=-5．878，P=0．000；（2．96±0．48）分，（3．17±0．24）分，t=-2．244，P=0．029]；2组间总体比较，腕踝针联合PCA组髋关节疼痛VAS评分低于PCA组，即存在分组效应（F=5．617，P=0．021）；时间因素和分组因素之间不存在交互效应（F=2．621，P=0．058）。2组患者术后不同时间点间镇痛药用量的差异具有统计学意义，即存在时间�Objective ：To observe the clinical curative effects and safety of wrist - ankle acupuncture analgesia combined with patient - controlled analgesia（PCA） in treatment of hip pain after total hip arthroplasty（THA）. Methods：Sixty -eight patients who received unilater- al THA were randomly divided into combination group（ 35 cases）and PCA group（33 cases）. All patients in both of the groups were taught pain knowledge before surgery,and then received PCA analgesia for 48 hours after surgery. Meanwhile, the patients in combination group were treated with wrist -ankle acupuncture analgesia from the third day before surgery, once a day for one course of treatment, 10 days for each course. The consumption of PCA analgesics were recorded every 12 hours within 48 hours after surgery. The hip pain were evaluated by using visual analogue scale（VAS） at 12,24,36 and 48 hours and 3,4 and 5 days after surgery respectively. The incidence rates of adverse reactions were observed within 48 hours after surgery and the hip function were also evaluated according to Harris hip scoring standard. Results：There was statistical difference inhip pain VAS scores between different postoperative timepoints, in other words, there was time effect （ F = 220. 239, P = 0.000）. There was no statistical difference in hip pain VAS scores between the 2 groups at 12,24,36 and 48 hours after surgery（6.22 ＋/- 1.01 vs 6. 15 ＋/- 1.13 points,t =0. 273,P =0. 786;5.32 ＋/-0.99 vs 5.17 ＋/- 1.27 points,t =0. 513,P = 0.610 ;3.83 ＋/- 0.26 vs 3.92 ＋/- 0.34 points, t = - 1. 667,P = 0. 098 ;3.06 ＋/- 0.28 vs 2.99 ＋/- 0.23 points, t = 0. 954, P = 0. 344）. The hip pain VAS scores were lower in combination group compared to PCA group at 3,4 and 5 days after surgery （3.68 ＋/- 0.25 vs 4.17 ＋/- 0.32 points,t = - 7. 528, P = 0. 000 ; 3.58 ＋/- 0.35 vs 4.03 ＋/- 0.26 points, t = - 5. 878, P = 0. 000 ; 2.96 ＋/- 0.48 vs 3.17 ＋/-0.24 points, t = -2. 244 ,P = 0. 029）. The hip pain VAS scores were lower in combination grou

关 键 词：关节成形术 置换 髋 疼痛 手术后 针刺镇痛 镇痛 病人控制 

分 类 号：R246.9[医药卫生—针灸推拿学]