电针对胸科手术后镇痛的临床研究  

Clinical research of electroacupuncture on the analgesic effect of thoracic perioperative stage

作　　者：周民涛 李毓[1] 韩学昌[1] 邢群智[1] 王亦瑶 董旭[1] 常俊晓[1] 

机构地区：[1]河南科技大学临床医学院河南科技大学第一附属医院,洛阳471003

出　　处：《中国针灸》2017年第7期705-709,共5页Chinese Acupuncture & Moxibustion

摘　　要：目的:探讨电针针刺"内麻点"与内关穴在胸科手术围术期镇痛的临床疗效及其作用机制。方法:选取择期行食管癌根治术全麻患者60例,按手术顺序分为观察组与对照组,每组30例。对照组单纯行全身麻醉处理,术后行舒芬太尼自控镇痛(PCIA);观察组在对照组基础上分别于麻醉诱导前30 min及术后予电针刺激"内麻点"及内关穴,连续波,强度以患者耐受为宜,分别刺激30 min。检测针刺前(T1),手术后2 h(T2)、12 h(T3)、24 h(T4)和48 h(T5)时间点两组患者血浆β-内啡肽(β-EP)、5-羟色胺(5-HT)和前列腺素E2(PGE_2)的含量。手术过程在脑电双频谱(BIS)保持同等状态下(50~60之间)记录术中麻醉药的用量。采用视觉模拟评分法(VAS)评估T2、T3、T4和T5时间点患者的疼痛程度,并记录各时间点疗效等级评定和安全等级评定。结果:(1)术中瑞芬太尼总用量观察组少于对照组[(1.83±0.56)mg vs(2.54±0.62)mg,P<0.05]。(2)观察组患者在T2、T3、T4时间点VAS评分低于对照组(均P<0.05)。(3)观察组血浆β-EP含量在T3、T4、T5时间点较对照组显著升高(均P<0.05),血浆5-HT和PGE_2含量在T2、T3和T4时间点较对照组显著降低(均P<0.05)。(4)观察组术后2 h、12 h、24 h镇痛优良率均高于对照组(均P<0.05)。(5)观察组安全等级1级率高于对照组(P<0.05)。结论:电针"内麻点"和内关穴能为胸部手术提供安全有效的术后镇痛,并可减少术中镇痛药用量,其机制可能与电针刺激能增加内源性β-EP产生和抑制炎性介质5-HT和PGE_2的释放有关。Objective To discuss the clinical therapeutic effects of electroacupuncture at Neimadian（Extra） and Neiguan（PC 6） on the analgesic effect of thoracic perioperative stage and its effect mechanism. Methods Sixty cases of esophageal cancer with elective radical resection under general anesthesia were divided into an observation group and a control group according to the operation sequence, 30 cases in each one. In the control group, the general anesthesia was simply applied and sufentanil was administered for patient controlled intravenous analgesia（PCIA） after operation. In the observation group, on the basis of the scheme as the control group, the electroacupuncture was used at Neimadian（Extra） and Neiguan（PC 6） 30 min before anesthesia induction and after operation, with continuous wave, tolerable intensity, lasting for 30 min. Separately, before acupuncture（T1） and 2 h（T2）, 12 h（T3）, 24 h（T4） and 48 h（T5） after operation, the plasma β-endorphin（β-EP）, 5-hydroxytryptamine（5-HT） and prostaglandin E2（PGE2） were determined. During operation, under the same state（from 50 to 60） of bispectrum of EEG（BIS）, the intraoperative anesthetic dose was recorded. Using visual analogue scale（VAS）, the pain degree was evaluated at T2, T3, T4 and T5 separately and the grade assessment of the therapeutic effects and safety were recorded at each time point. Results（1）The total dosage of sufentanil in the observation group was less than that in the control group [（1.83±0.56） mg vs（2.54±0.62） mg, P〈0.05].（2）VAS scores at T2, T3 and T4 in the patients of the observation group were all lower than those in the control group（all P〈0.05）.（3）The levels of plasma β-EP at T3, T4 and T5 in the observation group were increased significantly as compared with those in the control group（all P〈0.05） and the levels of plasma 5-HT and PGE2 at T2, T3 and T4 were reduced significantly as compared with those in the control group（all P〈0.05）.（4�

关 键 词：镇痛 电针 内麻点 穴 内关 胸科手术 

分 类 号：R246.2[医药卫生—针灸推拿学]