循经针刺联合股神经阻滞干预膝关节置换术后镇痛及功能康复:随机对照研究  

Acupuncture combined with femoral nerve block for postoperative analgesia after total knee arthroplasty and functional rehabilitation: a randomized controlled trial

作　　者：张永辉[1,2] 张林[1] 卢敏[3] 

机构地区：[1]湖南中医药大学,长沙410007 [2]漯河市中心医院,河南漯河462000 [3]湖南中医药大学第一附属医院,长沙410007

出　　处：《中国针灸》2018年第3期251-255,共5页Chinese Acupuncture & Moxibustion

基　　金：国家自然科学基金项目:81574004

摘　　要：目的:观察循经远端针刺联合股神经阻滞对膝关节置换术(TKA)后镇痛及膝关节功能康复的疗效。方法:选择60例行膝关节置换术的患者,随机分为观察组和对照组,各30例。所有患者均在手术前行股神经阻滞,术后予以镇痛泵镇痛及TKA术后康复治疗,观察组在此基础上加用针刺,穴取患侧太冲、昆仑、太溪、申脉、三阴交、后溪,双侧尺泽、曲池、手三里,留针30 min。每天1次,治疗2周。记录术后4 h、8 h、12 h、24 h、48 h静息时,术后12 h、24 h、48 h、7 d、14 d被动功能锻炼时膝关节视觉模拟评分(visual analogue score,VAS);患者术前、术后7 d、术后14 d美国纽约特种外科医院膝关节功能评分(HSS)、关节活动度(ROM);记录患者镇痛满意度,加用镇痛剂量及不良反应情况。结果:术后8 h、12 h、24 h、48 h膝关节静息状态VAS评分,观察组低于对照组(均P<0.05);术后12 h、24 h、48 h、7 d,观察组膝关节被动运动VAS评分低于对照组(均P<0.05)。观察组镇痛满意度高于对照组(P<0.05)。HSS评分方面,术后72 h、7 d、14 d,观察组优于对照组(均P<0.05);ROM方面,观察组优于对照组(均P<0.05)。安全性方面,观察组不良反应率低于对照组(P<0.05)。结论:循经针刺取穴联合股神经阻滞方法应用于TKA术后镇痛效果明显,在关节功能恢复方面效果确切,同时安全性高,不良反应小。Objective To observe the therapeutic effects on the postoperative analgesia after total knee arthroplasty（TKA） and functional rehabilitation with acupuncture at the distal points along the affected meridians and femoral nerve block. Methods A total of 60 patients with knee prosthesis were collected and randomized into an observation group and a control group, 30 cases in each one. All of the patients received the femoral nerve block before operation. The analgesia pump was used for analgesia after operation and TKA postoperative rehabilitation was adopted. Additionally, in the observation group, acupuncture was applied to Taichong（LR 3）, Kunlun（BL 60）, Taixi（KI 3）, Shenmai（BL 62）, Sanyinjiao（SP 6） and Houxi（SI 3） unilaterally on the affected side, as well as Chize（LU 5）, Quchi（LI 11） and Shousanli（LI 10） bilaterally. The needles were remained for 30 min, once a day, totally for 2 weeks. Separately, 4 h, 8 h, 12 h, 24 h and 48 h in resting after operation, as well as during the passive functional exercises 12 h, 24 h, 48 h, 7 d and 14 d after operation, the scores of visual analogue score（VAS） were recorded. HSS score, ROM before operation and 7 d and 14 d after operation, the analgesia satisfaction, the analgesic dose as well as the adverse reactions were recorded. Results Regarding the VAS scores, 8 h, 12 h, 24 h and 48 h in resting after operation, the results in the observation group were lower than those in the control group（all P〈0.05）. The VAS scores during the passive functional exercises 12 h, 24 h 48 h and 7 d after operation in the observation group were lower than those in the control group（all P〈0.05）. The analgesia satisfaction in the observation group was higher than that in the control group（P〈0.05）. 72 h, 7 d and 14 d after operation, HSS scores in the observation group were better than those in the control group（all P〈0.05） and the effects of ROM in the observation group were better than those in the control group（both P〈0.05

关 键 词：膝关节置换术后 针刺 循经取穴 股神经阻滞 镇痛 康复 

分 类 号：R246.2[医药卫生—针灸推拿学]