穴位注射对全膝关节置换术后芬太尼镇痛效果的影响  

Influence of Acupuncture Point Injection on the Analgesic Effect of Fentanyl After Total Knee Replacement

作　　者：师小伟[1] 彭生[1] 沈卫东[2] SHI Xiao-wei;PENG Sheng;SHEN Wei-dong(Shanghai Seventh People＇s Hospital,Shanghai 200137,China;Shanghai University of Traditional Chinese Medicine Shuguang Hospital,Shanghai 200020,China)

机构地区：[1]上海市第七人民医院,上海200137 [2]上海中医药大学附属曙光医院,上海200020

出　　处：《上海针灸杂志》2018年第8期928-931,共4页Shanghai Journal of Acupuncture and Moxibustion

摘　　要：目的观察穴位注射地佐辛对全膝关节置换术后芬太尼镇痛效果的影响。方法将60例患者随机平均分成观察组和对照组。手术开始前15 min观察组在手术同侧足三里穴注射地佐辛5 mg,对照组静脉注射地佐辛5 mg。术后均采用芬太尼静脉自控镇痛。观察两组术后6 h、12 h、24 h、48 h疼痛视觉模拟评分(VAS)、镇静程度评分(Ramsay评分),芬太尼累积消耗量和不良反应发生情况。结果术后观察组6 h、12 h的VAS及Ramsay评分均低于对照组(P<0.05),48 h内芬太尼累积消耗量少于对照组(P<0.05)。观察组术后拔管躁动、恶心呕吐、头晕嗜睡发生率低于对照组(P<0.05)。结论穴位注射地佐辛对全膝关节置换术镇痛效果好,能明显减少术后静脉自控镇痛芬太尼的用量和不良反应。Objective To investigate the impact of acupuncture point injection of dezocine on the analgesic effect of fentanyl after total knee replacement. Method Sixty patients were randomized to observation and control groups. The observation group received injection of 5 mg dezocine into point Zusanli（ST36） ipsilateral to the operation and the control group, intravenous injection of 5 mg dezocine, at 15 min before surgery. Fentanyl was used for intravenous patient-controlled analgesia in both groups after surgery. The Visual Analogue Scale（VAS） score, the Ramsay Sedation Scale（RSS） score, cumulative fentanyl consumption and adverse fentanyl reactions were recorded in the two groups at 6, 12, 24 and 48 hrs after surgery. Result The VAS score and the RSS score were lower in the observation group than in the control group at 6 and 12 hrs after surgery（P0.05）. Cumulative fentanyl consumption was lower in the observation group than in the control group within 48 hrs after surgery（P0.05）. The postoperative occurrence rates of extubation agitation, nausea and vomiting, dizziness and somnolence were lower in the observation group than in the control group（P0.05）. Conclusion Acupuncture point injection of dezocine has a good analgesic effect in total knee replacement. It can significantly reduce the postoperative dosage of fentanyl for intravenous patient-controlled analgesia and adverse reactions.

关 键 词：针刺镇痛 水针 针药并用 地佐辛 芬太尼 预防性镇痛 全膝关节置换术 

分 类 号：R246.2[医药卫生—针灸推拿学]