电针在全膝关节置换术后镇痛的临床疗效分析  

Electroacupuncture Intervention Reduces Post-surgical Pain of Patients Undergoing Total Knee Arthroplasty

作　　者：陈达[1] 盛东 徐景利 张泱悦[4] 林天烨 张庆文[1] CHEN Da;SHENG Dong;XU Jing-li;ZHANG Yang-yue;LIN Tian-ye;ZHANG Qing-wen(Department of Ortho-paedic Surgery,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510405,China;Department of Orthopaedic Surgery,Chongqing Orthopaedic Hospital of Traditional Chinese Medicine,Chongqing 400012;Graduate School,the First Clinical Medical College of Guangzhou University of Traditional Chinese Medicine,Guangzhou 51040;Department of Stomatology,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510405)

机构地区：[1]广州中医药大学第一附属医院骨科,广州510405 [2]重庆市中医骨科医院骨科,重庆400012 [3]广州中医药大学第一临床医学院研究生院,广州510405 [4]广州中医药大学第一附属医院口腔科,广州510405

出　　处：《针刺研究》2018年第10期616-621,共6页Acupuncture Research

基　　金：广东省科技计划项目(No.2014A020212556)

摘　　要：目的:观察电针疗法对全膝关节置换术(TKA)后镇痛的有效性与安全性。方法:将40例重度膝关节骨性关节炎患者,按随机数字表法分为电针组(电针结合多模式镇痛)和对照组(单纯多模式镇痛),每组20例。术中两组患者均采用硬膜外麻醉,术后两组患者常规硬膜外自控式镇痛及口服塞来昔布止痛,电针组辅助针刺止痛。穴位选取为术侧梁丘、血海、阴陵泉、足三里、丰隆及丘墟穴,针刺疗程为术后第1天至第7天,1次/日,每次30min。记录患者术后静息及活动状态疼痛视觉模拟量尺(VAS)评分、膝关节主动及被动活动度、止痛药使用情况及其他并发症等。结果:电针组术后第3、5、7天患者静息及活动状态VAS评分均明显低于对照组,差异具有统计学意义(P<0.05)。电针组与对照组比较,在改善膝关节活动度方面差异无统计学意义(P>0.05)。电针组患者按压镇痛泵次数少于对照组,差异具有统计学意义(P<0.05)。电针组出现头晕头痛、恶心呕吐等并发症及术后额外止痛药物的使用均低于对照组,但差异无统计学意义(P>0.05)。两组术后感染风险监测指标比较,差异无统计学意义(P>0.05)。结论:电针能有效改善TKA术后早期疼痛,并有可能减少TKA术后并发症的发生率及止痛药物的使用。Objective To observe the analgesic effect and safety of electroacupuncture（EA）intervention for patients undergoing total knee arthroplasty（TKA）.Methods A total of 40 patients undergoing TKA were randomly assigned to control group（simple multi-mode analgesia,n=20）and EA group（EA combined with multi-mode analgesia,n=20）.Both groups were treated with epidural anesthesia during surgical operation,and conventional epidural automatic analgesia and oral Celecoxib after surgery.Following surgery,EA was applied to Liangqiu（ST 34）-Xuehai（SP 10）,Yinlingquan（SP 9）-Zusanli（ST 36）,Fenglong（ST 40）-Qiuxu（GB 40）on the operation side for 30 min,once daily for 7 consecutive days.The patients＇ pain state during rest and motion was assessed by using visual analogue scale（VAS）.The active and passive knee flexion range of motion（ROM）,use of painkillers including the number of patient＇s controlled epidural analgesia（PCEA）during 48 hafter surgery,and other complications were recorded.Results After the treatment,the VAS scores under rest and motion state were both significantly lower in the EA group than in the control group on day 3,5 and 7 after surgery（P〈0.05）.During 48 hafter surgery,the number of PECA was significantly lower in the EA group than in the control group（P〈0.05）.Of the two 20 cases in the control and EA groups,3 and 1 asked to receive muscular injection of Tramadol Hydrochloride for pain relief,3 and 2 experienced nausea-vomiting,2 and 1 had dizziness and headache,and 2 and 1 had a chest distress feeling,respectively,which had no significant differences between the two groups（P〈0.05）.The white blood cell（WBC）count in both groups were decreased gradually from day 1 to 7 after surgery,and plasma C-reactive protein content on day 5 and 7 were also lowered in both groups,without statistical differences between the two groups in the post-operative complications,dosages of additional postoperative analgesic drugs,and levels of plasma WBC and C-reactiv

关 键 词：电针镇痛 全膝关节置换术 术后疼痛 药物 术后并发症 

分 类 号：R246.2[医药卫生—针灸推拿学]