不同强度经皮穴位电刺激对胸腔镜术后镇痛疗效的影响  

Effects of transcutanclus electrical acupoint stimulation with different intensities on analgesia after thoracoscopic surgery

作　　者：冯吉杰 王珂 张雪慧 陈彤宇 周嘉[1] FENG Jijie;WANG Ke;ZHANG Xuehui;CHEN Tongyu;ZHOU Jia(Department of Cardiothoracic Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated toShanghai University of Traditional Chinese Medicine, Shanghai 200437, China;Department of Cardiothoracic Surgery, ShuguangHospital Affilicited to Shanghai University of Piaditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院心胸外科,上海200437 [2]上海中医药大学附属曙光医院心胸外科,上海201203

出　　处：《上海中医药大学学报》2019年第2期50-54,共5页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(81573796);上海市科委科研计划资助项目(16401932400);上海市促进市级医院临床技能与临床创新能力三年行动计划项目(16CR1031B)

摘　　要：目的:观察不同强度的经皮穴位电刺激(TEAS)对胸腔镜手术后患者的镇痛疗效。方法:纳入68例行胸腔镜手术治疗的肺脏疾病患者,随机分为低强度TEAS组、中强度TEAS组、高强度TEAS组和电针组,每组各17例。患者于术后48 h内分别应用低(5 mA)、中(12 mA)、高(26 mA)强度的TEAS或电针辅助镇痛。比较各组患者的术后疼痛程度、镇痛药物追加例数及围手术期内源性阿片肽水平的变化。结果:术后48 h、72 h,中强度TEAS组和电针组患者的疼痛程度均优于高强度TEAS组(P<0.01)。术后72 h内,中强度TEAS组和电针组追加镇痛药物的例数明显少于高强度TEAS组(P<0.05)。术后48 h,中强度TEAS组和电针组患者的血浆β-内啡肽、脑啡肽水平均较治疗前升高(P<0.05,P<0.01),低强度TEAS组患者的血浆脑啡肽水平较治疗前亦升高(P<0.05);中强度TEAS组和电针组患者的血浆β-内啡肽水平高于低强度TEAS组和高强度TEAS组(P<0.05,P<0.01)。结论:中强度TEAS能够有效改善胸腔镜手术患者的术后疼痛,其作用优于低强度和高强度TEAS,与电针的镇痛效应和机制相似,值得临床推广。Objective: To observe the analgesic efficacy of transcutanclus electrical acupoint stimulation(TEAS) with different intensities on the patients after thoracoscopic surgery. Methods: Sixty-eight participants with lung diseases who underwent the thoracoscopic surgery were included and randomly divided into the TEAS group with low-intensity(referred to as "L-TEAS group"),TEAS group with middle-intensity(referred to as "M-TEAS group"),TEAS group with high-intensity(referred to as "H-TEAS group") and electroacupuncture group(referred to as "EA group"),17 cases in each group. The patients in different groups were treated with TEAS at low-(5 mA),middle-(12 mA) and high-(26 mA) intensities or EA stimulation respectively in the following 48 hours after the surgery. The postoperative pain,the number of the cases who accepted additional analgesic drugs and the plasma levels of endogenous opioid peptides in the perioperative period were compared. Results: At 48 h and 72 h after surgery,the pain degree in the M-TEAS group and EA group was beter than that in the H-TEAS group(P<0.01). During the 72 hours following surgery,the number of the cases who accepted additional analgesic drugs in the M-TEAS group and EA group was significantly less than that in the H-TEAS group(P<0.05). At 48 h after surgery,the plasma levels of β-endorphin and enkephalin were increased in M-TEAS group and EA group(P<0.05,P<0.01),and the plasma level of enkephalin was also increased in the L-TEAS group( P<0.05);the plasma level of β-endorphin in the M-TEAS group and EA group was higher than that in the L-TEAS group and H-TEAS group( P<0.05,P<0.01). Conclusion: Meddle-intensity TEAS can effectively improve the postoperative pain in patients undergoing thoracoscopic surgery. Its effect is better than that of the low-and highintensity TEAS,and its analgesic effect and mechanism are similar to electroacupuncture,which is worth popularizing in clinic.

关 键 词：经皮穴位电刺激 不同强度 胸腔镜 肺部手术 术后疼痛 

分 类 号：R246.2[医药卫生—针灸推拿学]