电针疗法联合连续收肌管阻滞在全膝关节置换术患者术后镇痛中的应用  

Electroacupuncture combined with continuous adductor canal block for postoperative analgesia in patients undergoing total knee arthroplasty

作　　者：向继林 张宇[1] 吴佳[2] 税云华 诸源江[1] XIANG Jilin;ZHANG Yu;WU Jia;SHUI Yunhua;ZHU Yuanjiang(Anesthesiology Department,Sichuan Orthopedic Hospital,Chengdu 610041,China;Rheumatology and Osteoarthritis Department,Sichuan Orthopedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院麻醉科,成都610041 [2]四川省骨科医院风湿骨关节病科,成都610041

出　　处：《中国针灸》2024年第1期57-61,共5页Chinese Acupuncture & Moxibustion

基　　金：中国初级卫生保健基金会临床应用研究与医学培训公益项目:S020220801CD。

摘　　要：目的:观察电针疗法联合连续收肌管阻滞(CACB)在全膝关节置换术(TKA)患者术后镇痛中的应用效果及对患者疼痛因子水平的影响。方法:将82例接受单侧TKA治疗的膝关节骨关节炎患者随机分为观察组和对照组,每组41例。对照组患者于手术结束气管导管拔出后接受患侧超声引导下的CACB,观察组在对照组基础上于术后1~7 d行电针疗法,穴取患侧合谷、足三里、太冲、太溪、阴陵泉、阳陵泉,合谷与足三里、太冲与太溪、阴陵泉与阳陵泉接电针仪,疏密波,1 Hz/30 Hz,每次30 min,每天1次。比较两组患者术前,术后1、3、7、14 d膝关节活动度;术后6、12、24、48 h疼痛视觉模拟量表(VAS)评分;术后48 h内镇痛泵按压次数和补救镇痛次数;术前,术后6、12、24、48 h患者血清前列腺素E2 (PGE2)、β-内啡肽(β-EP)水平。记录患者术后48 h内不良反应发生率。结果:术后1、3、7 d,观察组患者膝关节活动度大于对照组(P<0.05);术后6、12、24、48 h,观察组患者静息、活动状态下VAS评分均低于对照组(P<0.05);观察组术后48 h内镇痛泵按压次数、补救镇痛次数少于对照组(P<0.05);术后6、12、24 h,观察组血清PGE2水平低于对照组(P<0.05),血清β-EP水平高于对照组(P<0.05)。术后48 h内,两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:电针疗法可提高CACB在TKA患者中的镇痛效果,可能通过抑制PGE2生成、促进β-EP合成发挥镇痛作用,且安全性较高。Objective To observe the efficacy of electroacupuncture(EA)combined with continuous adductor canal block(CACB)for postoperative analgesia in patients undergoing total knee arthroplasty(TKA),and to explore its effect on pain factor levels.Methods Eighty-two patients with knee osteoarthritis undergoing unilateral TKA were randomly divided into an observation group and a control group,with 41 patients in each group.The patients in the control group were treated with CACB under ultrasound guidance on the affected side after removal of the endotracheal tube.In the observation group,electroacupuncture therapy was added on day 1-7 after operation;the acupoints included Hegu(LI 4),Zusanli(ST 36),Taichong(LR 3),Taixi(KI 3),Yinlingquan(SP 9)and Yanglingquan(GB 34),with disperse-dense wave,in frequency of 1 Hz/30 Hz,30 min each session,once a day.The knee joint range of motion was compared between the two groups before operation and on postoperative day 1,3,7,and 14.The pain visual analog scale(VAS)scores were compared 6,12,24,and 48 h after operation.The number of times that the pain pump was pressed within 48 h after operation and the number of remedial analgesia were also compared.Serum levels of prostaglandin E2(PGE2)andβ-endorphin(β-EP)were measured preoperatively and at 6,12,24,and 48 h after operation.Adverse reaction rates within 48 h after operation were documented.Results On postoperative day 1,3,and 7,the observation group exhibited greater knee joint range of motion than that in the control group(P<0.05).At 6,12,24,and 48 h after operation,VAS scores at rest and during activity in the observation group were lower than those in the control group(P<0.05).The observation group had lower numbers of pain pump use and remedial analgesia within 48 h after operation than those in the control group(P<0.05).Serum PGE2 levels were lower in the observation group at 6,12,and 24 h after operation(P<0.05),while serumβ-EP levels were higher(P<0.05)than those in the control group.There was no statistical difference in the inc

关 键 词：全膝关节置换术 连续收肌管阻滞 电针疗法 镇痛 疼痛因子 

分 类 号：R246.9[医药卫生—针灸推拿学]