巨刺电针联合超前镇痛治疗初次单膝人工关节置换后疼痛  

Opposing needling acupuncture combined with preemptive analgesia in treatment of pain after initial unilateral total knee arthroplasty

作　　者：许明岚 胡小雪 沈军 向峥 张成波 肖涟波 Xu Minglan;Hu Xiaoxue;Shen Jun;Xiang Zheng;Zhang Chengbo;Xiao Lianbo(Department of Anesthesiology,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Department of Orthopedics Surgery,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Institute of Arthritis Research in Integrated Medicine,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200052,China)

机构地区：[1]上海中医药大学附属光华医院麻醉科,上海市200052 [2]上海中医药大学附属光华医院关节外科,上海市200052 [3]上海市中医药研究院中西医结合关节炎研究所,上海市200052

出　　处：《中国组织工程研究》2025年第21期4529-4536,共8页Chinese Journal of Tissue Engineering Research

基　　金：上海市科学技术委员会自然科学基金项目/面上项目(22ZR1453000),项目负责人:沈军;上海市科学技术委员会医学创新研究专项面上项目(22Y11923200),项目负责人:沈军;上海市科学技术委员会医学创新研究专项面上项目(21Y11921500),项目负责人:肖涟波;上海市卫生健康委员会、上海市中医药管理局中医药标准化项目(2023JS03),项目负责人:肖涟波;上海市长宁区卫生健康委员会科研项目(20214Y020),项目负责人:许明岚。

摘　　要：背景:随着人工生物材料和手术技术的不断更新进步,人工膝关节置换已成为改善膝骨关节炎患者生活质量的首选方式。但是人工膝关节置换后疼痛剧烈,目前尚无较好的治疗措施。电针治疗是缓解疼痛的低成本选择,结合超前镇痛具有广泛应用前景。目的:观察巨刺电针联合超前镇痛对膝骨关节炎患者初次行单侧人工膝关节置换后镇痛效果的影响。方法:采用随机对照设计,选择上海市光华中西医结合医院初次行单膝人工关节置换患者120例为研究对象,采用统计软件SPSS 25随机分为3组:超前电针组、术后电针组和假电针组,每组40例。超前电针组在术前1 d、麻醉诱导前30 min、术后1-3 d进行巨刺法电针治疗;术后电针组在术后1-3 d进行相同取穴和参数的治疗,术前1 d、麻醉诱导前30 min行假电针治疗;假电针组取相同穴位参数的5次假电针治疗。比较3组术后患者数字疼痛评分较术前改善情况、术中瑞芬太尼和丙泊酚使用量、患者术后首次使用静脉自控镇痛的时间、术后恶心呕吐例数、术后术侧大腿周径增加率和电针实施盲法成功率。结果与结论:(1)与超前电针组比较,术后第4天术后电针组和假电针组静息数字疼痛评分差值明显降低,术后第7天假电针组静息数字疼痛评分差值明显降低(P<0.05);(2)与超前电针组比较,术后第4天术后电针组和假电针组运动数字疼痛评分差值明显降低(P<0.05),术后第7天3组运动数字疼痛评分差值无显著性意义(P>0.05);(3)与超前电针组比较,术后电针组和假电针组术中瑞芬太尼用量明显增加(P<0.05);(4)与超前电针组比较,术后电针组和假电针组术后首次使用静脉镇痛泵自控镇痛的时间明显缩短(P<0.05);(5)与超前电针组比较,术后电针组和假电针组术后恶心例数明显增加(P<0.05);(6)与超前电针组比较,术后第3,7天术后电针组和假电针组大腿周径增加率�BACKGROUND:With the continuous improvement of artificial biological materials and surgical techniques,total knee arthroplasty has become the preferred way to improve the quality of life of patients with knee osteoarthritis.However,patients with knee osteoarthritis have severe pain after knee arthroplasty,and there is no good treatment at present.Electroacupuncture therapy is a low-cost option for pain relief and has wide application prospects in combination with preemptive analgesia.OBJECTIVE:To investigate the effect of opposing needling acupuncture with preemptive analgesia on postoperative analgesia after initial unilateral total knee arthroplasty in patients with knee osteoarthritis.METHODS:Using a randomized controlled design,120 participants were selected from Shanghai Guanghua Hospital of Integrative Medicine.All of them received the initial unilateral total knee arthroplasty.The patients were divided into three groups by using the statistical software SPSS 25:pre-electroacupuncture group,post-electroacupuncture group,and sham group,with 40 patients in each group.In pre-electroacupuncture group,opposing needling acupuncture was performed 1 day before operation,30 minutes before anesthesia induction,and 1-3 days after operation.In post-electroacupuncture group,opposing needling acupuncture was performed with the same acupoints and parameters 1-3 days after operation,thus the sham electroacupuncture was performed 1 day before operation and 30 minutes before anesthesia induction.The sham group was treated with the same acupuncture point parameters with five times of sham electroacupuncture.The improvement of numerical rating scale after operation,the consumption of remifentanil and propofol used during operation,the time when patient first used the patient-controlled analgesia,the number of postoperative nausea and vomiting,the increase rate of thigh circumference,and the success rate of blind method were compared among the three groups.RESULTS AND CONCLUSION:(1)Compared with the pre-electroacupuncture group,

关 键 词：超前镇痛 巨刺电针 人工膝关节置换 骨关节炎 术后急性疼痛 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687