耳穴疗法在小儿骨科截骨手术后多模式镇痛中的应用研究  

Application of auricular acupoint therapy after multimodal postoperative analgesia for lower extremity osteotomy in children

作　　者：梁明超 肖婷 李海霞 杜真 汤可香 屈双权 Liang Mingchao;Xiao Ting;Li Haixia;Du Zhen;Tang Kexiang;Qu Shuangquan(Department of Anesthesia&Surgery,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)麻醉手术科,长沙410007

出　　处：《临床小儿外科杂志》2024年第12期1174-1179,共6页Journal of Clinical Pediatric Surgery

基　　金：湖南省科技厅临床技术创新引导计划项目(2021SK50508)。

摘　　要：目的本研究旨在评估耳穴疗法联合舒芬太尼在小儿下肢截骨矫形手术后多模式镇痛中的应用效果,为耳穴疗法在小儿术后镇痛中的应用提供临床证据。方法本研究为前瞻性随机对照研究。以2022年6月至2022年12月在湖南省儿童医院行下肢截骨矫形手术的学龄期患儿为研究对象,年龄6~12岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级。根据随机数字表法将患儿分为耳穴治疗治疗组(E组)和对照组(C组),每组各50例。两组均于手术结束后予常规舒芬太尼静脉自控镇痛治疗;E组于手术结束前行双耳耳穴压豆,术后按压耳穴(每日按压3次,每个穴位每次按压20~30下);C组手术结束前用耳穴胶布分别贴敷双耳耳穴,但不压豆、不按压耳穴。记录两组术后2 h(T_(0))、6 h(T_(1))、12 h(T_(2))、24 h(T_(3))、48 h(T_(4))的东大略儿童医院疼痛评分(Children’s Hospital of Eastern Ontario Pain Scale,CHEOPS)、术后48 h自控镇痛(patient control analgesia,PCA)按压次数以及布洛芬补救镇痛情况;于手术结束前10 min、术后48 h采集静脉血,检测血清C反应蛋白(C-reactive protein,CRP)和β-内啡肽(beta-endorphin,β-EP)浓度;观察患儿术后呼吸抑制、恶心呕吐、皮肤瘙痒发生情况。结果共97例(E组48例、C组49例)患儿完成本研究。两组患儿年龄、性别等一般资料差异无统计学意义(P>0.05)。两组患儿静息及运动CHEOPS疼痛评分在T_(0)时间点分别为(3.48±0.77)分、(3.63±0.79)分和(3.69±0.77)、(3.82±0.78)分;T_(1)时间点分别为(3.58±0.77)分、(4.27±0.82)分和(3.73±0.64)分、(4.16±0.77)分;T_(2)时间点分别为(4.25±0.79)分、(4.44±0.77)分和(6.35±1.03)分、(6.43±1.04)分;T_(3)时间点分别为(4.38±0.84)分、(4.58±0.90)分和(5.84±0.77)分、(4.58±0.90)分;T_(4)时间点分别为(5.19±0.70)分、(5.58±0.65)分和(5.63±1.03)分、(5.84±0.96)分;其中T_(2)和T_(3)时间点的静息及运动时疼痛评�Objective To evaluate the efficacy of auricular acupressure plus sufentanil after multimodal postoperative analgesia for lower extremity osteotomy in children and provide clinical evidence for its application in postoperative pain management.Methods For this prospective randomized controlled study,100 children aged 6-12 years with ASA physical status gradeⅠ-Ⅱundergoing elective lower extremity osteotomy were selected.They were randomized into two groups of auricular point(E group)and control(C group)(n=50 each).Both groups received conventional sufentanil intravenous patient-controlled analgesia(IV-PCA)after surgery.In E group,auricular bean pressing before the end of operation and pressed auricle after operation were performed.In C group,auricular taping of both ears before the end of operation and there was no pressing of bean or auricle.Children’s Hospital of Eastern Ontario Pain Scale(CHEOPS)scores at 2 h(T_(0)),6 h(T_(1)),12 h(T_(2)),24 h(T_(3))and 48 h(T_(4))post-operation were recorded in both groups.Number of PCA presses and use of ibuprofen for remedial analgesia were recorded at 48h post-operation.Venous blood was collected at the time of skin suture and 48h post-operation for detecting the serum concentrations of C-reactive protein(CRP)and beta-endorphin(β-EP).The postoperative occurrences of respiratory depression,nausea&vomiting and skin pruritus were observed.Results A total of 97 children(E group 48,C group 49)successfully completed this study.No significant inter-group difference existed in general profiles.The resting and movement CHEOPS pain scores for two groups at T_(0) were(3.48±0.77),(3.63±0.79)and(3.69±0.77),(3.82±0.78)points;At T_(1),(3.58±0.77),(4.27±0.82)and(3.73±0.64),(4.16±0.77)points;At T_(2),(4.25±0.79),(4.44±0.77)and(6.35±1.03),(6.43±1.04)points.At T_(3),(4.38±0.84),(4.58±0.90)and(5.84±0.77),(4.58±0.90)points;At T_(4),(5.19±0.70),(5.58±0.65)and(5.63±1.03),(5.84±0.96)points.Statistically significant inter-group differences existed in resting and movement pa

关 键 词：耳穴疗法 镇痛 疼痛管理 截骨术 下肢 儿童 

分 类 号：R24[医药卫生—中医临床基础]