经皮耳迷走神经刺激联合患者静脉自控镇痛对全膝关节置换术患者术后疼痛的影响  

Effect of transcutaneous auricular vagus nerve stimulation combined with patient-controlled intravenous analgesia on postoperative pain in patients with total knee arthroplasty

作　　者：黄豪逊 王行何 张妍 张瑾 李腾 王子恒 朱杨子 王立伟[2] HUANG Hao-xun;WANG Xing-he;ZHANG Yan;ZHANG Jin;LI Teng;WANG Zi-heng;ZHU Yang-zi;WANG Liwei(Xuzhou Central Hospital Postgraduate Training Base of Jinzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Anesthesiology Department,Xuzhou Central Hospital,Xuzhou 221000,Jiangsu Province;College of Anesthesia,Xuzhou Medical University,Xuzhou 221004,Jiangsu Province;Jiangsu Key Laboratory of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,Jiangsu Province)

机构地区：[1]锦州医科大学徐州市中心医院研究生培养基地,江苏徐州221000 [2]徐州市中心医院麻醉科,江苏徐州221000 [3]徐州医科大学麻醉学院,江苏徐州221004 [4]徐州医科大学江苏省麻醉学重点实验室,江苏徐州221004

出　　处：《针刺研究》2025年第2期190-196,共7页Acupuncture Research

基　　金：江苏省医学重点学科建设基金资助项目(No.JSDW202231);江苏省老年健康科研项目(No.LKZ2023016);徐州市彭城英才项目(No.XWRCSL20220135)。

摘　　要：目的:探索经皮耳迷走神经刺激(taVNS)联合患者自控静脉镇痛(PCIA)对全膝关节置换术(TKA)患者术后疼痛的影响。方法:选择拟行TKA的患者129例,随机分为taVNS组(70例,脱落5例)和假刺激组(70例,脱落6例)。taVNS组在左耳耳甲艇处进行taVNS联合PCIA治疗;假刺激组在左耳耳甲艇处进行假taVNS联合PCIA治疗。比较两组患者术后1~7 d疼痛时间加权均数(TWA)疼痛评分,术后1~7 d的疼痛视觉模拟量尺(VAS)评分,术后48 h内恶心、呕吐、皮肤瘙痒、嗜睡等不良反应的发生情况和镇痛泵按压次数,术前1 d、术后7 d的贝克焦虑量表(BAI)评分、贝克抑郁量表(BDI)评分、匹兹堡睡眠质量指数(PSQI)评分。结果:与假刺激组相比,taVNS组术后7 d的TWA疼痛评分显著降低(P<0.01);taVNS组在术后第3、4、5天VAS评分显著降低(P<0.001,P<0.01,P<0.05),术后第1、2、6、7天VAS评分差异无统计学意义;taVNS组术后48 h恶心发生率和镇痛泵按压次数显著降低(P<0.01)。两组治疗前后BDI,BAI,PSQI评分组间差异无统计学意义。与本组术前1 d相比,假刺激组和taVNS组术后7 d PSQI评分显著降低(P<0.01,P<0.001)。结论:taVNS联合PCIA可减轻TKA患者术后疼痛程度,降低术后恶心的发生率,降低术后阿片类药物用量。Objective To explore the effect of transcutaneous auricular vagus nerve stimulation(taVNS)combined with patient-controlled intravenous analgesia(PCIA)on postoperative pain in patients undergoing total knee arthroplasty(TKA).Methods A total of 140 patients with TKA were randomly divided into the taVNS group(n=70,with 5 dropped-out)and the sham stimulation group(n=70,with 6 dropped-out).The taVNS group received taVNS at the left ear conchae combined with PCIA treatment,while the sham stimulation group received sham taVNS at the left ear conchae combined with PCIA treatment.The time-weighted average(TWA)pain score,visual analogue scale(VAS)score of 1—7 days after surgery,the occurrence of adverse reactions such as nausea,vomiting,skin pruritus,drowsiness,respiratory depression,and the number of PCIA pump compressions within 48 hours after surgery were observed and compared between the 2 groups.The Beck Anxiety Inventory(BAI)scores,Bake Depression Inventory(BDI)scores,and Pittsburgh Sleep Quality Index(PSQI)scores were obtained on the day before surgery and 7 days after surgery.Results Compared with the sham stimulation group,the TWA pain score of the taVNS group was significantly decreased at the 7^(th)day postoperatively(P<0.01),and the VAS scores of the taVNS group were significantly lower than those of the sham stimulation group on postoperative days 3^(rd),4^(th),and 5^(th)(P<0.001,P<0.01,P<0.05),with no statistical significance in VAS scores on postoperative days 1^(st),2^(nd),6^(th),and 7^(th).Compared with the sham stimulation group,the incidence of nausea and the number of PCIA pump compressions within 48 hours after surgery in the taVNS group was significantly decreased(P<0.05).There was no statistical significance in the differences between the BDI,BAI,and PSQI scores before and after surgery in both groups.PSQI scores in the sham stimulation group and taVNS group were significantly lower than those in the same group 1 day before surgery(P<0.01,P<0.001).Conclusion The taVNS combined with PCIA can reduce

关 键 词：经皮耳迷走神经刺激 术后镇痛 患者静脉自控镇痛 全膝关节置换术 

分 类 号：R614[医药卫生—麻醉学]