经皮穴位电刺激用于前交叉韧带重建患者辅助镇痛效果的临床观察

Clinical observation on the assistant analgesic effect of transcutanclus electrical acupoint stimulation in patients with anterior cruciate ligament reconstruction

关键词:  前交叉韧带重建  多模式镇痛  经皮穴位电刺激

Key words:  anterior cruciate ligament reconstruction  multimodal analgesia  transcutanclus electrical acupoint stimulation

摘要:

[目的] 观察经皮穴位电刺激（TEAS）能否增强神经阻滞及药物对前交叉韧带重建患者术后疼痛的镇痛效果。[方法] 选择拟行前交叉韧带手术的患者60例，美国麻醉医师协会分级（ASA）Ⅰ-Ⅱ级，随机分为TEAS组和非TEAS组，两组患者均在腰麻下行手术治疗，镇痛方案：麻醉成功后行收肌管阻滞，手术结束时静脉注射帕瑞昔布钠；TEAS组患者术后6 h及术后第1、2天于双侧合谷、太冲、下巨虚、三阴交实施TEAS；非TEAS组患者选取与TEAS组同样的穴位，仅在相应区域放置电极片，不通电；术后疼痛控制不佳时给予曲马多100 mg口服补救镇痛。记录两组患者术前、术后4、6、8、12、24、48 h的静息疼痛视觉模拟评分（VAS），术后曲马多用量，术后恶心、呕吐发生情况，同时记录两组患者睡眠质量满意度评分及总体满意度评分。[结果] TEAS组术后8、12、24、48 h VAS评分低于非TEAS组，差异具有统计学意义（P<0.05），而术前及术后4、6 h的两组间VAS评分差异无统计学意义（P>0.05）。与非TEAS组相比，TEAS组患者术后曲马多使用减少（P<0.05），恶心、呕吐的发生率降低（P<0.05）。TEAS组患者术后24 h及48 h睡眠质量满意度评分及就诊总体满意度评分优于非TEAS组，差异具有统计学意义（P<0.05）。[结论] TEAS用于辅助膝关节镜前交叉韧带患者术后镇痛，可有效降低术后镇痛评分，减少曲马多用量，减少患者术后恶心呕吐不良反应的发生，提高患者睡眠质量及术后总体满意度。

Abstract:

[Objective] To observe whether transcutanclus electrical acupoint stimulation (TEAS) can enhance the analgesic effect of nerve block and drugs on postoperative pain of patients with anterior cruciate ligament reconstruction.[Methods] Sixty patients,ASA Ⅰ-Ⅱ grade,who were to undergo anterior cruciate ligament surgery were randomly divided into TEAS group (Group A) and non-TEAS group (Group B). The two groups were operated under spinal anesthesia. The analgesic scheme:adductor canal block after successful anesthesia,intravenous injection of parecoxib sodium at the end of the operation. Patients in group A were treated with TEAS at bilateral Hegu,Taichong,Xiajuxu and Sanyinjiao at 6 h after operation,and on the first and second days after operation. Patients in group B selected the same acupoints as those in group A,and only placed electrode sheets in the corresponding areas without electricity. Tramadol (100 mg) was given for remedial analgesia when postoperative pain control was poor. The visual analogue scale (VAS) of resting pain,postoperative tramadol dosage,postoperative nausea and vomiting,sleep quality satisfaction score and overall satisfaction score of two groups were recorded before and after surgery at 4,6,8,12,24 and 48 h.[Results] The VAS scores of group A at 8,12,24 and 48 h after operation were lower than those of group B (P<0.05),but there was no significant difference in VAS scores between two groups before operation and at 4 h and 6 h after operation (P>0.05). Compared with group B,patients in group A used less tramadol after operation (P<0.05),and the incidence of nausea and vomiting decreased (P<0.05). Patients in group A were better than those in group B in their sleep quality satisfaction scores and overall satisfaction scores at 24 h and 48 h after operation (P<0.05).[Conclusion] TEAS is used to assist the postoperative analgesia of patients with anterior cruciate ligament under knee arthroscope,which can effectively reduce the postoperative analgesia score,reduce the amount of tramadol,reduce the incidence of postoperative nausea and vomiting,and improve the sleep quality and overall satisfaction of patients after surgery.