电针对胸科手术后镇痛的临床研究

发布时间：2018-05-28 18:47

本文选题：镇痛 + 电针　；参考：《中国针灸》2017年07期

【摘要】：目的:探讨电针针刺"内麻点"与内关穴在胸科手术围术期镇痛的临床疗效及其作用机制。方法:选取择期行食管癌根治术全麻患者60例,按手术顺序分为观察组与对照组,每组30例。对照组单纯行全身麻醉处理,术后行舒芬太尼自控镇痛(PCIA);观察组在对照组基础上分别于麻醉诱导前30 min及术后予电针刺激"内麻点"及内关穴,连续波,强度以患者耐受为宜,分别刺激30 min。检测针刺前(T1),手术后2 h(T2)、12 h(T3)、24 h(T4)和48 h(T5)时间点两组患者血浆β-内啡肽(β-EP)、5-羟色胺(5-HT)和前列腺素E2(PGE_2)的含量。手术过程在脑电双频谱(BIS)保持同等状态下(50~60之间)记录术中麻醉药的用量。采用视觉模拟评分法(VAS)评估T2、T3、T4和T5时间点患者的疼痛程度,并记录各时间点疗效等级评定和安全等级评定。结果:(1)术中瑞芬太尼总用量观察组少于对照组[(1.83±0.56)mg vs(2.54±0.62)mg,P0.05]。(2)观察组患者在T2、T3、T4时间点VAS评分低于对照组(均P0.05)。(3)观察组血浆β-EP含量在T3、T4、T5时间点较对照组显著升高(均P0.05),血浆5-HT和PGE_2含量在T2、T3和T4时间点较对照组显著降低(均P0.05)。(4)观察组术后2 h、12 h、24 h镇痛优良率均高于对照组(均P0.05)。(5)观察组安全等级1级率高于对照组(P0.05)。结论:电针"内麻点"和内关穴能为胸部手术提供安全有效的术后镇痛,并可减少术中镇痛药用量,其机制可能与电针刺激能增加内源性β-EP产生和抑制炎性介质5-HT和PGE_2的释放有关。
[Abstract]:Objective: to investigate the clinical effect and mechanism of EA and Neiguan points in perioperative analgesia of thoracic surgery. Methods: 60 patients with esophageal cancer undergoing radical operation were divided into observation group and control group, 30 cases in each group. The control group was treated with general anesthesia only, the patient controlled analgesia was performed with sufentanil after operation, and the observation group was treated with electroacupuncture at 30 min before anesthesia induction and with electroacupuncture stimulation of "Nei Ma Dun" and Neiguan points after anesthesia induction. The continuous wave and intensity of the treatment group were suitable for patient tolerance. Stimulation for 30 mins respectively. The plasma levels of 尾 -endorphin (尾 -EPS-5-HT) and prostaglandin E _ 2-PGE _ (2) were measured at 2 h before acupuncture, 12 h after operation and 24 h T4 and 48 h T 5). The dosage of anesthetic during operation was recorded under the same condition of bispectral BISs. Visual analogue score (VASA) was used to evaluate the pain degree of patients with T2T3, T4 and T5, and to record the curative effect and safety grade of each time point. Results the total dose of remifentanil during operation in the observation group was less than that in the control group [1.83 卤0.56)mg vs(2.54 卤0.62mgg / g] (P0.05).) the VAS score of the patients in the observation group at T2T3T3 / T4 time point was lower than that in the control group (all P0.05%). The plasma 尾 -EP content in the observation group was significantly higher than that in the control group at T3T4T5 time point (all P0.05A, plasma 5-HT was significantly higher than that in the control group). The safety grade 1 rate of observation group was higher than that of control group (P 0.05). The analgesic excellent and good rate of observation group was higher than that of control group at 2 h ~ 12 h ~ 24 h after operation (all P 0.05%.) the safety grade 1 grade rate of observation group was higher than that of control group (P 0.05) at the time point of T _ 2T _ 3 and T _ 4. Conclusion: EA and Neiguan points can provide safe and effective postoperative analgesia for thoracic surgery, and reduce the dosage of painkillers during operation. The mechanism may be related to the increase of endogenous 尾 -EP production and inhibition of the release of 5-HT and PGE_2 by electroacupuncture stimulation.
【作者单位】：河南科技大学临床医学院河南科技大学第一附属医院;
【分类号】：R246.2

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