文章摘要
经皮穴位电刺激对全膝关节置换术后老年患者自控静脉镇痛效果的影响
Effect of percutaneous acupoint electrical stimulation on patient-controlled intravenous analgesia in elderly patients after total knee arthroplasty
  
DOI：10.12089/jca.2019.03.008
中文关键词: 经皮穴位电刺激  术后镇痛  全膝关节置换术  老年患者
英文关键词: Percutaneous acupoint electrical stimulation  Postoperative analgesia  Total knee arthroplasty  Aged
基金项目:国家自然科学基金（81471106）；湖南省自然科学基金（2017JJ3445）
作者单位E-mail
张鹏辉 050051,石家庄市,河北医科大学第三医院麻醉科  
刘朋 050051,石家庄市,河北医科大学第三医院麻醉科  
李惠洲 050051,石家庄市,河北医科大学第三医院麻醉科  
王明洁 050051,石家庄市,河北医科大学第三医院麻醉科  
赵爽 050051,石家庄市,河北医科大学第三医院麻醉科  
李昭 050051,石家庄市,河北医科大学第三医院麻醉科  
刘欣 050051,石家庄市,河北医科大学第三医院麻醉科  
王秀丽 050051,石家庄市,河北医科大学第三医院麻醉科 wangxl301@aliyun.com 
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中文摘要:
      
目的 观察经皮穴位电刺激(percutaneous acupoint electrical stimulation, TEAS)对全膝关节置换术(total knee arthroplasty, TKA)后老年患者自控静脉镇痛效果的影响。
方法 选择2017年8月至2018年1月择期行单侧TKA的老年患者80例，男25例，女55例，年龄65~75岁，BMI 18~32 kg/m2，ASAⅡ或Ⅲ级。采用随机数字表法分为TEAS组（T组）和对照组（C组），每组40例。T组麻醉诱导前30 min于双侧合谷穴和内关穴行TEAS至手术结束，频率为2～100 Hz的疏密波,电流强度为患者能够耐受有较强震颤感但无刺痛的强度（约6~10 mA）；C组在相同穴位上贴电极片并连接治疗仪但不做电刺激。两组患者术后均采用舒芬太尼静脉自控镇痛。观察两组患者术后1、6、24、48 h 静息和活动时的疼痛视觉模拟评分(VAS 评分)，术后48 h镇痛方案满意度评分，镇痛泵舒芬太尼用量和恶心、呕吐、瘙痒、呼吸抑制等不良反应的发生情况。
结果 与C组比较，T组术后6 h静息时VSA评分明显降低（P<0.05），术后1、6 h活动时VAS评分明显降低（P<0.05）；T组术后6、24、48 h舒芬太尼累计用量明显减少（P<0.05）；T组术后恶心、呕吐等不良反应的发生率明显降低（P<0.05）；两组术后48 h满意度评分差异无统计学意义。
结论 术中行径皮穴位电刺激可减轻全膝关节置换术后老年患者疼痛程度，减少术后患者自控静脉镇痛阿片类药物用量，降低术后恶心、呕吐的发生率。
英文摘要:
      
Objective To observe the analgesic effect of transcutaneous electrical acupoint stimulation (TEAS) on patient-controlled intravenous analgesia after total knee arthroplasty.
Methods From August 2017 to January 2018, eighty elderly patients of the elective TKA, including 25 males and 45 females, aged 65 - 75 years, ASA physical status Ⅱ or Ⅲ, were randomly divided into 2 groups using random number table (n=40): TEAS group (group T) and control group (group C). The patients in group T received TEAS (disperse-dense waves, frequency 2-100Hz) at the points of PC6 (Neiguan) and LI4 (Hegu) from 30 minutes before anesthesia induction to the end of surgery. The optimal intensity was 6 - 10 mA that patients can tolerate with strong tremor but no tingling . The patients in group C received electrode plate at the same acupoints without any electrical stimulation. The patients in both groups were treated with sufentanil for postoperative patient-controlled analgesia. The primary outcomes included resting and activity pain intensity evaluated by visual analog scale（VAS）at 1, 6, 24, and 48 hours after surgery. Secondary outcomes included the satisfaction score of analgesic scheme at 48 hours after surgery, the cumulative dosage of sufentanil in analgesic pump， and the occurrence of adverse reactions such as nausea, vomiting, pruritus, respiratory depression, etc.
Results Compared with group C, the resting VAS score at 6 hours after operation and the activity VAS score at 1 hour and 6 hours after operation were significantly lower (P < 0.05) , the cumulative consumption of sufentanil at 6 hours, 24 hours and 48 hours after operation decreased significantly (P < 0.05) and the occurrence of adverse reactions such as nausea and vomiting were lower in group T (P < 0.05). There was no significant difference in the satisfaction score between the two groups.
Conclusion TEAS can reduce the pain degree of the elderly patients after total knee arthroplasty, the amount of opioid analgesic drugs in patient-controlled intravenous analgesia, and the incidence of postoperative nausea and vomiting.
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