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| 颊针疗法对腹腔镜胆囊切除术患者术后肩痛的影响 |
| Effect of buccal acupuncture on post-laparoscopic shoulder pain in patients undergoing laparoscopic cholecystectomy |
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| DOI：10.12089/jca.2026.04.005 |
| 中文关键词: 颊针 围术期 腹腔镜胆囊切除术 术后肩痛 |
| 英文关键词: Buccal acupuncture Perioperative period Laparoscopic cholecystectomy Post-laparoscopic shoulder pain |
| 基金项目:国家自然科学基金青年项目（82405520）；江苏省中医药科技发展计划项目（MS2022057）；无锡市卫生健康委科技成果与适宜技术推广项目（T202304） |
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| 中文摘要: |
目的： 探讨术前行颊针疗法对腹腔镜胆囊切除术患者术后肩痛的影响。
方法： 选择行腹腔镜胆囊切除术患者，年龄18～70岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：颊针组和对照组。颊针组于麻醉诱导前行颊针干预（双侧头穴、颈穴、肩胛带穴、肩穴、上焦穴、中焦穴、下焦穴），留针40 min；对照组未行颊针干预。两组麻醉诱导及维持方案一致。主要指标为术后48 h内肩痛的发生率。次要指标包括术中丙泊酚、瑞芬太尼用量，术后4、8、12、24及48 h的VAS疼痛评分，术后48 h内镇痛泵总按压次数、有效按压次数及补救镇痛率，术后肩痛持续时间大于12 h的发生率，麻醉诱导前、术毕即刻及术后24 h的PaCO2以及血清炎性因子IL-6、TNF-α浓度。术后不良反应包括术后恶心、呕吐、头晕、腹胀。
结果： 共纳入患者126例，每组63例。与对照组比较，颊针组术中丙泊酚、瑞芬太尼用量明显降低，术后4、8、12及24 h的VAS疼痛评分明显降低，镇痛泵总按压次数、有效按压次数及补救镇痛率明显降低，术后48 h肩痛和疼痛持续时间大于12 h的发生率明显降低，术毕即刻PaCO2明显降低，术毕即刻、术后24 h血清炎性因子IL-6、TNF-α浓度明显降低，术后恶心、呕吐发生率明显降低（P＜0.05）。
结论： 在腹腔镜胆囊手术麻醉诱导前行颊针疗法可以减少术中丙泊酚、瑞芬太尼用量，降低术后肩痛发生率，提高术后镇痛质量，有利于患者术后康复。 |
| 英文摘要: |
Objective: To investigate the effect of preoperative buccal acupuncture intervention on postoperative shoulder pain in patients undergoing laparoscopic cholecystectomy.
Methods: Patients aged 18-70 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled for laparoscopic cholecystectomy were enrolled. Patients were randomly divided into two groups using a random number table: buccal acupuncture group and control group. Patients in the buccal acupuncture group received buccal acupuncture intervention before anesthesia induction, including bilateral head, neck, shoulder girdle, shoulder, Shangjiao, Zhongjiao, and Xiajiao points, with needle retention for 40 minutes. Patients in the control group received no buccal acupuncture. Anesthesia induction and maintenance protocols were identical in both groups. The primary outcome was the incidence of shoulder pain within 48 hours postoperatively. The secondary outcomes included intraoperative dosages of propofol and remifentanil; VAS pain scores at 4, 8, 12, 24, and 48 hours postoperatively; total and effective pressing times of the analgesic pump, as well as the rescue analgesia rate within 48 hours postoperatively; the incidence of shoulder pain and shoulder pain lasting more than 12 hours postoperatively; PaCO2 levels, and serum concentrations of inflammatory factors IL-6 and TNF-α before anesthesia induction, immediately after surgery, and at 24 hours postoperatively. Postoperative adverse reactions included nausea, vomiting, dizziness, and abdominal distension.
Results: A total of 126 patients were included, 63 patients in each group. Compared with the control group, the buccal acupuncture group showed significantly reduced intraoperative dosages of propofol and remifentaniel, lower VAS pain scores at 4, 8, 12, and 24 hours postoperatively, fewer total and effective analgesic pump pressings, reduced rate of rescue analgesia, fewer patients with shoulder pain at 48 hours and pain duration longer than 12 hours, significantly lower PaCO2 immediately after surgery, significantly lower serum IL-6 and TNF-α levels immediately after surgery and at 24 hours postoperatively, and a lower incidence of nausea and vomiting (P < 0.05).
Conclusion: Preoperative buccal acupuncture intervention before anesthesia induction in laparoscopic cholecystectomy can reduce intraoperative propofol and remifentaniel consumption, decrease the incidence of postoperative shoulder pain, improve the quality of postoperative analgesia, and facilitate postoperative rehabilitation. |
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