Department of Endocrinology and Metabolism, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Heidelberg School of Chinese Medicine, Karlsruher Straße 12, 69126 Heidelberg, Germany ; ICBAS, University of Porto, Rua de Jorge Viterbo Ferreira No. 228, 4050-313 Porto, Portugal.
Evid Based Complement Alternat Med. 2013;2013:219817. doi: 10.1155/2013/219817. Epub 2013 Mar 14.
Rationale. Poststernotomy pain and impaired breathing are common clinical problems in early postoperative care following heart surgery. Insufficiently treated pain increases the risk of pulmonary complications. High-dose opioids are used for pain management, but they may cause side effects such as respiratory depression. Study Design. We performed a prospective, randomized, controlled, observer-blinded, three-armed clinical trial with 100 patients. Group 1 (n = 33) and Group 2 (n = 34) received one 20 min session of standardized acupuncture treatment with two different sets of acupoints. Group 3 (n = 33) served as standard analgesia control without additional intervention. Results. Primary endpoint analysis revealed a statistically significant analgesic effect for both acupuncture treatments. Group 1 showed a mean percentile pain reduction (PPR) of 18% (SD 19, P < 0.001). Group 2 yielded a mean PPR of 71% (SD 13, P < 0.001). In Group 1, acupuncture resulted in a mean forced vital capacity (FVC) increase of 30 cm(3) (SD 73) without statistical significance (P = 0.303). In Group 2, posttreatment FVC showed a significant increase of 306 cm(3) (SD 215, P < 0.001). Conclusion. Acupuncture revealed specific analgesic effects after sternotomy. Objective measurement of poststernotomy pain via lung function test was possible.
背景。心脏手术后的早期术后护理中,胸骨后疼痛和呼吸受损是常见的临床问题。疼痛治疗不充分会增加肺部并发症的风险。高剂量阿片类药物用于疼痛管理,但可能会引起呼吸抑制等副作用。
研究设计。我们进行了一项前瞻性、随机、对照、观察者盲、三臂临床试验,共纳入 100 例患者。第 1 组(n = 33)和第 2 组(n = 34)接受两次标准化针刺治疗,每次 20 分钟,采用两组不同穴位。第 3 组(n = 33)作为标准镇痛对照组,不进行额外干预。
结果。主要终点分析显示两种针刺治疗均具有统计学显著的镇痛效果。第 1 组的平均百分比疼痛缓解率(PPR)为 18%(SD 19,P < 0.001)。第 2 组的平均 PPR 为 71%(SD 13,P < 0.001)。第 1 组的针刺治疗使用力肺活量(FVC)平均增加 30cm³(SD 73),但无统计学意义(P = 0.303)。第 2 组的 FVC 在治疗后显著增加了 306cm³(SD 215,P < 0.001)。
结论。针刺治疗显示出胸骨切开术后的特定镇痛效果。通过肺功能测试对胸骨后疼痛进行客观测量是可行的。