1 Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.
2 Departments of Anesthesiology and Epidemiology and Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA.
J Intensive Care Med. 2019 Aug;34(8):652-661. doi: 10.1177/0885066617708558. Epub 2017 Jun 1.
Acupuncture treatment has been employed in China for over 2500 years and it is used worldwide as analgesia in acute and chronic pain. Acupuncture is also used in general anesthesia (GA). The aim of this systematic review and meta-analysis was to assess the efficacy of electroacupuncture (EA) in addition to GA in patients undergoing cardiac surgery.
We searched 3 databases (Pubmed, Cochrane Library, and Web of Science-from 1965 until January 31, 2017) for randomized controlled trials (RCTs) including patients undergoing cardiac surgery and receiving GA alone or GA + EA. As primary outcomes, we investigated the association between GA + EA approach and the dosage of intraoperative anesthetic drugs administered, the duration of mechanical ventilation (MV), the postoperative dose of vasoactive drugs, the length of intensive care unit (ICU) and hospital stay, and the levels of troponin I and cytokines.
The initial search yielded 477 citations, but only 7 prospective RCTs enrolling a total of 321 patients were included. The use of GA + EA reduced the dosage of intraoperative anesthetic drugs ( < .05), leading to shorter MV time ( < .01) and ICU stay ( < .05) as well as reduced postoperative dose of vasoactive drugs ( < .001). In addition, significantly lower levels of troponin I ( < .01) and tumor necrosis factor α ( < .01) were observed.
The complementary use of EA for open-heart surgery reduces the duration of MV and ICU stay, blunts the inflammatory response, and might have protective effects on the heart. Our findings stimulate future RCT to provide definitive recommendations.
针刺疗法在中国已有超过 2500 年的历史,被广泛应用于急慢性疼痛的镇痛。针刺疗法也应用于全身麻醉(GA)。本系统评价和荟萃分析的目的是评估电针(EA)在心脏手术患者 GA 中的疗效。
我们在 3 个数据库(Pubmed、Cochrane Library 和 Web of Science-从 1965 年到 2017 年 1 月 31 日)中搜索了包括接受 GA 单独或 GA+EA 的心脏手术患者的随机对照试验(RCT)。作为主要结果,我们研究了 GA+EA 方法与术中麻醉药物剂量、机械通气(MV)时间、术后血管活性药物剂量、重症监护病房(ICU)和住院时间以及肌钙蛋白 I 和细胞因子水平之间的关系。
最初的搜索产生了 477 条引文,但只有 7 项前瞻性 RCT 纳入了总共 321 名患者。GA+EA 的使用减少了术中麻醉药物的剂量(<0.05),导致 MV 时间(<0.01)和 ICU 停留时间(<0.05)缩短,以及术后血管活性药物剂量减少(<0.001)。此外,还观察到肌钙蛋白 I(<0.01)和肿瘤坏死因子-α(<0.01)水平显著降低。
心脏手术中 EA 的联合应用可缩短 MV 和 ICU 停留时间,减轻炎症反应,并可能对心脏有保护作用。我们的研究结果为未来的 RCT 提供了明确的建议。