Tu Qing, Shi Jinlin, Yu Hong, Zhang Shuang, Gu Shuhan, Gan Jianhui
Department of Anesthesiology,the Affiliated Tangshan People's Hospital of North China University of Science and Technology, Tangshan 063000, Hebei Province, China.
Zhongguo Zhen Jiu. 2018 Jul 12;38(7):711-5. doi: 10.13703/j.0255-2930.2018.07.007.
To explore the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative analgesia of ureteroscopic holmium laser lithotripsy.
One hundred and twenty adult patients, American Association of Anesthesiologists (ASA) Class Ⅰ or Ⅱ, scheduled to ureteroscopic holmium laser lithotripsy, were randomly assigned into an observation group and a control group, 60 cases in each one. The patients in the observation group were treated with TEAS for postoperative analgesia. TEAS was implemented at bilateral Shenshu (BL 23) and Yinlingquan (SP 9) at the time of back ward and postoperative 4 h, 8 h, 12 h. TEAS at 7:00, 11:00 and 15:00 at the above acupoints were used on the second and third days; while placebo (twice a day, 100 mg a time) was used. Tramadol hydrochloride tablets for postoperative analgesia were applied in the contnol group, twice a day, 100 mg a time, and electrode sheets without stimulation were put on Shenshu (BL 23) and Yinlingquan (SP 9). When analgesia was insufficient with the score of visual analogue scale (VAS)≥3, the patients were treated with tramadol tablets for remedy analgesia. The VAS score, the concentrations of serotonin (5-HT) and substance P (SP) in 3 mL venous blood at the time of back ward (T), postoperative 4 h (T), 12 h (T), 24 h (T), and 48 h (T) were detected respectively. The total amount of medication for remedy analgesia and the incidence of adverse reactions, such as nausea and vomiting within postoperative 48 h were compared between the two groups.
The VAS scores at T through T were lower than those at T in the two groups (all <0.05). Compared with the control group, the VAS scores at T through T in the observation group were lower (all <0.05). The total dose of remedy analgesic medicine within 48 h after operation in the observation group was lower than that in the control group (<0.05). Compared with the control group, the concentrations of 5-HT at T, T, T and SP at T through T were lower (all <0.05). The numbers of constipation, nausea and vomiting in the observation group were less than those in the control group (both <0.05).
TEAS can relieve the pain and reduce the total amount of analgesic medicine, the levels of substance causing pain and the incidence of adverse reactions after ureteroscopic holmium laser lithotripsy.
探讨经皮穴位电刺激(TEAS)对输尿管镜钬激光碎石术后镇痛的效果。
120例美国麻醉医师协会(ASA)Ⅰ或Ⅱ级、拟行输尿管镜钬激光碎石术的成年患者,随机分为观察组和对照组,每组60例。观察组患者采用TEAS进行术后镇痛。在术后回病房时及术后4 h、8 h、12 h于双侧肾俞穴(BL 23)和阴陵泉穴(SP 9)实施TEAS。术后第2天和第3天于上述穴位7:00、11:00及15:00进行TEAS;对照组则使用安慰剂(每日2次,每次100 mg)。对照组采用盐酸曲马多片进行术后镇痛,每日2次,每次100 mg,并于肾俞穴(BL 23)和阴陵泉穴(SP 9)放置无刺激的电极片。当视觉模拟评分法(VAS)评分≥3分提示镇痛效果不佳时,患者加用曲马多片补救镇痛。分别检测两组患者回病房时(T₀)、术后4 h(T₁)、12 h(T₂)、24 h(T₃)及48 h(T₄)时3 mL静脉血中5-羟色胺(5-HT)和P物质(SP)的浓度、VAS评分。比较两组补救镇痛药物的总用量及术后48 h内恶心、呕吐等不良反应的发生率。
两组患者T₀至T₄时的VAS评分均低于T₀时(均P<0.05)。与对照组比较,观察组T₁至T₄时的VAS评分更低(均P<0.05)。观察组术后48 h内补救镇痛药物的总剂量低于对照组(P<0.05)。与对照组比较,观察组T₀时5-HT、T₁至T₃时5-HT及T₁至T₄时SP的浓度更低(均P<0.05)。观察组便秘、恶心、呕吐的例数少于对照组(均P<0.05)。
TEAS可缓解输尿管镜钬激光碎石术后疼痛,减少镇痛药物总用量、致痛物质水平及不良反应的发生率。