Pan Lu-Ping, Yang Yu, Shao Jin, Ren Zhi-Wei, Yu Li-Na, Yan Min
the Second Affiliated Hospital of Medical College of Zhejiang University, Hangzhou 310009, China; Shaoxing Hospital of TCM, Shaoxing 312000, Zhejiang Province.
Shaoxing Hospital of TCM, Shaoxing 312000, Zhejiang Province.
Zhongguo Zhen Jiu. 2019 Jan 12;39(1):19-23. doi: 10.13703/j.0255-2930.2019.01.004.
OBJECTIVE: To observe and evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) at different time points on postoperative analgesia in perioperative period in patients undergoing shoulder arthroscopic surgery, and to explore the optimal time to use TEAS for shoulder arthroscopic surgery. METHODS: A total of 120 patients undergoing unilateral shoulder arthroscopy under general anesthesia, graded withⅠtoⅡaccording to ASA criteria were randomly divided into 3 groups, 40 patients in each one. The patients in the group A were treated with preoperative TEAS at sham acupoints combined with postoperative TEAS at Hegu (LI 4) and Neiguan (PC 6); the patients in the group B were treated with preoperative TEAS at Hegu (LI 4) and Neiguan (PC 6) combined with postoperative TEAS at sham acupoints; the patients in the group C were treated with TEAS at sham acupoints before and after operation. The parameters of TEAS were dilatational wave, 2 Hz/100 Hz in frequency, 30 min. When the resting-state visual analogue scale (VAS) of incision was more than 3 points, the patient-controlled intravenous analgesia (PCIA) pump of sufentanil was administered to maintain the VAS no more than 3 points. The time point when PCIA pump was firstly used, the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery were recorded. Intraoperative anesthetic doses were recorded in the three groups. The resting-state and task-state VAS were evaluated at 0, 6, 12, 24 hours after surgery; the patient's satisfaction rate and adverse effects were recorded. RESULTS: The time when PCIA pump was firstly used in the group A and the group B was significantly longer than that in the group C, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A and group B were significantly less than those in the group C (all <0.05); the incidence of postoperative nausea-vomiting and sore throat was reduced (all <0.05). The time when PCIA pump was firstly used in the group A was significantly longer than that in the group B, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A were significantly less than those in the group B (all <0.05); no significant difference of the incidence of postoperative nausea-vomiting and sore throat was observed between the group A and group B (both >0.05). There were no statistically significant difference in VAS score at different postoperative time points and postoperative analgesia satisfaction rate between the two groups (all >0.05). CONCLUSION: Perioperative TEAS could improve the postoperative analgesia in patients undergoing arthroscopic shoulder surgery, delay the time when PCIA pump is firstly used, reduce the dosage of postoperative analgesics and adverse events. Compared before surgery, postoperative TEAS has better analgesia.
目的:观察并评价不同时间点经皮穴位电刺激(TEAS)对肩关节镜手术患者围手术期术后镇痛的影响,探讨TEAS用于肩关节镜手术的最佳时机。 方法:选取120例在全身麻醉下行单侧肩关节镜手术、ASA分级为Ⅰ~Ⅱ级的患者,随机分为3组,每组40例。A组患者术前在假穴行TEAS,术后在合谷(LI 4)和内关(PC 6)行TEAS;B组患者术前在合谷(LI 4)和内关(PC 6)行TEAS,术后在假穴行TEAS;C组患者术前和术后均在假穴行TEAS。TEAS参数为疏密波,频率2 Hz/100 Hz,持续30 min。当切口静息状态视觉模拟评分(VAS)大于3分时,给予舒芬太尼患者自控静脉镇痛(PCIA)泵,维持VAS不超过3分。记录PCIA泵首次使用时间、舒芬太尼用量及术后24 h内PCIA泵有效按压次数。记录三组术中麻醉用药量。于术后0、6、12、24 h评估静息状态和任务状态VAS;记录患者满意度及不良反应。 结果:A组和B组PCIA泵首次使用时间显著长于C组,A组和B组术后24 h内舒芬太尼用量及PCIA泵有效按压次数显著少于C组(均P<0.05);术后恶心呕吐和咽痛发生率降低(均P<0.05)。A组PCIA泵首次使用时间显著长于B组,A组术后24 h内舒芬太尼用量及PCIA泵有效按压次数显著少于B组(均P<0.05);A组和B组术后恶心呕吐和咽痛发生率比较差异无统计学意义(均P>0.05)。两组术后不同时间点VAS评分及术后镇痛满意度比较差异无统计学意义(均P>0.05)。 结论:围手术期TEAS可改善肩关节镜手术患者术后镇痛效果,延迟PCIA泵首次使用时间,减少术后镇痛药用量及不良事件。与术前TEAS相比,术后TEAS镇痛效果更佳。
Medicine (Baltimore). 2022-7-15