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穴位刺激在术后加速康复中的镇痛作用:系统评价和荟萃分析。

Acupoint Stimulation for Pain Control in Enhanced Recovery After Surgery: Systematic Review and Meta-Analysis.

机构信息

Department of Traditional Chinese Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China.

Department of Library, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China.

出版信息

J Integr Complement Med. 2024 Jun;30(6):493-506. doi: 10.1089/jicm.2023.0272. Epub 2023 Dec 29.


DOI:10.1089/jicm.2023.0272
PMID:38153965
Abstract

Postoperative pain control is a challenge in enhanced recovery after surgery (ERAS). The current study reviewed the efficacy and safety of incorporating acupoint stimulation for postoperative pain control in ERAS. Ten databases for relevant randomized controlled trials (RCTs) published in English or Mandarin Chinese were searched from 1997 to 2022. The quality of each article was appraised using the Cochrane Collaboration Risk of Bias Criteria and the modified Jadad Scale. The primary outcome was pain control, measured using the visual analog scale 24 h after surgery. Eleven trials met the eligibility criteria and were included in the study. Acupoint stimulation was found more effective than control treatments in terms of pain intensity (standardized mean difference [SMD] -0.94; 95% confidence interval [CI] -1.35 to -0.53), analgesic drug consumption (SMD -1.87; 95% CI -2.98 to -0.75), postoperative nausea (PON; SMD 0.31; 95% CI 0.13 to 0.73), postoperative vomiting (POV; SMD 0.57; 95% CI 0.11 to 2.92), and PON and POV (PONV; SMD 0.29; 95% CI 0.16 to 0.53). The Zusanli (ST36) and Neiguan (PC6) were the most-used acupoints in the included trials (8/11). The reported adverse reaction was only one case of bruising. Acupoint stimulation improved pain control in patients undergoing ERAS more than control treatments. The findings provide an evidence-based premise for incorporating acupoint stimulation into ERAS strategies. More rigorous RCTs are needed in the future.

摘要

术后疼痛控制是加速康复外科(ERAS)的挑战。本研究综述了穴位刺激在 ERAS 术后疼痛控制中的疗效和安全性。从 1997 年至 2022 年,检索了 10 个英文和中文数据库中相关的随机对照试验(RCT)。使用 Cochrane 协作风险偏倚评估标准和改良 Jadad 量表评估每个文章的质量。主要结局是术后 24 小时使用视觉模拟评分法评估疼痛控制。11 项试验符合纳入标准,并纳入研究。与对照组相比,穴位刺激在疼痛强度(标准化均数差 [SMD] -0.94;95%置信区间 [CI] -1.35 至 -0.53)、镇痛药消耗(SMD -1.87;95%CI -2.98 至 -0.75)、术后恶心(PON;SMD 0.31;95%CI 0.13 至 0.73)、术后呕吐(POV;SMD 0.57;95%CI 0.11 至 2.92)和 PON 和 POV(PONV;SMD 0.29;95%CI 0.16 至 0.53)方面更有效。纳入试验中最常用的穴位是足三里(ST36)和内关(PC6)(8/11)。报告的不良反应仅有 1 例瘀斑。穴位刺激比对照组更能改善 ERAS 患者的疼痛控制。研究结果为将穴位刺激纳入 ERAS 策略提供了一个基于证据的前提。未来需要更多严格的 RCT。

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