经皮穴位电刺激改善人工全膝关节置换术后疼痛临床研究
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摘要
目的:评价经皮穴位电刺激对于全膝关节置换术后的镇痛效果。方法:选取2018年6月至2018年9月山东省中医院收治的关节骨科行单侧全膝关节置换术(TKA)的患者50例作为研究对象,按照随机数字表法分为对照组与观察组,每组25例。对照组患者术后采用自控静脉镇痛、塞来昔布口服镇痛。观察组在对照组的基础上于术前30 min及术后1～7 d功能康复锻炼前30 min行经皮穴位电刺激治疗。采用疼痛视觉模拟(VAS)评分评估2组患者术后第1、2、3、5、7天患膝静息状态疼痛程度及第3、5、7天行功能康复锻炼时患肢疼痛程度,观察2组患者第3、5、7天患膝关节活动度,并记录术后恶心、呕吐的发生率。结果:在术后第1、2、3、5、7天静息状态下患膝疼痛VAS评分观察组均低于对照组,差异有统计学意义(P <0. 05);术后第3、5、7天行功能锻炼时患膝疼痛VAS评分观察组低于对照组,差异有统计学意义(P <0. 05);术后第3、5、7天膝关节的活动度观察组高于对照组,差异有统计学意义(P <0. 05);观察组术后恶心、呕吐发生率低于对照组,差异有统计学意义(P <0. 05)。结论:经皮穴位电刺激可以缓解全膝关节置换术后早期患膝静息状态及功能活动时的疼痛,并可增加膝关节活动度,降低术后恶心、呕吐发生率。
Objective: To investigate the analgesic effect of transcutaneous electric acupoint stimulation( TEAS) on early stage after total knee arthroplasty( TKA). Methods: A total of 50 patients who underwent unilateral TKA in the Department of Joint Orthopaedics,Shandong Hospital of Traditional Chinese Medicine from June 2018 to September 2018 were randomly divided into an observation group and a control group. The control group: self-controlled intravenous analgesia and celecoxib were used after operation. On the basis of the control group,the observation group received transcutaneous acupoint electrical stimulation 30 minutes before operation and 30 minutes before functional rehabilitation exercise 1-7 days after operation. Visual analogue pain scale( VAS) was used to evaluate the pain degree of knee resting state on the 1 st,2 nd,3 rd,5 th,7 th day after operation and limb pain on the 3 rd,5 th and 7 th day after functional rehabilitation exercise. The knee joint activity on the 3 rd,5 th and 7 th day was observed. The use of emergency adjuvant analgesics 72 hours after operation was recorded. Nausea and vomiting were recorded. Results: The VAS scores of knee pain in rest state in the observation group were lower than those in the control group on the 1 st,2 nd,3 rd,5 th and 7 th day after operation,with statistical significance( P < 0. 05); The VAS scores of functional exercise in the observation group were lower than those in the control group on the 2 nd,3 rd,5 th and 7 th day after operation,with statistical significance( P < 0. 05); and the activity of knee joint in the observation group on the 3 rd,5 th and 7 th day after operation was higher than that in the control group,with significant difference( P < 0. 05). The incidence of nausea and vomiting in the observation group was lower than that in the control group,and the difference was statistically significant( P < 0. 05). Conclusion: Transcutaneous acupoint electrical stimulation can relieve the pain of knee resting state and functional activity in the early stage after total knee arthroplasty,increase the range of motion of knee joint,and reduce the incidence of nausea and vomiting after total knee arthroplasty.
Objective: To investigate the analgesic effect of transcutaneous electric acupoint stimulation( TEAS) on early stage after total knee arthroplasty( TKA). Methods: A total of 50 patients who underwent unilateral TKA in the Department of Joint Orthopaedics,Shandong Hospital of Traditional Chinese Medicine from June 2018 to September 2018 were randomly divided into an observation group and a control group. The control group: self-controlled intravenous analgesia and celecoxib were used after operation. On the basis of the control group,the observation group received transcutaneous acupoint electrical stimulation 30 minutes before operation and 30 minutes before functional rehabilitation exercise 1-7 days after operation. Visual analogue pain scale( VAS) was used to evaluate the pain degree of knee resting state on the 1 st,2 nd,3 rd,5 th,7 th day after operation and limb pain on the 3 rd,5 th and 7 th day after functional rehabilitation exercise. The knee joint activity on the 3 rd,5 th and 7 th day was observed. The use of emergency adjuvant analgesics 72 hours after operation was recorded. Nausea and vomiting were recorded. Results: The VAS scores of knee pain in rest state in the observation group were lower than those in the control group on the 1 st,2 nd,3 rd,5 th and 7 th day after operation,with statistical significance( P < 0. 05); The VAS scores of functional exercise in the observation group were lower than those in the control group on the 2 nd,3 rd,5 th and 7 th day after operation,with statistical significance( P < 0. 05); and the activity of knee joint in the observation group on the 3 rd,5 th and 7 th day after operation was higher than that in the control group,with significant difference( P < 0. 05). The incidence of nausea and vomiting in the observation group was lower than that in the control group,and the difference was statistically significant( P < 0. 05). Conclusion: Transcutaneous acupoint electrical stimulation can relieve the pain of knee resting state and functional activity in the early stage after total knee arthroplasty,increase the range of motion of knee joint,and reduce the incidence of nausea and vomiting after total knee arthroplasty.
引文
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[12]谢晶军,王丹,方剑乔.不同经穴经皮穴位电刺激对大鼠痛阈及血压调节效应的比较[J].中华中医药杂志,2015,30(11):4144-4146.
[13]郑荣芝,侯俊明,赵庆盼,等.经皮穴位电刺激复合静脉全麻对全子宫切除术后恶心呕吐的影响[J].陕西中医药大学学报,2018,41(3):46-49.
[14]韩济生.针麻镇痛研究[J].针刺研究,2016,41(5):377-387.
[15]陈雪,王保国,李锦,等.经皮穴位电刺激对经蝶垂体瘤切除患者围术期静脉全麻的影响[J].中国针灸,2013,33(8):732-736.
[16]于辉,祁丽艳,黄巍,等.经皮内关穴电刺激对乳腺癌术中心率和术后恶心、疼痛的影响[J].实用肿瘤学杂志,2012,26(4):324-327,335.
[17]王明山,陈怀龙,毕燕琳,等.经皮穴位电刺激对丙泊酚主导的全凭静脉麻醉的强化作用[J].临床麻醉学杂志,2008,24(8):726-728.
[18]Arai YC,Kato N,Matsura M,et al. Transcutaneous electrical nerve stimulation at the PC-5 and PC-6 acupoints reduced the severity of hypotension after spinal anaesthesia in patients undergoing Caesarean section[J]. Br J Anaesth,2008,100(1):78-81.
[19]秦呈燕,张海苓,贾存显.床旁训练对人工膝关节置换术后患者康复效果的临床研究[J].泰山医学院学报,2016,37(1):67-69.
[2]许乐洋,张学林,杨丰建,等.老年患者全膝关节置换围术期疼痛管理[J].老年医学与保健,2018,24(4):470-472.
[3]Gozani SN. Fixed-site high-frequency transcutaneous electrical nerve stimulation for treatment of chronic low back and lower extremity pain[J]. J Pain Res,2016,9:469-479.
[4]陈创,李姗,唐朝正,等.经皮穴位电刺激对脑卒中患者下肢运动功能和ADL能力的影响[J].中国康复,2016,31(3):168-170.
[5]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
[6]严广斌.视觉模拟评分法[J].中华关节外科杂志(连续型电子期刊),2014,8(2):273.
[7]卢爱军.全膝关节置换术围术期多模式联合镇痛的临床应用[J].湖北民族学院学报:医学版,2018,35(2):28-30.
[8]葛军昌,吴巨生,王鹏宇.连续收肌管阻滞联合膝关节周围局部浸润在全膝关节置换术后多模式镇痛的应用[J].全科医学临床与教育,2018,16(3):294-297.
[9]úrsula Bueno do Prado Guirro,Elizabeth Milla Tambara,Fernanda Reinaldi Munhoz. Femoral nerve block:assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction[J].Brazilian Journal of Anesthesiology(English edition),2013,63(6):483-491.
[10]陈超,张一,郭海英,等.电针结合康复训练治疗全膝关节置换术后下肢肿胀疗效观察[J].山东中医药大学学报,2015,39(2):139-141.
[11]陈举.电针联合功能锻炼对膝骨关节炎全膝人工关节置换术后关节功能康复的临床观察[D].福州:福建中医药大学,2016.
[12]谢晶军,王丹,方剑乔.不同经穴经皮穴位电刺激对大鼠痛阈及血压调节效应的比较[J].中华中医药杂志,2015,30(11):4144-4146.
[13]郑荣芝,侯俊明,赵庆盼,等.经皮穴位电刺激复合静脉全麻对全子宫切除术后恶心呕吐的影响[J].陕西中医药大学学报,2018,41(3):46-49.
[14]韩济生.针麻镇痛研究[J].针刺研究,2016,41(5):377-387.
[15]陈雪,王保国,李锦,等.经皮穴位电刺激对经蝶垂体瘤切除患者围术期静脉全麻的影响[J].中国针灸,2013,33(8):732-736.
[16]于辉,祁丽艳,黄巍,等.经皮内关穴电刺激对乳腺癌术中心率和术后恶心、疼痛的影响[J].实用肿瘤学杂志,2012,26(4):324-327,335.
[17]王明山,陈怀龙,毕燕琳,等.经皮穴位电刺激对丙泊酚主导的全凭静脉麻醉的强化作用[J].临床麻醉学杂志,2008,24(8):726-728.
[18]Arai YC,Kato N,Matsura M,et al. Transcutaneous electrical nerve stimulation at the PC-5 and PC-6 acupoints reduced the severity of hypotension after spinal anaesthesia in patients undergoing Caesarean section[J]. Br J Anaesth,2008,100(1):78-81.
[19]秦呈燕,张海苓,贾存显.床旁训练对人工膝关节置换术后患者康复效果的临床研究[J].泰山医学院学报,2016,37(1):67-69.