摘要
目的观察耳穴疗法用于全膝关节置换术围手术期镇痛的效果。方法选择ASAⅠ～Ⅲ级行单侧全膝关节置换骨性关节炎患者60例,随机分为耳穴镇痛组和对照组,每组30例,所有患者手术均由同一组医师施行,实施气管插管全身麻醉。耳穴镇痛组患者术前用王不留行籽按压耳穴配合术后患肢局部穴位敷贴镇痛,对照组采用常规治疗,两组患者均术前1天口服塞来昔布400 mg,术后口服塞来昔布每日2次,每次200 mg。当视觉模拟评分(visual analogue scales,VAS)>7分时,予盐酸布桂嗪0.1 g补救。术后两组采用相同的锻炼方法。记录静息时的VAS评分,镇静满意度,发生不良反应情况,术后膝关节活动度(range of motion,ROM)及美国特种外科医院膝关节评分(hospital for special surgery scores,HSS)。结果耳穴镇痛组患者术后6、24 h的静息VAS疼痛评分分别为(5.99±0.67)、(4.26±0.59)分,均明显低于对照组患者(7.02±0.85,4.92±0.43,P<0.01);两组患者术后1、48 h VAS评分差异无统计学意义(P>0.05);两组患者镇静满意程度总体相似;与对照组比较,耳穴镇痛组患者并发症发生率减少,但差异无统计学意义(4:11,P>0.05);ROM和HSS评分方面,耳穴镇痛组术前ROM为75.63°±5.74°,对照组术前ROM为75.43°±5.63°,差异无统计学意义(P>0.05);耳穴镇痛组术后2周主动与被动ROM分别为96.50°±3.79°、107.8°±3.37°,对照组分别为93.50°±3.50°、105.27°±3.25°,均有统计学意义(P<0.05);耳穴镇痛组术前HSS评分为(60.23±3.44)分,对照组为(61.70±2.83)分,差异无统计学意义(P>0.05);术后HSS评分分别为(86.97±2.33)、(85.37±2.30)分,差异有统计学意义(P<0.05)。结论膝关节置换术围手术期配合应用耳穴疗法有助于减轻患者的术后疼痛,减少术后总的麻醉剂使用量,有助于患者的早期康复,同时有着费用低、并发症少、操作简单、安全的优点。
Objective To observe the effect of auricular acupoint pressing（AAP） for analgesia during perioperative period of total knee joint replacement.Methods Sixty patients with osteoarthritis of ASA gradeⅠ-Ⅲscheduled to receive unilateral total knee joint replacement were equally randomized into the AAP group and the control group,30 in each group.The general anesthesia on all patients was implemented by physicians of an identical group through endotracheal intubation.To the patients in the AAP group,AAP with Vaccaria seed was applied before operation,and the local analgesia on affected limb with acupoint pasting was used after operation. Besides,administering of celecoxib 400 mg on the day before operation,and celecoxib 200 mg twice daily post-operation was given to all patients.When the visual analogue scales（VAS） reached more than 7 points,0.1 g of bucinnazine hydrochloride was given for supplement.Meantime,same post-operative training methods were adopted in both groups.The resting VAS pain scores,contentment of sedation,incidence of adverse event,post-operative range of motion（ROM） of knee joint and Hospital for Special Surgery（HSS） score were recorded. Results The resting VAS pain scores at 6 h and 24 h after operation was 5.99±0.67 scores and 4.26±0.59 scores in the AAP group respectively,which was significantly lower than that in the control group at the corre-sponding time（7.02±0.85 scores and 4.92±0.43 scores,P0.01）;but it showed insignificant difference between the two groups at 1 h and 48 h after operation（P0.05）;sedation contentment in the two groups was similar;incidence of adverse event in the AAP groups seemed lower（4 cases vs.11 cases）,but the intergroup difference was statistically insignificant（P0.05 ）.ROM before surgery were 75.63°±5.74°and 75.43°±5.63°in the two groups respectively,showing no significant difference（P0.05）,two weeks after operation, the initiative ROM raised to 96.50°±3.79°and 93.50°±3.50°,and the passive ROM reached 107.8°±3.37°and 105.27°±3.25°in the two groups respectively,with statistical significance between them（P0.05）.HSS score was similar between groups before operation（60.23±3.44 scores vs.61.70±2.83 scores,P0.05）; while it became 86.97±2.33 scores and 85.37±2.30 scores after operation,showing significant difference between groups（P0.05）.Conclusion Applying auricular acupoint pressing in perioperative period of knee joint replacement is favorable for alleviating postoperative pain,decreasing narcotic consumption,and promoting early rehabilitation,and it has the advantages of low cost,less complication,simple manipulation and high safety.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2010年第9期931-934,共4页
Chinese Journal of Integrated Traditional and Western Medicine
关键词
全膝置换
镇痛
耳穴
穴位敷贴
视觉模拟评分
关节活动度
美国特种外科医院膝关节评分
total knee joint replacement
analgesia
auricular point
acupoint pressing
visual analogue scale
range of movement
American Hospital for Special Surgery scoring on knee joint
作者简介
通讯作者：童培建，Tel：13906503677，E-mail：tongpeijian@163．com
