针刺对吗啡麻醉及镇痛后并发症防治效果观察

Observation on the effect of acupuncture for preventing and treating the complication after Morphine anesthesia and analgesia

目的:观察针刺对吗啡麻醉及镇痛后并发症的防治效果,探讨针刺治疗机制。方法:将择期经尿道行前列腺电切术患者随机分为3组,每组20例。腰麻后,Ⅰ组不再进行操作;Ⅱ组、Ⅲ组行针刺治疗,留针30min,Ⅱ组穴取合谷、曲池、内关、支沟,Ⅲ组穴取足三里、上巨虚、下巨虚、三阴交。观察围麻醉期不同时点各组患者的肠鸣音、恶心、呕吐、瘙痒等变化情况。结果:吗啡腰麻后各组患者肠鸣音减少。Ⅱ组针刺后及手术开始时肠鸣音次数增加,与Ⅰ组、Ⅲ组同时点相比,差异有统计学意义(均P<0.05);Ⅱ组呕吐、瘙痒的发生率分别为5.0%(1/20)、30.0%(6/20),均低于Ⅰ组的35.0%(7/20)、80.0%(16/20)。结论:无神经传导阻滞情况下,针刺治疗对吗啡相关并发症有治疗效果;神经传导通路阻断后,针刺治疗对吗啡引起的并发症治疗作用减弱。针刺治疗机制可能与神经通路有关。

Objective To investigate the effects of acupuncture for preventing and treating the complication after Morphine anesthesia and analgesia and to explore the mechanism of acupuncture treatment, Methods Patients scheduled to undergo transurethral resection of prostate （TURP） were randomly divided into 3 groups, 20 cases in each group. After lumbar anesthesia, group Ⅱ and Ⅲ were treated with acupuncture, and group Ⅰ with no acupuncture, retaining needle for 30 minutes. Hegu （LI 4）, Quchi （LI 11）, Neiguan （PC 6）, Zhigou （TE 6） were selected in group Ⅱ , and Zusanli （ST 36）, Shangjuxu （ST 37）, Xiajuxu （ST 39） and Sanyinjiao （SP 6） selected in group Ⅲ. The indices of bowel sounds, nausea and vomiting, itching were observed before, during and one day after operation. Results After lumbar anesthesia with Morphine, the bowel sounds were significant decrease in all the 3 groups. After acupuncture and before TURP the number of times of bowel sound were increased in group H with significant differences as compared with those in group Ⅰ and group Ⅲ at the same time point （all P〈0. 05）. The incidence rates of vomiting and itching were 5.0% （1/20） and 30. 0 （6/20） respectively in group Ⅱ , which were less than 35.0% （7/20） and 80. 0% （16/20） in group Ⅰ . Conclusion Acupuncture has a therapeutic effect on the complication induced by Morphine without nerve block. However, the therapeutic effect of acupuncture is attenuated after nerve block. Its mechanism may be related to nervous pathway.