摘要
目的:观察术前针刺对开胸手术患者围术期镇痛效果的影响。方法:选择开胸肺癌手术患者 120例, 随机分为四组,每组 30 例。A组、B组术前 3 d予以针刺超前镇痛,每日 1 次,连续 3 d。A组、C组予以术后针刺镇痛。D组为全麻对照组。四组患者均控制疼痛指数在 3 以下。选取与镇痛相关的β-内啡肽和与应激相关的皮质醇为观察指标,检测四组患者手术前后的水平变化,统计四组患者术后镇痛药物芬太尼的具体用量。结果:A组术前一天β-内啡肽与C组和D组比较,均P<0.05。B组术前一天与C组和D组比较,均P<0.05。皮质醇数据自身比较,A组、B组、D组入院与拔管后一天比较,术前一天与拔管后一天比较,均P<0.05;C组入院与拔管后一天比较, P<0.05。四组患者术后镇痛泵的芬太尼含量经单因素方差分析,P<0.05,差异有统计学意义。结论:超前镇痛在开胸手术患者应用中,具有提高镇痛指标β-内啡肽的效应,与传统的术后镇痛比较有明显优势。对于应激指标皮质醇则无明显差异,手术和拔管等刺激对机体产生较大的即时应激,针刺无明显优势。术后针刺可在一定程度上替代镇痛药物的使用量,此次配比减少 20%。
Objective： To observe the effect of preoperative effect on peri-operative pain in patients following a thoracotomy. Methods： 120 cases following lung-cancer thoracotomy were randomly allocated into four groups, 30 in each group. Cases in group A and B were treated with acupuncture analgesia 3 d before operation; cases in group A and C were treated with acupuncture analgesia after operation; and cases in group D were treated with general anesthesia. The pain management indexes in four groups were all controlled below 3. After that, analgesia-related β-endorphin and stress-related cortisol were observed before and after operation. In addition, the specific doses of postoperative analgesic-Fentanyl in four groups were compared. Results： The comparison of β-endorphin between group A, C and D showed P〈0.05 one day before operation, so did group B, C and D 1 day before operation. The intra-group comparison of cortisol between the day of admission and 1 day after extubation and between 1 day before operation and one day after extubation in group A, B and D showed P〈0.05, so did group C between the day of admission and 1 day after extubation. In addition, the contents of Fentanyl in postoperative analgesic pump in four groups showed P〈0.05 through one-factor analysis of variance, showing a significant difference. Conclusion： Preemptive analgesia could increase the β-endorphin in patients following a thoracotomy and showed remarkable advantage when compared with the conventional postoperative analgesia. It did not cause significant difference regarding stress index cortisol. Acupuncture has no remarkable advantage when compared with operation and extubation for the major immediate stress. Additionally, postoperative acupuncture could be a substitute for the dose of pain killers and the match can be reduced by 20%.
基金
Traditional Chinese Medicine Scientific Research Project by the Shanghai Municipal Health Bureau (2006L012A)
