耳针在全髋置换术围手术期镇痛应用的病例对照研究

Case-control study on application of auricular acupuncture for the treatment of analgesia during perioperative period in total hip arthroplasty

目的:观察耳针在全髋置换术围手术期镇痛的疗效。方法:自2008年3月至2010年8月,将60例因晚期股骨头坏死首次行单侧全髋置换术的患者分为耳针组和对照组,每组30例。耳针组:男11例,女19例;平均年龄(60.93±5.90)岁;于术前2d在神门、皮质下、肾和髋关节4处耳穴行耳穴埋针和每日4次的耳穴按压治疗。对照组:男12例,女18例;平均年龄(59.87±6.21)岁;不行耳穴埋针和耳穴按压治疗。采用VAS(visualanalogscale)疼痛评分评估两组患者术后疼痛程度,Harris评分评估患者的髋关节功能。两组患者术后均予PCA镇痛泵静脉镇痛48h(镇痛泵内400ml液体中含800mg曲马多和0.8mg芬太尼),记录不同时间镇痛泵的用量及使用镇痛泵期间不良反应的发生情况。结果:耳针组在术后第3、4、5、7天的VAS疼痛评分分别为(3.61±0.29)、(3.59±0.30)、(2.97±0.26)、(2.29±0.45)分,低于对照组的(4.19±0.28)、(4.00±0.31)、(3.15±0.29)、(2.83±0.31)分。术后0～12、12～24、24～36h和36～48h各时段耳针组镇痛泵的用量分别为(72.27±8.06)、(60.40±8.16)、(44.13±4.75)、(40.40±3.69)ml,均比对照组用量(86.27±8.51)、(73.87±8.32)、(54.53±5.20)、(44.67±6.31)ml减少。在使用PCA期间耳针组出现恶心呕吐5例,少于对照组的21例。耳针组术后2周Harris评分(78.90±5.14)分,高于对照组的(73.37±5.99)分。结论:耳针能减轻全髋置换术后的疼痛,减少镇痛药物的用量,减少患者使用镇痛泵期间的恶心呕吐发生,改善患者术后近期髋关节的功能。

Objective：To investigate clinical effects of auricular acupoint（AA） in the treatment of analgesia during perioperative period in total hip arthroplasty. Methods：From March 2008 to August 2010,60 patients with late osteonecrosis of the femoral head were treated by total hip arthroplasty and randomly divided into auricular acupuncture（AA） group and control group,30 patients in each group. There were 11 males and 19 females in the AA group,with an average age of（60.93±5.90）years;the patients were treated with auricular acupuncture on the point of Shenmen,Subcortex,Kidney and hip joint for four times a week. There were 12 males and 18 females in control group,with an average age of（59.87±6.21） years;while the patients without auricular acupuncture. VAS score was used to evaluat the degree of pain;Harris score was used to evaluat the function of hip joint. All patients received patient controlled analgesia pump（PCA） for 48 hours after surgery（400 ml liquids were in PCA pump,including 800 mg tramadol and 0.8 mg fentanyl）. The dosage of liquids and adverse reaction of PCA pump in different time were recorded. Results：The VAS score on the 3rd,4th,5th and 7th day separately was（3.61±0.29）,（3.59±0.30）,（2.97±0.26）,（2.29±0.45）,and lower than control group,which separately was （4.19±0.28）,（4.00±0.31）,（3.15±0.29）,（2.83±0.31）. The dosage of PCA in AA group separately was （72.27±8.06）,（60.40±8.16）,（44.13±4.75）,（40.40±3.69） ,and less than control group,which was（86.27±8.51）,（73.87±8.32）,（54.53±5.20）,（44.67±6.31）on the time of 0～12、12～24、24～36 h and 36～48 h after surgery. During the using of PCA,nausea and vomiting occurred in 5 cases,less than control group（21 cases）. Harris score in AA group （78.90±5.14） was higher than control group（73.37±5.99） 2 weeks after operation. Conclusion：Auricular acupuncture can reduce postoperative pain,reduce the usage of analgesic and complications,such as nausea and vomiting,improve the function of hip joint after operation.