围术期经皮穴位电刺激对肩关节镜手术患者术后镇痛效果的影响

Effects of perioperative transcutaneous electrical acupoint stimulation on postoperative analgesia in patients undergoing shoulder arthroscopic surgery

目的:观察并评估围手术期不同时间点行经皮穴位电刺激对肩关节镜手术患者术后辅助镇痛的效果,旨在寻找经皮穴位电刺激在肩关节镜手术使用的最佳时机。方法:选择在全身麻醉下行单侧肩关节镜手术患者120例,美国麻醉医师协会(ASA)分级为Ⅰ~Ⅱ级,随机分成3组,每组40例。A组于术前取假穴位行电刺激治疗联合术后取患侧合谷、内关穴行电刺激治疗;B组于术前取患侧合谷、内关穴行电刺激治疗联合术后取假穴位行电刺激治疗;C组于术前及术后均取假穴位行电刺激治疗。电针参数:疏密波,频率2 Hz/100 Hz,持续30min。术后当患者切口静息视觉模拟量表(VAS)评分 >3分时给予舒芬太尼静脉自控镇痛泵进行镇痛补救,并维持患者术后静息VAS评分≤3分,记录术后第一次给予静脉自控镇痛泵的时间点、术后24 h内镇痛泵内舒芬太尼的使用剂量以及有效按压次数;观察并记录3组患者术中麻醉药使用剂量;分别于术毕即刻、术后第6小时、第12小时、第24小时对患者进行静息以及活动时VAS评分,同时记录患者对术后镇痛的满意率以及不良反应。结果:与C组比较,A、B两组患者术后首次使用补救镇痛的时间明显延长,术后24h内镇痛泵内舒芬太尼的使用剂量、有效按压次数减少(均P<0.05);术后恶心呕吐、咽喉痛的发生率明显降低(均P<0.05);与B组比较,A组患者术后首次使用补救镇痛的时间延长,术后24h内镇痛泵内舒芬太尼的使用剂量、有效按压次数减少(均P<0.05),而术后恶心呕吐、咽喉痛、口干发生率组间比较差异无统计学意义(均P >0.05)。各组患者术后不同时间点VAS评分及对术后镇痛满意率比较差异无统计学意义(均P >0.05)。结论:围手术期应用经皮穴位电刺激可以提高肩关节镜手术患者术后镇痛效果,延长术后首次使用补救镇痛的时间,降低术后镇痛药物剂量以及术后不良反应,与术前比,术后使用经皮穴位电刺激镇痛效果更佳。

Objective To observe and evaluate the effects of transcutaneous electrical acupoint stimulation(TEAS) at different time points on postoperative analgesia in perioperative period in patients undergoing shoulder arthroscopic surgery, and to explore the optimal time to use TEAS for shoulder arthroscopic surgery. Methods A total of 120 patients undergoing unilateral shoulder arthroscopy under general anesthesia, graded with Ⅰ to Ⅱ according to ASA criteria were randomly divided into 3 groups, 40 patients in each one. The patients in the group A were treated with preoperative TEAS at sham acupoints combined with postoperative TEAS at Hegu(LI 4) and Neiguan(PC 6);the patients in the group B were treated with preoperative TEAS at Hegu(LI 4) and Neiguan(PC 6) combined with postoperative TEAS at sham acupoints;the patients in the group C were treated with TEAS at sham acupoints before and after operation. The parameters of TEAS were dilatational wave, 2 Hz/100 Hz in frequency, 30 min. When the resting-state visual analogue scale(VAS) of incision was more than 3 points, the patient-controlled intravenous analgesia(PCIA) pump of sufentanil was administered to maintain the VAS no more than 3 points. The time point when PCIA pump was firstly used, the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery were recorded. Intraoperative anesthetic doses were recorded in the three groups. The resting-state and task-state VAS were evaluated at 0, 6, 12, 24 hours after surgery;the patient's satisfaction rate and adverse effects were recorded. Results The time when PCIA pump was firstly used in the group A and the group B was significantly longer than that in the group C, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A and group B were significantly less than those in the group C(all P<0.05);the incidence of postoperative nausea-vomiting and sore throat was reduced(all P<0.05). The time when PCIA pump was firstly used in the group A was significantly longer than that in the group B, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A were significantly less than those in the group B(all P<0.05);no significant difference of the incidence of postoperative nausea-vomiting and sore throat was observed between the group A and group B(both P >0.05). There were no statistically significant difference in VAS score at different postoperative time points and postoperative analgesia satisfaction rate between the two groups(all P >0.05). Conclusion Perioperative TEAS could improve the postoperative analgesia in patients undergoing arthroscopic shoulder surgery, delay the time when PCIA pump is firstly used, reduce the dosage of postoperative analgesics and adverse events. Compared before surgery, postoperative TEAS has better analgesia.