经皮穴位电刺激用于老年患者全髋关节置换术后早期疼痛治疗的临床研究

Study on Transcutaneous Electrical Acupoints Stimulation for Early postoperative pain relief after total hip arthroplasty in elderly patients

目的本研究选择全髋关节置换术的老年患者,应用经皮穴位电刺激(TEAS),观察术后早期疼痛治疗效果。方法选择60例行全髋关节置换术的老年患者(>65岁),随机分为两组:TEAS组30例:患者于切皮前30 min、术后2、4、20和48 h接受30 min经皮穴位电刺激(双侧内关、合谷穴;手术侧风市穴及足三里穴)治疗;对照组30例:假刺激组(选择相同穴位相同刺激时间,但刺激电流强度为零)。所有患者术后接受病人自控静脉镇痛48 h。通过观察患者术后各时段芬太尼的用量及镇痛效果评分(VAS),记录镇痛相关不良反应发生率及补救药物使用频率。结果两组患者一般临床资料差异无统计学意义。两组术后8、24和48 h静息和活动状态下疼痛评分比较,差异无统计学意义(P>0.05)。在术后24 h和48 h,对照组患者芬太尼的消耗量显著高于TEAS组(P<0.001)。TEAS组术后镇痛相关不良反应发生率及应用补救药物频率显著低于对照组(恶心16.7%vs.46.7%;呕吐10.0%vs.32.3%;眩晕6.7%vs.26.7%;补救药物频率13.3%vs.36.7%,P<0.05)。结论经皮穴位电刺激用于老年患者全髋关节置换术后早期镇痛,可以有效缓解术后疼痛,明显减少术后镇痛药物的用量,不良反应发生率低。

Objective To investigate whether TEAS has favorable effect on early postoperative analgesia in elderly patients undergoing total hip arthroplasty（THA）. Methods Sixty elderly patients requiring THA surgery were enrolled and randomly assigned to one of the two groups： Group TEAS received true TEAS（bilateral P6, L14;ST36, GB31 ipsilateral to the surgery site） and the control Group received sham treatment. All patients received patient-controlled analgesia for 48 h postoperatively. Analgesia was assessed by pain intensity using a visual analogue scale（VAS-10 cm） and postoperative fentanyl consumption was recorded. The incidence of analgesia-related side effects and frequency of salvage analgesic medication were also recorded. Results There was no difference in patients＇ demographic data between the two groups. Postoperative pain intensity measured by VAS was similar in both groups（P〈0.05）. Fentanyl consumption in the control Group was higher than that in Group TEAS at 24 h and 48 h（P〈0.001） after surgery. The incidence of opioid-related side effects（nausea 16.7% vs. 46.7%; vomiting 10.0% vs. 32.3%, P〈0.05） and rescue medication（13.3% vs. 36.7%,P〈0.05） for postoperative analgesia was significantly lower in Group TEAS than in the control Group. Conclusion TEAS is an effective and complementary approach for early analgesia and can reduce postoperative analgesic requirement with lower side effects in elderly patients after THA.