针刺复合局部麻醉应用于经皮椎体成形术的临床研究

Acupuncture combined with local anesthesia for percutaneous vertebroplasty

目的:观察针刺复合局部麻醉应用于经皮椎体成形术的镇痛、镇静效果。方法:将60例单节段骨质疏松性椎体压缩骨折准备行经皮椎体成形术的患者随机分为观察组、对照1组、对照2组,每组20例。观察组为术前20 min电针合谷、内关、足三里穴,术中维持电刺激,配合术中常规局部麻醉;对照1组术前30 min予肌内注射帕瑞昔布钠40 mg,配合术中常规局部麻醉;对照2组术前30 min静脉推注地佐辛5 mg,配合术中常规局部麻醉。观察比较3组的视觉模拟评分(VAS)及Ramesy镇静评分。结果:观察组与对照2组穿刺时、灌注骨水泥时VAS评分高于针刺前(均P<0.01),灌注骨水泥时VAS评分高于穿刺时(P<0.05,P<0.01),手术结束时VAS评分低于穿刺时和灌注骨水泥时(P<0.05,P<0.01);对照1组穿刺时、灌注骨水泥时、手术结束时VAS评分均高于针刺前(P<0.05,P<0.01),手术结束时VAS评分低于穿刺时和灌注骨水泥时(P<0.05,P<0.01)。各组间各时点VAS评分、Ramesy评分比较差异均无统计学意义(均P>0.05)。结论:针刺复合局部麻醉应用于经皮椎体成形术与局部麻醉配合镇痛药物,具有同样的镇痛效果、镇静效果,可作为经皮椎体成形术术中麻醉更好的方式。

Objective To observe the analgesic and sedative effects of acupuncture combined with local anesthesia for percutaneous vertebroplasty（PVP）. Methods Sixty patients of single segmental osteoporotic vertebral compression fractures who were prepared to receive PVP were randomly divided into an observation group, a control 1 group, a control 2 group,20 cases in each group. The patients in the observation group were treated with electroacupuncture（EA） at Hegu（LI 4）, Neiguan（PC 6） and Zusanli（ST 36） 20 min before operation; during operation, EA was given combined with regular anesthesia. The patients in the control 1 group were treated with intramuscular injection of parecoxib sodium（40 mg）, combined with regular anesthesia. The patients in the control 2 group were treated with intravenous injection of dezocine（5 mg）, combined with regular anesthesia. Visual analogue scale（VAS） and Ramesy sedation score were compared among the three groups. Results In the observation group and control 2 group, the VAS during puncture and bone cement placement was higher than that before acupuncture（all P〈0.01）; the VAS during bone cement placement was higher than that before puncture（P〈0.05, P〈0.01）; the VAS after operation was lower than that during puncture and bone cement placement（P〈0.05, P〈0.01）. In the control 1 group, the VAS during puncture and bone cement placement and after operation was higher than that before acupuncture（P〈0.01, P〈0.05）, the VAS after operation was lower than that during puncture and bone cement placement（P〈0.05, P〈0.01）. There was no significant difference in VAS and Ramesy score among three groups at all time points（all P〉0.05）. Conclusion Compared with local anesthesia and analgesics, acupuncture combined with local anesthesia has similar analgesic and sedative effect for PVP, which could be considered a better method for PVP anesthesia.