经皮穴位电刺激在老年骨关节炎初次全膝关节置换术麻醉中超前镇痛效果的临床研究

Clinical Study on Preemptive Analgesia Effect of Transcutaneous Electrical Acupoint Stimulation during First Total Knee Arthroplasty in Elderly Patients with Osteoarthritis

目的:探讨经皮穴位电刺激(TEAS)在老年骨关节炎初次全膝关节置换术(TKA)麻醉中的超前镇痛效果。方法:100例老年骨关节炎行初次TKA的患者,随机分为观察组和对照组各50例。两组均在麻醉诱导前于超声引导下行术肢股神经阻滞麻醉,观察组在此基础上给予TEAS超前镇痛,两组均在全麻下实施TKA。比较两组术中麻醉药物用量、术后恢复情况、生化指标、术后疼痛程度及不良反应发生情况。结果:与对照组比较,观察组患者术中瑞芬太尼、丙泊酚用量明显减少,术后苏醒时间、拔管时间也显著缩短(P<0.05)。观察组患者术后1 h、6 h、24 h视觉模拟评分法(VAS)评分均显著低于对照组(P<0.05)。两组术后即刻白细胞介素-6(IL-6)、C反应蛋白(CRP)、血糖(Glu)指标均明显升高,而观察组各指标均明显低于对照组(P<0.05)。观察组术后24 h镇痛满意率为96.0%,显著高于对照组的84.0%(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:TEAS超前镇痛应用于骨关节炎初次行TKA的老年患者安全有效,可缓解术后疼痛,减少术中麻醉药物用量,促进术后苏醒和康复。

Objective:To explore the preemptive analgesia effect of transcutaneous electrical acupoint stimulation(TEAS)during the first total knee arthroplasty(TKA)in elderly patients with osteoarthritis.Methods:A total of 100 elderly patients undergoing first TKA for osteoarthritis were randomly divided into observation group and control group,with 50 cases in each group.Before the induction of anesthesia,both groups were anesthetized with ultrasonic-guided femoral nerve block,and the observation group was given TEAS as preanalgesia on this basis,and both groups were given TKA under general anesthesia.The intraoperative anesthetic dosage,postoperative recovery,biochemical indicators,postoperative pain and adverse reactions of the two groups were compared.Results:Compared with the control group,the intraoperative remifentanil and propofol dosage in the observation group were significantly reduced,and the postoperative waking time and extubation time were also significantly shortened(P<0.05).The VAS scores at 1 h,6 h and 24 h after treatment in the observation group were significantly lower than those in the control group(P<0.05).Immediately after the operation,the levels of IL-6,CRP and Glu were significantly increased in the two groups,and these indicators in the observation group were significantly lower than those in the control group(P<0.05).The satisfaction rate of 24 h postoperative analgesia in the observation group was 96.0%,which was significantly higher than that(84.0%)of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:The preemptive analgesia of TEAS for the first TKA in elderly patients with osteoarthritis is safe and effective,which can relieve postoperative pain,reduce intraoperative anesthetic dosage,and promote postoperative revival and recovery.