经皮穴位电刺激对全膝人工关节置换术后镇痛疗效评价的临床研究

Analgesic effect of transcutaneous electrical acupointstimulation on total knee arthroplasty

目的评价经皮穴位电刺激对全膝人工关节置换术后镇痛药物的使用及术后不良反应的影响。方法将中国中医科学院望京医院骨关节二科行单侧全膝人工关节置换术(total knee arthroplasty,TKA)的70例患者按随机对照原则分为试验组和对照组各35例。术后,对照组手术患者行基础镇痛,试验组在基础镇痛的基础上行经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)治疗至术后第7 d。分别记录术后患膝疼痛视觉模拟量表(visual analogue scale,VAS)和患膝痛阈值,术后首次使用补救镇痛药物的时间和术后补救镇痛药物用量及术后恶心、呕吐等不良反应的情况。结果术后第1 d,2组患者膝关节VAS评分和痛阈值不具有统计学差异(P>0.05),术后第3、7 d,试验组膝关节疼痛VAS评分均低于对照组(P<0.05),痛阈值高于对照组(P<0.05);试验组术后首次使用补救镇痛的时间明显较对照组延后(P<0.05);术后补救镇痛药物的使用量及不良反应发生率均少于对照组(P<0.05)。结论经皮穴位电刺激能有效缓解TKA后患者的早期疼痛;延后术后首次使用补救镇痛药物的时间,减少镇痛药物的用量,降低术后不良反应的发生率。

Objective To evaluate the effect of transcutaneous electrical acupoint stimulation on the use of analgesics and adverse reactions after total knee arthroplasty.Methods Seventy patients undergoing total knee arthroplasty(TKA)in our department were randomly assigned to the experimental group and to the control group,with 35 patients in each group.After surgery,patients in the control group were treated with base analgesia,while patients in the experimental group received additional transcutaneous electrical acupoint stimulation(TEAS)until the 7th day after surgery.The visual analogue scale(VAS)and knee pain threshold after surgery,the time of the first use of remedial analgesics and amount of remedial analgesics after surgery,and postoperative adverse reactions such as nausea and vomiting were recorded respectively.Results On the 1st day after surgery,there was no statistical difference in knee VAS score and pain thresholds between the two groups(P>0.05).On the 3rd and 7th day after surgery,knee VAS score was lower in the experimental group than in the control group(P<0.05),and the pain threshold was higher in the experimental group than in the control group(P<0.05);The time of the first postoperative remedial analgesia was significantly longer in the experimental group than in the control group(P<0.05);The dosage of remediation analgesics and the incidence of adverse reactions were lower in the experimental group than in the control group(P<0.05).Conclusions Transcutaneous electrical acupoint stimulation can effectively relieve the early pain after total knee arthroplasty,which can delay the time of the first use of remedial analgesics after operation and reduce the dosage of analgesics and reduce the incidence of postoperative adverse reactions.