电针结合局部麻醉对经皮椎体成形术患者镇静和镇痛的影响

Impact of Electroacupuncture Combined with Topical Anesthesia on Sedation and Analgesia in Patients Receiving Percutaneous Vertebroplasty

目的 观察电针合谷、内关和足三里穴结合局部麻醉对经皮椎体成形术(PVP)患者镇静和镇痛的影响。方法 纳入实施PVP的骨质疏松性压缩骨折患者70例,根据患者自由选择麻醉方式的不同,将其分为对照组(36例)和研究组(34例)。对照组采用局部麻醉配合镇痛药物麻醉,研究组则采用电针合谷、内关和足三里穴结合局部麻醉。观察患者手术过程中生命体征与应激指标水平的变化情况,同时采用Ramsay镇静评分与疼痛视觉模拟评分(VAS)对患者镇静和镇痛情况进行评估。比较两组不良反应发生率。结果 手术前(T_(0)时),两组平均动脉压(MAP)和心率(HR)比较,差异无统计学意义(P>0.05);穿刺(T_(1))时、骨水泥灌注(T_(2))时及术毕即刻(T_(3)),研究组MAP和HR低于对照组(P<0.05);两组各时段血氧饱和度(Sa O2)比较,差异无统计学意义(P>0.05)。T_(1)、T_(2)和T_(3)时,两组血清皮质醇(CORT)与去甲肾上腺素(NE)水平较T_(0)时升高(P<0.05),且对照组均高于研究组(P<0.05)。两组各时段Ramsay评分比较,差异无统计学意义(P>0.05)。研究组各时段VAS评分均低于对照组(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 电针合谷、内关和足三里穴结合局部麻醉能维持PVP患者术中的体征稳定,有效减轻患者应激反应,达到良好的镇痛和镇静效果,且安全性有保障。

Objective To observe the effects of electroacupuncture at Hegu(LI4), Neiguan(PC6), and Zusanli(ST_(3)6) plus topical anesthesia on sedation and analgesia in patients undergoing percutaneous vertebroplasty(PVP).Method Seventy patients going to receive PVP for osteoporotic compression fracture were recruited and divided into a control group(36 cases) and a study group(34 cases) according to the patient’s selection of anesthesia type. The control group received topical anesthesia in combination with analgesics, and the study group received electroacupuncture at Hegu, Neiguan, and Zusanli plus topical anesthesia. Throughout the surgery, patient’s vital signs and stress index levels were observed. At the same time, the Ramsay sedation scale and visual analog scale(VAS)scores were used to evaluate the sedation and analgesia status. The adverse reaction rate was compared between the two groups. Result Before the surgery(T_(0)), there were no significant differences in the mean arterial pressure(MAP) or heart rate(HR) between the two groups(P>0.05);the MAP and HR were lower in the study group than in the control group at puncture(T_(1)) and bone cement infusion(T_(2)) and right after the surgery(T_(3))(P<0.05);there was no significant difference in the level of SaO2 between the two groups at any time point(P>0.05). At T_(1), T_(2), and T_(3), the levels of serum cortisol(CORT) and norepinephrine(NE) were higher than those at T_(0) in both groups(P<0.05) and were higher in the control group than in the study group(P<0.05). There were no significant differences in the Ramsay score between the two groups at any time point(P>0.05). The VAS score was lower in the study group than in the control group at each time point(P<0.05). The between-group difference in the adverse reaction rate was statistically insignificant(P>0.05). Conclusion Electroacupuncture at Hegu, Neiguan, and Zusanli plus topical anesthesia can maintain the vital signs and reduce stress reactions of patients during the PVP surgery and achieve satisfactory analgesia and sedation with a reliable safety rating.