腕踝针联合静脉自控镇痛对胸外科手术后疼痛程度、炎症疼痛介质及应激激素表达的影响研究

Effects of wrist-ankle acupuncture combined with vein-controlled analgesia on pain,inflammatory pain mediators and stress hormones expression after thoracic surgery

目的探讨腕踝针联合静脉自控镇痛对胸外科手术后疼痛程度、炎症疼痛介质及应激激素表达的影响。方法将2019年2月至2022年2月河北省中医院收治的126例行胸外科手术治疗的患者纳入本次前瞻性研究,按照就诊顺序和随机数字表法分为研究组(n=63)和对照组(n=63)。对照组患者术后采用静脉自控镇痛,研究组患者术后采用腕踝针+静脉自控镇痛。比较2组患者T0(术后清醒时刻)、T1(术后2 h)、T2(术后6 h)、T3(术后12 h)、T4(术后24 h)、T5(术后48 h)的视觉模拟评分法(VAS)和血清炎症疼痛介质[包括前列腺素E2(PGE2)、P物质(SP)和β内啡肽(β-EP)]、应激激素水平[皮质醇、去甲肾上腺素(NE)],并观察不良反应发生情况。结果2组在T0、T4和T5时的VAS评分比较,差异无统计学意义(P>0.05);研究组在T1、T2、T3的VAS评分分别为(2.70±0.67)、(3.09±0.58)和(3.01±0.71)分,较对照组[(2.98±0.71)、(3.32±0.67)和(3.28±0.80)分]明显降低,差异均有统计学意义(P<0.05)。研究组在T3、T4和T5的血清PGE2为(151.72±15.27)、(199.24±19.48)、(155.40±16.69)μg/mL,P物质为(1.53±0.15)ng/mL、(1.90±0.21)ng/mL、(1.79±0.25)ng/mL,较对照组[PGE2(203.37±18.19)、(245.71±21.65)、(196.10±20.14)μg/mL;P物质(1.75±0.19)、(2.04±0.23)、(1.97±0.28)ng/mL]显著下降,差异均有统计学意义(P<0.05)。研究组在T3、T4和T5的β-EP为(15.73±1.56)、(13.96±1.23)、(17.96±1.50)μg/mL,较对照组[(12.55±137)、(9.36±1.19)、(13.63±1.22)μg/mL]显著增加,差异均有统计学意义(P<0.05),但2组在T0时的血清PGE2、P物质和β-EP比较,差异无统计学意义(P>0.05)。研究组在T3、T4和T5的皮质醇分别为(167.65±11.52)、(185.70±10.41)、(133.92±9.47)mmol/L,NE为(96.93±7.18)、(125.30±6.75)、(90.57±7.40)mmol/L,较对照组[皮质醇(189.56±12.29)、(224.73±9.88)、(160.43±10.55)mmol/L;NE(121.82±7.94)、(143.52±8.05)、(110.36±8.09)mmol/L]均显著降低,差异均有统计学意义(P<0.05),但2组在T0时的血清皮质醇、NE差异均无统计学意义(P>0.05)。研究组不良反应发生率为22.22%,与对照组的31.75%比较,差异无统计学意义(P>0.05)。结论腕踝针联合静脉自控镇痛在胸外科手术后的镇痛效果显著,可有效降低炎症疼痛介质和应激激素水平,且安全性良好。

Objective To investigate the effect of wrist-ankle acupuncture combined with vein-controlled analgesia on pain,inflammatory pain mediators and stress hormones expression after thoracic surgery(TS).Methods 126 patients undergoing TS in Hebei Hospital of traditional Chinese Medicine from February 2019 to February 2022 were enrolled in this prospective study,and were divided into study group(n=63)and control group(n=63)according to the order of treatment and random number table.Patients in the control group were treated with vein-controlled analgesia,and patients in the study group were treated with wrist-ankle acupuncture+vein-controlled analgesia,and the data of the two groups were compared as follows.Visual analog scale(VAS)scores at T0(postoperative awake time),T1(postoperative 2 h),T2(postoperative 6 h),T3(postoperative 12 h),T4(postoperative 24 h)and T5(postoperative 48 h),serum inflammatory pain mediators(including PGE2,SP andβ-EP)and stress hormones[cortisol,norepinephrine(NE)]at T0,T3,T4 and T5 were compared,and the occurrence of adverse reactions was observed.Results There was no statistically significant difference on VAS scores between the two groups at T0,T4 and T5(P>0.05),VAS scores at T1,T2 and T3 in the study group were(2.70±0.67),(3.09±0.58)and(3.01±0.71)pionts,respectively,which were lower than those in the control group[(2.98±0.71),(3.32±0.67)and(3.28±0.80)pionts],the differences were statistically significant(P<0.05).Serum PGE2 of the study group at T3,T4 and T5 was(151.72±15.27),(199.24±19.48)and(155.40±16.69)μg/mL,respectively,and serum SP was(1.53±0.15),(1.90±0.21)and(1.79±0.25)ng/mL,which were lower than those in the control group[PGE2(203.37±18.19),(245.71±21.65),(196.10±20.14)μg/mL,SP(1.75±0.19)ng/mL,(2.04±0.23),(1.97±0.28)ng/mL],the differences were statistically significant(P<0.05).Serumβ-EP at T3,T4 and T5 in the study group were(15.73±1.56),(13.96±1.23)and(17.96±1.50)μg/mL,respectively,which were higher than those in the control group[(12.55±137),(9.36±1.19)and(13.63±1.22)μg/mL],the differences were statistically significant(P<0.05).But serum PGE2,SP andβ-EP in the two groups was no dramatically difference at T0.Serum cortisol at T3,T4 and T5 in the study group were(167.65±11.52),(185.70±10.41)and(133.92±9.47)mmol/L,respectively,serum NE were(96.93±7.18),(125.30±6.75)and(90.57±7.40)mmol/L,respectively,which were lower than those in the control group[cortisol(189.56±12.29),(224.73±9.88)and(160.43±10.55)mmol/L,NE(121.82±7.94),(143.52±8.05)and(110.36±8.09)mmol/L],the differences were statistically significant(P<0.05),but there was no dramatical difference on cortisol and NE between the two groups at T0(P>0.05).The incidence of adverse reactions was 22.22%in the study group and 31.75%in the control group,and there was no dramatical difference(P>0.05).Conclusion Wrist-ankle acupuncture combined with vein-controlled analgesia has significant analgesic effect after TS,it can effectively reduce the inflammatory pain mediators and stress hormones expression with good safety.