针刺治疗胸腔镜手术后创口疼痛的临床方案研究

Clinical Study on Acupuncture Treatment of Wound Pain after Thoracoscopic Surgery

目的 观察针刺治疗胸腔镜手术后创口疼痛的临床方案及疗效。方法 收集180例行胸腔镜手术的患者随机分为试验组A、试验组B与对照组,每组60例。各组患者于术后开始使用镇痛泵镇痛,试验组A在镇痛泵镇痛的基础上于手术后针刺双侧合谷、内关、足三里及创口所在肋间对应夹脊穴;试验组B在镇痛泵镇痛的基础上于手术后针刺双侧足临泣、丘墟、太冲穴。针刺治疗共分为4次,时间点分别为术后4、24、48、72 h。分别记录各组患者各个治疗时间点后的直观模拟量表法(VAS)和简化的McGill疼痛问卷(SF-MPQ)评分,并于术后4 h及72 h检测患者周围血中儿茶酚胺(多巴胺、去甲肾上腺素、肾上腺素)。结果 各组治疗后的VAS、SF-MPQ评分均较治疗前下降(P <0.05),3个组的VAS、SF-MPQ评分下降趋势不同(P <0.05),试验组B<试验组A<对照组(P <0.05);3个组外周血中肾上腺素含量治疗前后及组间差异均无统计学意义(P> 0.05);多巴胺含量各组治疗前后差异均有统计学意义(P <0.05),且组间差异均有统计学意义(P <0.05);去甲肾上腺素含量各组治疗前后及组间差异均无统计学意义(P> 0.05)。结论 针刺治疗胸腔镜手术后创口疼痛有显著疗效,且辨证选穴疗效较传统经验取穴疗效更明显。

Objective:To observe the clinical plan and effect of acupuncture in the treatment of thoracoscopic wound pain.Methods:A total of 180 patients undergoing thoracoscopic surgery were randomly divided into exper-imental group A,experimental group B and control group,with 60 cases in each group.The patients in the three groups were treated with analgesic pump after surgery.Experimental group A was treated with analgesic pump after surgery by acupuncture at bilateral Hegu,Neiguan,Zusanli and corresponding Jiaji point between the ribs where the wound was located.In experimental group B,analgesia with analgesic pump was based on acupuncture of both sides of the Zulinqi,Qiuxu,Taichong point after operation.The acupuncture treatment was divided into four times,and the time points were 4,24,48 and 72 h,respectively.Visual Analog Scale(VAS)and simplified McGill Pain Questionnaire(SF-MPQ)scores after four treatment time points were recorded in the three groups,respectively,and peripheral blood catecholamines(dopamine,norepinephrine,epinephrine)were detected at 4 and 72 h after surgery.Results:The VAS and SF-MPQ scores of the three groups after treatment decreased compared with those before treatment(P<0.05),the decreasing trend of VAS and SF-MPQ scores in the three groups was different(P<0.05),experimental group B<experimental group A<control group(P<0.05);there was no signifi-cant dfference in the content of epinephrine in peripheral blood between the three groups before and after treat-ment(P>0.05);there was a significant difference in dopamine content between the three groups before and after treatment(P<0.05);there were significant statistical differences between the groups(P<0.05);there was no signif-icant difference in norepinephrine content between the three groups before and after treatment(P>0.05).Conclu-sion:Acupuncture has significant curative effect on thoracoscopic wound pain,and the curative effect of point selection based on syndrome differentiation is more obvious than that of traditional experience.