针刺足三里、内关穴对老年髋关节置换术后镇痛疗效及对血清炎症因子的影响

Effect of Acupuncture at Zusanli(ST36)and Neiguan(PC6)on Analgesia and Serum Inflammatory Factors in Elderly Patients after Hip Replacement

目的探讨针刺足三里、内关穴对老年髋关节置换术后镇痛疗效及对血清炎症因子的影响。方法选择196例行全髋关节置换术的老年患者作为研究对象,采用随机数字法平均分为观察组与对照组:对照组术后给予常规对症止痛及冰袋冷敷治疗,观察组术后6 h在对照组基础上给予足三里、内关穴针刺治疗。于术后6 h、24 h、48 h、72 h及第5天采用疼痛视觉模拟评分(Visual analogue scale,VAS)评价患者疼痛状态,于术后6 h、48 h及72 h评价术后胀气情况;于术后6 h、24 h、48 h及72 h检测血清炎症因子:前列腺素E2(Prostaglandin E2,PGE2)、白细胞介素-1β(Interleukin-1β,IL-1β)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α);于髋关节置换术前、术后72 h、出院时采用Harris髋关节评分标准评价髋关节功能。结果两组患者术后24 h VAS评分最高,随后逐渐降低(P<0.05);术后48 h观察组VAS评分降至术后6 h水平,而对照组仍高于术后6 h水平(P<0.05);术后24 h、48 h、72 h及第5天观察组VAS评分均低于对照组(P<0.05)。术后两组患者腹胀评分均逐渐降低(P<0.05);术后48 h、72 h观察组腹胀评分低于对照组(P<0.05)。观察组术后肠鸣音出现及恢复正常时间、首次排气及排便时间均较对照组短(P<0.05)。两组患者术后24 h PGE2、IL-1β、TNF-α水平最高,术后72 h逐渐降低(P<0.05);术后5 d观察组PGE2、IL-1β、TNF-α水平降至术后6 h水平,而对照组仍高于术后6 h水平(P<0.05);术后24 h、72 h及第5天观察组PGE2、IL-1β、TNF-α水平均低于对照组(P<0.05)。两组术后Harris髋关节评分均逐渐升高(P<0.05);术后72 h及出院时观察组Harris髋关节评分高于对照组(P<0.05)。结论针刺足三里、内关穴可以更好地降低老年髋关节置换术后疼痛程度,缩短疼痛时间,同时更好地促进胃肠道功能恢复,其机制可能与降低PGE2、IL-1β、TNF-α等炎症因子相关。

Objective To explore the analgesic effect of acupuncture at Zusanli(ST36)and Neiguan(PC6)on elderly patients after hip replacement and its influence on serum inflammatory factors.Methods A total of 196 elderly patients undergoing total hip arthroplasty were selected as the research objects,and were divided into observation group and control group by random number method.The control group was given routine symptomatic analgesia and cold compress after operation,and the observation group was given acupuncture at Zusanli(ST36)and Neiguan(PC6)on the basis of the control group 6 hours after operation.Patients'pain status was evaluated by visual analogue scale(VAS)at 6 h,24 h,48 h,72 h and 5 d after operation,and postoperative flatulence was evaluated at 6 h,48 h and 72 h after operation.Serum inflammatory factors including prostaglandin E2(PGE2),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)were detected at 6 h,24 h,48 h and 72 h after operation.Harris hip score was used to evaluate hip function before and 72 hours after operation and at discharge from the hospital.Results The VAS score was the highest in the two groups 24 hours after operation,and then gradually decreased(P<0.05).After 48 hours,the VAS score of the observation group decreased 6 hours after operation,while that of the control group was still higher than that 6 hours after operation(P<0.05).The VAS scores of the observation group were lower than those of the control group at 24 h,48 h,72 h and 5 d after operation(P<0.05).After operation,the abdominal distension scores of both groups decreased gradually(P<0.05).The abdominal distension score of the observation group was lower than that of the control group at 48 h and 72 h after operation(P<0.05).Compared with those of the control group,the time for bowel sounds to appear and return to be normal,the time for first exhaust and defecation in the observation group were shorter(P<0.05).The levels of PGE2,IL-1β and TNF-α in the two groups were the highest at 24 h after operation,and gradually decreased at 72 h after operation(P<0.05).The levels of PGE2,IL-1β and TNF-α 5 days after operation in the observation group decreased to the levels at 6 hours after operation,while those in the control group were still higher than those at 6 hours after operation(P<0.05).The levels of PGE2,IL-1β and TNF-α in observation group were lower than those in control group at 24 h,72 h and 5 d after operation(P<0.05).Harris hip score in both groups increased gradually after operation(P<0.05).Harris hip score in the observation group was higher than that in the control group 72 h after operation and at discharge(P<0.05).Conclusion Acupuncture at Zusanli(ST36)and Neiguan(PC6)can better reduce the pain degree,shorten the pain time and promote the recovery of gastrointestinal function in elderly patients after hip replacement,and its mechanism may be related to the reduction of inflammatory factors such as PGE2,IL-1β and TNF-α.