电针术前预处理对全膝关节置换术术后镇痛效果的影响观察

Effect of preoperative electroacupuncture pretreatment on postoperative analgesia in total knee arthroplasty

目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部浸润麻醉+静脉自控镇痛(PCIA),对照组给予局部浸润麻醉+PCIA。比较2组手术前后血浆缓激肽(BK)、前列腺素E2(PGE2)、P物质(SP)、β内啡肽(β-ep)、强啡肽(Dyn),术后12、24、48 h VAS评分,麻醉药物使用情况及不良反应。结果术后2组血浆BK、PGE2、SP、β-ep、Dyn水平与同组术前比较,差异有统计学意义(P<0.01)。观察组血浆BK、PGE2、SP水平低于对照组(P<0.05),β-ep、Dyn水平高于对照组(P<0.05)。静息VAS评分:术后12、24、48 h,2组间VAS评分比较,差异无统计学意义(F=0.694,P=0.406);组内各时间点VAS评分比较,差异有统计学意义(F=256.6,P<0.01)。活动VAS评分:术后12、24、48 h,2组间VAS评分比较,差异有统计学意义(F=7.072,P=0.008);组内各时间点VAS评分比较,差异有统计学意义(F=300.885,P<0.01)。观察组首次按压时间晚于对照组(P<0.01),PCIA总按压次数少于对照组(P<0.01),补救镇痛例数少于对照组,但差异无统计学意义(P>0.05)。观察组术后恶心、呕吐发生率低于对照组(P<0.05);2组头晕、嗜睡、呼吸抑制、瘙痒发生率比较,差异无统计学意义(P>0.05)。结论电针预处理可增强TKA患者术后局部浸润麻醉+PCIA的镇痛效果。

Objective To observe the effect of preoperative electroacupuncture(EA)pretreatment on postoperative analgesia in patients undergoing total knee arthroplasty(TKA)under general anesthesia.Methods 96 patients undergoing their first unilateral TKA under general anesthesia at Xuzhou Central Hospital were enrolled and randomly divided into an observation group and a control group according to a random table number,with 48 cases in each group.The observation group received EA pretreatment combined with local infiltration anesthesia and patient-controlled intravenous analgesia(PCIA),while the control group received local infiltration anesthesia and PCIA.Plasma levels of bradykinin(BK),prostaglandin E2(PGE2),substance P(SP),β-endorphin(β-ep),and dynorphin(Dyn)before and after surgery,and VAS scores at 12,24,and 48 hours postoperatively,as well as anesthesia drug usage and adverse reactions,were compared between the two groups.Results Postoperatively,plasma levels of BK,PGE2,SP,β-ep,and Dyn in both groups differed significantly from their preoperative levels(P<0.01).The observation group had lower plasma levels of BK,PGE2,and SP than the control group(P<0.05),and higher levels ofβ-ep and Dyn(P<0.05).For resting VAS scores at 12,24,and 48 hours postoperatively,there was no significant difference between the two groups(F=0.694,P=0.406),but intra-group comparisons at each time point showed significant differences(F=256.6,P<0.01).For activity VAS scores at 12,24,and 48 hours,significant differences were observed between the groups(F=7.072,P=0.008),and intra-group comparisons at each time point also showed significant differences(F=300.885,P<0.01).The observation group had a later first press time than the control group(P<0.01),fewer total PCIA presses(P<0.01),and fewer cases requiring additional analgesia,though this difference was not statistically significant(P>0.05).The incidence of nausea and vomiting was lower in the observation group than the control group(P<0.05),but there were no significant differences in the incidence of dizziness,drowsiness,respiratory depression,or itching between the two groups(P>0.05).Conclusion EA pretreatment enhances the analgesic effect of local infiltration anesthesia combined with PCIA in patients undergoing TKA.