全膝置换围手术期耳针镇痛的临床应用

目的:观察耳针在全膝关节置换术围手术期镇痛的疗效.方法:将60例因膝骨性关节炎晚期行单侧首次全膝关节置换术的患者被完全随机分成两组,耳针组31例,对照组29例.耳针组患者在术前晚子“神门”、“皮质下”、“肺”和“膝关节”四处耳穴埋针,对照组在耳部轮1、2、3、4四处假埋针治疗.术后采用直观模拟疼痛量表评估患者术后疼痛程度;所有患者术后72 h内使用患者自控镇痛泵,患者每次在模拟疼痛评分＞4.0时先行耳穴按压5 min,如疼痛缓解不明显再行自控镇痛泵治疗.于不同的时间点分别记录自控镇痛泵的用量,并记录术后3d内患者发生恶心呕吐、嗜睡等不良反应的情况.结果:耳针患者在术后12、24、36、48、60、72 h的疼痛评分和术后第1、2、3天自控镇痛泵使用量均低于对照组且差异有统计学意义;耳针组术后3d内发生恶心呕吐、眩晕嗜睡的倒数少于对照组,差异有统计学意义;耳针组患者未观察到任何与耳针治疗相关的不良反应.结论:耳针能减轻全膝关节置换术后的疼痛,减少镇痛药物的用量及术后不良反应的发生.

Application of Auricular acupuncture for Analgesia in Perioperative Period in Total Knee Arthroplasty

Objective:To observe the effect of auricular acupoint(AA)for analgesia during perioperative period in total knee arthroplasty.Methods:60 patients undergoing the first unilateral Total Knee Arthroplasty(TKA)for the terminal knee osteoarthritis(OA) were randomly divided into the Auricular acupuncture(AA)group and the control group,31 in AA group,the other in the control group.At four Acupuncture point on the ear named shenmenthalamus lung andknee joint,AA group received auricular needle-embedding the before surgery.and the control group received sham needle-embedding in sham acupuncture points.Pain of patients during postoperatively were evaluated with a visual analog scale(VAS);All patients received Patient Controlled Analgesia(PCA)for 72hours after surgery(in the PCA pump,300 mL liquid includes 800 mg tramadol and 0.5mg fentanyl).They were encouraged to stimulate the needles for 5 min every time they experienced pain﹥4.0 score and only after that to inject the PCA pump,if needed.The consumption of analgesia was recorded at each time quantum;The Incidence of postoperative complications was counted during PCA.Results:Compared to the control group,VAS for pain of the patients of AA group had significantly lower to hours 12、24、36、48、60 and 72 after surgery.The consumption of analgesia of AA group during the 1d 2d and 3d after surgery were significant less;The Incidence of nausea or vomiting and dizziness or drowsiness in AA group was significantly less than in the control group during using the PCA pump.Conclusion:In total knee arthroplasty Auricular acupuncture can significantly relieve the postoperative pain of patients and the consumption of patient controlled analgesia,reduce the occurrence of post operative nausea or vomiting and dizziness or drowsiness.