2012—2021年围术期针刺领域相关文献的计量学分析

目的 基于CiteSpace软件和中国知网（CNKI）数据库、中国社会科学引文索引数据库（CSSCI）和Web of Science（WoS）对围术期针刺领域2012—2021年的研究状况和趋势进行可视化分析。

方法 以针刺和围术期相关检索词对CNKI、CSSCI、WoS收录的中英文文献分别进行检索,检索范围为2012年1月1日至2021年12月31日发表的文献。采用CiteSpace 5.7.R5进行文献计量学分析,包括人员和机构发文情况、人员和机构共现情况、关键词热度、突现度及时间线图。

结果 共纳入1 607篇中文文献和1 201篇英文文献。整体发文数量随年度有一定波动,2019年度发文数量最多。中英文发文数量最多的作者分别为上海中医药大学附属曙光医院的沈卫东（32篇）和韩国的Inhyuk Ha（19篇）,最多的机构为上海中医药大学附属曙光医院（66篇）和上海中医药大学（43篇）。出现频次最高的关键词为“针刺”和“经皮穴位电刺激”等技术,以及“针刺镇痛”和“术后恶心呕吐”等适应证。代表研究趋势的关键词为“脑功能网络”、“加速康复外科”、“睡眠质量”和“老年”。

结论 针刺减少术后并发症、改善患者术后转归是围术期针刺持续关注的领域,老年患者、脑功能和加速康复外科是未来应重点关注的研究方向。     

针刺对输尿管镜钬激光碎石术后疼痛及住院天数的影响

目的:观察针刺对输尿管镜钬激光碎石术后疼痛及住院天数等的影响.方法:选取泌尿外科需行输尿管镜钬激光碎石术住院患者100例,简单随机分为治疗组和对照组各50例,对照组采用常规手术方案,治疗组在常规手术的基础上术中加入针刺(气冲穴、足五里穴、曲泉穴)治疗,观察患者术后疼痛、术后满意率、住院天数等的差异.结果:治疗组的术后6...     

综合护理缓解骨科手术患者术后疼痛的效果分析

目的探讨综合护理缓解骨科手术患者术后疼痛的效果。方法依据不同护理方法将2017-01—2018-10间在息县人民医院接受骨科手术的84例患者分为2组,每组42例。对照组实施常规护理,观察组实施综合护理。比较2组患者术后疼痛缓解效果和总体满意率。结果术后第1、3、5天,观察组患者疼痛评分明显优于对照组,总体满意率高于对照组,2组差异均有统计学意义(P0.05)。结论对骨科术后患者实施综合护理,能有效缓解术后疼痛,提高患者对护理工作的满意率,有利于患者早期进行康复锻炼和功能的恢复。     

针刺联合止吐药防治全麻术后恶心呕吐效果的Meta分析

目的 系统评价针刺(手针、电针)防治全麻术后恶心呕吐的效果。方法 计算机检索Embase、PubMed、Cochrane、中国知网、维普、中国生物医学文献数据库、万方医学等数据库,纳入有关针刺联合止吐药防治全麻术后恶心、呕吐的随机对照试验(RCT),检索年限为建库至2022年9月,采用RevMan 5.3进行统计分析。结果 共纳入15篇文献,患者1 493例,其中止吐药组741例,针刺联合止吐药组752例。与止吐药组比较,针刺联合止吐药组术后恶心发生率明显降低(OR=0.43, 95%CI 0.34～0.54,P<0.001),术后呕吐发生率明显降低(OR=0.55, 95%CI 0.45～0.66,P<0.001)。结论 与单用止吐药比较,采用针刺(手针、电针)联合止吐药患者术后恶心和呕吐的发生率更低。     

肋骨打孔关胸法用于缓解术后疼痛的临床分析

目的探讨肋骨打孔关胸法,用于缓解开胸术后疼痛,减少早期肺部并发症可行性。方法选择100例行开胸手术的病人,随机分成2组,每组50例,A组用肋骨打孔关胸法,关胸时在切口的下位肋骨上用骨科用克氏针分别打3—4个眼孔,用10号丝线自7L眼穿入,结扎;B组直接绕肋关胸,用10号丝线直接绕过上下肋骨缝合3—4针,结扎。术后于相同时间分别采用视觉模糊评分法（VAS）评价术后疼痛度,观察术后胸部疼痛感,早期肺部并发症的发生率及平均住院日。结果采用肋骨打孔关胸可以避免对肋间神经的损伤,明显减轻开胸病人术后的疼痛。在术后恢复过程中,早期未发生肺不张、感染等肺部并发症,明显缩短住院日。结论肋骨打fL关胸用于减轻术后疼痛,减少肺部并发症,缩短住院日是可行的,值得临床推广。     

综合护理干预缓解混合痔患者术后疼痛的效果观察

为探讨综合护理干预在缓解混合痔患者术后疼痛方面的效果,选择混合痔手术患者60例,按入院顺序单双数分为干预组和对照组,各30例。干预组患者在常规护理基础上同时给予综合护理干预,包括心理支持、呼吸训练。音乐疗法、排便护理;对照组患者只接受常规护理。采用视觉模拟量表（VAS）对两组患者疼痛程度进行评价,并进行对比分析。结果显示,干预组术后24h、48h、3d、7dVAS评分均低于对照组,P〈0．05。结果表明,综合护理干预可以有效缓解混合痔患者术后建痛。     

术前预防性使用褪黑素缓解术后急性疼痛效果的Meta分析

目的 评价术前预防性使用褪黑素对缓解术后急性疼痛的效果。方法 计算机检索PubMed、Embase、Cochrane Library、中国知网、万方和维普等数据库,时间从建库至2021年9月20日,术前预防性使用褪黑素用于缓解术后急性疼痛的随机对照试验,根据Cochrane干预措施系统评价手册推荐的方法进行Meta分析。结果 共纳入21篇文献,共计1 589例患者,其中褪黑素组860例,对照组729例。与对照组比较,褪黑素组术后6 h(MD=-1.65分,95%CI-2.20～-1.11分,P<0.05)、12 h(MD=-1.16分,95%CI-2.09～-0.23分,P<0.05)、24 h(MD=-1.13分,95%CI-1.41～-0.86分,P<0.05)的VAS疼痛评分明显降低,术中芬太尼用量明显减少(MD=-19.59μg, 95%CI-33.28～-5.9μg,P<0.05),术后首次给予镇痛药时间明显延长(MD=60.21 min, 95%CI 44.08～76.34 min,P<0.05),术后24 h内镇痛药用量明显减少(SMD=-1...     

规范化术后疼痛护理改善泌尿科急诊术后疼痛效果评价

目的总结规范化术后疼痛护理用于泌尿科急诊术后疼痛的效果。方法随机将98例接受泌尿科急诊手术的患者分为2组,各49例。对照组采用常规护理,观察组采用规范化术后疼痛护理,对比分析2组的护理效果。结果 2组的术后疼痛情况、并发症对比,差异具有统计学意义(P0.05)。结论规范化术后疼痛护理用于泌尿科急诊术后的镇痛效果明显。     

慢性术后疼痛防治研究进展

慢性术后疼痛(CPSP)指由手术引起的,在术区或邻近术区发生的持续时间超过3个月的疼痛,是一种常见的手术后并发症。因其迁延难愈的特性给患者和社会造成巨大经济负担。目前对CPSP的认识尚不完善,缺乏统一完整的CPSP防治体系,该综述从危险因素控制、围手术期用药、针刺治疗3个角度就目前关于CPSP的防治现状进行综述。     

针灸治疗下腰痛疗效的Meta分析

目的 :对针灸治疗下腰痛(LBP)的临床疗效进行Meta分析。方法 :计算机检索2004年1月至2014年5月Pub Med、EMbase、The Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普(VIP)和万方数据库(Wanfang Data),查找针灸与其他疗法比较治疗LBP患者疗效的随机对照试验(RCT),由2位评价员依据纳入排除标准分别独立筛选文献、提取资料和评价纳入研究的方法学质量后,通过Rev Man 5.2软件对治疗前后VAS、ODI、JOA、RMDQ等评分变化进行Meta分析。结果 :最终纳入10个RCT,共计751例患者。Meta分析结果显示:单纯针灸治疗组VAS评分改善优于非针灸治疗组[RR=-1.32;95%CI(-1.41,-1.22);Z=27.28;P0.000 01];单纯针灸治疗组ODI评分改善优于非针灸治疗组[RR=-5.07;95%CI(-7.50,-2.65);Z=4.10;P0.000 1];单纯针灸治疗组JOA评分改善优于非针灸治疗组[RR=2.83;95%CI(2.02,3.63);Z=6.90;P0.000 01];单纯针灸治疗组RMDQ评分改善优于非针灸治疗组[RR=-2.80;95%CI(-3.49,-2.11);Z=7.95;P0.000 01]。结论:单纯针灸疗法在改善下腰痛患者疼痛症状和腰部功能障碍方面具有一定的疗效和优势。     

Randomized sham‐controlled trial of acupuncture for postoperative pain control after stapled haemorrhoidopexy

Aim Haemorrhoidectomy usually causes moderate to strong postoperative pain. Chinese studies have found that acupuncture may have an analgesic effect in posthaemorrhoidectomy patients. This is the first Western study aiming assess the efficacy of acupuncture as an adjunct analgesic therapy after stapled haemorrhoidopexy. Method In a randomized controlled trial, 50 patients were allocated to three groups. Conventional drug therapy (oral diclofenac and metamizol, local lidocaine) served as baseline analgesia. In the control group (n = 17) only this regimen was used. In addition to baseline analgesia, 17 patients received verum acupuncture. Sham acupuncture was performed on 16 patients. Being the primary outcome measure, pain was measured twice daily using the numerical rating scale (NRS) and compared statistically by repeated‐measures analysis of variance. The study was registered (DRKS00003116). Results After verum acupuncture, pain intensity was not significantly lower when compared with conventional analgesia (primary hypothesis, P = 0.057), but was when compared to sham acupuncture (P = 0.007). In the afternoon of postoperative day 1, for example, NRS was 2.7 (SD 1.5) in the verum group, but 4.0 (1.0) in the sham group and 4.1 (1.9) under conventional analgesia. Furthermore, significantly fewer rescue analgesics were necessary if verum acupuncture was applied. Cardiovascular parameters were stable in all three groups, and no complications were recorded. Conclusions In posthaemorrhoidectomy patients, acupuncture appears to be an effective adjunct to conventional analgesia. Further studies are necessary to confirm these observations and to refine the acupuncture technique.     

目标导向治疗对高风险外科手术患者术后感染影响的Meta分析

目的 系统评价目标导向治疗( goal-directed therapy,GDT)对外科高风险患者术后感染发生率的影响.方法 通过检索美国《医学索引》(MEDLINE)、Cochrane临床试验数据库、生物医学与药理学文摘数据库(EMBASE)、荷兰《医学文摘》、中国生物医学文献数据库(CBM)和中国期刊网全文数据库(CNKI)等文献数据库,系统收集全世界范围内外科高风险患者术前予以血流动力学目标指导性治疗的随机对照试验(RCT)的相关文献.按Cochrane系统评价方法筛选试验、评价质量、提取资料,采用RevMan5.0软件进行Meta分析. 结果 纳入合格文献16篇,共计研究对象3309例患者,合并结果显示,与对照组比较手术前或术中予以GDT可显著降低高风险外科手术部位感染(SSI)[ Peto比值比(OR) =0.60,95％可信区间(95％ CI)0.46 ～0.77,P＜0.001]、肺炎(OR=0.69,95％ CI0.53 ～0.90,P=0.007)及泌尿系感染(OR=0.44,95％ CI0.22～0.88,P=0.02),各试验组间统计学无异质性(P＞0.1,I2＜ 50％);总感染率显著降低(OR=0.37,95％ CI0.22～0.61,P＜0.00001).结论 早期应用血流动力学目标指导性治疗能降低外科高风险患者的医院获得性感染.     

Adjuvant use of intravenous lidocaine for procedural burn pain relief: a randomized double-blind, placebo-controlled, cross-over trial

Background

Pain is a major issue for patients with severe burn. High dose intravenous opioids form the mainstay of procedural burns pain management; however it was suggested that intravenous lidocaine assists with minimising the pain experience. This study aimed to evaluate whether intravenous lidocaine improved analgesic efficacy and decreased opioid consumption during a burn wound care procedure.

Methods

A prospective double-blind randomized crossover study compared intravenous lidocaine versus placebo alongside patient controlled analgesia (PCA) in 45 patients with severe burn undergoing wound care procedures (i.e. dressing change ± debridement) on two consecutive days. Subjects were randomised to either the intervention or control condition on the first dressing day, and received the alternate condition on the second dressing day. During the intervention condition, subjects received lidocaine of 1.5 mg/kg/body weight followed by two boluses of 0.5 mg/kg at 5-min intervals followed by a continuous infusion. During the control condition, 0.9% sodium chloride was administered at an equivalent volume, dose and rate to that of lidocaine. Primary end points included pain intensity as measured by verbal rating scale (VRS), time to rescue analgesia, opioid requests and consumption and overall anxiety and level of satisfaction.

Results

Changes in the VRS score was significantly lower for lidocaine [difference (95% CI) = 0.36 (0.17 − 0.55)] as compared to placebo. However, there were no significant clinical or statistical differences regarding the effects of lidocaine and placebo on opioid requests and consumption, anxiety or level of satisfaction during the first and second dressing procedures.

Conclusions

In this study, the clinical benefit of intravenous lidocaine for pain relief during burn wound dressing changes in terms of overall pain scores and opioid consumption was unremarkable. Further investigations using different lidocaine regimes for the management of procedural burn pain are warranted.     

氯诺昔康超前镇痛的术后镇痛效果和安全性Meta分析

目的 通过对随机对照实验的数据进行Meta分析,系统评价氯诺昔康超前镇痛对术后镇痛的效果和安全性.方法 检索PubMed、Embase、Cochrane Library、CNKI、万方数据知识服务平台和中国知网等文献数据库,查找氯诺昔康超前镇痛对术后镇痛的效果和安全性的随机对照实验,并由两位研究人员对资料进行筛选与评价,使用RevMan5.3软件对结果进行Meta分析. 结果 共纳入4个随机对照实验.实验组术前静脉注射氯诺昔康,对照组使用安慰剂.Meta分析结果显示,患者术后VAS评分在各时间点情况分别为:术后4h,均数差(mean deviation,MD)=-1.58,95％置信区间(confidence interval,CI)为-2.38～-0.77 (P＜0.01);术后8h,MD=-1.43,95％CI为-2.09～--0.77 (P＜0.01);术后12h,MD=-1.35,95％CI为1.72～-0.98 (P＜0.01);术后24h,MD=-1.02,95％CI为-1.29～-0.76(P＜0.01).副作用发生情况:相对危险度(relative risk,RR)=1,95％CI为0.47～2.12(P=1). 结论 鉴于现有研究结果,氯诺昔康超前镇痛对术后4、8、12、24h患者具有镇痛效果,结果具有统计学意义,氯诺昔康超前镇痛产生副作用情况尚不明朗.     

Effects of unstable shoes on chronic low back pain in health professionals: A randomized controlled trial

ObjectiveThe aim of this study was to evaluate the effectiveness of unstable shoes in reducing low back pain in health professionals.MethodsOf a volunteer sample of 144 participants, 40 with nonspecific chronic low back pain were eligible and enrolled in this study. Participants were randomized to an intervention group, who wore unstable shoes (model MBT Fora), or a control group, who wore conventional sports shoes (model Adidas Bigroar). The participants had to wear the study shoes during their work hours, and at least 6 hours per workday, over a period of 6 weeks. The primary outcome was low back pain assessed on a Visual Analog Scale. The secondary outcomes were patient satisfaction, disability evaluated using Roland-Morris questionnaire and quality of life evaluated using EQ-VAS.ResultsThe intervention group showed a significant decrease in pain scores compared to the control group. The rate of satisfaction was higher in the intervention group (79%) compared to the control group (25%). There was no significant difference for the Roland-Morris disability questionnaire score and the EQ-VAS scale.ConclusionsThe results of this clinical trial suggest that wearing unstable shoes for 6 weeks significantly decreases low back pain in patients suffering from chronic low back pain but had no significant effect on quality of life and disability scores.     

Stochastic resonance whole body vibration reduces musculoskeletal pain: A randomized controlled trial

AIM: To examined the effects of stochastic resonance whole-body vibration training on musculoskeletal pain in young healthy individuals.METHODS: Participants were 43 undergraduate students of a Swiss University. The study was designed as a randomized controlled trial (RCT) with randomized group allocation. The RCT consisted of two groups each given 12 training sessions during four weeks with either 5 Hz- Training frequency (training condition) or 1.5 Hz Training frequency (control condition). Outcome was current musculoskeletal pain assessed in the evening on each day during the four week training period.RESULTS: Multilevel regression analysis showed musculoskeletal pain was significantly decreased in the training condition whereas there was no change in the control condition (B = -0.023, SE = 0.010, P = 0.021). Decrease in current musculoskeletal pain over four weeks was linear.CONCLUSION: Stochastic resonance whole-body vibration reduced musculoskeletal pain in young healthy individuals. Stochastic resonance vibration and not any other exercise component within training caused pain reduction.     

Effect sizes of non-surgical treatments of non-specific low-back pain

Numerous randomized trials have been published investigating the effectiveness of treatments for non-specific low-back pain (LBP) either by trials comparing interventions with a no-treatment group or comparing different interventions. In trials comparing two interventions, often no differences are found and it raises questions about the basic benefit of each treatment. To estimate the effect sizes of treatments for non-specific LBP compared to no-treatment comparison groups, we searched for randomized controlled trials from systematic reviews of treatment of non-specific LBP in the latest issue of the Cochrane Library, issue 2, 2005 and available databases until December 2005. Extracted data were effect sizes estimated as Standardized Mean Differences (SMD) and Relative Risk (RR) or data enabling calculation of effect sizes. For acute LBP, the effect size of non-steroidal anti-inflammatory drugs (NSAIDs) and manipulation were only modest (ES: 0.51 and 0.40, respectively) and there was no effect of exercise (ES: 0.07). For chronic LBP, acupuncture, behavioral therapy, exercise therapy, and NSAIDs had the largest effect sizes (SMD: 0.61, 0.57, and 0.52, and RR: 0.61, respectively), all with only a modest effect. Transcutaneous electric nerve stimulation and manipulation had small effect sizes (SMD: 0.22 and 0.35, respectively). As a conclusion, the effect of treatments for LBP is only small to moderate. Therefore, there is a dire need for developing more effective interventions.     

Effect of CO2 gas warming on pain after laparoscopic surgery

Background: Previous studies have suggested that gas temperature has an influence on postlaparoscopy pain. This trial therefore was conducted to study the effect of gas warming on pain after upper abdominal laparoscopic surgery. Methods: Patients who underwent laparoscopic cholecystectomy, fundoplication, or Heller's myotomy were included and randomly allocated to receive either warm or cold gas. Primary end point was shoulder tip pain, and secondary end points were subcostal, trocar wound, and visceral pains, as well as other postoperative events. Criteria of pain assessment were the visual analog scale, verbal rating scale, and amount of analgesics. Results: A total of 100 patients were suitable for postoperative evaluation. The groups were well matched. Shoulder tip and subcostal pains were significantly more intense after gas warming (p < 0.05). The three assessment criteria showed the same differences. No difference was observed concerning trocar wound and visceral pains and the other secondary end points. Subdiaphragmatic temperature was not significantly different (34.4° with warming vs. 34° without warming). Conclusions: Gas warming does not reduce, and probably increases, postoperative shoulder tip and subcostal pains. Received: 25 September 1998/Accepted: 13 January 1999     

Regional anesthesia and chronification of acute postoperative pain

Chronification of acute postoperative pain is the consequence of a number of factors; the article mentions different preemptive strategies that may put a limit to its development. Certain anesthetic and analgesic techniques have been assessed over the last years, and most articles highlight the usefulness of carrying out regional anesthesia techniques from the intraoperative period through several days into the postoperative period. Preventing the patients from suffering acute postoperative pain is one of the most appropriate tools for stopping the activation of the mechanisms involved in pain chronification. None of the regional techniques are equally valid and applicable to all surgical procedures.