TEAS 对老年全髋置换手术后静脉自控镇痛患者应激反应的影响

目的：通过运用经皮穴位电刺激(TEAS)技术辅助老年全髋置换手术后静脉自控镇痛(PCIA)，探讨更为安全有效的多模式镇痛方法。方法腰部麻醉下全髋置换术且术后进行 PCIA 的患者60例，随机分为试验组、对照组，各30例。试验组分别于术毕、术后4、24、48 h 对患者进行 TEAS；两组于术前30 min(T1)、术毕30 min(T2)、术后第1天清晨(T3)、术后第2天清晨(T4)均测定血清皮质醇、血糖；两组术后均进行疼痛评分、镇静评分，调查其他不良反应及镇痛用药量。结果试验组在 T2皮质醇、血糖水平较 T1均明显升高(P <0.01)，在 T3、T4皮质醇、血糖水平与对照组比较，明显降低(P <0.05)。与对照组相比，试验组 VAS 各时段评分差异均有统计学意义(P <0.01)。试验组不良反应发生率明显低于对照组，差异具有统计学意义(P <0.05)。辅助 TEAS 治疗后，试验组镇痛药液消耗量明显减少，按压次数减少(P <0.05)。结论用 TEAS 技术辅助老年全髋置换手术后 PCIA 能有效抑制应激，增强镇痛效果，减少或避免不良反应的发生。

Effect of transcutaneous electrical acupoint stimulation on stress reaction in elderly patients with intravenous patient-controlled analgesia after total hip replacement operation

Objective To observe the effect of transcutaneous electrical acupoint stimulation on stress reaction in elderly pa-tients with intravenous patient-controlled analgesia after total hip replacement operation.Methods A total of 60 cases of patients with patient-controlled intravenous analgesia spinal anesthesia after total hip replacement surgery were randomly divided into exper-imental group (n=30)and the control group (n=30).The experimental group respectively at the completion of surgery,postopera-tive 4,24,48 h was treated by transcutaneous electrical acupoint stimulation.The serum cortisol and blood glucose was detected in two groups at preoperative 30 min (T1 ),30 min after operation (T2 ),1 d after operation in the morning (T3 ),2 d after operation (T4 ).The pain scores,sedation scores,adverse reactions and analgesic dosage were investigated in two groups after operation.Re-sults In the experimental group,cortisol and blood glucose levels increased compared T2 and T1 (P <0.01 ).Compared with the control group,cortisol and blood glucose levels in the experimental group decreased at T3 and T4 (P <0.05 ).Compared with the control group,the VAS scores was significantly different in the experimental group(P < 0.01 ).The side effects in experimental group were significantly lower than those in the control group(P <0.05).After TEAS treatment,the physic liquor consumption and press the number decreased significantly (P < 0.05 ).Conclusion TEAS technology for elderly total hip replacement operation PCIA could effectively inhibit stress,enhance the analgesic effect,reduce or avoid the occurrence of adverse reactions.