不同强度经皮穴位电刺激对胸腔镜术后镇痛疗效的影响
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摘要
目的:观察不同强度的经皮穴位电刺激(TEAS)对胸腔镜手术后患者的镇痛疗效。方法:纳入68例行胸腔镜手术治疗的肺脏疾病患者,随机分为低强度TEAS组、中强度TEAS组、高强度TEAS组和电针组,每组各17例。患者于术后48 h内分别应用低(5 mA)、中(12 mA)、高(26 mA)强度的TEAS或电针辅助镇痛。比较各组患者的术后疼痛程度、镇痛药物追加例数及围手术期内源性阿片肽水平的变化。结果:术后48 h、72 h,中强度TEAS组和电针组患者的疼痛程度均优于高强度TEAS组(P<0.01)。术后72 h内,中强度TEAS组和电针组追加镇痛药物的例数明显少于高强度TEAS组(P<0.05)。术后48 h,中强度TEAS组和电针组患者的血浆β-内啡肽、脑啡肽水平均较治疗前升高(P<0.05,P<0.01),低强度TEAS组患者的血浆脑啡肽水平较治疗前亦升高(P<0.05);中强度TEAS组和电针组患者的血浆β-内啡肽水平高于低强度TEAS组和高强度TEAS组(P<0.05,P<0.01)。结论:中强度TEAS能够有效改善胸腔镜手术患者的术后疼痛,其作用优于低强度和高强度TEAS,与电针的镇痛效应和机制相似,值得临床推广。
Objective: To observe the analgesic efficacy of transcutanclus electrical acupoint stimulation(TEAS) with different intensities on the patients after thoracoscopic surgery. Methods: Sixty-eight participants with lung diseases who underwent the thoracoscopic surgery were included and randomly divided into the TEAS group with low-intensity(referred to as "L-TEAS group"),TEAS group with middle-intensity(referred to as "M-TEAS group"),TEAS group with high-intensity(referred to as "H-TEAS group") and electroacupuncture group(referred to as "EA group"),17 cases in each group. The patients in different groups were treated with TEAS at low-(5 mA),middle-(12 mA) and high-(26 mA) intensities or EA stimulation respectively in the following 48 hours after the surgery. The postoperative pain,the number of the cases who accepted additional analgesic drugs and the plasma levels of endogenous opioid peptides in the perioperative period were compared. Results: At 48 h and 72 h after surgery,the pain degree in the M-TEAS group and EA group was beter than that in the H-TEAS group(P<0.01). During the 72 hours following surgery,the number of the cases who accepted additional analgesic drugs in the M-TEAS group and EA group was significantly less than that in the H-TEAS group(P<0.05). At 48 h after surgery,the plasma levels of β-endorphin and enkephalin were increased in M-TEAS group and EA group(P<0.05,P<0.01),and the plasma level of enkephalin was also increased in the L-TEAS group( P<0.05); the plasma level of β-endorphin in the M-TEAS group and EA group was higher than that in the L-TEAS group and H-TEAS group( P<0.05,P<0.01). Conclusion: Meddle-intensity TEAS can effectively improve the postoperative pain in patients undergoing thoracoscopic surgery. Its effect is better than that of the low-and highintensity TEAS,and its analgesic effect and mechanism are similar to electroacupuncture,which is worth popularizing in clinic.
Objective: To observe the analgesic efficacy of transcutanclus electrical acupoint stimulation(TEAS) with different intensities on the patients after thoracoscopic surgery. Methods: Sixty-eight participants with lung diseases who underwent the thoracoscopic surgery were included and randomly divided into the TEAS group with low-intensity(referred to as "L-TEAS group"),TEAS group with middle-intensity(referred to as "M-TEAS group"),TEAS group with high-intensity(referred to as "H-TEAS group") and electroacupuncture group(referred to as "EA group"),17 cases in each group. The patients in different groups were treated with TEAS at low-(5 mA),middle-(12 mA) and high-(26 mA) intensities or EA stimulation respectively in the following 48 hours after the surgery. The postoperative pain,the number of the cases who accepted additional analgesic drugs and the plasma levels of endogenous opioid peptides in the perioperative period were compared. Results: At 48 h and 72 h after surgery,the pain degree in the M-TEAS group and EA group was beter than that in the H-TEAS group(P<0.01). During the 72 hours following surgery,the number of the cases who accepted additional analgesic drugs in the M-TEAS group and EA group was significantly less than that in the H-TEAS group(P<0.05). At 48 h after surgery,the plasma levels of β-endorphin and enkephalin were increased in M-TEAS group and EA group(P<0.05,P<0.01),and the plasma level of enkephalin was also increased in the L-TEAS group( P<0.05); the plasma level of β-endorphin in the M-TEAS group and EA group was higher than that in the L-TEAS group and H-TEAS group( P<0.05,P<0.01). Conclusion: Meddle-intensity TEAS can effectively improve the postoperative pain in patients undergoing thoracoscopic surgery. Its effect is better than that of the low-and highintensity TEAS,and its analgesic effect and mechanism are similar to electroacupuncture,which is worth popularizing in clinic.
引文
[1] CHEN T,WANG K,XU J,et al. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery:A Randomized Study[J].Evid Based Complement Alternat Med,2016,2016:2126416.doi:10.1155/2016/2126416.
[2] 辛娟娟,宿杨帅,杨兆坤,等. 不同强度电针、热灸样刺激对香草酸瞬时受体亚型1基因敲除小鼠痛阈的影响[J].针刺研究,2012,37(6):431- 439.
[3] JU Z,GUO X,WANG K,et al. Electroacupuncture with different current intensities to treat knee osteoarthritis:a single- blinded controlled study[J].Int J Clin Exp Med,2015,8(10):18981- 18989.
[4] 涂青,史金麟,于虹,等. 经皮穴位电刺激对经输尿管软镜联合钬激光碎石术后镇痛的影响[J].中国针灸,2018,38(7):711- 715.
[5] 马志红,闫芳,赵云彦,等. 经皮穴位电刺激配合瑞芬太尼进行分娩镇痛的临床研究[J].上海针灸杂志,2018,37(5):526- 530.
[6] 谷书涵,甘建辉,郎贺斌. 不同经皮穴位电刺激方式用于腹腔镜下胃癌根治术后镇痛效果及胃肠功能恢复的比较[J].福建医科大学学报,2018,52(2):125- 129.
[7] 沈菲菲,夏泽华. 经皮穴位电刺激对混合痔术后镇痛疗效的临床观察[J].上海中医药杂志,2017,51(S1):130- 132.
[8] 兰飞,徐娜,王天龙. 经皮穴位电刺激用于老年患者全髋关节置换术后早期疼痛治疗的临床研究[J].北京医学,2017,39(10):1003- 1006.
[9] WANG B,TANG J,WHITE P F,et al. Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement[J].Anesth Analg,1997,85(2):406- 413.
[10] 安立新,陈雪,李锦,等. 经皮穴位电刺激及电针对幕上肿瘤切除术患者术后恢复及镇痛的影响[J].中国疼痛医学杂志,2013,19(2):66- 70.
[11] 韩济生. 针麻镇痛研究[J].针刺研究,2016,41(5):377- 387.
[12] SEHGAL N,SMITH H S,MANCHIKANTI L. Peripherally acting opioids and clinical implications for pain control[J].Pain Physician,2011,14(3):249- 258.
[13] TSIKLAURI N,PIRKULASHVILI N,NOZADZE I,et al. Antinociceptive tolerance to NSAIDs in the anterior cingulate cortex is mediated via endogenous opioid mechanism[J].BMC Pharmacol Toxicol,2018,19(1):2.
[14] ZHAO Z Q. Neural mechanism underlying acupuncture analgesia[J].Prog Neurobiol,2008,85(4):355- 375.
[2] 辛娟娟,宿杨帅,杨兆坤,等. 不同强度电针、热灸样刺激对香草酸瞬时受体亚型1基因敲除小鼠痛阈的影响[J].针刺研究,2012,37(6):431- 439.
[3] JU Z,GUO X,WANG K,et al. Electroacupuncture with different current intensities to treat knee osteoarthritis:a single- blinded controlled study[J].Int J Clin Exp Med,2015,8(10):18981- 18989.
[4] 涂青,史金麟,于虹,等. 经皮穴位电刺激对经输尿管软镜联合钬激光碎石术后镇痛的影响[J].中国针灸,2018,38(7):711- 715.
[5] 马志红,闫芳,赵云彦,等. 经皮穴位电刺激配合瑞芬太尼进行分娩镇痛的临床研究[J].上海针灸杂志,2018,37(5):526- 530.
[6] 谷书涵,甘建辉,郎贺斌. 不同经皮穴位电刺激方式用于腹腔镜下胃癌根治术后镇痛效果及胃肠功能恢复的比较[J].福建医科大学学报,2018,52(2):125- 129.
[7] 沈菲菲,夏泽华. 经皮穴位电刺激对混合痔术后镇痛疗效的临床观察[J].上海中医药杂志,2017,51(S1):130- 132.
[8] 兰飞,徐娜,王天龙. 经皮穴位电刺激用于老年患者全髋关节置换术后早期疼痛治疗的临床研究[J].北京医学,2017,39(10):1003- 1006.
[9] WANG B,TANG J,WHITE P F,et al. Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement[J].Anesth Analg,1997,85(2):406- 413.
[10] 安立新,陈雪,李锦,等. 经皮穴位电刺激及电针对幕上肿瘤切除术患者术后恢复及镇痛的影响[J].中国疼痛医学杂志,2013,19(2):66- 70.
[11] 韩济生. 针麻镇痛研究[J].针刺研究,2016,41(5):377- 387.
[12] SEHGAL N,SMITH H S,MANCHIKANTI L. Peripherally acting opioids and clinical implications for pain control[J].Pain Physician,2011,14(3):249- 258.
[13] TSIKLAURI N,PIRKULASHVILI N,NOZADZE I,et al. Antinociceptive tolerance to NSAIDs in the anterior cingulate cortex is mediated via endogenous opioid mechanism[J].BMC Pharmacol Toxicol,2018,19(1):2.
[14] ZHAO Z Q. Neural mechanism underlying acupuncture analgesia[J].Prog Neurobiol,2008,85(4):355- 375.