电针对全膝关节置换术后患者的辅助镇痛效应及对血清β-内啡肽及前列腺素E_2水平的影响

详细信息    查看全文 | 推荐本文 |

英文篇名：Effect of electroacupunture on supplementary analgesia and the levels of serum β-endorphin and prostaglandin E_2 in patients with total knee arthroplasty 作者：陈达 ; 盛东 ; 徐景利 ; 张泱悦 ; 林天烨 ; 张庆文 英文作者：CHEN Da;SHENG Dong;XU Jing-li;ZHANG Yang-yue;LIN Tian-ye;ZHANG Qing-wen;the First Hospital Affiliated to Guangzhou University of CM;Department of Orthopaedics, Chongqing Orthopedics Hospital of TCM;the First Clinical Medical School, Guangzhou University of CM; 关键词：全膝关节置换术 ; 电针 ; β-内啡肽 ; 前列腺素E2 ; 镇痛 英文关键词：total knee arthroplasty;;electroacupunture;;β-endorphin;;prostaglandin E2;;analgesia 中文刊名：ZGZE 英文刊名：Chinese Acupuncture & Moxibustion 机构：广州中医药大学第一附属医院;重庆市中医骨科医院骨科;广州中医药大学第一临床医学院; 出版日期：2019-03-06 17:26 出版单位：中国针灸 年：2019 期：v.39;No.366 基金：广东省科技计划项目:2014A020212556 语种：中文; 页：ZGZE201903006 页数：4 CN：03 ISSN：11-2024/R 分类号：23-26

摘要

目的:观察电针对全膝关节置换术(total knee arthroplasty,TKA)后患者的辅助镇痛作用,并探讨其作用机制。方法:将40例重度膝关节骨关节炎患者随机分为观察组和对照组,每组20例。术中两组患者均采用硬膜外麻醉,术后采用常规硬膜外自控式镇痛及口服塞来昔布胶囊止痛,观察组于术后第1天至第7天采用电针疗法辅助止痛,穴位选取术侧梁丘、血海、阴陵泉、足三里、丰隆及丘墟,每次30 min,每天1次。记录患者术后静息、活动状态疼痛视觉模拟评分(visual analogue scale,VAS)。于术后第1、7天检测两组患者血清前列腺素E2及β-内啡肽水平。结果:于术后第3、5、7天静息状态及活动状态VAS评分观察组均优于对照组(均P<0.05);治疗后两组血清β-内啡肽水平均提高、前列腺素E2水平降低(均P<0.05),且观察组变化幅度均大于对照组(均P<0.05)。结论:电针对全膝关节置换术后患者有辅助镇痛作用,促进β-内啡肽的合成及抑制前列腺素E2的合成是其可能作用机制之一。
        Objective To observe the effect on supplementary analgesia after total knee arthroplasty(TKA) treated with electroacupunture, and explore it's mechanism. Methods A total of 40 patients with severe knee osteoarthritis were randomized into an observation group and a control group, 20 cases in each one. During the operation, patients were given epidural anesthesia in the two groups, conventional patient controlled epidural analgesia and oral celecoxib were applied after the operation. In the observation group, electroacupunture was used at Liangqiu(ST 34), Xuehai(SP 10),Yinlingquan(SP 9), Zusanli(ST 36), Fenglong(ST 40) and Qiuxu(GB 40) on the operation side from the 1 st to 7 th day after the operation to support analgesia, 30 min for each time, once a day. The visual analogue scale(VAS) was used to record postoperative pain of resting state and active state. The levels of serum prostaglandin E2 and β-endorphin were measured on the 1 st and 7 th day after surgery in the two groups. Results In the observation group, the VAS scores of resting state and active state were superior to the control group on the 3 rd, 5 th and 7 th day after the operaton(all P<0.05); after the treatment, the level of serum β-endorphin was increased and the level of serum prostaglandin E2 was reduced in the two groups(all P<0.05), and the change of the observation group was larger than that of the control group(both P<0.05).Conclusion Electroacupunture has the effect of supplementary analgesia for patients after TKA, the mechanism may be related to promote the synthesis of β-endorphin and inhibit the synthesis of prostaglandin E2.

引文

[1]孙京涛,刘宏建,魏瑄,等.电针联合三七消肿止痛散外敷在全膝关节置换术后快速康复中的应用[J].中医正骨,2017,29(3):10-13.
    [2]朱俊腾.电针缓解人工膝关节置换术术后疼痛及改善活动受限的研究[D].福州:福建中医药大学.2014.
    [3]马川.电针内麻点在全膝关节置换术后镇痛的临床观察[D].北京:北京中医药大学.2015.
    [4]李立文,祁晓华.电针缓解人工膝关节置换术后疼痛42例临床观察[J].云南中医中药杂志,2010,31(2):45.
    [5]陈超,张一,郭海英,等.电针结合康复训练治疗全膝关节置换术后下肢肿胀疗效观察[J].山东中医药大学学报,2015,39(2):139-141.
    [6]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国矫形外科杂志,2014,22(3):287-288.
    [7]陈举.电针联合功能锻炼对膝骨关节炎全膝人工关节置换术后关节功能康复的临床观察[D].福州:福建中医药大学.2016.
    [8]Han JS,Chen XH,Sun SL,et al.Effect of low-and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF[J].Pain,1991,47(3):295-298.
    [9]韩济生.针刺镇痛频率特异性的进一步证明[J].针刺研究,2001,26(3):224-227.
    [10]赵勇军.斜刺血海、梁丘穴治疗膝关节疼痛疗效观察[J].中医正骨,2002,14(11):46.
    [11]王相奇,蒋亚芳,秦克枫.斜刺血海、梁丘治疗膝关节疼痛282例[J].中国针灸,2003,23(5):311.
    [12]陈小平.复方丹参穴位封闭治疗膝关节痛的临床观察[J].广东医学,1996,37(7):482.
    [13]袁香玉,杜战雷,郝跃滨.阳陵泉透阴陵泉治疗髌骨软骨病20例疗效观察[J].冰雪运动,1994,16(2):63-64.
    [14]周建中,王长峰,马勇,等.骨关节炎模型兔膝关节腔注射丹皮酚联合针刺足三里血清白细胞介素1β、肿瘤坏死因子α的变化[J].中国组织工程研究,2012,16(22):4096-4099.
    [15]Olsrud J,Latt J,Brockstedt S,et al.Magnetic resonance imaging artifacts caused by ancurysm clips and shunt valves:dependence on field strength(1.5 and 3 T)and imgaing parameters[J].J Magn Rcson Imaging,2005,22(3):433-437.
    [16]Takahashi H,Suguro T,Okazima Y,et al.Inflammatory cytokines in the herniated disc of the lumbar spine[J].Spine,1996,21(2):218-224.
    [17]Gu WY,Yao H,Vega AL,et al.Diffusivity of ions in agarose gels and intervertebral disc:effect of porosity[J].Ann Biomed Eng,2004,32(12):1710-1717.
    [18]李玉飞,刘勇,李康华.湖南省膝关节炎城乡比较[J].湖南师范大学学报(医学版),2015,12(6):50-53.