不同频率电针预处理对混合痔外剥内扎术后肛门疼痛的影响
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摘要
目的:比较不同频率电针预处理对混合痔外剥内扎术后肛门疼痛的影响。方法:将120例行外剥内扎术的混合痔患者随机分为电针A组(2 Hz/100 Hz疏密波)、电针B组(2 Hz连续波)和电针C组(100 Hz连续波),每组40例。3组均在术前30 min电针下髎、承山穴,刺激强度以患者可耐受为度。比较3组患者术中追加麻醉药物例数;术后第4、12、24小时各时间点肛门疼痛视觉模拟评分(VAS)和肢体活动评分情况;术后24 h内最大VAS评分和口服氨酚双氢可待因的剂量。结果:电针A组、电针B组、电针C组术中追加麻醉药物例数分别为4、5、4例,差异无统计学意义(P>0.05);3组术后第4小时肛门疼痛VAS评分和肢体活动评分比较,差异无统计学意义(均P>0.05),在术后第12小时,电针A、B两组VAS评分和肢体活动评分低于电针C组(均P<0.05),在术后第24小时,电针A组VAS评分和肢体活动评分低于电针B、C两组(均P<0.05);术后24 h内最大VAS评分和口服氨酚双氢可待因的剂量比较,电针A组低于电针B、C两组(均P<0.05)。结论:不同频率电针预处理均具有缓解混合痔外剥内扎术后肛门疼痛的作用,但不同频率电针镇痛效果有所不同,2 Hz/100 Hz疏密波的电针镇痛作用更佳,优于2 Hz、100 Hz连续波。
Objective To compare the effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy. Methods A total of 120 patients with mixed hemorrhoids were randomly divided into an electroacupuncture group A(dilatational wave, 2 Hz/100 Hz in frequency), an electroacupuncture group B(continuous wave, 2 Hz in frequency) and an electroacupuncture group C(continuous wave, 100 Hz in frequency), 40 cases in each group. Electroacupuncture at Xialiao(BL 34) and Chengshan(BL 57) was applied with tolerant intensity for 30 min before operation in all groups. The number of additional anesthetic drugs in the 3 groups, the visual anal pain score(VAS) and limb activity score at 4, 12, and 24 h after operation, the maximum VAS score within24 h after surgery and oral dose of aminophenol dihydrocodeine were compared. Results The number of additional anesthetic drugs in the electroacupuncture group A, the electroacupuncture group B and the electroacupuncture group C were 4, 5, 4 respectively, and there was not statistically significant(P>0.05). There was no significant difference in the anal pain VAS score and limb activity score at 4 h after operation among the 3 groups(P>0.05), at the 12 h after operation, the VAS scores and limb activity scores in the electroacupunctures group A and B were lower than those in the electroacupuncture group C(P<0.05), at 24 h after operation, the VAS score and limb activity score in the electroacupuncture group A were lower than those in the electroacupuncture group B and C(P<0.05), the maximum VAS score within 24 h and oral dose of aminophenol dihydrocodeine within 24 h after operation in the electroacupuncture group A were lower than those in the electroacupuncture group B and C(P<0.05). Conclusion Different frequency electroacupuncture preconditioning has the effect of alleviating anal pain after milligan-morgan hemorrhoidectomy. The analgesic effect of electroacupuncture with different frequencies is different. The electroacupuncture analgesic effect of2 Hz/100 Hz dilatational wave is better than 2 Hz and 100 Hz continuous waves.
Objective To compare the effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy. Methods A total of 120 patients with mixed hemorrhoids were randomly divided into an electroacupuncture group A(dilatational wave, 2 Hz/100 Hz in frequency), an electroacupuncture group B(continuous wave, 2 Hz in frequency) and an electroacupuncture group C(continuous wave, 100 Hz in frequency), 40 cases in each group. Electroacupuncture at Xialiao(BL 34) and Chengshan(BL 57) was applied with tolerant intensity for 30 min before operation in all groups. The number of additional anesthetic drugs in the 3 groups, the visual anal pain score(VAS) and limb activity score at 4, 12, and 24 h after operation, the maximum VAS score within24 h after surgery and oral dose of aminophenol dihydrocodeine were compared. Results The number of additional anesthetic drugs in the electroacupuncture group A, the electroacupuncture group B and the electroacupuncture group C were 4, 5, 4 respectively, and there was not statistically significant(P>0.05). There was no significant difference in the anal pain VAS score and limb activity score at 4 h after operation among the 3 groups(P>0.05), at the 12 h after operation, the VAS scores and limb activity scores in the electroacupunctures group A and B were lower than those in the electroacupuncture group C(P<0.05), at 24 h after operation, the VAS score and limb activity score in the electroacupuncture group A were lower than those in the electroacupuncture group B and C(P<0.05), the maximum VAS score within 24 h and oral dose of aminophenol dihydrocodeine within 24 h after operation in the electroacupuncture group A were lower than those in the electroacupuncture group B and C(P<0.05). Conclusion Different frequency electroacupuncture preconditioning has the effect of alleviating anal pain after milligan-morgan hemorrhoidectomy. The analgesic effect of electroacupuncture with different frequencies is different. The electroacupuncture analgesic effect of2 Hz/100 Hz dilatational wave is better than 2 Hz and 100 Hz continuous waves.
引文
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[16]周杰,陈贞羽,龚杰,等.不同参数组合电针对炎性痛模型大鼠镇痛效果及炎症因子的影响[J].新中医, 2018, 50(2):1-5.
[17]赵天易,席强,郭义.电针治疗手术后疼痛刺激参数的研究现状和分析[J].上海针灸杂志, 2015, 34(5):464-467.
[18]孙瑞卿,王贺春,王韵,等.不同频率的电针对大鼠神经源性痛的治疗作用[J].中国应用生理学杂志, 2002, 18(12):128-131.
[19]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.
[20]马文,朱余明,周红,等.针药复合麻醉中不同频率电针对肺切除患者应激反应的保护作用[J].中国针灸,2011,31(11):1020-1024.
[2]周民涛,李毓,韩学昌,等.电针对胸科手术后镇痛的临床研究[J].中国针灸, 2017, 37(7):705-709.
[3]宋扬,徐天舒,钱海华.电针大肠俞、承山、二白穴对混合痔术后并发症的疗效观察[J].针刺研究, 2017, 42(6):533-536.
[4]朱丹,白洁静,张晓庆,等.电针参数定量化的研究进展[J].中国针灸, 2015, 35(5):525-527.
[5]中华中医药学会.中医肛肠科常见病诊疗指南[M].北京:中国中医药出版社, 2012:1-4.
[6]李仲廉.临床疼痛治疗学(修订版)[M].天津:天津科学技术出版社, 1999:263.
[7]张浩臣,王丽.最新中国肛肠疾病流行病学调查结果在京发布[J].中国医药导报, 2015, 12(27):169.
[8]鲍云生,金玉贵,何琪.中西医结合治疗混合痔术后疼痛疗效观察[J].新中医, 2016, 48(10):80-82.
[9]霍巨,刘丽辉.中药熏洗坐浴治疗湿热下注型混合痔术后并发症临床研究[J].辽宁中医杂志, 2015, 42(5):1010-1012.
[10]石学敏.针灸学[M].北京:中国中医药出版社, 2002:171.
[11]杨士伟,辛学知,刘钧宁,等.电针八髎穴治疗盆底痉挛综合征疗效观察[J].中国针灸, 2014, 34(9):869-872.
[12]孙平良,杨伟,张磊昌.电针承山穴治疗混合痔术后疼痛疗效对比观察[J].中国针灸, 2011, 31(5):413-415.
[13]龙庆,李艳,李俊,等.针刺下髎、长强穴治疗混合痔PPH术后肛门坠胀临床观察[J].中国针灸, 2016, 36(6):603-606.
[14]顾陈怿,胡军,蔡云彪.电针刺激参数的的研究进展[J].中国针灸, 2003, 23(8):489.
[15]庄晟坚,龚杰,周杰,等.不同电针刺激参数对镇痛效应的实验研究进展[J].浙江中医药大学学报, 2015, 39(12):913-917.
[16]周杰,陈贞羽,龚杰,等.不同参数组合电针对炎性痛模型大鼠镇痛效果及炎症因子的影响[J].新中医, 2018, 50(2):1-5.
[17]赵天易,席强,郭义.电针治疗手术后疼痛刺激参数的研究现状和分析[J].上海针灸杂志, 2015, 34(5):464-467.
[18]孙瑞卿,王贺春,王韵,等.不同频率的电针对大鼠神经源性痛的治疗作用[J].中国应用生理学杂志, 2002, 18(12):128-131.
[19]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.
[20]马文,朱余明,周红,等.针药复合麻醉中不同频率电针对肺切除患者应激反应的保护作用[J].中国针灸,2011,31(11):1020-1024.