经皮穴位电刺激应用于膝关节镜手术的临床研究
|
摘要
目的观察经皮穴位电刺激对膝关节镜手术围手术期的影响。方法将60例择期行膝关节镜手术的膝骨关节炎患者随机分为治疗组和对照组,每组30例。对照组术前不做任何治疗,治疗组术前采用经皮穴位电刺激治疗。观察两组手术前后5-羟色胺(5-HT)含量的变化情况,比较两组术后恶心程度评分及尿潴留发生率。结果两组术后5-HT含量与同组术前比较,差异均具有统计学意义(P<0.05)。治疗组手术前后5-HT含量的差值与对照组比较,差异具有统计学意义(P<0.05)。两组术后恶心程度评分比较,差异具有统计学意义(P<0.05)。治疗组术后尿潴留发生率为3.3%,对照组为20.0%,两组比较差异具有统计学意义(P<0.05)。结论膝关节镜手术应用经皮穴位电刺激具有较好的抗不良应激反应的作用,可缓解术后恶心程度,有效预防尿潴留的发生。
Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS) on arthroscopic knee surgery over the perioperative period. Method Sixty patients with knee osteoarthritis(KOA)undergoing arthroscopic knee surgery at a scheduled time were randomized into treatment and control groups, with 30 cases in each group. The treatment group was intervened by TEAS before surgery, while the control group received no treatment. The content of 5-hydroxytryptamine(5-HT) in the two groups was observed before and after surgery. The postoperative nausea score and the incidence of urinary retention of the two groups were compared. Result The content of 5-HT showed a significant change after surgery in the two groups(P<0.05). The change in the content of5-HT in the treatment group was significantly different from that in the control group(P<0.05). The postoperative nausea score in the treatment group was significantly different from that in the control group(P<0.05). The postoperative incidence of urinary retention was 3.3% in the treatment group and 20.0% in the control group, and the difference was statistically significant(P<0.05). Conclusion The application of TEAS to arthroscopic knee surgery has a good effect on resisting the adverse stress reaction. It can relieve postoperative nausea and effectively prevent urinary retention.
Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS) on arthroscopic knee surgery over the perioperative period. Method Sixty patients with knee osteoarthritis(KOA)undergoing arthroscopic knee surgery at a scheduled time were randomized into treatment and control groups, with 30 cases in each group. The treatment group was intervened by TEAS before surgery, while the control group received no treatment. The content of 5-hydroxytryptamine(5-HT) in the two groups was observed before and after surgery. The postoperative nausea score and the incidence of urinary retention of the two groups were compared. Result The content of 5-HT showed a significant change after surgery in the two groups(P<0.05). The change in the content of5-HT in the treatment group was significantly different from that in the control group(P<0.05). The postoperative nausea score in the treatment group was significantly different from that in the control group(P<0.05). The postoperative incidence of urinary retention was 3.3% in the treatment group and 20.0% in the control group, and the difference was statistically significant(P<0.05). Conclusion The application of TEAS to arthroscopic knee surgery has a good effect on resisting the adverse stress reaction. It can relieve postoperative nausea and effectively prevent urinary retention.
引文
[1]Turcot K,Aissaoui R,Boivin K,et al.The responsiveness of three-dimensional knee accelerations used as an estimation of knee instability and loading transmission during gait in osteoarthritis patient's follow-up[J].Osteoarthritis Cartilage,2009,17(2):213-219.
[2]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
[3]莫彩鲜.老年人微创手术麻醉并发症临床分析[J].微创医学,2010,5(5):475-477.
[4]Birch S,Hesselink JK,Jonkman FA,et al.Clinical research on acupuncture.Part 1.What have reviews of the efficacy and safety of acupuncture told us so far?[J]JAltern Complement Med,2004,10(3):468-480.
[5]Su TF,Zhang LH,Peng M,et al.Cannabinoid CB2receptors contribute to upregulation ofβ-endorphin in inflamed skin tissues by electroacupuncture[J].Mol Pain2011,7:98.
[6]Chen L,Zhang J,Li F,et al.Endogenous anandamide and cannabinoid receptor-2 contribute to electroacupuncture analgesia in rats[J].J Pain,2009,10(7):732-739.
[7]Catherine M,Norman A,David G,et al.避免麻醉常见错误[M].冯艺,译.北京:人民卫生出版社,2008:475-479.
[8]董悦,董玉茹,姜胤,等.手针、电针及经皮穴位电刺激调节人脑功能的功能性磁共振观察[J].中国疼痛医学杂志,2013,19(2):75-79.
[9]赵夏洁,尹金玲,李航兵,等.经皮神经电刺激的镇痛作用机制及最新研究进展[J].实用医学杂志,2015,31(21):3480-3482.
[10]张蔚婷,罗非,亓颖伟,等.穴位电刺激对痛信息处理过程的调制作用之脑电图研究[J].北京大学学报(医学版),2003,35(3):236-240.
[11]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.
[12]方剑乔,王均炉,邵晓梅,等.针药复合麻醉的新思路--经皮穴位电刺激参与全麻行控制性降压中对器官保护的可行性[J].针刺研究,2007,32(6):402-406.
[13]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[14]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国临床医生杂志,2008,36(1):28-30.
[15]高迪.关节镜下治疗膝半月板损伤104例(侧)临床分析[D].长春:吉林大学,2007:9-10.
[16]王跃辉.基于下肢力线的膝骨关节炎“筋-骨”平衡体系研究[D].广州:广州中医药大学,2011:11.
[17]尤颢,杨谦.电外科手术设备的进展[J].中国医疗器械杂志,2012,36(4):285-287.
[18]金英利.针刀对KOA兔韧带力学改变及韧带胶原相关因子基因蛋白表达的影响研究[D].北京:北京中医药大学,2014:13.
[19]Saito M,Shimizu S,Ohmasa F,et al.Characterization of silodosin and naftopidl in the treatment of bladder dysfunction in the spontaneously hypertensive rat[J].Neurourol Urodyn,2012,32(4):393-398.
[20]Liang Y,Bao G,Gong L,et al.Evaluating the analgesic effect and advantage of transcutaneous electrical acupoint stimulation combined with opioid drugs for moderate to severe cancer-related pain:a study protocol for a randomized controlled trial[J].Trials2019,20(1):40.
[21]Yin CP,Li YN,Zhao J,et al.Effect of transcutaneous electrical acupoint stimulation on the EC50 of remifentanil suppressing responses to tracheal extubation in elderly patients[J].Medicine(Baltimore),2018,97(52):e13814.
[22]Wang Z,Chen Y,Chen C,et al.Pain management of surgical abortion using transcutaneous acupoint electrical stimulation:An orthogonal prospective study[J].J Obstet Gynaecol Res,2018,44(7):1235-1242.
[23]Moon YK,Kim MH,Nam HJ.Comparison of the effectiveness between transcutaneous electrical nerve stimulation,manual acupuncture,and electroacupuncture on tinnitus:study protocol for a randomized controlled trial[J].Trials,2018,19(1):342.
[24]Gao F,Zhang Q,Li Y,et al.Transcutaneous electrical acupoint stimulation for prevention of postoperative delirium in geriatric patients with silent lacunar infarction:a preliminary study[J].Clin Interv Aging2018,13:2127-2134.
[25]Tu Q,Yang Z,Gan J,et al.Transcutaneous Electrical Acupoint Stimulation Improves Immunological Function During the Perioperative Period in Patients With Non-Small Cell Lung Cancer Undergoing Video-Assisted Thoracic Surgical Lobectomy[J].Technol Cancer Res Treat,2018,17:1533033818806477.
[26]AminiSaman J,Mohammadi S,Karimpour H,et al Transcutaneous Electrical Nerve Stimulation at the Acupuncture Points to Relieve Pain of Patients Under Mechanical Ventilation:A Randomized Controlled Study[J].J Acupunct Meridian Stud,2018,11(5):290-295.
[27]具紫勇,游世晶,王珂,等.经皮穴位电刺激对大运动量耐力训练大鼠血清睾酮和尿素氮含量及ATP酶活力的影响[J].上海针灸杂志,2013,32(4):313-315.
[28]李小梅.经皮穴位电刺激的临床镇痛进展[J].中国疼痛医学杂志,2014,20(11):826-829.
[29]金玮,吕雅,陈双懂,等.内关穴经皮穴位电刺激防治甲状腺肿瘤术后恶心呕吐疗效的临床观察[J].中国中西医结合杂志,2013,33(9):1199-1202.
[30]吴群,莫云长,黄陆平,等.经皮穴位电刺激联合丙泊酚靶控输注对开颅术围手术期应激反应的影响[J].中国中西医结合杂志,2013,33(12):1621-1625.
[2]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
[3]莫彩鲜.老年人微创手术麻醉并发症临床分析[J].微创医学,2010,5(5):475-477.
[4]Birch S,Hesselink JK,Jonkman FA,et al.Clinical research on acupuncture.Part 1.What have reviews of the efficacy and safety of acupuncture told us so far?[J]JAltern Complement Med,2004,10(3):468-480.
[5]Su TF,Zhang LH,Peng M,et al.Cannabinoid CB2receptors contribute to upregulation ofβ-endorphin in inflamed skin tissues by electroacupuncture[J].Mol Pain2011,7:98.
[6]Chen L,Zhang J,Li F,et al.Endogenous anandamide and cannabinoid receptor-2 contribute to electroacupuncture analgesia in rats[J].J Pain,2009,10(7):732-739.
[7]Catherine M,Norman A,David G,et al.避免麻醉常见错误[M].冯艺,译.北京:人民卫生出版社,2008:475-479.
[8]董悦,董玉茹,姜胤,等.手针、电针及经皮穴位电刺激调节人脑功能的功能性磁共振观察[J].中国疼痛医学杂志,2013,19(2):75-79.
[9]赵夏洁,尹金玲,李航兵,等.经皮神经电刺激的镇痛作用机制及最新研究进展[J].实用医学杂志,2015,31(21):3480-3482.
[10]张蔚婷,罗非,亓颖伟,等.穴位电刺激对痛信息处理过程的调制作用之脑电图研究[J].北京大学学报(医学版),2003,35(3):236-240.
[11]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.
[12]方剑乔,王均炉,邵晓梅,等.针药复合麻醉的新思路--经皮穴位电刺激参与全麻行控制性降压中对器官保护的可行性[J].针刺研究,2007,32(6):402-406.
[13]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[14]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国临床医生杂志,2008,36(1):28-30.
[15]高迪.关节镜下治疗膝半月板损伤104例(侧)临床分析[D].长春:吉林大学,2007:9-10.
[16]王跃辉.基于下肢力线的膝骨关节炎“筋-骨”平衡体系研究[D].广州:广州中医药大学,2011:11.
[17]尤颢,杨谦.电外科手术设备的进展[J].中国医疗器械杂志,2012,36(4):285-287.
[18]金英利.针刀对KOA兔韧带力学改变及韧带胶原相关因子基因蛋白表达的影响研究[D].北京:北京中医药大学,2014:13.
[19]Saito M,Shimizu S,Ohmasa F,et al.Characterization of silodosin and naftopidl in the treatment of bladder dysfunction in the spontaneously hypertensive rat[J].Neurourol Urodyn,2012,32(4):393-398.
[20]Liang Y,Bao G,Gong L,et al.Evaluating the analgesic effect and advantage of transcutaneous electrical acupoint stimulation combined with opioid drugs for moderate to severe cancer-related pain:a study protocol for a randomized controlled trial[J].Trials2019,20(1):40.
[21]Yin CP,Li YN,Zhao J,et al.Effect of transcutaneous electrical acupoint stimulation on the EC50 of remifentanil suppressing responses to tracheal extubation in elderly patients[J].Medicine(Baltimore),2018,97(52):e13814.
[22]Wang Z,Chen Y,Chen C,et al.Pain management of surgical abortion using transcutaneous acupoint electrical stimulation:An orthogonal prospective study[J].J Obstet Gynaecol Res,2018,44(7):1235-1242.
[23]Moon YK,Kim MH,Nam HJ.Comparison of the effectiveness between transcutaneous electrical nerve stimulation,manual acupuncture,and electroacupuncture on tinnitus:study protocol for a randomized controlled trial[J].Trials,2018,19(1):342.
[24]Gao F,Zhang Q,Li Y,et al.Transcutaneous electrical acupoint stimulation for prevention of postoperative delirium in geriatric patients with silent lacunar infarction:a preliminary study[J].Clin Interv Aging2018,13:2127-2134.
[25]Tu Q,Yang Z,Gan J,et al.Transcutaneous Electrical Acupoint Stimulation Improves Immunological Function During the Perioperative Period in Patients With Non-Small Cell Lung Cancer Undergoing Video-Assisted Thoracic Surgical Lobectomy[J].Technol Cancer Res Treat,2018,17:1533033818806477.
[26]AminiSaman J,Mohammadi S,Karimpour H,et al Transcutaneous Electrical Nerve Stimulation at the Acupuncture Points to Relieve Pain of Patients Under Mechanical Ventilation:A Randomized Controlled Study[J].J Acupunct Meridian Stud,2018,11(5):290-295.
[27]具紫勇,游世晶,王珂,等.经皮穴位电刺激对大运动量耐力训练大鼠血清睾酮和尿素氮含量及ATP酶活力的影响[J].上海针灸杂志,2013,32(4):313-315.
[28]李小梅.经皮穴位电刺激的临床镇痛进展[J].中国疼痛医学杂志,2014,20(11):826-829.
[29]金玮,吕雅,陈双懂,等.内关穴经皮穴位电刺激防治甲状腺肿瘤术后恶心呕吐疗效的临床观察[J].中国中西医结合杂志,2013,33(9):1199-1202.
[30]吴群,莫云长,黄陆平,等.经皮穴位电刺激联合丙泊酚靶控输注对开颅术围手术期应激反应的影响[J].中国中西医结合杂志,2013,33(12):1621-1625.