摘要
目的研究针刺三阴交穴配合耳穴压豆在全髋关节置换术(THA)围术期镇痛的临床效果。方法将该院60例THA患者(符合股骨头坏死晚期诊断标准)按随机数字表法分为对照组30例,治疗组30例。对照组采用口服塞来昔布进行THA围术期镇痛:术前2 d开始给予塞来昔布口服400 mg,术后给予塞来昔布口服每日2次,每次200 mg。治疗组针刺三阴交穴配合耳穴压豆进行THA围术期镇痛:术前2 d开始给予针灸、压豆治疗,针刺患侧三阴交穴,得气后予平补平泻手法,留针15 min,每日1次;耳穴取神门、交感、皮质下、髋,予王不留行子按压10 min,每日1次。采用视觉模拟疼痛评分(静息状态:RVAS;主被动功能训练:IVAS)、总体镇痛满意度(GSS)评估各组患者的术后疼痛改善情况,并记录术后不良反应事件;测量各组患者血5-羟色胺(5-HT)水平;通过Harris评分量表评估各组患者的术后髋关节功能。结果60例患者均获随访(3个月)。术后72 h时治疗组RVAS明显小于对照组(P<0.05),治疗组IVAS评分在术后24、48、72 h均有所下降(P<0.05);术后1周治疗组GSS高于对照组(P<0.05);治疗组出现恶心呕吐病例数低于对照组(P<0.05),其他如头晕、尿潴留、加用其他镇痛药患者两组差异无统计学意义(P>0.05);各组患者血5-HT水平在术后均升高。在术后72 h时,治疗组血5-HT水平较对照组升高(P<0.05);此外,与对照组比较,术后2周治疗组患者Harris评分明显升高(P<0.05)。而在术后3个月时,两组患者Harris评分差异无统计学意义(P>0.05)。结论针刺三阴交穴配合耳穴压豆在THA围术期镇痛有效,能够加速术后髋关节功能恢复,这可能与外周血中血5-HT水平升高密切相关。
Objective To study the clinical effect of acupuncture at Sanyinjiao point in coordinated with auricular point pressing with beans for analgesia during perioperative period of total hip replacement(THA).Methods Sixty patients with THA(meeting the diagnosis criteria of advanced femoral head necrosis)were divided into the control group(30 cases)and treatment group(30 cases)according to the random number table method.The control group took oral celecoxib for conducting perioperative analgesia of THA:oral celecoxib 400 mg was given on preoperative 2 d,oral celecoxib was postoperative given,twice daily,200 mg per time;the treatment group conducted the THA perioperative analgesia by acupuncture at Sanyinjiao point in coordinated with auricular point pressing with beans:the acupuncture and bean pressing treatment began on preoperative 2 d,the acupuncture at Sanyinjiao point on the affected side was performed,and after obtaining qi,the patient was treated with tonifying,tonifying and purging manipulation,and the needle was kept for 15 min,once a day.The auricular points took the Shenmen,sympathetic,subcortical and hip,and the patient was pressed with Vaccaria segetalis seeds for 10 min,once a day.The visual analogue pain score(resting state:RVAS;active and passive functional training:RVAS)and overall analgesia satisfaction(GSS)were adopted to evaluate the postoperative pain improvement situation in each group and postoperative adverse reaction events were recorded.The level of blood 5-ht was detected in each group.The postoperative hip joint function was assessed by the Harris score scale.Results Sixty patients all were followed up for 3 months.RVAS at postoperative 72 h in thetreatment group was significantly smaller than that in the control group(P<0.05),and the IVAS score in the treatment group was decreased at postoperative 24,48,72 h(P<0.05).GSS at postoperative 1 week in the treatment group was higher than that in the control group(P<0.05).The number of cases appearing nausea and vomiting in the treatment group was
作者
祝震亚
童蕾
ZHU Zhenya;TONG Lei(Department of Orthopedics,Jiaxing Municipal Hospital of Traditional Chinese Medicine,Jiaxing,Zhejiang 314001,China)
出处
《重庆医学》
CAS
2020年第12期1938-1942,共5页
Chongqing medicine
基金
浙江省嘉兴市科技计划项目(2016BY28041)。
关键词
三阴交穴
耳穴压豆
全髋置换术
围术期镇痛
5-羟色胺
Sanyinjiao point
auricular point pressing with beans
total hip replacement
perioperative analgesia
5-HT
