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[1]李文龍,李陽(yáng)陽(yáng),張海龍,等.腕踝針聯(lián)合自控鎮(zhèn)痛泵治療全髖關(guān)節(jié)置換術(shù)后髖關(guān)節(jié)疼痛的臨床研究[J].中醫(yī)正骨,2016,28(10):24-28.
　LI Wenlong,LI Yangyang,ZHANG Hailong,et al.Clinical study on wrist-ankle acupuncture analgesia combined with patient-controlled analgesia for treatment of hip pain after total hip arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):24-28.
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腕踝針聯(lián)合自控鎮(zhèn)痛泵治療全髖關(guān)節(jié)置換術(shù)后髖關(guān)節(jié)疼痛的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年10期
頁(yè)碼:
24-28
欄目:
臨床研究
出版日期:
2016-10-20

文章信息/Info

Title:
Clinical study on wrist-ankle acupuncture analgesia combined with patient-controlled analgesia for treatment of hip pain after total hip arthroplasty
作者:
李文龍1; 李陽(yáng)陽(yáng)1; 張海龍1; 劉又文2
1.河南中醫(yī)藥大學(xué),河南 鄭州 450008;
2.河南省洛陽(yáng)正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽(yáng) 471002
Author(s):
LI Wenlong1; LI Yangyang1; ZHANG Hailong1; LIU Youwen2
1.Henan University of Traditional Chinese Medicine,Zhengzhou 450008,Henan,China 2.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關(guān)鍵詞:
關(guān)節(jié)成形術(shù); 置換; 髖;  疼痛; 手術(shù)后;  針刺鎮(zhèn)痛;  鎮(zhèn)痛; 病人控制
Keywords:
arthroplasty; replacement; hip;  pain; postoperative;  acupuncture analgesia;  analgesia; patient-controlled
摘要:
目的:觀察腕踝針聯(lián)合自控鎮(zhèn)痛泵(patient controlled analgesia,PCA)治療全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty,THA)后髖關(guān)節(jié)疼痛的臨床療效和安全性。方法:68例接受單側(cè)THA手術(shù)的患者隨機(jī)分為2組,腕踝針聯(lián)合PCA組35例、PCA組33例。2組患者術(shù)前均接受疼痛知識(shí)宣教,術(shù)后均采用PCA鎮(zhèn)痛48 h。腕踝針聯(lián)合PCA組在此基礎(chǔ)上從術(shù)前3 d開始行腕踝針針刺鎮(zhèn)痛治療,每日1次,10 d為1個(gè)療程,共治療1個(gè)療程。記錄術(shù)后48 h內(nèi)2組患者每12 h的PCA鎮(zhèn)痛藥使用量; 分別在術(shù)后12、24、36、48 h及術(shù)后3、4、5 d采用疼痛視覺模擬量表(visual analogue scale,VAS)對(duì)2組患者髖關(guān)節(jié)疼痛情況進(jìn)行評(píng)估; 觀察術(shù)后48 h內(nèi)2組患者不良反應(yīng)發(fā)生情況; 術(shù)后2周,依據(jù)髖關(guān)節(jié)Harris評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)髖關(guān)節(jié)功能。結(jié)果:2組患者髖關(guān)節(jié)疼痛VAS評(píng)分術(shù)后不同時(shí)間點(diǎn)間的差異具有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=220.239,P=0.000); 術(shù)后12、24、36、48 h時(shí),2組髖關(guān)節(jié)疼痛VAS評(píng)分的組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(6.22±1.01)分,(6.15±1.13)分,t=0.273,P=0.786;(5.32±0.99)分,(5.17±1.27)分,t=0.513,P=0.610;(3.83±0.26)分,(3.92±0.34)分,t=-1.667,P=0.098;(3.06±0.28)分,(2.99±0.23)分,t=0.954,P=0.344]; 術(shù)后3、4、5 d時(shí),腕踝針聯(lián)合PCA組髖關(guān)節(jié)疼痛VAS評(píng)分低于PCA組[(3.68±0.25)分,(4.17±0.32)分,t=-7.528,P=0.000;(3.58±0.35)分,(4.03±0.26)分,t=-5.878,P=0.000;(2.96±0.48)分,(3.17±0.24)分,t=-2.244,P=0.029]; 2組間總體比較,腕踝針聯(lián)合PCA組髖關(guān)節(jié)疼痛VAS評(píng)分低于PCA組,即存在分組效應(yīng)(F=5.617,P=0.021); 時(shí)間因素和分組因素之間不存在交互效應(yīng)(F=2.621,P=0.058)。2組患者術(shù)后不同時(shí)間點(diǎn)間鎮(zhèn)痛藥用量的差異具有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=667.298,P=0.000); 術(shù)后0～12 h、12～24 h、24～36 h、36～48 h腕踝針聯(lián)合PCA組鎮(zhèn)痛藥用量均少于PCA組[(76.49±7.69)mL,(80.98±5.81)mL,t=-2.705,P=0.009;(63.51±6.10)mL,(69.98±5.37)mL,t=-4.636,P=0.000;(45.61±4.29)mL,(49.76±6.01)mL,t=-3.295,P=0.002;(41.28±3.75)mL,(43.52±3.85)mL,t=-2.430,P=0.018]; 2組間總體比較,腕踝針聯(lián)合PCA組鎮(zhèn)痛藥用量少于PCA組,即存在分組效應(yīng)(F=37.065,P=0.000); 時(shí)間因素和分組因素不存在交互效應(yīng)(F=1.765,P=0.155)。術(shù)后2周,腕踝針聯(lián)合PCA組患髖Harris評(píng)分高于PCA組[(80.37±4.56)分,(76.06±2.73)分,t=4.693,P=0.000]。術(shù)后48 h內(nèi),腕踝針聯(lián)合PCA組發(fā)生惡心嘔吐6例、尿潴留3例、眩暈2例、嗜睡2例,PCA組發(fā)生惡心嘔吐13例、尿潴留8例、眩暈3例、嗜睡4例; 腕踝針聯(lián)合PCA組不良反應(yīng)發(fā)生率低于PCA組(χ2=16.147,P=0.000)。結(jié)論:對(duì)于THA術(shù)后髖關(guān)節(jié)疼痛,腕踝針聯(lián)合PCA較單純PCA鎮(zhèn)痛效果好、鎮(zhèn)痛藥用量少,有利于髖關(guān)節(jié)功能恢復(fù),且不良反應(yīng)少。
Abstract:
Objective:To observe the clinical curative effects and safety of wrist-ankle acupuncture analgesia combined with patient-controlled analgesia(PCA)in treatment of hip pain after total hip arthroplasty(THA).Methods:Sixty-eight patients who received unilateral THA were randomly divided into combination group(35 cases)and PCA group(33 cases).All patients in both of the groups were taught pain knowledge before surgery,and then received PCA analgesia for 48 hours after surgery.Meanwhile,the patients in combination group were treated with wrist-ankle acupuncture analgesia from the third day before surgery,once a day for one course of treatment,10 days for each course.The consumption of PCA analgesics were recorded every 12 hours within 48 hours after surgery.The hip pain were evaluated by using visual analogue scale(VAS)at 12,24,36 and 48 hours and 3,4 and 5 days after surgery respectively.The incidence rates of adverse reactions were observed within 48 hours after surgery and the hip function were also evaluated according to Harris hip scoring standard.Results:There was statistical difference in hip pain VAS scores between different postoperative timepoints,in other words,there was time effect(F=220.239,P=0.000).There was no statistical difference in hip pain VAS scores between the 2 groups at 12,24,36 and 48 hours after surgery(6.22+/-1.01 vs 6.15+/-1.13 points,t=0.273,P=0.786; 5.32+/-0.99 vs 5.17+/-1.27 points,t=0.513,P=0.610; 3.83+/-0.26 vs 3.92+/-0.34 points,t=-1.667,P=0.098; 3.06+/-0.28 vs 2.99+/-0.23 points,t=0.954,P=0.344).The hip pain VAS scores were lower in combination group compared to PCA group at 3,4 and 5 days after surgery(3.68+/-0.25 vs 4.17+/-0.32 points,t=-7.528,P=0.000; 3.58+/-0.35 vs 4.03+/-0.26 points,t=-5.878,P=0.000; 2.96+/-0.48 vs 3.17+/-0.24 points,t=-2.244,P=0.029).The hip pain VAS scores were lower in combination group compared to PCA group in general,in other words,there was group effect(F=5.617,P=0.021).There was no interaction between time factor and group factor(F=2.621,P=0.058).There was statistical difference in the consumption of PCA analgesics between different postoperative timepoints,in other words,there was time effect(F=667.298,P=0.000).The consumption of PCA analgesics was less in combination group compared to PCA group at 0-12,12-24,24-36 and 36-48 hours after surgery(76.49+/-7.69 vs 80.98+/-5.81 ml,t=-2.705,P=0.009; 63.51+/-6.10 vs 69.98+/-5.37 ml,t=-4.636,P=0.000; 45.61+/-4.29 vs 49.76+/-6.01 ml,t=-3.295,P=0.002; 41.28+/-3.75 vs 43.52+/-3.85 ml,t=-2.430,P=0.018).The consumption of PCA analgesics was less in combination group compared to PCA group in general,in other words,there was group effect(F=37.065,P=0.000).There was no interaction between time factor and group factor(F=1.765,P=0.155).The Harris hip scores were higher in combination group compared to PCA group at 2 weeks after surgery(80.37+/-4.56 vs 76.06+/-2.73 points,t=4.693,P=0.000).Nausea and vomiting(6),uroschesis(3),dizziness(2)and somnolence(2)were found in combination group,while nausea and vomiting(13),uroschesis(8),dizziness(3)and somnolence(4)were found in PCA group within 48 hours after surgery.The incidence rate of adverse reactions was lower in combination group compared to PCA group(χ2=16.147,P=0.000).Conclusion:The combination therapy of wrist-ankle acupuncture analgesia and PCA has the advantages of better clinical effects and less consumption of PCA analgesics compared to the monotherapy of PCA in the treatment of hip pain after THA,and it is more conducive to the hip function recovery with less adverse reactions.

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備注/Memo

備注/Memo:
基金項(xiàng)目:河南省研究生教育創(chuàng)新培養(yǎng)基地2015年度研究生創(chuàng)新基金項(xiàng)目
通訊作者:劉又文 E-mail:[email protected]
更新日期/Last Update: 2016-10-20