摘要
目的：观察腕踝针联合自控镇痛泵（patient controlled analgesia，PCA）治疗全髋关节置换术（total hip arthroplasty，THA）后髋关节疼痛的临床疗效和安全性。方法：68例接受单侧THA手术的患者随机分为2组，腕踝针联合PCA组35例、PCA组33例。2组患者术前均接受疼痛知识宣教，术后均采用PCA镇痛48h。腕踝针联合PCA组在此基础上从术前3d开始行腕踝针针刺镇痛治疗，每日1次，10d为1个疗程，共治疗1个疗程。记录术后48h内2组患者每12h的PCA镇痛药使用量；分别在术后12、24、36、48h及术后3、4、5d采用疼痛视觉模拟量表（visual analogue scale，VAS）对2组患者髋关节疼痛情况进行评估；观察术后48h内2组患者不良反应发生情况；术后2周，依据髋关节Harris评分标准评价髋关节功能。结果：2组患者髋关节疼痛VAS评分术后不同时间点问的差异具有统计学意义，即存在时间效应（F=220．239，P=0．000）；术后12、24、36、48h时，2组髋关节疼痛VAS评分的组间差异均无统计学意义[（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]；术后3、4、5d时，腕踝针联合PCA组髋关节疼痛VAS评分低于PCA组[（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组间总体比较，腕踝针联合PCA组髋关节疼痛VAS评分低于PCA组，即存在分组效应（F=5．617，P=0．021）；时间因素和分组因素之间不存在交互效应（F=2．621，P=0．058）。2组患者术后不同时间点间镇痛药用量的差异具有统计学意义，即存在时间效应（F=667．298，P=0．000）；术后0～12h、12～24h、24～36h、36～48h腕踝针联合PCA组镇痛药用量均少于PCA组[（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组间总体比较，腕踝针联合PCA组镇痛药用量少于PCA组，即存在分组效应（F=37．065，P=0．000）；时间因素和分组因素不存在交互效应（F=1．765，P=0．155）。术后2周，腕踝针联合PCA组患髋Harris评分高于PCA组[（80．37±4．56）分，（76．06±2．73）分，t=4．693，P=0．000]。术后48h内，腕踝针联合PCA组发生恶心呕吐6例、尿潴留3例、眩晕2例、嗜睡2例，PCA组发生恶心呕吐13例、尿潴留8例、眩晕3例、嗜睡4例；腕踝针联合PCA组不良反应发生率低于PCA组（χ2=16．147，P=0．000）。结论：对于THA术后髋关节疼痛，腕踝针联合PCA较单纯PCA镇痛效果好、镇痛药用量少，有利于髋关节功能恢复，且不良反应少。
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 unilater- al 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 inhip 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 gen- eral,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 oth- er 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 com- pared to PCA group in general, in other words, there was group effect （ F = 37. 065, P = 0. 000 ）. There was no interaction between time faetor 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 som- nolence （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.
出处
《中医正骨》
2016年第10期24-28,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
河南省研究生教育创新培养基地2015年度研究生创新基金项目
关键词
关节成形术
置换
髋
疼痛
手术后
针刺镇痛
镇痛
病人控制
arthroplasty, replacement, hip
pain, postoperative
acupuncture analgesia
analgesia, patient - controlled
