摘要
目的观察电针足三里和地机在剖宫产手术后镇痛的临床效果以及临床治疗的安全性。方法选取择期行子宫下段剖宫产术病人60例。随机均分为两组,对照组术后给予舒芬太尼自控镇痛(PCIA),治疗组术后给予电针刺激30 min。检测针刺前(T1)、手术后2 h(T2)、12 h(T3)、24 h(T4)和48 h(T5)血液标本中b-内啡肽(b-EP)、5-羟色胺(5-HT)和前列腺素E2(PGE_2)的含量。采用视觉模拟评分法(VAS)评估T2、T3、T4和T5时间点患者的疼痛程度,并记录各时间点疗效等级评定、安全等级评定和不良反应。结果治疗组患者在T2、T3、T4时间点VAS评分低于对照组(P<0.05)。治疗组患者血浆中b-EP在T3、T4、T5时间点含量相对于对照组显著升高(P<0.05)。治疗组患者血浆5-HT和PGE_2水平在T2、T3和T4时间点含量与对照组相比显著降低(P<0.05)。组内比较,血浆中5-HT和PGE_2在对照组T2、T3和T4与T1相比含量显著升高(P<0.05),b-EP在治疗组T3、T4和T5比T1时间点含量升高(P<0.05);PGE_2和5-HT在治疗组各时间点之间差异无统计学意义(P>0.05)。两组疗效等级评定,治疗组术后2 h优良率为86.7%,优于对照组的60.0%(P<0.05)。治疗组安全性等级高于对照组(P<0.05)。结论电针能为剖宫产手术提供安全有效的术后镇痛,其机制可能是电针刺激足三里和地机能增加内源性b-EP产生和抑制炎症性介质5-HT和PGE_2的释放。
Objective To observe the clinical efficacy of electroacupuncture at Zusanli（ST36） and Diji（SP8） in easing pain after Caesarean section（C-section） and the safety of the treatment. Method Sixty patients going to receive lower-uterine-segment C-section were enrolled and randomized into two groups. The control group was intervened by patient-controlled intravenous analgesia（PCIA） with Sufentanil after the surgery, while the treatment group was intervened by 30-minute electroacupuncture（EA） after the surgery. The contents of blood b-endorphin（b-EP）, 5-hydroxytryptamine（5-HT） and prostaglandin E2（PGE2） were evaluated at several time points： prior to EA（T1）, 2 h after the surgery（T2）, 12 h after the surgery（T3）, 24 h after the surgery（T4） and 48 h after the surgery（T5）. Visual Analogue Scale（VAS） was adopted to measure pain intensity at T2, T3, T4 and T5. The therapeutic efficacy, safety level and adverse reactions were recorded at each time point. Result The VAS score was significantly lower in the treatment group than in the control group at T2, T3 and T4（P〈0.05）. The content of plasma b-EP in the treatment group was significantly increased compared to that in the control group at T3, T4, and T5（P〈0.05）. The contents of plasma 5-HT and PGE2 in the treatment group were significantly decreased compared to those in the control group（P〈0.05）. In the control group, the contents of 5-HT and PGE2 at T2, T3, and T4 were significantly higher than those at T1（P〈0.05）; in the treatment group, the content of b-EP at T3, T4 and T5 was significantly higher than that at T1（P〈0.05）. There were no significant intra-group differences in comparing the contents of PGE2 and 5-HT at each time point in the treatment group（P〉0.05）. Regarding the efficacy evaluation, the excellent rate was 86.7% in the treatment group 2 h after the surgery, significantly higher than 60.0% in the control group（P〈0.05）. The security level in the treatment group was markedly higher than that in the control group（P〈0.05）. Conclusion EA can provide a safe and effective post-operation analgesia for C-section, and the possible mechanism is that EA at Zusanli and Diji increases the secretion of b-EP and inhibits the release of inflammatory mediators 5-HT and PGE2.
出处
《上海针灸杂志》
2017年第8期951-955,共5页
Shanghai Journal of Acupuncture and Moxibustion
关键词
电针
穴
足三里
穴
地机
针刺镇痛
疼痛
手术后
Electroacupuncture
Point
Zusanli（ST36）
Point
Diji（SP8）
Acupuncture analgesia
Pain
postoperative
