腕踝针治疗腹腔镜胆囊术后疼痛疗效观察

摘要

目的：观察腕踝针治疗腹腔镜胆囊术后疼痛的临床疗效。方法将150例在腹腔镜下行胆囊切除术患者随机分为A组、B组和C组,每组50例。A组在麻醉诱导前行腕踝针治疗,留针12 h；B组在麻醉诱导前针刺穴位旁皮肤,留针12 h；C组在麻醉诱导前不采用任何治疗方法。3组均采用全身静吸复合麻醉,并采用静脉镇痛泵用于术后镇痛。分别记录3组患者术后1 h、2 h、4 h、8 h、12 h、24 h、36 h、48 h切口痛,内脏痛的VAS评分,比较各组总有效率、术后镇痛药物用量及不良反应发生率。结果 A组术后4 h、8 h、12 h、24 h、36 h切口痛和内脏痛VAS评分与C组比较,差异均具有统计学意义(P＜0.01,P＜0.05)。A组术后8 h、12 h、24 h、36 h切口痛VAS评分和术后12 h、24 h、36 h内脏痛VAS评分与B组比较,差异均具有统计学意义(P＜0.05)。A组总有效率为96.0%,B组为84.0%,C组为86.0%,A组总有效率与B组和C组比较,差异均具有统计学意义(P＜0.05)。A 组术后芬太尼总添加量为(52.4±10.8)μg,B 组为(92.2±11.0)μg,C 组为(107.2±11.5)μg。A组术后芬太尼总添加量与B组和C组比较,差异均具有统计学意义(P＜0.05,P＜0.01)。A组术后不良反应发生率为12.0%,B组为58.0%,C组为66.0%,A组术后不良反应发生率与B组和C组比较,差异具有统计学意义(P＜0.01)。结论腕踝针配合静脉镇痛泵能缓解腹腔镜胆囊切除术后疼痛,可作为外科术后镇痛治疗的手段之一。%Objective To observe the clinical efficacy of wrist-ankle acupuncture in treating pain due to laparoscopic cholecystectomy.Method Totally 150 patients who were going to receive laparoscopic cholecystectomy were randomized into group A, group B, and group C, 50 cases in each group. Group A was intervened by wrist-ankle acupuncture prior to anesthesia, with the needles retained for 12 h; group B was by subcutaneous needling at the area nearby the points prior to anesthesia, with the needles retained for 12 h; group C didn’t receive any intervention before anesthesia. For the three groups, general inhalational and intravenous anesthesia was adopted for surgery, and patient-controlled intravenous analgesia for post-operation analgesia. The incision pain and visceral pain in the three groups were recorded by using Visual Analogue Scale (VAS) respectively 1 h, 2 h, 4 h, 8 h, 12 h, 24 h, 36 h, and 48 h after the operation. The total effective rate, analgesics consumption after operation, and incidence rate of adverse reaction were compared.Result There were significant differences in comparing the VAS scores of incision pain and visceral pain between group A and group C 4 h, 8 h, 12 h, 24 h, and 36 h after the operation (P<0.01,P<0.05). Between group A and group B, there were significant differences in comparing the VAS score of incision pain 8 h, 12 h, 24 h, and 36 h after the operation and the VAS score of visceral pain 12 h, 24 h, and 36 h after the operation (P<0.05). The total effective rate was 96.0% in group A, which was significantly different from 84.0% in group B and 86.0% in group C (P<0.05). The consumption of Fentaneyl citrate injection was (52.4±10.8)μg in group A, which was significantly different from (92.2±11.0)μg in group B and (107.2±11.5)μg in group C (P<0.05,P<0.01). The incidence rate of adverse reactions was 12.0% in group A, which was significantly different from 58.0% in group B and 66.0% in group C (P<0.01).Conclusion Wrist-ankle acupuncture plus patient-controlled intravenous analgesia can mitigate pain after laparoscopic cholecystectomy, and thus it can be taken as one of the post-operational analgesic approaches.