【作者】 李立文；

【导师】 祁晓华；

【作者基本信息】 南京中医药大学 ， 中医学， 2010， 硕士

【摘要】 目的：本研究通过分组观察,比较针药结合治疗人工膝关节置换术后疼痛的疗效,为改进和优化其镇痛治疗方案,进一步探讨针刺镇痛的作用机理提供临床依据。方法：将60例行人工膝关节置换术(Total Knee Replacement, TKR)的患者(计60个膝关节),按就诊顺序随机分为治疗组(电针+西药组)和对照组(西药组),在常规治疗、护理及功能康复锻炼的基础上,两组患者均于术后当天口服止痛药塞来昔布(西乐葆)200mg,每日两次,共7天。其中,治疗组在术后麻醉药性消失时,给予电针(疏密波)治疗,根据术后包扎范围,分组取穴,每日1次,计7次。治疗期间,记录患者一般情况(心率、血压、呼吸、血氧饱和度等)、采用疼痛视觉模拟评分法(Visual Analogue Scales, VAS)来观察术后七天两组患者镇痛效果以及术后前3天剧痛期电针的即时止痛效果、血液流变学指标,以及患者睡眠质量、镇痛效果满意度评分等,最后统一以VAS评分记录为主来进行疗效评价。结果：1、两组治疗后疼痛VAS评分逐日下降(P<0.05),治疗组术后7天VAS评分下降幅度较对照组明显,具有统计学意义(P<0.05),且术后前3天针刺治疗后较治疗前VAS得分有所下降,电针即时止痛效果显著,具有统计学意义(P<0.05)；2、治疗组患者睡眠质量评分及住院镇痛效果满意度评分均显著优于对照组(P<0.05)；3、治疗组术后第7天血液流变学多项指标均明显低于对照组(P<0.05)；4、两组患者在术后3天早晚的心率、血压、呼吸、血氧饱和度以及术后不良反应均无明显差异(P>0.05)。结论：1.两种治疗方案对于缓解人工膝关节置换术后疼痛都有明显的疗效,针药结合的镇痛效果则更为显著；电针即时镇痛效果较好,病人乐于接受。2.加用电针能够更有效的降低血液粘度,改善血液循环,起到活血通络,通则不痛的作用。3.疼痛的缓解可以改善术后患者的睡眠质量,利于身体康复、关节功能的恢复,从而提高患者住院满意度,有益于手术的进一步推广。4.针药结合缓解术后疼痛,安全,价廉,无副作用,值得临床上进一步的推广和研究。更多还原

【Abstract】 Objective:This study group was to compare the combined treatment of acupuncture of pain after total knee replacement effect, in order to improve and optimize their pain treatment, to further explore the mechanism of acupuncture analgesia for clinical basis. Methods:60 routine total knee replacement (Total Knee Replacement, TKR) patients (total 60 knees), according to visiting randomly divided into treatment group (EA + WM group) and control group (western group) In conventional treatment, care and functional rehabilitation exercises based on the patients in both groups after the day of oral pain medication celecoxib (Celebrex) 200mg, twice daily for 7 days. Anesthetic treatment group resistance disappears, giving EA (density wave) treatment, according to the scope of postoperative dressing, group acupoints,1 day, total 7 times. During treatment, patients recorded the general situation (heart rate, blood pressure, respiration, oxygen saturation, etc.), use of visual analogue pain score (Visual Analogue Scales, VAS) to observe the analgesic effect after seven days in both groups before and after 3 days pain of the immediate analgesic effect of electroacupuncture, hemorheology, and sleep quality in patients, analgesia satisfaction score, etc., and finally unified to VAS score recorded mainly to efficacy evaluation.Results:1. After treatment, pain VAS score decreased day by day, before and after their treatment, a significant statistical significance (P<0.05), between the two groups, the second day after the daily treatment group score was significantly lower than the control group (P<0.05); immediate analgesic effect of acupuncture was significantly (P<0.05).2. Sleep quality in patients treated with analgesia scores and patient satisfaction scores were significantly better than the control group (P<0.05).3.7 days after the treatment group a number of blood rheology were significantly lower than the control group (P<0.05).4. Two groups after 3 days in the morning and evening heart rate, blood pressure, respiration, blood oxygen saturation and postoperative adverse events were not significantly different (P>0.05). Conclusion:1.Two kinds of treatment for the relief of pain after total knee replacement patients have a significant effect, the analgesic effect of acupuncture combined with even more significant; immediate analgesic effect of EA is better, the patient happy to accept.2.Plus electric acupuncture can effectively reduce blood viscosity, improve blood circulation, play Huoxuetongluo, General is not the role of pain.3.Postoperative pain relief can improve the quality of sleep in patients, beneficial physical rehabilitation, restoration of joint function, to improve patient satisfaction with hospitalization, surgery to further promote benefit.4.Acupuncture pain relief, safe, inexpensive, no side effects, is worthy of further promotion and research.更多还原