外科理论与实践

外科理论与实践 ›› 2021, Vol. 26 ›› Issue (06): 537-542.doi: 10.16139/j.1007-9610.2021.06.016

• 论著 • 上一篇    下一篇

针刺联合胸椎旁阻滞用于全麻肋间神经移位术的临床研究

于士剑, 王雪湖, 张琳, 林微微, 崔娓()   

  1. 上海市静安区中心医院麻醉科，上海 200040
  • 收稿日期:2021-03-15 出版日期:2021-11-25 发布日期:2022-07-27
  • 基金资助:
    综合医院中西医结合专项(ZHYY-ZXYJHZX-201613)

Study on acupuncture with thoracic paravertebral block for patients with intercostal nerve transfer and general anesthesia

YU Shijian, WANG Xuehu, ZHANG Lin, LIN Weiwei, CUI Wei()   

  1. Department of Anesthesiology, Jing’an District Central Hospital, Shanghai 200040, China
  • Received:2021-03-15 Online:2021-11-25 Published:2022-07-27

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摘要：

目的：分析针刺联合胸椎旁阻滞减轻全麻肋间神经移位术病人的术后疼痛、减少术后并发症发生。方法：行肋间神经移位的手术病人共88例，随机分为3组：静脉自控镇痛（A组）、胸椎旁阻滞复合静脉自控镇痛（B组）和胸椎旁阻滞复合静脉自控镇痛加用针刺（C组）。A组34例，B组28例，C组26例。术前1天C组电针刺激（支沟、后溪、合谷、双侧内关）20 min。B组和C组均手术日行胸椎旁阻滞，术毕静脉自控镇痛。A组术毕静脉自控镇痛。记录病人术后恶心呕吐的发生率、术后芬太尼镇痛用量。采用ELISA法检测3组病人手术前、后的β内啡肽（β-endorphin， β-EP）、白细胞介素6(interleukin-6，IL-6)、肿瘤坏死因子α(tumor necrosis factor-α，TNF-α)、5羟色胺(5-hydroxytryptamine ，5-HT )和皮质醇浓度的变化，统计3组各参数的差异。结果：C组术后自控镇痛的芬太尼用量少于A、B组（P<0.05），术后恶心呕吐的发生率低于A、B组（P<0.05）。B组术后2 h （T2）与A组相比，仅血清IL-6浓度显著降低（P<0.05）。C组与A组相比，β-EP浓度升高，IL-6、TNF-α和皮质醇浓度显著降低，差异有统计学意义（P<0.05）。C组与B组相比，β-EP浓度升高，皮质醇浓度降低（P<0.05）。C组经针刺干预第1天后（T1），血清β-EP、5-HT、皮质醇浓度较术前第1天（T0）显著降低，但IL-6浓度显著升高（P<0.05）。T2 β-EP、5-HT和TNF-α浓度较T0显著降低，而IL-6浓度升高，差异有统计学意义（P<0.05）。T2病人血清TNF-α浓度与T1相比显著降低（P<0.05）。结论：针刺联合胸椎旁阻滞用于全麻肋间神经移位术，术后镇痛效果良好，可提高血中β-EP的浓度，抑制促炎因子IL-6、TNF-α、皮质醇的释放。

关键词: 针刺, 胸椎旁阻滞, 术后镇痛

Abstract: Objective To analyze the clinical effect of acupuncture combined with thoracic paravertebral block (TPVB) in the treatment of pain and complications of the patients with intercostal nerve transfer and general anesthesia. Methods Eighty-eight patients with intercostal nerve transfer were randomized into three groups: 34 cases with patient controlled intravenous analgesia (PCIA) just after operation in group A, 28 cases with TPVB given when entering the operation and(PCIA) at the end of operation in group B, and 26 cases with TPVB and(PCIA) combined with acupuncture in group C. Acupuncture analgesia was used in group C with electroacupuncture stimulated for 20 minutes on points of Zhigou, Houxi, Hegu and bilateral Neiguan just the day before operation. Incidence of postoperative nausea and vomiting and the postoperative dosage of analgesic fentanyl were recorded. The indices related with analgesia including β-endorphin (β-EP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), 5-hydroxytryptamine (5-HT) and cortisol were detected using ELISA method before and after operation and compared among 3 groups. Results The dosage of fentanyl was lower in group C than those in group A and B significantly (P<0.05) and the incidence of nausea and vomiting lower than those in group A and B (P<0.05). Only serum IL-6 concentration 2 hours after operation in group B decreased significantly compared with that in group A (P<0.05). When compared those in group A, β-EP increased and IL-6, TNF-α and cortisol decreased in group C significantly (P<0.05). The concentration of β-EP increased and cortisol decreased significantly in C group(P<0.05) compared with those in B group. Comparing with that of 1 day before operation, The concentrations of serum β-EP, 5-HT and cortisol decreased and IL-6 increased in C group significantly (P<0.05) after acupuncture intervention. The concentration of β-EP, 5-HT and TNF-α in serum decreased significantly 2 hours after operation than before, while the concentrations of IL-6 in serum increased significantly (P<0.05). The concentration of TNF-α in patients 2 hours after operation decreased significantly (P<0.05). Conclusions Acupuncture combined with TPVB and general anesthesia could have good analgesic effect, which increases the concentration of β-EP and inhibits the release of pro-inflammatory factors such as IL-6, TNF-α and cortisol.

Key words: Acupuncture, Thoracic paravertebral block, Postoperative analgesia

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