摘要
目的:观察浮针对经皮椎间孔镜下髓核摘除术中疼痛及血流动力学的影响,评价浮针镇痛、改善血流动力学的有效性及安全性。方法:168例接受经皮椎间孔镜下髓核摘除术患者按照随机数字表法分为浮针组84例和对照组84例。对照组术区采用0.5%利多卡因注射液行浸润麻醉,浮针组在对照组治疗基础上于术前30 min采用浮针针刺症状侧下肢委中穴,逆经进针,扫散行针,留针至手术结束。比较两组患者穿刺置管、关节突成形、减压操作时患者平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度、视觉模拟量表(visual analogue scale,VAS)评分,两组患者术后即刻及术后24 h再次手术意愿比例,术前及术后1 d、3个月、12个月Oswestry功能障碍指数(Oswestry disability index,ODI),针刺皮下血肿,感染等相关并发症情况。结果:手术后,浮针组有效率为96.4%(81/84),对照组有效率为97.6%(82/84),两组有效率比较,差异无统计学意义(P>0.05)。穿刺置管时,两组患者血氧饱和度、MAP、HR比较,差异无统计学意义(P>0.05);关节突成形、减压操作时,浮针组MAP、HR显著低于对照组,血氧饱和度显著高于对照组(P<0.05)。穿刺置管时,两组患者VAS评分比较,差异无统计学意义(P>0.05);关节突成形、减压操作时,浮针组VAS评分显著低于对照组(P<0.05)。手术结束时、术后24 h,浮针组患者再次手术意愿率均高于对照组(P<0.05)。两组患者术后不同时间ODI均显著低于手术前(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:浮针超前镇痛可有效缓解经皮椎间孔镜下髓核摘除术中疼痛,并可稳定血压、HR等,且无明显不良反应。
Objective:To observe the effect of floating acupuncture on pain and hemodynamics during percutaneous transforaminal endoscopic discectomy,and to evaluate the efficacy and safety of floating acupuncture analgesia and improving hemodynamics.Methods:A total of 168 patients who underwent percutaneous transforaminal endoscopic discectomy were divided into a floating acupuncture group of 84 cases and a control group of 84 cases according to the random number table method.In the control group,0.5%lidocaine injection was used for infiltration anesthesia in the operation area.On the basis of the treatment in the control group,the floating acupuncture group was acupuncture at Weizhong point of the lower extremity on the symptomatic side 30 minutes before the operation,the needle was inserted in a retrograde direction with a sweeping style,and the needle was retained until the end of the operation.The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation,and visual analogue scale(VAS)scores were compared between the two groups of patients during puncture and cannulation,arthroplasty,and decompression operations.And the ratio of willingness to reoperation immediately after the operation and 24 hours after the operation,Oswestry disability index(ODI),acupuncture subcutaneous hematoma,infection,and other related complications before surgery and at 1 d,3 months,and 12 months after surgery were also compared between the two groups.Results:After surgery,the effective rate of the floating acupuncture group was 96.4%(81/84),and the effective rate of the control group was 97.6%(82/84).There was no significant difference in the effective rate between the two groups(P>0.05).And there was no significant difference in blood oxygen saturation,MAP,and HR between the two groups during puncture and cannulation(P>0.05).During arthroplasty and decompression operations,the MAP and HR of the floating acupuncture group were significantly lower than those of the control group,and the blood oxygen saturation was significantly higher than that of the control group(P<0.05).There was no significant difference in the VAS score between the two groups during puncture and cannulation(P>0.05).The VAS score of the floating acupuncture group was significantly lower than that of the control group during arthroplasty and decompression operations(P<0.05).At the end of the operation and 24 hours after the operation,the willingness rate of reoperation in the floating acupuncture group was higher than that in the control group(P<0.05).The ODI of the two groups at different time after the operation was significantly lower than that before the operation(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Preemptive analgesia with floating acupuncture can effectively relieve pain during percutaneous transforaminal endoscopic discectomy,and can stabilize blood pressure,HR,etc.,without obvious adverse reactions.
作者
吕成国
孙超龙
白玉
陈爽
程慧
梅伟
杨勇
LYU Chengguo;SUN Chaolong;BAI Yu;CHEN Shuang;CHENG Hui;MEI Wei;YANG Yong(Zhengzhou Orthopaedics Hospital,Zhengzhou Henan China 450000;Shuqing Medical College of Zhengzhou,Zhengzhou Henan China 450064)
出处
《中医学报》
CAS
2022年第12期2688-2693,共6页
Acta Chinese Medicine
基金
河南省医学适宜技术推广项目(SYJS2020152)。
关键词
浮针
经皮椎间孔镜下髓核摘除术
疼痛
腰椎间盘突出症
血流动力学
floating needle
percutaneous transforaminal endoscopic discectomy
pain
lumbar disc herniation
hemodynamics
