不同頻率電針三陰交穴(SP-6)對剖腹產術後疼痛效應之評估; An Assessment on the Effect of Pain Relieving After Cesarean Section Operation Obtained by Applying Electroacupuncture of Different Frequencies on the Point of Sanyinchiao (SP-6)

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Title:	不同頻率電針三陰交穴(SP-6)對剖腹產術後疼痛效應之評估;An Assessment on the Effect of Pain Relieving After Cesarean Section Operation Obtained by Applying Electroacupuncture of Different Frequencies on the Point of Sanyinchiao (SP-6)
Authors:	魏以斌;I-PIN WEI
Contributors:	中國醫藥學院中國醫學研究所
Keywords:	電針;剖腹生產;術後疼痛;electroacupuncture;cesarean section;pain relieving after operation
Date:	1990
Issue Date:	2009-12-02 11:47:25 (UTC+8)
Abstract:	不同頻率電針三陰交穴(SP-6)對剖腹產術後疼痛緩解效應的評估研究生魏以斌中國醫藥學院中國醫學研究所中文摘要手術後的疼痛感覺是一種動態現象，即使接受同一種手術的不同病患，疼痛的感覺卻不相同。疼痛在手術後，麻醉藥消退後數小時最強烈，然後才逐漸減弱，但隨之產生的即是止痛劑的副作用。因此本研究探討電針穴位結合PCA對緩解術後疼痛的效應評估，並期能降低因使用鴉片類止痛劑而產生的副作用。本臨床研究以接受剖腹生產(cesarean section；CS)之產婦為對象。於開刀後分別施以低頻或高頻電針雙側三陰交穴(SP-6)，同時配合於開刀後使用病患自控式止痛器(PCA; Patient controlled analgesia)，用隨機試驗(randomization)、偽電針組(sham electroacupuncture)和單盲試驗(single-blind)來評估不同頻率電針對術後疼痛的鎮痛效果。本研究收集121位於中國醫藥學院附設醫院婦產科中接受半身麻醉進行剖腹生產的產婦，於開刀後依隨機取樣分為對照組、偽電針組、低頻電針組(2 Hz)及高頻電針組(100 Hz)四組，每組各約30位。於手術後記錄病患第一次要求成癮性止痛藥(morphine)的時間和二十四小時內PCA按鈕次數(PCA demands)和嗎啡使用劑量(PCA dose)，並觀察記錄病患生命徵象(vital signs)、鴉片類藥物副作用(opioid-related side effect)和疼痛分數(pain score)。本研究結果顯示，低頻電針組及高頻電針組於術後第一次要求止痛藥的時間間隔平均值分別比對照組延長了26.8分鐘及45.1分鐘，而高頻電針組亦比偽電針組延長30.0分鐘，且在統計學上具有顯著的差異。在術後二十四小時內使用嗎啡總劑量上，低頻電針組與高頻電針組分別比對照組減少27.0％，35.8％，同時亦分別比偽電針組減少21.5％，30.9％，且在統計學上具有顯著的差異。但偽電針組與對照組兩組間並無顯著差異。四個組別在疼痛分數的比較上，結果顯示在1.5小時、2小時、3小時、4小時、6小時，高頻電針組疼痛分數明顯低於對照組和偽電針組；而在1.5小時、2小時、3小時，低頻電針組疼痛分數明顯低於對照組，且在統計學上有顯著差異。6小時到16小時間則無明顯差異。而在20小時又呈現高頻電針組明顯低於對照組。最後統計鴉片類藥物副作用的發生率，得知低頻與高頻電針組頭暈的發生率較低。因此本研究結論為：低頻電針組與高頻電針組的確能延後剖腹生產術後第一次要求止痛藥的時間，同時能減少二十四小時內要求止痛藥的總劑量；而且無論低頻或高頻電針，的確能減少使用鴉片類藥物的副作用。關鍵詞：針刺、電針、剖腹生產、疼痛; An Assessment on the Effect of Pain Relieving After Cesarean Section Operation Obtained by Applying Electroacupuncture of Different Frequencies on the Point of Sanyinchiao (SP-6) I-PIN WEI Institute of Chinese Medical Sciences, China Medical College, Taiwan, R.O.C. ABSTRACT Post-operative pain is an active phenomenon. Even though the patients do the same operation, the post-operative pain on each patient is different. The pain occurs on the first several hours after the operation is very intense, and it will relax gradually. But the side effects of using analgesics occurred at the same time. Acupuncture put in use on the pain-relieve treatment after operation is very little, and there is no complete and specific conclusion on the pain-relieve mechanism of acupuncture, as well as the dose of acupuncture stimulation. Therefore, the purpose of this study was to estimate the effect between low frequency electro-acupuncture (2 Hz) and high frequency electro-acupuncture (100 Hz) combined PCA on pain relieve after operation. This study was performed at the Department of Obstetrics, China Medical College Hospital. One hundred and twenty one women were studied who had had spinal anesthesia after cesarean section (CS). The reason that we chose the post-cesarean section women as subjects was to examine the effects of low frequency electro- acupuncture (spleen 6) and high frequency electro- acupuncture (spleen 6) in conjunction with PCA on post-C-section pain. The subjects were randomized into four groups - control group (n=29), sham electro- acupuncture group (n=30), low frequency electro-acupuncture group (n=31) and high frequency electro-acupuncture group (n=30). The results show that when compared with the control group, the low frequency electro-acupuncture group and the high frequency electro- acupuncture group were 26.8 minutes and 45.1 minutes later than the control group for the first asked for pain medication, respectively. Both the differences ware statistically significant. The total dose of PCA used in the first 24 hours was 27% less in the low frequency electro-acupuncture group and 35.8% less in the high frequency electro-acupuncture group when compared with the controls. These differences were also statistically significant. In conclusion, the present study shows that both the low frequency and high frequency electro-acupunctures postponed the initial demand for pain control and decreased the total PCA dose for the first 24 hours. However, the difference of the total PCA dose between the control group and the sham electro- acupuncture group was not statistically significant. When comparing the pain scores, those of the low frequency and the
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