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請使用永久網址來引用或連結此文件:
http://ir.cmu.edu.tw/ir/handle/310903500/24261
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| 題名: | 術後針刺對人工膝關節置換術後疼痛緩解效應的評估;Assessment of the effect of postoperative acupuncture stimulation on pain relief after total knee replacement |
| 作者: | 陳昱辰;Yu-Chen Chen |
| 貢獻者: | 中國醫藥學院中國醫學研究所 |
| 關鍵詞: | 針刺;電針;人工膝關節置換術;疼痛;acupuncture;electro-acupuncture;total knee replacement;pain |
| 日期: | 1992 |
| 上傳時間: | 2009-12-22 10:23:47 (UTC+8) |
| 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 (PCA; Patient controlled analgesia)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。本臨床研究以接受單膝人工膝關節置換術(Total knee replacement；TKA)之病患為對象。於開刀後分別施以100 Hz頻率電針健側陽陵泉(GB-34)及陰陵泉穴(SP-9)，同時配合於開刀後使用病患自控式止痛器，用隨機試驗(randomization)、偽電針組(sham electroacupuncture)和單盲試驗(single-blind)來評估100 Hz頻率電針對術後疼痛的鎮痛效果。本研究收集90位於中國醫藥學院附設醫院骨科中接受全身麻醉進行單膝人工膝關節置換術的病患，於開刀後依隨機取樣分為對照組、偽電針組、100 Hz頻率電針組三組，每組各約30位。於手術後記錄病患二十四小時內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，在術後二十四小時內使用嗎啡總劑量上，100 Hz頻率電針組比對照組減少29.0％，同時亦比偽電針組減少27.2％，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。三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，100 Hz頻率電針組疼痛分數明顯低於對照組和偽電針組，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100 Hz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100 Hz頻率電針組眩暈的發生率較低。由本研究結果發現：100 Hz頻率電針組的確能減少二十四小時內要求止痛藥的總劑量；而且100 Hz頻率電針，的確能減少使用鴉片類藥物的副作用。; 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, neither the dose of acupuncture stimulation yet. Therefore, the purpose of this study was to estimate the effect 100Hz frequency electro-acupuncture stimulation combined PCA to pain relieve after operation. This study was performed at Department of Orthopaedics, China Medical College Hospital, including ninety patients who have had spinal anesthesia after total knee replacement. We choose total knee replacement (TKA)patients as subjects to examine the effects of 100Hz electro- acupuncture in conjunction with PCA on post-operation pain. The subjects were randomized into three groups - control group, sham electro- acupuncture group, 100Hz frequency electro-acupuncture group. Each group consisted of about thirty patients. The study results show that the total dose of PCA used within the first 24 hours was 29% less in the 100Hz frequency electro-acupuncture group when compared with control''s. This was also statistically significant. In conclusion, the present study shows that 100Hz frequency electro-acupuncture postpone the initial demand for pain control and decrease total PCA dose within the first 24 hours. When comparing pain scores, those 100Hz frequency electro-acupuncture group were lower than those of the control group, and the sham electro-acupuncture group within 6 hours. These were statistically significant. However, six hours later, all three groups had similar pain scores .Finally, opiate-related side effects were lowest in the low frequency and high frequency electro- acupuncture group. In conclusion, the present study shows that 100Hz frequency electro-acupuncture postpone the initial demand for pain control and decrease total PCA dose within the first 24 hours, and both of them can help to reduce the opiate-related side effects. |
| 顯示於類別: | [中國醫學研究所] 博碩士論文
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