| 摘要: | 為了探討2 Hz電針對人工膝關節置換手術術後疼痛的止痛效果。我們選擇退化性膝關節炎接受常規人工膝關節置換手術的病患34人，隨機分為控制組（12人），僅用 patient-controlled analgesia （PCA）；電針穴位組（12人），除了PCA外，另於手術對側足三里穴和陽陵泉穴施予2 Hz電針刺激30分鐘；電針非穴位組（10人），與電針穴位組相同，但2 Hz電針刺激施予手術對側足三里穴和陽陵泉穴各旁開1 cm處。以visual analgesia scale （VAS）、第一次壓PCA的時間、以及使用止痛藥的總劑量作為電針止痛的療效指標。同時也觀察受試者手術後的嘔吐發生率。結果顯示電針穴位組和電針非穴位組的第一次按壓PCA的時間都比控制組長，但使用止痛劑的總劑量和嘔吐的發生率三組相似 , 沒有統計學上差異。
2 Hz電針刺激與人工膝關節手術對側的足三里穴和陽陵泉穴，以及足三里穴和陽陵泉各旁開1 cm處，兩者都可以延長第一次按壓PCA的時間，說明2 Hz電針刺激能加強PCA減輕人工膝關節置換手術術後疼痛。2 Hz電針刺激足三里穴和陽陵泉穴，所產生的止痛效果與2 Hz電針足三里穴和陽陵泉各旁開1 cm處相似，由於足三里穴與其旁開1 cm處，以及陽陵泉穴與其旁開1 cm處同屬深腓神經和L4神經節段，因此推論在同一神經支配之穴區範圍內施行電針或針刺，可以得到相似效果。術後嘔吐的發生與止痛劑的劑量有密切關聯。
In order to investigate the analgesic effect of 2 Hz electroacupuncture (EA) for postoperative pain after total knee arthroplasty. We selected 34 patients , who have degenerative knee joint arthritis and need treatment with total knee arthroplasty, they were divided into three groups as follows: control group (CP), patient-controlled analgesia only; EA in acupoint group (EAAG), 2 Hz EA applied to Zusanli (St 36) and Yanlinchand (G34) acupoints that were contralateral to operation site for 30 min except PCA; EA in non-acupoint group (EANAG), the method was identical to EAAG, but 2 Hz EA applied to 1 cm lateral to Zusanli and 1 cm lateral to Yanlinchand acupoints. Visual analgesia scale score (VAS), the time of first demanding PCA, the frequency of PCA, total dose of analgesics and incidence of vomiting within 48 hrs after operation were used as indexes for evaluating EA analgesia. The results indicated that the time of first PCA was more prolonger in the EAAG and EANAG than in CG, whereas the total dose of analgesics and incidence of vomiting were no difference among total dose of analgesic and incidence of vomiting were no difference among the CG, EAAG and EANAG.
In conclusion, 2 Hz EA applied to Zusanli and Yanlinchand acupoints, and applied to 1 cm lateral to Zusanli and 1 cm lateral to Yanlinchand acupoints contralateral to total knee arthroplasty, both of them can prolong the time of first demanding PCA, suggesting 2 Hz can potentate the analgesic effect of PCA for postoperative pain after total knee arthroplasty. The analgesic effect of 2Hz EA applied to Zusanli and Yanlinchand acupoints was similar to 2 Hz EA applied to 1cm lateral to Zusanli and 1cm lateral to Yanlinchand acupoints, suggesting EA stimulation applied to the acupoint area that belong to the same nerve or nerve segment may obtain similar effect. Because Zusanli acupoint and 1 cm lateral to Zusanli acupoint, Yanlinchand and 1 cm lateral to Yanlinchand acupoint all belong to the distribution area of deep peroneal nerve and 4th lumbar nerve segment. |
