经皮穴位电刺激复合腰硬联合麻醉在髋关节置换术中的镇静镇痛应用效果
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Effect of Transcutaneous Point Electrical Stimulation and Combined Spinal- Epidural Anesthesia on Sedation and Analgesia in Hip Replacement
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    摘要:

    目的:观察经皮穴位电刺激复合腰硬联合麻醉对髋关节置换术患者术中镇静镇痛的效果。方法:选择80 例需行髋关节置换术患者为研究对象,按随机数字表法分为对照组和研究组各40 例。对照组给予腰硬联合麻醉,研究组在对照组基础上给予经皮穴位电刺激。记录麻醉前、手术开始、术中30 min、术后2 组动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)、脑电双频指数(BIS)、皮质醇(Cor)、儿茶酚胺(CA) 水平,于术后6 h、12 h、24 h、36 h 采用数字疼痛分级法(NRS) 评价患者疼痛情况,记录2 组不良反应情况。结果:麻醉前,2 组MAP、HR、SPO2、BIS 水平比较,差异无统计学意义(P>0.05)。手术开始,对照组MAP、HR 水平较麻醉前升高(P<0.05),研究组MAP、HR 水平低于对照组(P<0.05)。术中30 min,对照组MAP、HR 水平较麻醉前升高(P<0.05);研究组MAP 水平较麻醉前升高(P<0.05),HR 水平低于对照组(P<0.05)。术后,对照组MAP、HR 水平较麻醉前升高(P<0.05),研究组MAP 水平低于对照组(P<0.05)。手术开始、术中30 min、术后,2 组BIS 水平较麻醉前降低(P<0.05),研究组BIS 水平均低于对照组(P<0.05)。手术开始,2 组Cor、CA 水平较麻醉前无明显变化(P>0.05);术中30 min,2 组Cor、CA 水平较麻醉前升高(P<0.05),研究组Cor、CA 水平高于对照组(P<0.05);术后,2 组Cor、CA 水平较麻醉前无明显变化(P>0.05)。术后6 h、12 h、24 h、36 h,2 组NRS 评分逐渐降低(P<0.05),研究组NRS 评分低于同时间点对照组(P<0.05)。研究组不良反应发生率低于对照组(P<0.05)。结论:经皮穴位电刺激复合腰硬联合麻醉在髋关节置换术中的镇静效果较好,可稳定患者MAP、HR 水平,减轻应激反应,缓解患者术后疼痛,降低不良反应发生率。

    Abstract:

    Abstract:Objective:To observe the effect of the therapy of transcutaneous point electrical stimulation and combined spinal- epidural anesthesia on sedation and analgesia in patients during hip replacement. Methods: A total of 80 patients who would receive hip replacement were selected and divided into the control group and the study group according to the random number table method,with 40 cases in each group. The control group was given combined spinal- epidural anesthesia, and the study group was additionally given transcutaneous point electrical stimulation based on the treatment of the control group. Before anesthesia, at the beginning of operation, 30 minutes during operation and after operation, the levels of mean arterial pressure(MAP), heart rate(HR), oxygen saturation(SPO2), bispectral index(BIS), cortisol(Cor) and catecholamine(CA) in the two groups were recorded respectively. The pain of patients was evaluated by Numeric Rating Scale(NRS) 6 hours,12 hours,24 hours,and 36 hours after operation,and the adverse reactions in the two groups were recorded. Results: Before anesthesia, there were no significant differences being found in the comparisons of levels of MAP,HR,SPO2 and BIS between the two groups(P>0.05). At the beginning of operation,the levels of MAP and HR in the control group were increased when compared with those before anesthesia(P<0.05), and the above two levels in the study group were lower than those in the control group(P<0.05). The levels of MAP and HR in the control group 30 minutes during operation were increased when compared with those before anesthesia(P<0.05); the level of MAP in the study group was increased when compared with that before anesthesia(P<0.05),and the level of HR was lower than that in the control group(P<0.05). After operation,the levels of MAP and HR in the control group were increased when compared with those before anesthesia(P<0.05), and the level of MAP in the study group was lower than that in the control group(P<0.05). At the beginning of the operation,30 minutes during operation,and after the operation,the levels of BIS in the two groups were decreased when compared with those before anesthesia(P<0.05),and the levels of BIS in the study group were lower than those in the control group(P<0.05). At the beginning of operation, there were no significant changes in the levels of Cor and CA in the two groups when compared with those before anesthesia(P>0.05); the levels of Cor and CA in the two groups 30 minutes during operation were increased when compared with those before anesthesia(P<0.05), and the above two levels in the study group were higher than those in the control group(P<0.05); after operation, there were no significant changes in the levels of Cor and CA in the two groups when compared with those before anesthesia(P> 0.05). The scores of NRS in the two groups 6 hours,12 hours,24 hours and 36 hours after operation were decreased gradually(P<0.05), and the scores of NRS in the study group were lower than those in the control group at the same time respectively(P<0.05). The incidence of adverse reactions in the study group was lower than that in the control group(P<0.05). Conclusion: The therapy of transcutaneous point electrical stimulation and combined spinal- epidural anesthesia has a good effect on sedation in hip replacement, which can stabilize the levels of MAP and HR, reduce the stress responses, relieve the postoperative pain and reduce the incidence of adverse reactions.

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张妍,张亮,朱锋.经皮穴位电刺激复合腰硬联合麻醉在髋关节置换术中的镇静镇痛应用效果[J].新中医,2022,54(15):174-178

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  • 在线发布日期: 2022-08-04
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