Effect of Electroacupuncture Complicated with Thoracic Paravertebral Block on Postop⁃ erative Rapid Rehabilitation and Comfort of Patients Undergoing Thoracoscopic Radi⁃ cal Resection of Lung Cancer
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摘要:
目的:观察电针复合胸椎旁神经阻滞(TPVB)对行胸腔镜肺癌根治术患者术后快速康复和舒适度 的影响。方法:将 120 例行胸腔镜下肺癌根治术患者,随机分为对照 A 组、对照 B 组、观察组、对照 C 组各 30 例,其中对照 A 组 1 例因受试者数据收集不全予以剔除。对照 A 组直接实施全麻;对照 B 组给予 TPVB 后 实施全麻;观察组给予电针刺激双侧足三里穴、内关穴和内麻点 30 min 后复合 TPVB 术,再实施全麻;对照 C 组给予电针刺激双侧非经非穴 30 min 后复合 TPVB 术,再实施全麻。4 组术后镇痛均采用静脉镇痛泵或补用 曲马多。比较 4 组术中、术后相关指标变化情况。结果:本研究成功纳入 119 例符合条件并数据完整的受试 者。在术中 T 1 、T 2 、T 3 、T 4 、T 5 、T 6 时段,心率(HR)(T 5 时间段除外)与平均动脉压(MAP)值 4 组间比较, 差异有统计学意义(P<0.05);观察组 HR、MAP 值明显低于其他 3 组,组间两两比较,差异均有统计学意 义(P<0.05)。4 组间术中瑞芬太尼和维库溴铵使用量、术毕苏醒时间和拔管时间之间存在统计学差异(P< 0.05)。观察组术中瑞芬太尼使用量、维库溴铵使用量、术毕苏醒时间和拔管时间,均明显少于其他 3 组,差 异有统计学意义(P<0.05)。观察组镇痛泵按压次数少于其他 3 组,胸腔引流拔除时间、首次下床活动时 间、住院时间均短于其他 3 组,差异均有统计学意义(P<0.05)。在术后 t 1 ~t 5 时段,4 组静息、运动的 VAS 评分比较,差异有统计学意义 (P<0.05)。在术后 t 1 ~t 5 各时段,观察组静息、运动 VAS 评分均低于其他 3 组,差异均有统计学意义(P<0.05)。在术后 d 1 、d 2 、d 3 时段,4 组间布鲁格曼舒适度量表(BCS)评分比 较,差异有统计学意义 (P<0.05)。在术后 d 1 、d 2 时段,4 组间恶心、呕吐发生率比较,差异有统计学意 义(P<0.05)。在术后 d 2 、d 3 时段,观察组 BCS 评分明显高于其他 3 组(P<0.05)。在术后 d 1 、d 2 、d 3 时段, 观察组恶心、呕吐发生情况率明显低于其他 3 组(P<0.05)。在术后 d 1 、d 3 时段,4 组白细胞计数(WBC)、 中性粒细胞数目比较,差异有统计学意义(P<0.05)。观察组 WBC、中性粒细胞数目较其他 3 组明显降低, 差异有统计学意义(P<0.05)。结论:电针刺激双侧足三里穴、内关穴和内麻点穴复合 TPVB 应用于胸腔镜肺 癌根治术患者,可明显降低血压和 HR,减轻术后疼痛,减少镇痛药物使用量,缩短术毕苏醒、拔管时间,降 低恶心呕吐发生率,提高术后舒适度及缩短住院时间,加快术后康复进程。
Abstract:
Abstract:Objective:Toobservetheeffectofelectroacupuncturecomplicatedwiththoracic paravertebral block (TPVB) on postoperative rapid rehabilitation and comfort of patients undergoing thoracoscopic radical resection of lung cancer. Methods:A total of 120 patients undergoing thoracoscopic radical resection of lung cancer were randomly divided into the control group A,the control group B,the observation group, and the control group C,with 30 cases in each group. Among them,one subject in the control group A was excluded due to incomplete data collection. The control group A was given general anesthesia directly; the control group B was given general anesthesia after receiving TPVB;the observation group was treated with electroacupuncture to stimulate bilateral Zusanli point (ST 36), Neiguan point (PC 6), and Neima point,and combined with TPVB,followed by general anesthesia;the control group C was treated with electroacupuncture stimulation on bilateral non-meridian point,and combined with TPVB,followed by general anesthesia. For postoperative analgesia,all the four groups were given intravenous analgesia pump or tramadol. Compare the changes in relevant indicators during and after surgery among the four groups. Results:This study successfully included 119 eligible cases with complete data. During the time points of T 1 ,T 2 ,T 3 ,T 4 ,T 5 ,and T 6 ,the comparison of heart rate (HR) (excluding time period T 5 ) and mean arterial pressure (MAP) values in the four groups showed significance in the difference (P<0.05),and the HR and MAP values in the observation group were significantly lower than other three groups,the comparison between the each two groups showed significance in the difference (P<0.05). The amount of remifentanil and vecuronium during operation,the recovery time and extubation time after operation in the four groups showed significance in the difference (P<0.05). The amount of remifentanil and vecuronium during operation,the recovery time and extubation time after operation in the observation group were significantly less than the other three groups, the comparison showed significance in the difference (P<0.05). The pressing times of analgesic pump in the observation group were less than the other three groups,and the removal time of the thoracic drainage tube, the first time of getting out of bed activity and the hospitalization time were all shorter than the other three groups,differences being significant (P<0.05). During t 1 to t 5 periods after surgery,the comparison of Visual Analogue Scale (VAS) scores of rest and exercise in the four groups showed significance in the difference (P<0.05). During t 1 to t 5 ,the VAS scores of rest and exercise in the observation group were lower than those in the other three groups, the comparison showed significance in the difference (P<0.05). During the d 1 , d 2 , and d 3 periods, the Bruggrmann Confort Scals (BCS) scores among the four groups showed significance in the difference (P< 0.05). During d 1 and d 2 ,the incidence of nausea and vomiting in the four groups showed significance in the difference (P<0.05). During d 2 and d 3 ,the BCS scores in the observation group were significantly higher than those in the other three groups (P<0.05). During d 1 ,d 2 ,d 3 ,the incidence of nausea and vomiting in the observation group was significantly lower than those in the other three groups (P<0.05). During d 1 and d 3 periods after surgery,White blood cell count (WBC) and neutrophil number were compared among the four groups,and the difference were statistically significant (P<0.05). WBC and neutrophils in observation group were significantly lower than those in other groups,andthedifferencewerestatisticallysignificant(P< 0.05). Conclusion: Electroacupuncture stimulation of bilateral Zusanli , Neiguan , and Neima points combined with thoracic paravertebral block patients undergoing TPVB can significantly lower blood pressure and HR,alleviate postoperative pain,reduce the use of analgesics,shorten postoperative awakening and extubation time, reduce the incidence of nausea and vomiting, improve postoperative comfort, and shorten hospital stay,which can accelerate the process of postoperative recovery.