Liang Mingchao,Xiao Ting,Li Haixia,et al.Application of auricular acupoint therapy after multimodal postoperative analgesia for lower extremity osteotomy in children[J].Journal of Clinical Pediatric Surgery,2024,(12):1174-1179.[doi:10.3760/cma.j.cn101785-202310042-012]
耳穴疗法在小儿骨科截骨手术后多模式镇痛中的应用研究
- Title:
- Application of auricular acupoint therapy after multimodal postoperative analgesia for lower extremity osteotomy in children
- Keywords:
- Auriculotherapy; Analgesia; Pain Management; Osteotomy; Lower Extremity; Child
- 摘要:
- 目的 本研究旨在评估耳穴疗法联合舒芬太尼在小儿下肢截骨矫形手术后多模式镇痛中的应用效果,为耳穴疗法在小儿术后镇痛中的应用提供临床证据。方法 本研究为前瞻性随机对照研究。以2022年6月至2022年12月在湖南省儿童医院行下肢截骨矫形手术的学龄期患儿为研究对象,年龄6~12岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级。根据随机数字表法将患儿分为耳穴治疗治疗组(E组)和对照组(C组),每组各50例。两组均于手术结束后予常规舒芬太尼静脉自控镇痛治疗;E组于手术结束前行双耳耳穴压豆,术后按压耳穴(每日按压3次,每个穴位每次按压20~30下);C组手术结束前用耳穴胶布分别贴敷双耳耳穴,但不压豆、不按压耳穴。记录两组术后2 h(T0)、6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)的东大略儿童医院疼痛评分(Children’s Hospital of Eastern Ontario Pain Scale,CHEOPS)、术后48 h自控镇痛(patient control analgesia,PCA)按压次数以及布洛芬补救镇痛情况;于手术结束前10 min、术后48 h采集静脉血,检测血清C反应蛋白(C-reactive protein,CRP)和β-内啡肽(beta-endorphin,β-EP)浓度;观察患儿术后呼吸抑制、恶心呕吐、皮肤瘙痒发生情况。结果 共97例(E组48例、C组49例)患儿完成本研究。两组患儿年龄、性别等一般资料差异无统计学意义(P＞0.05)。两组患儿静息及运动CHEOPS疼痛评分在T0时间点分别为(3.48±0.77)分、(3.63±0.79)分和(3.69±0.77)、(3.82±0.78)分;T1时间点分别为(3.58±0.77)分、(4.27±0.82)分和(3.73±0.64)分、(4.16±0.77)分;T2时间点分别为(4.25±0.79)分、(4.44±0.77)分和(6.35±1.03)分、(6.43±1.04)分;T3时间点分别为(4.38±0.84)分、(4.58±0.90)分和(5.84±0.77)分、(4.58±0.90)分;T4时间点分别为(5.19±0.70)分、(5.58±0.65)分和(5.63±1.03)分、(5.84±0.96)分;其中T2和T3时间点的静息及运动时疼痛评分差异有统计学意义(P<0.05),其余时间点疼痛评分差异无统计学意义(P>0.05)。E组PCA有效按压次数为18(12,29)次,C组为30(15,38)次;E组布洛芬镇痛补救率为19%(9/48),C组为57%(28/49);术后48 h E组CRP为(44.04±1.87)mg/L,C组为(67.04±5.91)mg/L;E组β-EP为(48.70±13.52)pg/mL,C组为(34.95±2.86)pg/mL;E组术后恶心呕吐发生率为4%(2/48),C组为20%(10/49);术后镇痛效果的家属满意度评分;E组为8(8,9)分,C组为5(5,6)分;上述结果差异均具有统计学意义(P＜0.05)。两组术后均无一例呼吸抑制、皮肤瘙痒等不良反应发生。结论 耳穴疗法能够缓解小儿下肢截骨矫形手术后疼痛,减少镇痛药物的使用以及术后恶心呕吐的发生,应用于小儿围手术期镇痛安全有效。
- Abstract:
- Objective To evaluate the efficacy of auricular acupressure plus sufentanil after multimodal postoperative analgesia for lower extremity osteotomy in children and provide clinical evidence for its application in postoperative pain management. Methods For this prospective randomized controlled study,100 children aged 6-12 years with ASA physical status grade Ⅰ-Ⅱ undergoing elective lower extremity osteotomy were selected.They were randomized into two groups of auricular point (E group) and control (C group)(n=50 each).Both groups received conventional sufentanil intravenous patient-controlled analgesia (IV-PCA) after surgery.In E group,auricular bean pressing before the end of operation and pressed auricle after operation were performed.In C group,auricular taping of both ears before the end of operation and there was no pressing of bean or auricle.Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) scores at 2 h (T0),6 h (T1),12 h (T2),24 h (T3) and 48 h (T4) post-operation were recorded in both groups.Number of PCA presses and use of ibuprofen for remedial analgesia were recorded at 48h post-operation.Venous blood was collected at the time of skin suture and 48h post-operation for detecting the serum concentrations of C-reactive protein (CRP) and beta-endorphin (β-EP).The postoperative occurrences of respiratory depression,nausea & vomiting and skin pruritus were observed. Results A total of 97 children (E group 48,C group 49) successfully completed this study.No significant inter-group difference existed in general profiles.The resting and movement CHEOPS pain scores for two groups at T0 were (3.48±0.77),(3.63±0.79) and (3.69±0.77),(3.82±0.78) points; At T1,(3.58±0.77),(4.27±0.82) and (3.73±0.64),(4.16±0.77) points; At T2,(4.25±0.79),(4.44±0.77) and (6.35±1.03),(6.43±1.04) points.At T3,(4.38±0.84),(4.58±0.90) and (5.84±0.77),(4.58±0.90) points; At T4,(5.19±0.70),(5.58±0.65) and (5.63±1.03),(5.84±0.96) points.Statistically significant inter-group differences existed in resting and movement pain scores at T2 and T3 while there were no statistically significant differences at other timepoints.The effective number of PCA presses was 18(12,29) times in E group while 30(15,38) times in C group.Ibuprofen analgesic rescue rate was 19%(9/48) in E group versus 57%(28/49) in C group.CRP level 48h was (44.04±1.87) mg/L in E group versus (67.04±5.91) mg/L in C group.β-EP level was (48.70±13.52) pg/mL in E group versus (34.95±2.86) pg/mL in C group.The incidence of postoperative nausea and vomiting was 4%(2/48) in E group versus 20%(10/49) in C group.Postoperative analgesia family satisfaction score was 8(8,9) points in E group versus 5(5,6) points in C group.All of the above results showed statistically significant differences (P<0.05).There was no postoperative onset of respiratory depression or skin pruritus. Conclusions Auricular point therapy effectively may reduce postoperative pain,decrease analgesic usage and lower nausea and vomiting incidence lower extremity osteotomy in children.It offers a safe and viable option for perioperative pediatric care.
参考文献/References:
[1] Brindle M,Nelson G,Lobo DN,et al.Recommendations from the ERAS? Society for standards for the development of enhanced recovery after surgery guidelines[J].BJS Open,2020,4(1):157-163.DOI:10.1002/bjs5.50238.
[2] 阮剑辉,甘国胜,宋晓阳.多模式镇痛药物和技术在快速康复外科临床应用进展[J].广东医学,2020,41(23):2402-2406.DOI:10.13820/j.cnki.gdyx.20200775. Ruan JH,Gan GS,Song XY.Advances in clinical application of multimodal analgesic drugs and techniques in rapid rehabilitation surgery[J].Guangdong Med J,2020,41(23):2402-2406.DOI:10.13820/j.cnki.gdyx.20200775.
[3] 李灵晴,肖婷,陈政.布洛芬注射液对于小儿拇指多指畸形手术后镇痛的效果及安全性研究[J].临床小儿外科杂志,2022,21(3):272-277.DOI:10.3760/cma.j.cn101785-202112013-013. Li LQ,Xiao T,Chen Z.Safety and efficacy of intravenous ibuprofen for pain relief in children after polydactylectomy[J].DOI:10.3760/cma.j.cn101785-202112013-013.
[4] Reyes CS,Carrasco ER,Martín PC,et al.Analgesia multimodal:?se prescribe correctamente?[J].Canarias Pediátrica,2019,43(1):10-16.
[5] Heikkil? K,Peltonen LM,Salanter? S.Postoperative pain documentation in a hospital setting:a topical review[J].Scand J Pain,2016,11:77-89.DOI:10.1016/j.sjpain.2015.12.010.
[6] 钟小敏.耳穴在围手术期运用的研究进展[J].广州中医药大学学报,,38(3):641-646.DOI:10.13359/j.cnki.gzxbtcm.2021.03.037. Zhong XM.Research advances on auricular point application during perioperative period[J].J Guangzhou Univ Tradit Chin Med,2021,38(3):641-646.DOI:10.13359/j.cnki.gzxbtcm.2021.03.037.
[7] Liu MM,Tong YG,Chai L,et al.Effects of auricular point acupressure on pain relief:a systematic review[J].Pain Manag Nurs,2021,22(3):268-280.DOI:10.1016/j.pmn.2020.07.007.
[8] 中华人民共和国国家质量监督检验检疫总局,中国国家标准化管理委员会.耳穴名称与定位:GB/T 13734-2008[S].北京:中国标准出版社,2008. General Administration of Quality Supervision,Inspection and Quarantine of the People’s Republic of China,Standardization Administration of the People’s Republic of China.Nomenclatures and localizations of auricular points:GB/T 13734-2008[S].Beijing:Standards Press of China,2008.
[9] Zhong Q,Wang D,Bai YM,et al.Effectiveness of auricular acupressure for acute postoperative pain after surgery:a systematic review and meta-analysis[J].Chin J Integr Med,2019,25(3):225-232.DOI:10.1007/s11655-019-3063-1.
[10] Hou PW,Hsu HC,Lin YW,et al.The history,mechanism,and clinical application of auricular therapy in traditional Chinese medicine[J].Evid Based Complement Alternat Med,2015,2015:495684.DOI:10.1155/2015/495684.
[11] 黄丽春.耳穴治疗学[M].北京:科学技术文献出版社,2005. Huang LC.Auricular Acupoint Therapy[M].Beijing:Scientific and Technical Documentation Press,2005.
[12] Li Y,Du JL,Hao PL,et al.Effect of auricular point sticking therapy on perioperative pain in patients with partial lung resection[J].Chin Acupunct Moxibustion,2021,41(6):603-607.DOI:10.13703/j.0255-2930.20200505-k0003.
[13] 杜治昆,贾政军,王卓,等.右美托咪定联合罗哌卡因竖脊肌平面阻滞在多发性肋骨骨折术后镇痛中的效果[J].包头医学,2022,46(1):5-7.DOI:10.3969/j.issn.1007-3507.2022.01.003. Du ZK,Jia ZJ,Wang Z,et al.Efficacy of dexmedetomidine plus ropivacaine for erector spinae plane block in postoperative analgesia of multiple rib fractures[J].J Baotou Med,2022,46(1):5-7.DOI:10.3969/j.issn.1007-3507.2022.01.003.
[14] Usichenko TI,Henkel BJ,Klausenitz C,et al.Effectiveness of acupuncture for pain control after cesarean delivery:a randomized clinical trial[J].JAMA Netw Open,2022,5(2):e220517.DOI:10.1001/jamanetworkopen.2022.0517.
[15] Kovac AL.Postoperative nausea and vomiting in pediatric patients[J].Paediatr Drugs,2021,23(1):11-37.DOI:10.1007/s40272-020-00424-0.
[16] Chen JB,Tu Q,Miao S,et al.Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia:a meta-analysis of randomized controlled trials[J].Int J Surg,2020,73:57-64.DOI:10.1016/j.ijsu.2019.10.036.
[17] Mayor D.An exploratory review of the electroacupuncture literature:clinical applications and endorphin mechanisms[J].Acupunct Med,2013,31(4):409-415.DOI:10.1136/acupmed-2013-010324.
[18] Jin L,Yao R,Heng L,et al.Ultrasound-guided continuous thoracic paravertebral block alleviates postoperative delirium in elderly patients undergoing esophagectomy:a randomized controlled trial[J].Medicine (Baltimore),2020,99(17):e19896.DOI:10.1097/MD.0000000000019896.
[19] Xi LJ,Fang F,Yuan HJ,et al.Transcutaneous electrical acupoint stimulation for postoperative cognitive dysfunction in geriatric patients with gastrointestinal tumor:a randomized controlled trial[J].Trials,2021,22(1):563.DOI:10.1186/s13063-021-05534-9.
相似文献/References:
[1]孙光祥 黎志宏.布洛芬超前镇痛在儿童膝关节镜手术中的应用研究[J].临床小儿外科杂志,2010,9(04):0.
[2]陈政,付楚杰,彭拓超,等.盐酸纳布啡用于小儿尺桡骨骨折闭合复位克氏针内固定术后镇痛的临床观察[J].临床小儿外科杂志,2019,18(06):503.[doi:10.3969/j.issn.1671-6353.2019.06.013]
Chen Zheng,Fu Chujie,Peng Tuochao,et al.Analgesia of nabulphine hydrochloride after closed reduction and Kirschner wire internal fixation of ulnar and radius fractures in children[J].Journal of Clinical Pediatric Surgery,2019,18(12):503.[doi:10.3969/j.issn.1671-6353.2019.06.013]
[3]李艳,张从志,尹顺花,等.儿童输注GD2单克隆抗体Naxitamab期间的镇痛方案初探[J].临床小儿外科杂志,2023,22(07):630.[doi:10.3760/cma.j.cn101785-202303043-006]
Li Yan,Zhang Congzhi,Yin Shunhua,et al.Preliminary study of analgesic during infusion of GD2 monoclonal antibody naxitamab in children[J].Journal of Clinical Pediatric Surgery,2023,22(12):630.[doi:10.3760/cma.j.cn101785-202303043-006]
[4]张富洲,郑铁华,任艺,等.以单次胸段硬膜外阻滞为主的多模式镇痛在儿童Nuss手术中的应用[J].临床小儿外科杂志,2023,22(08):751.[doi:10.3760/cma.j.cn101785-202206020-010]
Zhang Fuzhou,Zheng Tiehua,Ren Yi,et al.Application of multimode analgesia based predominantly upon single thoracic epidural block during pediatric Nuss procedure[J].Journal of Clinical Pediatric Surgery,2023,22(12):751.[doi:10.3760/cma.j.cn101785-202206020-010]
备注/Memo
收稿日期:2023-10-24。
基金项目:湖南省科技厅临床技术创新引导计划项目(2021SK50508)
通讯作者:屈双权,Email:shuangquanqu@126.com