经皮穴位电刺激对颌骨骨折术后镇痛影响

Effect of Transcutaneous Acupoint Electrical Stimulation on Postoperative Analgesia of Jaw Fracture

摘要: 目的：探究经皮穴位电刺激在颌骨骨折术后病人镇痛中的作用。方法：本实验研究对象均来自徐州市中心医院口腔科2020年9月至2021年6月的76位需进行骨折切开复位内固定的患者。实验组：使用经静脉患者自控镇痛(patient-controlled intravenous analgesia, PCIA)。术后4小时对患者进行经皮穴位电刺激选取患者双侧合谷穴、劳宫穴，无创电极片连接经皮穴位电刺激仪后贴于穴位区域皮肤，同侧腧穴连接一组导线，疏密波，频率为2 Hz或100 Hz，脉冲宽度0.2~0.6 ms，强度为患者所能耐受的最大值，以穴位处有酸麻胀痛“得气”感为度。刺激时间为30 min。术后第1天开始，一天两次，每次时长30分钟。对照组与实验组区别在于仅连接电极片不给予电刺激，并告知患者仪器使用时无异常感觉。若上述治疗方法患者疼痛仍未缓解，追加使用氨酚曲马多。术后第6个小时、术后第1天、术后第2天测定患者VAS得分分别记为T0、T1、T2。镇痛泵用量情况及有效按压次数，氨酚曲马多平均使用剂量，术后出现头晕、恶心、腹胀、尿潴留并发症。结果：实验组与对照组患者T0时VAS平均得分依次为(1.54 ± 0.57)分，(1.65 ± 0.52)分，t值为1.045，P值为0.298，差异无统计学意义；实验组与对照组患者T1时VAS平均得分依次为(2.62 ± 0.67)分，(3.23 ± 0.71)分，t值为4.714，P值 < 0.0001，差异有统计学意义；实验组与对照组患者T2时VAS平均得分依次为(1.39 ± 0.49)分，(1.78 ± 0.56)分，t值为3.398，P值 < 0.0001，差异有统计学意义。实验组与对照组患者有效按压次数依次为(3.39 ± 0.89)次，(4.57 ± 1.18)次，t值为6.053，P值 < 0.0001，差异有统计学意义；实验组与对照组患者PCIA药物使用剂量依次为(94.80 ± 4.20) mg，(97.10 ± 2.93) mg，t值为3.354，P值为0.001，差异有统计学意义。两组患者均未追加氨酚曲马多。实验组患者有5例发生术后并发症，具体为发生头晕、恶心、腹胀、尿潴留例数依次为1、2、1、1。对照组患者有13例发生术后并发症发生头晕、恶心、腹胀、尿潴留例数依次为3、6、2、2。两组患者X2值为4.659，P值为0.031，两组患者差异有统计学意义。结论：经皮穴位电刺激能减轻颌骨骨折患者术后疼痛、减少镇痛药物用量及术后并发症。

Abstract: Objective: The objective is to explore the effect of percutaneous acupoint electrical stimulation on postoperative analgesia of jaw fracture patients. Methods: Seventy-six patients requiring open reduction and internal fixation of fractures were enrolled in this study from September 2020 to June 2021 in the Department of Stomatology, Xuzhou Central Hospital. Experimental group was the use of intravenous patient-controlled analgesia (patient-controlled intravenous analgesia lPCIA). Postoperative 4 hours, the patients were put percutaneous acupoint electrical stimulation with bilateral valley cave, laogong, noninvasive percutaneous electrodes connection point which sticked on the skin, ipsilateral developments to connect a group of lead, the density wave, the frequency of 2 Hz or 100 Hz; pulse width is 0.2~0.6 ms; The intensity is the maximum that the patient can tolerate. At the acupoint, there is acid hemp pain “get gas” feeling for degree. The stimulation time was 30 min. On the first day after surgery, the patients were treated twice a day for 30 minutes each time. The difference between the control group and the experimental group was that only electrodes were connected without electrical stimulation, and patients were informed that there was no abnormal sensation during the use of the instrument. If the patient’s pain is not relieved by the above treatment methods, amphenol tramadol is additionally used. VAS scores of the patients were recorded as T0, T1 and T2 at 6 h, 1 day and 2 days after surgery, respectively. Analgesic pump dosage and effective pressing times, average dose of amphenol tramadol, postoperative dizziness, nausea, abdominal distention, urinary retention complications were recorded. Results: The mean VAS scores of the experimental group and the control group at T0 were (1.54 ± 0.57) points, (1.65 ± 0.52) points; t value was 1.045; P value was 0.298; the difference was not statistically significant. The mean VAS scores of the experimental group and the control group at T1 were (2.62 ± 0.67) points, (3.23 ± 0.71) points; t value was 4.714; P value < 0.0001; the difference was statistically significant. The mean VAS scores of the experimental group and the control group at T2 were (1.39 ± 0.49) points and (1.78 ± 0.56) points, respectively, with t value of 3.398 and P value < 0.0001, indicating statistically significant differences. The effective pressing times of experimental group and control group were (3.39 ± 0.89) times, (4.57 ± 1.18) times; t value was 6.053 and P value < 0.0001; the difference was statistically significant. The dose of PCIA in experimental group and control group was (94.80 ± 4.20) mg, (97.10 ± 2.93) mg; t value was 3.354; P value was 0.001; the difference was statistically significant. No additional amphenol tramadol was added in both groups. There were 5 cases of postoperative complications in the experimental group, including dizziness, nausea, abdominal distension and urinary retention, which were 1, 2, 1 and 1 respectively. There were 13 patients in the control group with postoperative complications including dizziness, nausea and abdominal distension. The cases of urinary retention were 3, 6, 2 and 2 respectively. X2 value of the two groups was 4.659 and P value was 0.031, indicating the difference between the two groups. It was statistically significant. Conclusion: Percutaneous acupoint electrical stimulation can reduce postoperative pain, analgesic drug dosage and postoperative complications in patients with jaw fracture.