经皮穴位电刺激联合竖脊肌平面阻滞对后入路腰椎手术患者术后镇痛效果及炎症状态的影响

武晓旭; 罗树军; 仇秋苹; 吴安石

doi:10.16766/j.cnki.issn.1674-4152.003630

经皮穴位电刺激联合竖脊肌平面阻滞对后入路腰椎手术患者术后镇痛效果及炎症状态的影响

doi: 10.16766/j.cnki.issn.1674-4152.003630

1.
首都医科大学附属北京朝阳医院怀柔医院麻醉科，北京 101400
2.
首都医科大学附属北京朝阳医院麻醉科，北京 100020

基金项目:

北京市科技计划项目 z211110006619054

北京市医药管理中心青年人才培养“青苗”项目 QMH20200704

详细信息

通讯作者:
吴安石, E-mail: wuanshi88@163.com

中图分类号: R681.53
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- 文章访问数: 2
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- 被引次数: 0
出版历程
- 收稿日期: 2024-04-20
- 网络出版日期: 2024-11-19

Influence of transcutaneous electrical acupoint stimulation combined with erector spinae plane block on postoperative analgesia effect and inflammatory status in patients with posterior approach lumbar surgery

1.
Department of Anesthesiology, Huairou Hospital, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 101400, China

摘要

摘要: 目的应用经皮穴位电刺激(TEAS)联合竖脊肌平面阻滞(ESPB)对后入路腰椎手术患者开展镇痛治疗，并探究对患者镇痛及炎症的影响，旨在为临床优化后入路腰椎手术麻醉方案提供参考。方法纳入2021年10月—2023年1月首都医科大学附属北京朝阳医院怀柔医院收治的108例拟行后入路腰椎手术患者，根据简单化随机法(单双号法)分为ESPB组(单号，54例)与TEAS组(双号，54例)。比较2组患者各时间点生命体征、围手术期情况、炎症指标、疼痛情况(VAS)、并发症发生率。结果 T1~T2时，TEAS组心率(HR)、平均动脉压(MAP)均显著高于ESPB组(P < 0.05)；TEAS组苏醒时间、下床活动时间、住院时间、丙泊酚用量、瑞芬太尼用量均显著低于ESPB组(P＜0.05)；术后1 d，2组炎症指标水平均显著上升(P＜0.05)，而TEAS组各指标水平显著低于ESPB组(P＜0.05)；术后24 h内，2组VAS显著下降(P＜0.05)，且TEAS组术后6 h、12 h、24 h VAS均显著低于ESPB组(P＜0.05)；TEAS组并发症发生率(12.96%，7/54)与ESPB组(24.07%，13/54)比较差异无统计学意义(P＞0.05)。结论 TEAS联合ESPB可稳定后入路腰椎手术患者生命体征，减轻术后疼痛感与炎症反应，值得应用。
- 腰椎间盘突出症 /
- 腰椎手术 /
- 经皮穴位电刺激
Abstract: Objective To explore the influence on analgesia and inflammation in patients undergoing posterior approach lumbar surgery receiving analgesia therapy of transcutaneous electric acupoint stimulation (TEAS) combined with erector spinae plane block (ESPB), so as to provide a reference for clinical optimization of anesthesia regimen for posterior approach lumbar surgery. Methods A total of 108 patients who were admitted to Huairou Hospital, Beijing Chaoyang Hospital Affiliated to Capital Medical University and planned to undergo posterior approach lumbar surgery were included from October 2021 to January 2023. According to the simplified randomization method (single-double number method), they were divided into an ESPB group (single number, n=54) and a TEAS group (double number, n=54). The vital signs at each time point, perioperative conditions, inflammatory indicators, pain status (VAS), and incidence rates of anesthesia complications were compared between the two groups. Results At T1-T2, HR, and MAP in the TEAS group were significantly higher than those in the ESPB group (P < 0.05). The awakening time, ambulation time, hospitalization time, propofol dosage, and remifentanil dosage in the TEAS group were significantly shorter or less than those in the ESPB group (P < 0.05). The levels of white Inflammatory indicators in the two groups increased significantly 1 day after surgery (P < 0.05), but the levels in the TEAS group were significantly lower than those in the ESPB group (P < 0.05). Within 24 hours after surgery, the VAS score in both groups decreased significantly (P < 0.05), and the VAS in the TEAS group at 6 h, 12 h, and 24 h after surgery were significantly lower than those in the ESPB group (P < 0.05). There was no statistical significance in the total incidence rate of complications between the TEAS group (12.96%, 7/54) and the ESPB group (24.07%, 13/54, P>0.05). Conclusion TEAS combined with ESPB can stabilize the vital signs of patients undergoing posterior approach lumbar surgery, and relieve the postoperative pain and inflammatory response.
- Lumbar disc herniation /
- Lumbar surgery /
- Transcutaneous electric acupoint stimulation

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表 1 2组拟行后入路腰椎手术患者基线资料比较

Table 1. Comparison of baseline data between the two groups of patients undergoing posterior approach lumbar surgery

组别	例数	性别(男/女，例)	年龄(x±s，岁)	病程(x±s，年)	BMI(x±s)	手术时间(x±s，min)	麻醉时间(x±s，min)	突出节段(L_4~5/L₅~S₁，例)
ESPB组	54	28/26	57.32±5.92	4.25±0.63	23.48±1.30	153.28±25.29	185.81±30.57	21/33
TEAS组	54	30/24	56.48±5.74	4.37±0.70	23.59±1.25	160.58±26.93	178.20±26.74	18/36
统计量		0.149^a	0.749^b	0.936^b	0.448^b	1.452^b	1.377^b	0.361^a
P值		0.700	0.456	0.351	0.655	0.149	0.171	0.548
注：^a为χ²值，^b为t值。

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表 2 2组拟行后入路腰椎手术的患者不同时间生命体征比较(x±s)

Table 2. Comparison of vital signs at different time points between the two groups of patients undergoing posterior approach lumbar surgery (x±s)

组别	例数	HR(次/min)
组别	例数	T0	T1	T2	T3	T4
TEAS组	54	72.23±4.51	64.32±3.62^a	69.15±4.05^ab	70.13±5.23^b	73.01±5.74^bcd
ESPB组	54	72.05±4.23	61.51±3.35^a	64.39±4.11^ab	68.74±6.41^abc	72.63±5.34^bcd
F值		2.023	32.081	54.563	2.871	0.420
P值		0.161	＜0.001	＜0.001	0.117	0.520

组别	例数	MAP(mmHg)
组别	例数	T0	T1	T2	T3	T4
TEAS组	54	89.74±3.26	75.34±2.85^a	77.63±2.56^ab	80.18±2.21^abc	82.52±2.35^bcd
ESPB组	54	89.40±3.33	73.43±2.09^a	75.58±2.25^ab	79.97±2.35^abc	82.23±2.55^abcd
F值		0.037	9.021	23.975	2.016	0.148
P值		0.849	0.004	＜0.001	0.161	0.702

组别	例数	SpO₂(%))
组别	例数	T0	T1	T2	T3	T4
TEAS组	54	97.16±0.62	97.21±0.62	96.96±0.60	97.20±0.52	97.08±0.51
ESPB组	54	97.15±0.61	97.11±0.56	97.05±0.52	97.14±0.60	97.20±0.57
F值		0.085	0.021	1.143	2.573	0.527
P值		0.771	0.996	0.290	0.115	0.471
注：与同组T0比较，^aP < 0.05；与同组T1比较，^bP < 0.05；与同组T2比较，^cP < 0.05；与同组T3比较，^dP < 0.05。1 mmHg=0.133 kPa。

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表 3 2组拟行后入路腰椎手术的患者围手术期情况比较(x±s)

Table 3. Comparison of perioperative conditions between the two groups of patients undergoing posterior approach lumbar surgery (x±s)

组别	例数	苏醒时间(min)	下床活动时间(d)	住院时间(d)	瑞芬太尼用量(mg)	丙泊酚用量(mg)
TEAS组	54	20.11±2.54	5.53±0.75	12.43±2.15	0.96±0.21	218.76±16.35
ESPB组	54	22.58±3.19	6.01±0.81	13.80±2.07	1.24±0.32	258.48±19.58
t值		4.451	3.195	3.373	5.376	11.442
P值		＜0.001	0.002	0.001	＜0.001	＜0.001

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表 4 2组拟行后入路腰椎手术患者手术前后炎症指标比较(x±s)

Table 4. Comparison of inflammatory indicators before and after surgery between the two groups of patients undergoing posterior approach lumbar surgery (x±s)

组别	例数	WBC(g/L)		t值	P值	CRP(mg/L)		t值	P值	PCT(ng/mL)		t值	P值
组别	例数	术前	术后1 d	t值	P值	术前	术后1 d	t值	P值	术前	术后1 d	t值	P值
TEAS组	54	40.45±4.36	50.68±5.20	15.727	＜0.001	9.58±1.72	15.92±2.85	20.389	＜0.001	0.29±0.05	2.05±0.38	60.155	＜0.001
ESPB组	54	41.26±4.62	53.81±5.67	17.925	＜0.001	9.40±1.64	17.28±3.24	23.732	＜0.001	0.31±0.06	2.29±0.42	60.625	＜0.001
统计量		0.937^a	8.528^b			0.557^a	6.038^b			1.881^a	8.001^b
P值		0.351	0.003			0.579	0.021			0.063	0.005
注：^a为t值，^b为F值。

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表 5 2组拟行后入路腰椎手术患者不同时间VAS评分比较(x±s，分)

Table 5. Comparison of VAS scores at different time points between the two groups of patients undergoing posterior approach lumbar surgery (x±s, points)

组别	例数	术后2 h	术后6 h	术后12 h	术后24 h
TEAS组	54	3.85±0.45	3.12±0.52^a	2.53±0.37^ab	1.89±0.32^abc
ESPB组	54	4.06±0.41	3.40±0.63^a	2.89±0.45^ab	2.15±0.36^abc
F值		2.343	11.349	32.770	14.436
P值		0.132	0.001	＜0.001	＜0.001
注：与同组术后2 h比较，^aP < 0.05；与同组术后6 h比较，^bP < 0.05；与同组术后12 h比较，^cP < 0.05。

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