發(fā)布時(shí)間：2018-04-08 15:15

  本文選題：電針　切入點(diǎn)：內(nèi)麻點(diǎn)　出處：《北京中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：通過觀察電針內(nèi)麻點(diǎn)對(duì)人工全膝關(guān)節(jié)置換術(shù)后疼痛評(píng)分(Visual analogue score)及關(guān)節(jié)活動(dòng)度的影響,探討內(nèi)麻點(diǎn)對(duì)緩解TKA術(shù)后疼痛的療效及功能恢復(fù)的影響。方法：觀察2013年9月-2014年10月在中國中醫(yī)科學(xué)院望京醫(yī)院骨關(guān)節(jié)科住院治療并入組的60例因重度膝骨關(guān)節(jié)炎擇期行單側(cè)人工全膝關(guān)節(jié)置換的患者。將這些患者隨機(jī)分成電針組和空白對(duì)照組進(jìn)行臨床對(duì)照研究,試驗(yàn)組30人,對(duì)照組30人。分別對(duì)兩組患者的性別、年齡、病程、膝關(guān)節(jié)活動(dòng)度、術(shù)前及術(shù)后活動(dòng)時(shí)和靜息時(shí)VAS評(píng)分進(jìn)行統(tǒng)計(jì)。兩組患者的手術(shù)均由一組醫(yī)生完成,術(shù)中采取膝關(guān)節(jié)正中切口,在髕骨內(nèi)測分離股四頭肌肌腱,并將髕骨翻向外側(cè)。兩組患者均采用由德國LINK廠商生產(chǎn)的同一型號(hào)膝關(guān)節(jié)假體。兩組患者使用同樣的治療基本措施,包括：術(shù)前宣教、術(shù)中雞尾酒關(guān)節(jié)周圍注射、術(shù)后靜脈自控鎮(zhèn)痛泵、靜脈口服止痛藥物；康復(fù)鍛煉,從術(shù)后第一日開始使用雙下肢踝泵促進(jìn)血液循環(huán),雙下肢等張肌肉鍛煉和抬腿,鍛煉股四頭肌肌力,術(shù)后第二天開始被動(dòng)屈伸關(guān)節(jié)練習(xí)。兩組患者術(shù)后均采用同樣配方的鎮(zhèn)痛泵；均在術(shù)后返回病房時(shí)開始使用持續(xù)物理降溫,試驗(yàn)組術(shù)后第一日給予健側(cè)內(nèi)麻點(diǎn)電針治療,以患者能耐受的強(qiáng)度為宜。首先采用兩組獨(dú)立樣本非參數(shù)檢驗(yàn)分析兩組患者性別、年齡、病程、術(shù)前VAS等基線指標(biāo),證明兩組患者基本數(shù)據(jù)無明顯差異。采用重復(fù)測量設(shè)計(jì)觀察并記錄兩組患者的術(shù)后第一日、第二日、第三日、第七日進(jìn)行康復(fù)鍛煉時(shí)和靜息時(shí)的VAS評(píng)分及第七天膝關(guān)節(jié)被動(dòng)活動(dòng)度以及不良反應(yīng)事件的發(fā)生概率所有數(shù)據(jù)用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)：計(jì)量指標(biāo)采用均數(shù)±標(biāo)準(zhǔn)差、計(jì)數(shù)指標(biāo)采用例數(shù)及百分比進(jìn)行統(tǒng)計(jì)描述；計(jì)量資料用t檢驗(yàn)和非參數(shù)檢驗(yàn),計(jì)數(shù)資料用卡方檢驗(yàn)。結(jié)果：試驗(yàn)組和對(duì)照組患者術(shù)后VAS評(píng)分：術(shù)后1d活動(dòng)5.73±3.32vs6.13±3.04；靜息3.17±1.44vs4.03±1.56；術(shù)后2d活動(dòng)6.00±3.17vs6.10±3.05；靜息3.13±1.50vs3.90±1.45術(shù)后3d活動(dòng)4.60±1.67vs4.73±1.77；靜息2.06±1.34vs3.16±1.44,術(shù)后7d活動(dòng)3.53±1.66vs 3.87±1.94靜息1.93±1.38 vs 2.03±1.34；術(shù)后前三天試驗(yàn)組靜息VAS疼痛評(píng)分低于對(duì)照組且差異具有統(tǒng)計(jì)學(xué)意義(P0.05),第7天沒有統(tǒng)計(jì)學(xué)差異,術(shù)后兩組患者活動(dòng)VAS疼痛評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后關(guān)節(jié)活動(dòng)度也在發(fā)生變化,兩組患者術(shù)后第七日91.97±13.8 VS 86.53±11.7。P值大于0.05,說明兩組患者術(shù)后關(guān)節(jié)活動(dòng)度沒有統(tǒng)計(jì)學(xué)差異。結(jié)論：電針內(nèi)麻點(diǎn)試驗(yàn)組對(duì)于膝關(guān)節(jié)術(shù)后活動(dòng)痛沒有明顯影響,但對(duì)于靜息痛的效果優(yōu)于空白對(duì)照組能夠有效減輕全膝關(guān)節(jié)置換早期術(shù)后靜息疼痛,對(duì)于緩解患者早期術(shù)后疼痛起到一定積極的作用。
[Abstract]:Objective: to observe the effect of electroacupuncture (EA) on pain score and joint motion after total knee arthroplasty (TKA), and to explore the effect of EA on pain relief and functional recovery after TKA.Methods: from September 2013 to October 2014, 60 patients with severe knee osteoarthritis underwent unilateral total knee arthroplasty in Wangjing Hospital, Wangjing Hospital, Chinese Academy of traditional Chinese Medicine.These patients were randomly divided into electroacupuncture group and blank control group.Gender, age, course of disease, knee motion, VAS score before and after operation and resting time were statistically analyzed in both groups.The operation was performed by a doctor in both groups. The median incision of knee joint was taken during the operation. The quadriceps femoris tendon was separated from the internal patella and the patella was turned laterally.Both groups were treated with the same type of knee joint prosthesis made by German LINK manufacturer.The two groups were treated with the same basic treatment measures, including preoperation education, periarticular injection of cocktails during the operation, postoperative patient-controlled analgesia pump, oral administration of pain relievers, rehabilitation exercise,From the first day after operation, the ankle pump of both lower limbs was used to promote blood circulation, and the isomorphic muscles of both lower extremities were used to exercise and lift the legs, and the quadriceps femoris muscle strength was exercised, and the passive flexion and extension joint exercises began on the second day after operation.The patients in both groups were treated with the same analgesic pump and began to use the continuous physical cooling when they returned to the ward after operation. The experimental group was treated with normal side internal anesthesia acupuncture on the first day after operation, and the strength of patient tolerance was the best.The baseline indexes of sex, age, course of disease and preoperative VAS were analyzed by non-parametric test of two groups of independent samples, which proved that there was no significant difference in basic data between the two groups.Repeated measurement design was used to observe and record the first, second, third day after operation in both groups.On the seventh day, the VAS score of rehabilitation exercise and rest, the passive activity of knee joint and the occurrence probability of adverse events on the 7th day were counted by SPSS19.0 software: the mean 鹵standard deviation was used to measure the index.The counting index is described by the number of examples and the percentage, the measurement data by t test and non-parameter test, and the counting data by chi-square test.The score was lower than that in the control group and the difference was statistically significant (P 0.05), and there was no statistical difference on the 7th day.There was no significant difference in VAS pain score between the two groups after operation (P 0.05).Conclusion: the effect of electroacupuncture on postoperative active pain of knee joint is better than that of blank control group, but the effect of electroacupuncture on postoperative active pain of knee joint is better than that of blank control group, which can effectively alleviate the postoperative resting pain in the early stage of total knee arthroplasty.It plays a positive role in relieving early postoperative pain.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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