Objective: To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery.
Methods: Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T0), skin incision (T1), extubation (T2) and 2 h after operation (T3); the dosage of anesthetics and extubation time were recorded; the plasma levels of β-endorphin (β-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2) were measured at the following time points: T0, T3, 12 h after operation (T4), 24 h after operation (T5) and 48 h after operation (T6). Visual analogue scale (VAS) was used to evaluate the analgesic effect.
Results: The MAP at T1 and T2 in the group A was lower than that in group B and control group (P<0.05), and HR at T1 and T2 was lower than that in control group (P<0.05). The MAP and HR at T1 and T2 in the group B were lower than those in the control group (P<0.05). The dosage of remifentanil in the group A and group B was lower than that in the control group (P<0.05), and extubation time was earlier than that in the control group (P<0.05). The content of β-EP at T4, T5 and T6 in the group B was higher than that in the group A and control group (P<0.05); the contents of 5-HT and PGE2 at T3, T4 and T5 in the group A and group B were lower than those in the control group (P<0.05). The VAS scores at T3, T4 and T5 in the group A and group were lower than those in the control group (P<0.05).
Conclusion: The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.
目的：比较电针内麻点和内关穴超前镇痛与硬膜外神经阻滞超前镇痛在胸科手术围术期镇痛的临床效果。方法：将60例择期行食管癌根治术的患者随机分为观察1组、观察2组和对照组，每组20例。观察1组于麻醉诱导前30 min硬膜外腔注入0.375％罗哌卡因20 mL，术中正常麻醉；观察2组于麻醉诱导前电针双侧内麻点、内关穴30 min，术中正常麻醉；对照组单纯行全身麻醉，3组术后均行静脉自控镇痛（PCIA）。记录3组患者针刺/ 硬膜外穿刺前（T0）、切皮时（T1）、拔管时（T2）、术后2 h（T3）平均动脉压（MAP）和心率（HR）；记录术中麻醉药的用量及拔管时间；检测T0、T3，术后12 h（T4）、24 h（T5）和48 h（T6）血浆β-内啡肽（β-EP）、5-羟色胺（5-HT）、前列腺素E2（PGE2）的含量；采用视觉模拟量表（VAS）评估患者镇痛效果。结果：观察1组MAP在T1、T2时间点低于观察2组、对照组（P<0.05），HR在T1、T2时间点低于对照组（P<0.05）；观察2组MAP和HR在T1、T2时间点低于对照组（P<0.05）。观察1组、观察2组术中瑞芬太尼用量较对照组少（P<0.05），拔管时间较对照组早（P<0.05）。观察2组β-EP含量在T4、T5、T6时间点较观察1组、对照组升高（P<0.05）；观察1组、观察2组5-HT和PGE2含量在T3、T4、T5时间点较对照组降低（P<0.05）。观察1组、观察2组VAS评分在T3、T4、T5时间点低于对照组（P<0.05）。结论：电针内麻点和内关穴超前镇痛与硬膜外神经阻滞超前镇痛均能为胸部手术提供有效围术期镇痛，前者在维持术中血流动力学方面更平稳，对机体的生理干扰更小。.
Keywords: electroacupuncture; epidural nerve block; preemptive analgesia; thoracic surgery.