目的 探讨经皮穴位电刺激（transcutaneous electrical acupoint stimulation, TEAS）联合胸椎旁神经阻滞（thoracic paravertebral block, TPVB）对胸腔镜手术术后睡眠质量、疼痛和质量恢复的影响。方法 选取2022年6月—2023年3月行胸腔镜手术的60位患者作为研究对象,根据随机数字表法将患者分为对照组（C组）、TEAS组（T组）,每组患者30例。T组患者麻醉诱导前30 min于双侧肺俞、内关、神门行TEAS至手术结束。C组患者麻醉诱导前在相同穴位上贴电极片,但是不通电。麻醉诱导前两组患者均行TPVB,注入0.375%的罗哌卡因25 mL。观察并比较两组患者术前24 h（T0）、术后24 h（T1）、术后48 h（T2）、术后7 d（T3）、术后14 d（T4）的睡眠质量,术后24 h恢复质量量表（15-item Quality of Recovery, QoR-15）评分和术后拔管后视觉模拟评分法（visual analogue scale,VAS）评分,术后镇痛泵使用情况,术后恶心、呕吐（PONV）发生情况。结果 T1,T2,T3时间点,T组匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI）明显低于C组,差异有统计学意义（P<0.05）;T组术后24 h QoR-15总分高于C组且差异有统计学意义（P<0.05）;T1,T2,T3时间点T组的术后VAS评分明显低于C组,且差异有统计学意义（P<0.05）。T组镇痛泵按压次数少于C组。另外,T组术后恶心呕吐评分低于C组,差异有统计学意义（P<0.05）。术后其他并发症,两组相比差异无统计学意义（P>0.05）。结论 采取TEAS联合TPVB能减轻胸腔镜手术患者术后疼痛,并且改善术后恢复质量。
Objective To observe the effect of transcutaneous electrical acupoint stimulation （TEAS） and thoracic paravertebral block on sleep quality, pain, and quality of recovery after surgery in patients undergoing selective video-assisted thoracoscopic surgery. Methods A total of 60 patients undergoing video-assisted thoracoscopic surgery from June 2022 to March 2023 were selected and divided into the TEAS group or the control group by the random table method. Thirty minutes before anesthesia induction TEAS treatment was performed at Feishu, Neiguan, and Shenmen points bilaterally in the TEAS group until the end of surgery. The control group had the acupuncture electrodes on the same acupuncture point before anesthesia induction without electrical stimulus. The two groups of patients received a TPVB with ropivacaine （0.375%, 25 mL） before anesthesia induction. The visual analog scale （VAS） was used to evaluate pain scores after surgery and Pittsburgh Sleep Quality Index （PSQI） was used for evaluating subjective sleep quality. The PSQI scores were recorded at 24 h before operation （T0）, 24 h （T1）, 48 h （T2）, 7 d （T3）, and 14 d （T4） after operation. 15-item Quality of Recovery scores and VAS scores were also evaluated at 24 h after operation. Postoperative analgesic pump use and postoperative nausea and vomiting （PONV） were also recorded. Results Compared with the control group, the TEAS group showed significantly lower PSQI scores at T1, T2, and T3 （P<0.05）, a higher QoR-15 score at postoperative 24 h （P<0.05）, and lower VAS scores at T1, T2, and T3 （P<0.05）. The frequency of analgesic pump pressing of the TEAS group was lower than that of the control group. In addition, the PONV score of the TEAS group was lower than that of the control group （P<0.05）. There was no difference in other postoperative complications between the two groups （P>0.05）. Conclusion TEAS combined with TPVB can relieve postoperative pain and improve quality of recovery of patients after video-assisted thoracoscopic surgery.
[1] Xie HH, Zhou JP, Du W, et al.Impact of thoracic paravertebral block combined with general anesthesia on postoperative cognitive function and serum adiponectin levels in elderly patients undergoing lobectomy[J]. WideochirInne Tech Maloinwazyjne, 2019, 14(4): 538-544.
[2] Peng WW, Tang ZY, Zhang FR, et al.Neurobiological mechanisms of TENS-induced analgesia[J]. Neuroimage, 2019, 195(3): 396-408.
[3] Mi ZH, Gao J, Chen XP, et al.Effects of transcutaneous electrical acupoint stimulation on quality of recovery during early period after laparoscopic cholecystectomy.[J]. Zhongguo Zhen Jiu, 2018, 38(3): 256-260.
[4] Karaman S, Karaman T, Deveci H, et al.Effect of transcutaneous electrical nerve stimulation on quality of recovery and pain after abdominal hysterectomy[J]. J Anaesthesiol Clin Pharmacol, 2021,37(1): 85-89.
[5] Elboim GM, Andrawus NS, Shtarker H, et al.Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial[J]. Clin Interv Aging, 2019,14(1): 1841-1850.
[6] Nooreldeen R, Bach H.Current and future development in lung cancer diagnosis[J]. Int J Mol Sci, 2021, 22(16):8661.
[7] Hoy H, Lynch T, Beck M.Surgical treatment of lung cancer[J]. Crit Care Nurs Clin North Am,2019, 31(3): 303-313.
[8] Zhang WQ, Li JB, Huang Y, et al.The median effective volume of ultrasound-guided thoracic paravertebral nerve block with 0.3% ropivacaine in radical thoracoscopic surgery for lung cancer[J]. Technol Health Care, 30(6): 1343-1350.
[9] 张爽,甘建辉,涂青,等.经皮穴位电刺激对胸腔镜肺切除术病人拔管期应激反应的影响[J]. 安徽医药,2020,24(7):1407-1411.
[10] Wei W, Bai W, Yang Y, et al.Pulmonary protection of transcutaneous electrical acupoint stimulation in gynecological laparoscopic surgery: A randomized controlled trial[J]. Exp Ther Med, 2020, 19(1): 511-518.
[11] 刘同帅,马福国,孙立新,等.电针足三里、肺俞对肺癌根治术老年患者术后炎性反应及肺部并发症的影响[J]. 中国针灸,2016,36(11):1135-1138.
[12] Tang L, You F, Hu X, et al.Electroacupuncture improves insomnia by down-regulating peripheral benzodiazepine receptor expression in hippocampus, and up-regulating 5-HT, 5-HIAA, TNF-α and IL-1β contents in hypothalamus in insomnia rats[J]. J Clin Acupunct Moxib, 2019, 44(8):560-565.
[13] 张恒,李佳.针刺内关、神门对睡眠剥夺模型大鼠脑电波影响的比较研究[J]. 湖北中医杂志,2017,39(6):13-16.
[14] Song BJ, Chang YY, Li Y, et al.Effects of transcutaneous electrical acupoint stimulation on the postoperative sleep quality and pain of patients after video-assisted thoracoscopic surgery: a prospective, randomized controlled trial[J]. Nat Sci Sleep, 2020, 12(1): 809-819.
[15] Stark PA, Myles PS, Burke JA.Development and psychometric evaluation of a postoperative quality of recovery score[J]. Anesthesiology, 2013, 11(8): 1332-1340.
[16] Myles PS, Myles DB, Galagher W, et al.Minimal clinically important difference for three quality of recovery scales[J]. Anesthesiology, 2016, 125(1):39-45.
[17] Myles PS, Myles DB.An updated minimal clinically important difference for the QoR-15 scale[J]. Anesthesiology,2021, 135(5): 934-935.
[18] Myles PS, Myles DB.An updated min imal clinically important difference for the QoR-15 scale[J]. Anesthesiology, 2021, 13(5):934-935.
[19] 闫丽萍,刘跃光,吴辛甜,等.电针对坐骨神经慢性缩窄损伤大鼠脊髓N-甲基-D-天冬氨酸受体表达的影响[J]. 针刺研究,2013,38(5):380-384.
[20] Xie J, Chen LH, Ning ZY, et al.Effect of transcutaneous electrical acupoint stimulation combined with palonosetron on chemotherapy-induced nausea and vomiting: a single-blind, randomized, controlled trial[J]. Chin J Cancer, 2017, 36(5):213-221.
[21] 李建立,王雪娇,容俊芳.不同穴位配伍的经皮穴位电刺激对腹腔镜手术患者术后恶心呕吐及血清胃动素分泌的影响[J].针刺研究,2020,45(11):920-923,928.
