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护理学报 ›› 2024, Vol. 31 ›› Issue (6): 51-55.doi: 10.16460/j.issn1008-9969.2024.06.051

• 循证护理 • 上一篇    下一篇

经皮穴位电刺激治疗术后疼痛的最佳证据总结

王灵1,2, 秦芳1,2, 高钰琳2, 甄莉1, 冯日宣2, 刘兵2, 马正文2, 许笑宇2, 李国新1   

  1. 1.南方医科大学南方医院,广东 广州 510515;
    2.南方医科大学 护理学院,广东 广州 510515
  • 收稿日期:2023-11-19 出版日期:2024-03-25 发布日期:2024-04-08
  • 通讯作者: 李国新（1966-）,男,湖北大悟人,博士,主任医师,教授,副院长。E-mail：gzliguoxin@163.com
  • 作者简介:王灵（1999-）,女,福建龙岩人,本科学历,硕士研究生在读。
  • 基金资助:
    广东省重点领域研发计划资助项目（2021B0101420005）

Best evidence summary of transcutaneous electrical acupoint stimulation for postoperative pain

WANG Ling1,2, QIN Fang1,2, GAO Yu-lin2, ZHEN Li1, FENG Ri-xuan2, LIU Bing2, MA Zheng-wen2, XU Xiao-yu2, LI Guo-xin1   

  1. 1. Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;
    2. School of Nursing, Southern Medical University, Guangzhou 510515, China
  • Received:2023-11-19 Online:2024-03-25 Published:2024-04-08

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摘要： 目的 总结经皮穴位电刺激及其相关技术治疗术后疼痛的证据,为临床实践提供依据。方法 系统检索BMJ Best Practice、JBI、UpToDate、GIN、NICE、SIGN、RNAO、医脉通、梅斯医学网站、国家中医药管理局、Epistemonikos、Cochrane Library、PubMed、Embase、Web of Science、CBM、CNKI、万方、维普和中华医学期刊全文数据库中关于经皮穴位电刺激及其相关技术治疗术后疼痛的证据,由经过循证培训的小组成员对文献质量进行评价,对证据进行提取、汇总并分级。结果 共纳入13篇文献,包括1篇指南,3篇系统评价和9篇随机对照试验。从治疗适应证、治疗获益、刺激参数、干预时机、穴位选择和操作者资质6个方面汇总了24条证据。结论 经皮穴位电刺激治疗可以缓解术后疼痛,不同的刺激参数、干预时机及穴位选择会影响疗效,建议临床应用时结合各医院科室的实际情况,有针对性地选择证据,以提升其有效性。

关键词: 经皮穴位电刺激, 术后疼痛, 证据总结

Abstract: Objective To summarize the best evidence related to transcutaneous electrical acupoint stimulation(TEAS) and related techniques for postoperative pain and to provide reference for clinical practice. Methods Literature related to TEAS and related techniques for postoperative pain in BMJ Best Practice, JBI, UpToDate, GIN, NICE, SIGN, RNAO, Medlive, MedSci, National Administration of Traditional Chinese Medicine, Epistemonikos, Cochrane Library, PubMed, Embase, Web of Science, CBM, CNKI, Wanfang, VIP and Chinese Medical Journal Full-text Database were searched. The research team with evidence-based training evaluated the methodological quality of the literature, extracted, summarized and graded the evidence. Results Thirteen articles were collected, including 1 guideline, 3 systematic reviews, and 9 randomized controlled trials. A total of 24 pieces of evidence were summarized into 6 aspects of therapeutic indications, therapeutic benefits, stimulus parameters, intervention timing, acupoint selection and operating qualifications. Conclusion TEAS can alleviate postoperative pain. Different stimulus parameters, intervention timing and acupoint selection would influence the treatment effect. Healthcare professionals should combine the best evidence with clinical situation when applying the evidence, so as to improve the effectiveness of TEAS.

Key words: transcutaneous electrical acupoint stimulation, postoperative pain, evidence summary

中图分类号: 

  • R473.6
[1] Joshi GP, Kehlet H.Postoperative pain management in the era of eras: an overview[J].Best Pract Res Clin Anaesthesiol, 2019, 33(3):259-267. DOI:10.1016/j.bpa.2019.07.016.
[2] 彭胜, 王玉玲, 张斯清, 等. 基于数据挖掘的术后疼痛行耳穴贴压选穴规律分析[J]. 护理学报, 2021,28(5):21-25. DOI:10.16460/j.issn1008-9969.2021.05.021.
[3] Choi M, Wang L, Coroneos CJ, et al.Managing postoperative pain in adult outpatients: a systematic review and Meta-analysis comparing codeine with NSAIDs[J]. CMAJ, 2021, 193(24): E895-E905. DOI:10.1503/cmaj.201915.
[4] Yuan W, Wang Q.Perioperative acupuncture medicine: a novel concept instead of acupuncture anesthesia[J]. Chin Med J (Engl), 2019, 132(6):707-715. DOI:10.1097/CM9.0000000000000123.
[5] Hou Y, Yan Q, An H, et al.The use and protective effects of transcutaneous electrical acupoint stimulation during abdominal surgery: study protocol for a multicenter randomized parallel controlled trial[J]. Trials, 2019, 20(1):462. DOI: 10.1186/s13063-019-3558-2.
[6] Chen J, Zhang Y, Li X, et al.Efficacy of transcutaneous electrical acupoint stimulation combined with general anesthesia for sedation and postoperative analgesia in minimally invasive lung cancer surgery: a randomized, double-blind, placebo-controlled trial[J]. Thorac Cancer, 2020, 11(4): 928-934. DOI: 10.1111/1759-7714.13343.
[7] Yu X, Zhang F, Chen B.The effect of TEAS on the quality of early recovery in patients undergoing gynecological laparoscopic surgery: a prospective, randomized, placebo-controlled trial[J]. Trials, 2020, 21(1):43.DOI:10.1186/s13063-019-3892-4.
[8] 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017,32(21):1991-1994. DOI: 10.16821/j.cnki.hsjx.2017.21.025.
[9] AGREE Next Steps Consortium (2009). The AGREE II instrument[EB/OL]. [2022-12-29]. https://www.agreetrust.org/resource-centre/agree-ii/.
[10] Joanna Briggs Institute(JBI). JBI’s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers[EB/OL].[2022-12-29].https://jbi.global/critical-appraisal-tools.
[11] 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11): 964-967. DOI: 10.16821/j.cnki.hsjx.2015.11.002.
[12] 中国中西医结合学会麻醉专业委员会,甘肃省中西医结合学会麻醉专业委员会. 穴位刺激辅助治疗治疗术后疼痛临床实践指南(2021版)[J]. 中华麻醉学杂志, 2021, 41(10):1159-1165.DOI:10.3760/cma.j.cn131073.20211009.01002.
[13] Meng D,Mao Y,Song QM,et al.Efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) for postoperative pain in laparoscopy: a systematic review and Meta-analysis of randomized controlled trials[J]. Evid Based Complement Alternat Med, 2022, 2022: 9922879. DOI: 10.1155/2022/9922879.
[14] Huang YS, Yang JJ, Li XY, et al.Effectiveness and safety of electroacupuncture for the treatment of pain after laparoscopic surgery: a systematic review[J]. J Tradit Chin Med, 2022, 42(4): 505-512. DOI: 10.19852/j.cnki.jtcm.2022.04.002.
[15] Zhu J,Xu Q,Zou R,et al.Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice[J]. BMC Complement Altern Med, 2019, 19(1): 192. DOI: 10.1186/s12906-019-2583-8.
[16] 沈娜娜, 颜菡, 孟尽海. 术前穴位电针刺激对结直肠癌根治术患者术后恢复的影响[J]. 宁夏医科大学学报, 2023,45(1):49-54. DOI: 10.16050/j.cnki.issn1674-6309.2023.01.010.
[17] 周添奕, 黄思维, 顾颖, 等. 不同时机电针对胃肠恶性肿瘤术后胃肠功能恢复的影响[J].针灸推拿医学(英文版), 2022,20(5):392-398.
[18] 蔡清香, 王勇, 王佳南, 等. 穴位电刺激辅助麻醉对腹腔镜直肠癌根治术患者免疫功能及术后并发症的影响[J]. 中医药导报, 2021,27(5):103-108.
[19] 龙庆, 李艳, 闻永, 等. 不同频次电针治疗对混合痔外剥内扎术后肛门疼痛的影响[J]. 上海针灸杂志, 2020,39(9):1172-1175. DOI: 10.13460/j.issn.1005-0957.2020.09.1172.
[20] 王雪娇, 李建立, 蔚冬冬, 等. 穴位配伍因素对腹腔镜胆囊切除术患者针药平衡麻醉效果的影响[J]. 中华麻醉学杂志, 2020(6):707-710.
[21] 冯吉杰, 王珂, 张雪慧, 等. 不同强度经皮穴位电刺激对胸腔镜术后镇痛疗效的影响[J]. 上海中医药大学学报, 2019,33(2):50-54.DOI:10.16306/j.1008-861x.2019.02.012.
[22] 潘路平, 杨瑜, 邵瑾, 等. 围术期经皮穴位电刺激对肩关节镜手术患者术后镇痛效果的影响[J]. 中国针灸, 2019,39(1):19-23. DOI: 10.13703/j.0255-2930.2019.01.004.
[23] 龙庆, 李艳, 李俊, 等. 不同频率电针预处理对混合痔外剥内扎术后肛门疼痛的影响[J]. 中国针灸, 2019,39(5):477-481. DOI: 10.13703/j.0255-2930.2019.05.005.
[24] 陈云, 余剑波. 不同电针输出波形对瑞芬太尼诱发患者术后痛觉过敏的影响[J]. 中华麻醉学杂志, 2018,38(12):1441-1444.DOI:10.3760/cma.j.issn.0254-1416.2018.12.009.
[25] Sundaram VG,Thulasiraman SV,Kesavan B,et al.An observational study to assess postoperative pain control and formulate a comprehensive approach to the implementation of policy change for pain control in postoperative units[J]. Cureus, 2022, 14(12): e33026. DOI: 10.7759/cureus.33026.
[26] 王韵, 张翼, 王伟, 等. 内吗啡肽与强啡肽产生协同镇痛作用的新证据[J]. 中国疼痛医学杂志, 2002(2): 118-119.
[27] Cheing GL,Tsui AY,Lo SK,et al.Optimal stimulation duration of tens in the management of osteoarthritic knee pain[J]. J Rehabil Med, 2003, 35(2):62-68.DOI:10.1080/16501970306116.
[28] 韩济生. 针麻镇痛研究[J]. 针刺研究, 2016, 41(5): 377-387. DOI:10.13702/j.1000-0607.2016.05.001.
[29] Xing R, Yang Y, Zhang M, et al.Effect of transcutaneous electrical acupoint stimulation combined with transversus abdominis plane block on postoperative recovery in elderly patients undergoing laparoscopic gastric cancer surgery: a randomized controlled trial[J]. Pain Ther, 2022, 11(4):1327-1339. DOI: 10.1007/s40122-022-00429-2.
[30] Gliedt JA, Daniels CJ, Wuollet A.Narrative review of perioperative acupuncture for clinicians[J]. J Acupunct Meridian Stud, 2015, 8(5):264-269. DOI:10.1016/j.jams.2014.12.004.
[31] 胡小雪, 李建松, 金忆, 等. 经皮穴位电刺激在老年骨关节炎初次全膝关节置换术麻醉中超前镇痛效果的临床研究[J]. 山东中医杂志, 2021, 40(7):724-728. DOI:10.16295/j.cnki.0257-358x.2021.07.011.
[32] 杨磊, 郑宇, 张露芬. 针刺不同穴位对慢性炎症痛模型大鼠血清IL-4及IL-10的影响[J]. 西部中医药, 2020, 33: 30-33. DOI:10.12174/j.issn.1004-6852.2020.08.08.
[33] 李芳, 潘晓彦, 邓斯琪, 等. 基于数据挖掘探讨针刺缓解术后疼痛选穴规律[J]. 国际中医中药杂志, 2023(3):356-362. DOI:10.3760/cma.j.cn115398-20220426-00413.
[34] 韩济生. 疼痛学[M]. 北京:北京大学医学出版社, 2011:264-265.
[35] Vickers AJ,Vertosick EA,Lewith G,et al.Do the effects of acupuncture vary between acupuncturists? Analysis of the acupuncture trialists’ collaboration individual patient data Meta-analysis[J]. Acupunct Med, 2021, 39(4):309-317. DOI:10.1177/0964528420959089.
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