目的 研究经皮穴位电刺激(TEAS)对老年患者全身麻醉下全膝关节置换(TKA)康复质量、术后镇痛、不良反应及首次下地活动时间的影响.方法 选择2021-01-01-06-30无锡市中医医院收治的90例TKA手术老年患者作为研究对象,采用随机数字表法分为对照组与观察组,每组各45例.对照组在全身麻醉下实施TKA术.观察组在TEAS治疗联合全身麻醉下实施TKA术.分别于术前、术后1 d、术后3 d采用40项恢复质量评分量表(QoR-40)评价患者TKA术后恢复质量;在给予患者自控镇痛基础上,分别于术前、术后1 d、术后2 d和术后3 d采用疼痛视觉模拟评分法(VAS)评价患者的疼痛情况;评价2组患者的不良反应情况;比较2组患者首次下地时间的情况.结果 手术前,对照组与观察组患者 QoR-40 量表评分为(155.82±4.19)和(154.47±3.20)分,术后 1 d 为(164.22±4.96)和(170.76±4.65)分,术后3 d为(183.71±4.80)和(190.71±5.64)分,2组患者时间、组间、时间×组间效应差异均有统计学意义,F时间=1 262.487,F组间=40.091,F时间×组间=26.604,均P＜0.001.手术前,对照组与观察组患者膝关节静止时疼痛评分(RVAS)为(2.46±0.92)和(2.49±1.00)分,术后 1 d 为(4.13±0.84)和(3.57±0.89)分,术后 2 d 为(3.37±0.73)和(2.43±0.62)分,术后3 d为(2.49±0.61)和(1.58±0.47)分,2组患者时间、组间、时间×组间效应差异均有统计学意义,F时间=79.714,F组间=11.834,F时间×组间=4.896,均P＜0.05.手术前,对照组与观察组患者膝关节主动活动时疼痛评分(IVAS)为(3.84±0.68)和(3.88±0.74)分,术后 1 d 为(4.87±1.20)和(4.31±0.85)分,术后 2 d 为(4.41±0.65)和(3.26±0.66)分,术后3 d为(3.38±0.64)和(2.23±0.54)分,2组患者时间、组间、时间×组间效应差异均有统计学意义,F时间=30.013,F组间=9.634,F时间×组 间=9.057,均P＜0.05.术后对照组与观察组镇痛泵按压次数为27(25,30)和17(16,19)次,差异有统计学意义,Z=-4.419,P＜0.001;48 h镇痛补救率为40.00％和24.44％,差异有统计学意义,x2=5.600,P=0.018.研究期间观察组和对照组总不良反应发生率为6.67％和22.22％,差异有统计学意义,x2=4.406,P=0.036.观察组和对照组首次下地时间为(2.70±0.24)和(3.17±0.32)d,差异有统计学意义,t=7.882,P＜0.001.结论 经皮穴位电刺激可提高全身麻醉下老年患者全膝关节置换术的康复质量,改善患者术后疼痛情况,降低不良反应发生率,提前患者首次下地活动时间,加速患者术后康复.
Effect of transcutaneous electrical acupoint stimulation on rehabilitation quality in elderly patients with total knee arthroplasty
Objective To investigate the effects of transcutaneous electrical acupoint stimulation(TEAS)on rehabilitation quality,postoperative analgesia,adverse reactions and time of the first ambulation after surgery in elderly patients with total knee arthroplasty(TKA)under general anesthesia.Methods Totally 90 elderly patients with TKA admitted to Wuxi Traditional Chinese Medicine Hospital from January 1 to June 30,2021 were included and divided into the control group and the observation group using the random number table method,with 45 cases in each group.The control group underwent TKA under general anesthesia.The observation group received TEAS treatment on the basis of general anes-thesia.The recovery quality of patients after TKA was evaluated using the 40-item quality of recovery score(QoR-40)before sugery,at 1 day,and 3 days after surgery.On the basis of patient controlled analgesia,the visual analogue scale(VAS)pain score of each group was evaluated at preoperative,1,2 and 3 d after operation,respectively.The adverse reactions of the two groups were evaluated.The time of the first ambulation in the two groups of patients was compared.Results Before surger-y,the QoR-40 scale scores of the control group and the observation group were(155.82±4.19)and(154.47±3.20)points,which were(164.22±4.96)and(170.76±4.65)points 1 day after surgery,and(183.71±4.80)and(190.71±5.64)points 3 days after surgery.There were statistically significant differences in time,groups,and time X groups effects between the two groups,Ftime=1 262.487,Fgroups=40.091,Ftime×groups=26.604,all P＜0.001.Before surgery,the rest visual analogue scale(RVAS)scores of the control group and the observation group were(2.46±0.92)and(2.49±1.00)points,which were(4.13±0.84)and(3.57±0.89)points 1 day after surgery,(3.37±0.73)and(2.43±0.62)points 2 days after surgery,and(2.49±0.61)and(1.58±0.47)points 3 days after surgery.There were statistically significant differences in time,groups,and timeX groups effects between the two groups,Ftime=79.714,Fgroups=11.834,Ftime×groups=4.896,all P＜0.05.Before surger-y,the VAS scores of the control group and the observation group were(3.84±0.68)and(3.88±0.74)points,respectively.On the 1st day after surgery,they were(4.87±1.20)and(4.31±0.85)points,respectively.On the 2nd day after surgery,they were(4.41±0.65)and(3.26±0.66)points,respectively.On the 3rd day after surgery,they were(3.38±0.64)and(2.23±0.54)points,respectively.There were statistically significant differences in time,groups,and time×groups effects be-tween the two groups,Ftime=30.013,Fgroups=9.634,Ftime×groups=9.057,all P＜0.05.The postoperative control group and ob-servation group had 27(25,30)and 17(16,19)analgesic pump presses,and the difference was statistically significant,Z=-4.419 and P＜0.001.The 48 hour analgesic relief rates were 40.00％and 24.44％,and the difference was statistically signif-icant,x2=5.600,P=0.018.During the study period,the total adverse reactions in the observation group and the control group were 6.67％and 22.22％,respectively,with a statistically significant difference,x2=4.406,P=0.036.The first ambulation time in the observation group and the control group was(2.70±0.24)and(3.17±0.32)days,respectively,and the difference was statistically significant,t=7.882,P＜0.001.Conclusion TEAS can improve the rehabilitation quality of TKA in elderly patients under general anesthesia,reduce the incidence of postoperative pain and adverse reactions,advance the first time of am-bulation,so as to accelerate the postoperative rehabilitation of patients.
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