针刺法用于人工全膝关节置换术术后镇痛研究进展.docVIP

针刺法用于人工全膝关节置换术术后镇痛研究进展 　　[摘要] 人工全膝关节置换术（TKA）近年来已经广泛应用于骨科骨折患者中，TKA手术治疗的目的是解除膝关节疼痛以及膝关节功能的重建，但部分患者术后仍存在异常疼痛现象。以往对于TKA镇痛多采取多模式镇痛，如静脉镇痛、硬膜外镇痛、连续外周股神经阻滞，但均各具有一定的缺点。近年来临床研究发现，针刺镇痛在国内及国际上治疗TKA术后疼痛正逐渐得到广泛重视与认可，并取得了较好的效果。针刺及其相关技术作为临床手术镇痛的一种辅助治疗手段，在缓解患者术后疼痛中发挥了重要作用。本文从TKA术后疼痛发生的原因、TKA围术期常用的传统镇痛方法及针刺镇痛的作用机制、针刺镇痛用于TKA术后的镇痛效果方面进行总结分析，旨在为临床开展新的镇痛方案提供参考依据。 　　[关键词] 人工全膝关节置换术；术后疼痛；针刺；镇痛 　　[中图分类号] R687.4 [文献标识码] A [文章编号] 1673-7210（2017）05（c）-0059-04 　　[Abstract] In recent years， the total knee arthroplasty （TKA） has been widely used in patients with fracture in the Department of Orthopedics， the purpose of TKA is relieving pain of knee joint and reconstruction of knee joint function， but some patients still have abnormal pain after operation. In the past， multimodal analgesia， such as intravenous analgesia， epidural analgesia and continuous peripheral nerve block， is used for TAK analgesia， but all of them have certain disadvantages. In recent years， clinical studies have found that acupuncture analgesia in the treatment of postoperative pain of TKA in both domestic and international is gradually getting wide attention and recognition， and it has achieved good effects. As an adjuvant therapy of clinical surgery analgesia， acupuncture and related technologies play an important role in relieving the postoperative pain of patients. This paper summarizes the cause of postoperative pain of TKA， common traditional analgesic methods during perioperative TKA and its mechanism of acupuncture analgesia， the analgesic effect of acupuncture analgesia for postoperative TKA， aimed at providing reference for performing a new analgesic program in clinic. 　　[Key words] Total knee arthroplasty； Postoperative pain； Acupuncture； Analgesia 　　人工全膝关节置换术（total knee arthroplasty，TKA）是骨科常见的手术方法之一，TKA成功的金标准是患者解除膝关节疼痛以及膝关节功能的重建[1]。但大部分TKA患者术后存在疼痛现象，仅可以影响患者的早期康复，关节功能恢复不理想，还会增加患者术后的并发症。因此，TKA术后的镇痛问题成为临床研究的热点。近年来随着临床各种镇痛方案的逐渐增多，出现多模式镇痛和超前镇痛等多种镇痛方法和镇痛理念[2-5]。对于TAK镇痛采取多模式镇痛主要包括以下几种。①超前镇痛理念：术前给予镇痛药物，以非甾体抗炎药（NS