2020 年第 9 期 第 15 卷

针刺与口服盐酸曲马多缓释片或洛索洛芬钠片对肛肠痔术后患者疼痛及应激反应的影响

Effects of acupuncture, tramadol hydrochloride sustained release tablets and losoprofen sodium tablets on postoperative analgesia and stress response after hemorrhoids operation

作者：权隆芳1贾小强1程芳1李仁增1崔春辉1王爽2

英文作者：Quan Longfang1 Jia Xiaoqiang1 Cheng Fang1 Li Renzeng1 Cui Chunhui1 Wang Shuang2 

单位：1中国中医科学院西苑医院肛肠科，北京100091；2北京市西城区洪茂沟社区卫生站针灸科100037  

英文单位：1Department of Proctology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing 100091 China; 2Department of Acupuncture and Moxibustion Hongmaogou Community Health Service Center Xicheng Ditrict Beijing 100037 China

关键词：肛肠痔；针刺；盐酸曲马多缓释片；洛索洛芬钠片；术后镇痛

英文关键词：Hemorrhoids;Acupuncture;Tramadolhydrochloridesustained-releasetablets;Losuprofensodiumtablets;Postoperativeanalgesia

• 摘要：

• 目的 探讨肛肠痔术后针刺与口服盐酸曲马多缓释片或洛索洛芬钠片对患者疼痛及应激反应的影响。方法 选取2016年9月至2018年9月在中国中医科学院西苑医院拟行肛肠病痔手术的住院患者210例，完全随机分为3组，每组70例，术后24 h内分别采用单纯针刺疗法（A组）、口服盐酸曲马多缓释片（B组）及口服洛索洛芬钠片（C组）镇痛。记录治疗前和治疗后0.5、2、6 h的疼痛视觉模拟量表（VAS）评分并分析镇痛总有效率，观察术后创缘水肿、尿潴留发生情况，通过数字评分法(NRS)评估患者满意度，酶联免疫吸附试验检测治疗前和治疗后3 d血清炎性因子水平。结果 镇痛治疗前3组VAS评分差异无统计学意义（P＞0.05）；治疗后0.5、2 h，A组VAS评分明显低于B组和C组［（3.4±1.7）分比（4.5±1.7）、（4.6±1.8）分，（2.3±1.5）分比（3.2±1.8）、（3.2±1.8）分］，总有效率明显高于B组和C组［87.1%（61/70）比67.1%（47/70）、65.7%（46/70），94.3%（66/70）比84.3%（59/70）、80.0%（56/70）］（均P＜0.01）；治疗后6 h，3组VAS评分差异无统计学意义（P＞0.05）。A组创缘水肿和尿潴留发生率明显低于、满意度NRS评分明显高于B组和C组（均P＜0.05）。治疗后3组白细胞介素8、肿瘤坏死因子α、高敏C反应蛋白水平明显低于治疗前，A组均明显低于B组和C组（均P＜0.05）。结论 相比口服药物盐酸曲马多缓释片或洛索洛芬钠片，针刺疗法对肛肠痔术后镇痛及其并发症创缘水肿、尿潴留均有明显疗效，且能明显缓解手术带来的应激反应，患者满意度较高。

• Objective To investigate the effects of acupuncture, tramadol hydrochloride sustained-release tablets and loxoprofen sodium tablets on postoperative pain and stress response after hemorrhoids operation. Methods From September 2016 to September 2018, 210 patients who underwent hemorrhoids operation in Xiyuan Hospital, China Academy of Chinese Medical Sciences were randomly divided into 3 groups, with 70 cases in each group. The group A had acupuncture analgesia; the group B and group C took tramadol hydrochloride sustained release tablets and losuprofen sodium tablets respectively. Pain Visual Analogue Scale(VAS) score was recorded before and 0.5, 2, 6 h after treatment. Occurrences of wound edema and urinary retention were observed. Patients′ satisfaction was assessed by numerical rating scale(NRS). Serum inflammatory factors were detected before and 3 d after treatment by enzyme linked immunosorbent assay. Results There was no statistical difference in VAS score among the 3 groups before treatment（P＞0.05）. At 0.5 and 2 h after treatment, VAS scores in group A were significantly lower and analgesia effective rates were higher than those in group B and C［（3.4±1.7） vs （4.5±1.7）,（4.6±1.8）; （2.3±1.5） vs （3.2±1.8）,（3.2±1.8）; 87.1%（61/70） vs 67.1%（47/70）, 65.7%（46/70）; 94.3%（66/70） vs 84.3%（59/70）, 80.0%（56/70）］(all P＜0.01). At 6 h after treatment, VAS score showed no significant difference among groups（P＞0.05）. Incidences of wound edema and urinary retention in group A were significantly lower and NRS score of patient satisfaction was higher than those in group B and C(all P＜0.05). Serum levels of interleukin-8, tumor necrosis factor-α and high sensitive C-reactive protein significantly decreased after treatment and the levels in group A were significantly lower than those in group B and C（all P＜0.05）. Conclusion Acupuncture therapy for postoperative analgesia of hemorrhoids is more effective in relieving wound edema and urinary retention, reducing stress response and improving patients′ satisfaction than tramadol hydrochloride sustained release tablets and losoprofen sodium tablets.