穴位刺激改善腰椎術後疼痛之文獻探討

Discussion Literature of Acupoint Stimulation to Reduce Postoperative Pain for Patients with Spinal Surgery

李雅雯(Ya-Wen Li) ； 陳秀玲(Hsiu-Ling Chen) ； 吳秀雲(Hsiu-Yun Wu) ； 謝伶瑜(Ling-yu Hsieh)

《中西整合醫學雜誌》 17卷4期 (2015/12) Pp. 15-22

摘要

臨床實務上針對疼痛管理雖已有明確的政策與臨床實務指引，但腰椎手術病人在術後休息時仍經驗到中等至嚴重程度的疼痛，因此，陸續有研究輔以穴位刺激管理術後疼痛和噁心嘔吐之副作用。本文目的為透過文獻探討方式，統整穴位刺激改善腰椎手術患者術後疼痛之實證，搜尋2015年2月以前的中、英文文獻，包括華藝線上圖書館、PubMed、Cochrane Library、Medline、ProQuest等五個資料庫。最終評讀4篇高品質之隨機臨床試驗。研究發現，所有病人皆有使用自控式止痛，再執行耳穴按壓對腰椎術後疼痛並無顯著緩解成效，而不論於術前或術後再執行經皮穴位電刺激、或於術後結合耳穴按壓與經皮穴位電刺激，皆能有效降低腰椎術後的疼痛分數，且使用的止痛藥劑量較少或噁心嘔吐情形較輕微，此成效可作為以中西醫整合管理術後疼痛和鴉片類藥物相關副作用之參考依據，鼓勵臨床醫護人員可學習相關技能，以提升腰椎手術患者術後之止痛品質。

關鍵字

穴位刺激 ； 腰椎手術 ； 術後疼痛 ； 文獻探討

並列摘要

There are well-established polices and practices for pain management, but spinal surgery patients still experience moderate to serious postoperative pain at rest. Therefore, more studies providing acupoint stimulation as an adjunct to patient-controlled analgesia to manage postoperative pain and postoperative nausea and vomiting (PONV). The aim of the study was to perform discussion literature to summarize the effectiveness of reducing postoperative pain in spinal surgery patients with acupoint stimulation. The search focused on articles published before 2015, February and databases included Airiti Library, PubMed, Cochrane Library, MEDLINE, and ProQuest. Finally, four randomized controlled trials with high quality met the selection criteria. Results showed that postoperative pain was not significantly reduced by auricular acupressure. Moreover, regardless of receiving transcutaneuos acupoint electric stimulation (TAES) before or after surgery, or auricular acupressure combined with TAES after surgery were effectively reduced postoperative pain, analgesic usage, and PONV severity with spinal surgery. These effects on integrating traditional Chinese medicine into western medicine can be used as a reference potential for managing postoperative pain and opioid-related side effects for clinical practice. Encourages clinical staff to learn the skill for improving postoperative analgesia quality is recommended.

並列關鍵字

Acupoint Stimulation ； Spinal Surgery ； Postoperative Pain ； Discussion Literature

參考文獻

Gepstein R, Arinzon Z, Folman Y, Shuval I, Shabat S：Efficacy and complications of patient-controlled analgesia treatment after spinal surgery. Surg Neurol. 2007；67：360-366.

Guay J：Postoperative pain significantly influences postoperative blood loss in patients undergoing total knee replacement. Pain Med. 2006；7：476-482.

Kolettas A, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, Pitsiou G, Papaiwannou A, Lampaki S, Karavergou A, Pataka A, Machairiotis N, Katsikogiannis N, Mpakas A, Tsakiridis K, Fassiadis N, Zarogoulidis K, Zarogoulidis P. Postoperative pain management. J Thorac Dis. 2015；7：S62-72.

NIH Consensus Development Program: Acupuncture. NIH Consensus Statement Online. 1997；15：1-34.

馬素華：穴位點壓法簡介，長庚護理 1998；9：85-90。