目的 观察穴位体表电刺激对术后患者硬膜外自控镇痛（PCEA）效果、镇痛药用量、血清皮质醇浓度和不良反应的影响。方法 选择经腹全宫切除术患者40例（ASAⅠ～Ⅱ级），随机分成二组，每组20例。A组：于术后第4，8小时 Han's各刺激30 min，术后行PCEA。B组：单纯行术后PCEA（对照组）。术后随访镇痛效果、镇静评分、布氏舒适评分（BCS），分段记录24 h镇痛药用量及总按压次数/实进次数（D1/D2）比值，血清皮质醇含量，肛门恢复排气时间和不良反应情况。结果 两组镇痛效果满意，A组BCS评分高于B组（P＜0.05）。A组镇痛药用量为（31.7±1.9）ml，与对照组（34.2±2.1）ml相比差异有显著性（P＜0.01）。血清皮质醇浓度两组均较术前下降，但A组术后8 h的下降幅度大于对照组。A组恢复肛门排气时间快于B组，而且恶心、呕吐与对照组相比有所减少。结论 术后患者硬膜外腔自控镇痛（PCEA）复合应用穴位体表电刺激，可增强镇痛效果，减少用药量，降低不良反应，是安全有效的复合镇痛方法。%Objective To evaluate the effects of Han's Acupoint Nerve Stimulator on postoperative patient controlled epidural analgesia(PCEA). Methods 40 patients of ASA Ⅰ～Ⅱ undergoing hysterectomy were randomly divided into two groups: A group (20 cases) was given Han's and PCEA postoperatively; control group(20 cases) was given PCEA only. The VAS score, Ramesay score, Bruggrmann comfort scale ,dosage of analgesia, and complications were observed. In some patients, the serum cortisol level were measured before anesthesia and 8, 18 and 42 h after operation. Results The Bruggrmann comfort scale was higher in A group than that in control group(P＜0.05). The dosage of analgesia in A group was (31.7±1.9) ml, as compared to (34.2±2.1)ml in control group, showing a significant difference(P＜0.01). The serum cortisol decreased in both groups, but the level was lower in A group than in control group 8 h after operation. Adverse effects such as nausea and vomiting were obviously less in A group than in control group. Conclusion PCA combined with transcutaneous electric nerve stimulation can enhance the analgesic efficacy, reduce analgesia dosage and decrease adverse effects.
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