運用針灸對於降低全膝關節置換術後疼痛之成效──系統性文獻回顧

The Effects of Acupuncture for Pain Relief After Total Knee Replacement: A Systematic Review

背景：目前已有數篇探討運用針灸於降低全膝關節置換術後疼痛之研究，但其成效結果並未一致。目的：確定針灸對於降低全膝關節置換術後疼痛之成效。方法：以系統性文獻回顧法，使用「Acupuncture」、「Total knee Replacement」、「Pain」、「針灸」、「全膝關節置換術」、「疼痛」等關鍵字搜尋2006年1月至2017年6月的中英文資料庫包含The Cochrane Library、Science Direct、Embase、PubMed、CINAHL、台灣期刊論文索引、台灣博碩士論文系統、中文電子期刊資料庫、中國期刊全文數據庫、萬芳數據庫。文章選取標準為針灸介入降低全膝關節置換術後疼痛之隨機控制試驗。結果：共得以10篇進行分析整理，介入措施以耳穴療法或針刺療法為主。研究結果統整出（1）耳穴療法以神門、肺、皮質下及膝關節耳穴為主，針刺療法以血海、梁丘、犢鼻、內膝眼、陽陵泉、足三里等穴位為主。（2）耳穴療法每次按壓時間為3分鐘，每天三至四次。（3）電針頻率以2Hz或10至100Hz交替使用為主，每次時間為20至30分鐘，每天一次或每週二次。結論：針灸於全膝關節置換術鎮痛之臨床應用，可有效降低疼痛，發展穴位按壓標準作業流程，能增加護理功能的獨特性。 Background: Several previous studies have investigated the effectiveness of acupuncture for pain relief after total knee replacement. However, the results of these studies are inconsistent. Purpose: We conducted a systematic review of studies evaluating the effectiveness of acupuncture for pain relief after total knee replacement. Methods: Electronic literature search of Cochrane Library, Science Direct, Embase, PubMed, CINAHL, Index to Taiwan Periodical Literature System, National Digital Library of Theses and Dissertations in Taiwan, Chinese Electronic Periodical Services, China Academic Journals Full-text Database, and Wanfang. Keywords that were used included: “acupuncture＂, “total knee replacement＂, “pain＂. Studies were conducted between January 2006 to June 2017. We included all randomized controlled trials that compared acupuncture with standard care, evaluating pain relief outcomes in patients with total knee replacement. Studies were screened for inclusion criteria and non-Chinese or non-English language reports were excluded. Results: Of the 10 studies extracted, results supported the effectiveness of acupuncture for pain relief after total knee replacement. Intervention included auricular therapy and acupuncture based therapy. The results showed that (1) the commonly used auricular therapy points include Xi (AH4), Shenmen (TF4),Fei(CO14), Pizhixia (AT4), the main acupointsofXuehai(SP10), Liangqiu(ST34), Dubi(ST35), Neixiyan (EX-LE4), Yanglingquan (GB34) andZusanli (ST36); (2) auricular therapy each lasted 3 minutes and performed three to four times a day. (3) electro-acupuncture frequencies were used alternately at 2 Hz or 10 to 100 Hz for 20 to 30 minutes daily or twice per week. Conclusions: Developing a standard operating procedure in acupressure will not only improve the quality of clinical nursing care, but will also exude the unique function of nursing.