Application of electroacupuncture assisted local anesthesia in transperineal prostate biopsy
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摘要: 目的 初步探讨电针辅助局部麻醉在经会阴前列腺穿刺活检术中的有效性和安全性。方法 选取2022年8月1日—2023年9月15日在上海中医药大学附属曙光医院泌尿中心行经会阴前列腺穿刺活检术的150例患者作为研究对象，将患者随机分为常规局麻药组(A组，50例)、电针+常规局麻药组(B组，50例)和电针+半量局麻药组(C组，50例)。A组采用足量利多卡因进行前列腺周围神经阻滞麻醉，B组和C组在取止痛穴位合谷、关元、三阴交和镇静穴位神庭穴进行电针刺激的基础上分别给予足量和半量的利多卡因局部麻醉。比较3组患者单次局麻下手术完成率；置入探头时、局部麻醉时、穿刺时、发针时、手术结束时的疼痛程度(VAS评分)；术前30 min、手术开始时、手术中、手术结束时的焦虑水平(VAS-a评分)以及收缩压、心率的波动；手术配合程度(Likert 5级评分)和不良事件发生率。结果 3组患者的基线水平比较差异无统计学意义(P>0.05)；A组有6例因疼痛追加麻醉，B组有3例因疼痛追加麻醉，C组有4例因疼痛追加麻醉，3组比较差异无统计学意义；对单次局麻下完成手术的患者进行分析，发现B组和C组在置入探头时、局部麻醉时、穿刺时、发针时、手术结束后的5个时间点的VAS评分均差异无统计学意义，且都显著低于A组，差异有统计学意义(P < 0.05)。3组在术前30 min的VAS-a评分比较差异无统计学意义，B、C组在手术开始时、术中、手术结束时的VAS-a评分比较差异无统计学意义，且都低于A组(P < 0.05)。3组手术开始时收缩压、心率波动差异无统计学意义，B组与C组在手术开始时、术中、手术结束时的收缩压、心率波动比较差异无统计学意义，且都低于A组(P < 0.05)。B、C组主刀医师对患者的配合程度评价比较差异无统计学意义，且都优于A组，差异有统计学意义(P < 0.05)。3组不良事件发生率比较差异无统计学意义(P>0.05)。结论 电针辅助局麻在经会阴前列腺穿刺活检术中的疗效良好，能够有效降低患者的疼痛程度、焦虑水平，稳定术中血压及心率，降低麻醉药品用量，提高手术顺利度，安全性可靠。
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关键词:
- 电针辅助麻醉 /
- 经会阴前列腺穿刺活检 /
- 疼痛程度 /
- 焦虑水平 /
- 血压心率 /
Abstract: Objective To preliminarily investigate the effectiveness and safety of electroacupuncture-assisted regional anesthesia in transrectal prostate biopsy.Methods From August 1st, 2022 to September 15th, 2023, 150 patients who underwent transperineal prostate biopsy at the Urology Center of Shuguang Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine were selected as the study subjects. The patients were randomly divided into three groups: conventional local anesthesia group(group A, 50 cases), electroacupuncture + conventional local anesthesia group(group B, 50 cases), and electroacupuncture + half-dose local anesthesia group(group C, 50 cases). The group A received full-dose lidocaine for peripheral nerve block anesthesia around the prostate. In group B and group C, in addition to electroacupuncture stimulation at the analgesic acupuncture points Hegu, Guanyuan, Sanyinjiao, and Shenting, full-dose and half-dose lidocaine local anesthesia were respectively administered. The completion rate of the procedure under single local anesthesia was compared among the three groups. The pain levels(measured by VAS scores) during probe insertion, local anesthesia administration, puncture, needle advancement, and at the end of the surgery were evaluated. The anxiety levels(measured by VAS-a scores) 30 minutes before the surgery, at the start of the surgery, during the surgery, and at the end of the surgery, as well as the fluctuations in systolic blood pressure and heart rate, were assessed. The degree of surgical cooperation(measured by a Likert 5-point scale) and the incidence of adverse events were also recorded.Results There were no significant differences in baseline levels among the three groups (P>0.05). Six patients required additional anesthesia due to pain in group A. Three patients required additional anesthesia due to pain in group B. Four patients required additional anesthesia due to pain in group C. However, the difference was not statistically significant. Analyzing the patients completed the procedure under single local anesthesia, it was found that the group B and the group C had similar VAS scores at five time points: probe insertion, local anesthesia administration, puncture, needle advancement, and at the end of the surgery. These scores were significantly lower than those of the group A, with statistical significance (P < 0.05). There were no significant differences in VAS-a scores among the three groups at 30 minutes before the surgery. The group B and the group C had similar VAS-a scores at the start of the surgery, during the surgery, and at the end of the surgery, and all scores were lower than those of the group A (P < 0.05). There were no significant differences in systolic blood pressure or heart rate fluctuations among the three groups at the start of the surgery. The group B and the group C had similar systolic blood pressure and heart rate fluctuations at the start of the surgery, during the surgery, and at the end of the surgery, and all fluctuations were lower than those of the group A (P < 0.05). The surgical cooperation level assessed by the primary surgeons showed no significant differences between the group B and the group C, and both groups had better cooperation levels than the group A, with statistical significance (P < 0.05). There were no significant differences in the incidence of adverse events among the three groups(P>0.05).Conclusion Electroacupuncture-assisted local anesthesia is effective and safe in transrectal prostate biopsy. It can effectively reduce patient pain and anxiety levels, stabilize intraoperative blood pressure and heart rate, reduce the dosage of anesthetics, improve the smoothness of the procedure, and ensure reliable safety. -
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表 1 3组患者基线特征对比
X±S，M(Q1，Q3)，例(%) 患者特征 A组(50例) B组(50例) C组(50例) P值 年龄/岁 67.30±6.54 67.52±5.58 68.34±5.25 0.642 BMI(kg/m2) 25.06±2.29 24.68±2.15 25.11±1.89 0.539 PSA/(ng/mL) 21.39(11.73，46.29) 25.62(8.86，71.15) 24.69(9.86，68.40) 0.726 前列腺体积/mL 54.50(34.75，79.75) 43.00(23.75，72.00) 48.00(26.75，76.00) 0.219 病理结果 0.966 阳性 36(72.0) 37(74.0) 37(74.0) 阴性 14(28.0) 13(26.0) 13(26.0) 
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表 2 3组不同时间点VAS评分的比较
分，X±S 组别 例数 置入探头时 局部麻醉时 穿刺时 发针时 手术结束时 A组 44 3.07±1.13 63.41±8.89 54.66±7.84 50.20±9.06 44.07±5.88 B组 47 2.53±0.80 40.66±7.60 35.15±6.40 25.68±4.98 18.66±5.18 C组 46 2.45±0.86 39.00±6.12 34.35±6.54 24.46±4.48 20.43±4.27 P值(A vs B) 0.007 < 0.001 < 0.001 < 0.001 < 0.001 P值(A vs C) 0.002 < 0.001 < 0.001 < 0.001 < 0.001 P值(B vs C) 0.699 0.295 0.579 0.362 0.099 P值(A vs B vs C) 0.004 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 3组不同时间点VAS-a评分比较
分，X±S 组别 例数 术前30 min 手术开始时 术中 手术结束时 A组 44 56.39±6.26 57.91±5.88 51.02±6.95 46.00±5.35 B组 47 54.91±6.01 47.34±5.58 40.04±6.16 36.00±6.26 C组 46 56.67±5.64 47.09±6.22 39.07±7.08 35.37±6.09 P值(A vs B) 0.242 < 0.001 < 0.001 < 0.001 P值(A vs C) 0.820 < 0.001 < 0.001 < 0.001 P值(B vs C) 0.158 0.836 0.485 0.609 P值(A vs B vs C) 0.316 < 0.001 < 0.001 < 0.001
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表 4 3组不同时间点收缩压、心率的波动值比较
X±S 组别 例数 术前30 min 手术开始时 术中 手术结束时 收缩压波动/mmHg 心率波动/(次/min) 收缩压/波动/mmHg 心率波动/(次/min) 收缩压波动/mmHg 心率波动/(次/min) 收缩压波动/mmHg 心率波动/(次/min) A组 44 5.12±0.96 5.11±1.13 7.05±1.08 7.30±1.30 6.32±1.18 6.77±1.27 5.80±1.13 5.84±1.20 B组 47 5.19±1.10 4.91±1.25 4.11±1.31 4.30±1.30 2.96±1.04 3.87±0.90 2.30±0.91 3.02±0.87 C组 46 5.04±0.84 5.02±1.00 4.00±1.12 4.22±1.26 3.15±1.11 3.70±0.81 2.54±0.62 3.11±0.67 P值(A vs B) 0.702 0.403 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 P值(A vs C) 0.732 0.700 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 P值(B vs C) 0.462 0.649 0.663 0.764 0.400 0.400 0.194 0.642 P值(A vs B vs C) 0.762 0.703 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 5 穿刺医师对3组患者手术配合度评价比较
例 组别 例数 很配合 配合 一般 不配合 很不配合 A组 44 26 13 5 0 0 B组 47 40 5 2 0 0 C组 46 38 6 2 0 0 P值(A vs B) 0.004 P值(A vs C) 0.009 P值(B vs C) 0.793 P值(A vs B vs C) 0.007
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表 6 3组患者的治疗相关不良事件比较
例(%) 组别 例数 尿潴留 发热 肉眼血尿 直肠出血 A组 44 0(0) 1(2.3) 2(4.5) 0(0) B组 47 0(0) 1(2.1) 3(6.4) 0(0) C组 46 0(0) 1(2.2) 2(4.3) 0(0) P值(A vs B vs C) 0.993
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