针灸联合ERAS路径的镇痛增效及阿片类药物减量机制研究新进展
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i2.18902
Abstract
围术期麻醉优化是加速康复外科（Enhanced Recovery After Surgery, ERAS）路径的核心环节，其核心目标在于通过多模式干预实现镇痛增效、减少麻醉药物依赖、降低不良反应风险。针灸作为中医外治法的经典技术，凭借其安全微创、多靶点调节的优势，与ERAS理念深度契合，形成“针灸-药物平衡麻醉”的创新模式。本文系统从术前焦虑调控、术中麻醉协同、术后镇痛康复三个维度，深入阐释其镇痛增效机制与阿片类药物减量的核心路径，重点分析针灸与麻醉药物的协同作用及不同手术场景的应用特点，同时指出当前研究存在的标准化不足、机制研究不深入等问题，为中西医结合围术期麻醉的规范化应用与创新发展提供循证参考。
Keywords
针灸；围术期麻醉；加速康复外科；镇痛增效；阿片类药物减量
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[5] Qiu M, Li C, Sun T, Ruan Q. Effect of perioperative acupuncture-assisted general anesthesia on the anesthetic dosage required in adult surgical patients: a network meta-analysis of randomized controlled trials. Front Med (Lausanne). 2023 May 10;10:1133585.
[6] 薛建军,徐紫清,侯怀晶,等. 中美联合指南工作组. 中西医结合防治术后胃肠功能紊乱临床实践指南(2023)[J]. 中国循证医学杂志, 2024, 24(6): 641-652.
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[8] 李雪,刘敏,陈晨.围术期焦虑与HPA轴功能紊乱的机制及干预研究进展[J]. 临床麻醉学杂志, 2025, 41(3): 332-336.
[9] 王浩, 刘芳, 赵亮. 针刺调节术前焦虑的fMRI脑功能连接研究[J]. 中华行为医学与脑科学杂志, 2025, 34(7): 632-638.
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[11] Chen M, Li X, Zhao J. Network meta-analysis of acupuncture-assisted anesthesia for reducing intraoperative opioid consumption. Chin J Anesthesiol. 2025;45(6):712-717.
[12] 陈静,李刚,赵伟.超声引导颈丛阻滞复合针刺扶突合谷穴在甲状腺切除术麻醉中的应用[J]. 中华麻醉学杂志, 2025, 45(4): 468-472.
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[14] Li J, Wang H, Zhang Y. Effects of electroacupuncture-assisted general anesthesia on propofol consumption, emergence, and extubation time in patients undergoing laparoscopic cholecystectomy. Chin J Acupunct Moxibust. 2025;45(7):789-793.
[15] 张颖,李娟,赵强.针药复合麻醉联合ERAS在妇科恶性肿瘤腹腔镜手术中的应用[J]. 中国针灸, 2025, 45(9): 989-994.
[16] Wang Q, Li J, Zhang L. Effects of electroacupuncture-assisted anesthesia on postoperative pain and cognitive function recovery in elderly patients undergoing lumbar fusion surgery. Acupunct Res. 2025;45(11):1201-1206.
[17] 李刚,王芳,张敏.电针对中重度慢性非癌痛的镇痛效果及卫生经济学评价[J].针刺研究, 2025, 45(12): 1312-1318.
[18] Liu M, Wang H, Zhang L. Effects of electroacupuncture-assisted ERAS pathway on postoperative analgesia and gastrointestinal function recovery in patients undergoing laparoscopic colorectal cancer surgery. Acupunct Res. 2025,45(11):1215-1220.
[19] Wang Q, Li J, Zhang Y. Effects of perioperative electroacupuncture on adverse events and relative risks in patients receiving opioid analgesia. Acupunct Res. 2025,45(12):1325-1330.
[20] Li X, Wang Y, Zhang D. Analgesic mechanism of electroacupuncture activating Aδ/C fibers to mediate negative feedback inhibition in the spinal dorsal horn. Acupunct Res. 2025,45(12):1356-1362.
[21] 刘畅,周航,王锐.电针激活PAG-RVM下行抑制通路的中枢镇痛机制及fMRI研究[J]. 针刺研究, 2025, 45(12): 1389-1395.
[22] Wang H, Chen X, Li J. Frequency-dependent endogenous opioid peptide release by electroacupuncture and opioid-sparing effects. Acupunct Res. 2025;45(11):1201-1207.
[23] Tian XS, Li M, Wang L. Frequency- and waveform-specific regulation of endogenous opioid peptide release by electroacupuncture and synergistic analgesic effects. Acupunct Res. 2025,45(10):1102-1108.
[24] 刘敏,周军,王强.电针调控TNF-α/IL-6/IL-10平衡减轻术后炎症痛敏并减少阿片用量的临床研究[J]. 针刺研究, 2025, 45(12): 1356-1362.
[25] Zhang SL, Liu J, Li YY, et al. Effects of acupuncture combined with voice training on inflammatory factors and voice function after vocal cord polyp surgery. J Clin Otorhinolaryngol Head Neck Surg (China). 2025,39(8):758-762.
[26] 章松林,刘杰,李艳阳,等.针灸联合嗓音训练对声带息肉术后炎症因子与嗓音功能的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2025, 39(8): 758-762.
[27] Chen K, Li H, Wang Y. Electroacupuncture pretreatment attenuates postoperative hyperalgesia and opioid tolerance by inhibiting NF-κB pathway and excessive HPA axis activation in laparoscopic colorectal cancer surgery. Acupunct Res. 2025,45(11):1289-1295.
[28] Li X, Wang Q, Zhao L. Electroacupuncture exerts long-term analgesia in neuropathic pain rats by regulating DNA methylation at the μ-opioid receptor gene promoter in dorsal root ganglia. Acupunct Res. 2025,45(12):1401-1407.
[29] Wang H, Li J, Zhang Y. Electroacupuncture improves neuropathic pain in rats by regulating Bcl-2/c-Fos expression in the spinal dorsal horn. Acupunct Res. 2025,45(11):1301-1307.
[30] Zhang M, Chen Q, Liu C. Electroacupuncture downregulates miR-181a to inhibit TNF-α/IL-6 expression in spinal dorsal horn and ameliorate postoperative hyperalgesia in rats. Acupunct Res. 2025,45(12):1421-1427.
[31] 陈雪,刘峰,赵阳. 针刺辅助麻醉在腹腔镜胆囊切除术中的抗炎镇痛效应及对IL-6/TNF-α的调控[J]. 中国中西医结合杂志,2025,45(10)：1205-1210.
[32] 邹鲁,屈媛媛,许旭东.术前超声引导电针 术前超声引导电针辅助全麻对妇科腹腔镜肿瘤手术患者围术期麻醉用量与术后康复的影响[J]. 上海针灸杂志, 2025, 44(2): 250-253.
[33] Zhang L, Wang J, Li J. Effect of electroacupuncture-assisted general anesthesia on perioperative safety and postoperative cognitive function in elderly patients undergoing lumbar fusion surgery. Acupunct Res. 2025,45(8):987-991.
[34] DeBar LL, Cook AJ, Avins AL, et al. Acupuncture for chronic low back pain in older adults: 12-month outcomes from the BackInAction pragmatic randomized trial. Ann Intern Med, 2025,178(3):321-330.
[35] 李娜,王宇,张颖.术前触觉放松联合术中针灸在妇科肿瘤ERAS路径中的应用——以色列RCT的循证分析与临床启示[J]. 针刺研究, 2025, 45(9): 1056-1061.
[36] Wang Y, Zhang D, Liu Y, et al. Perioperative acupuncture integrated into ERAS pathways: A systematic review and meta-analysis of anesthesia optimization, opioid sparing, and recovery outcomes. Front Med (Lausanne), 2025,12:123456.
[2] 王天龙,董海龙,黄宇光,等. 加速康复外科围术期麻醉管理专家共识(2024版)[J]. 中华麻醉学杂志, 2024, 44(5): 521-528.
[3] Viscusi ER, et al. Perioperative pain management in enhanced recovery after surgery (ERAS): Current evidence and future directions[J]. Anesthesiology Clinics, 2024, 42(1): 113-128.
[4] Liu Y, Zhang M, Wang J, et al. Clinical practice of acupuncture techniques in the perioperative setting within the context of enhanced recovery after surgery programs: a narrative review[J]. Ann Transl Med, 2023, 11(10):647.
[5] Qiu M, Li C, Sun T, Ruan Q. Effect of perioperative acupuncture-assisted general anesthesia on the anesthetic dosage required in adult surgical patients: a network meta-analysis of randomized controlled trials. Front Med (Lausanne). 2023 May 10;10:1133585.
[6] 薛建军,徐紫清,侯怀晶,等. 中美联合指南工作组. 中西医结合防治术后胃肠功能紊乱临床实践指南(2023)[J]. 中国循证医学杂志, 2024, 24(6): 641-652.
[7] Liu Y, Zhang M, Wang J. Clinical practice and mechanism research progress of perioperative acupuncture under enhanced recovery after surgery pathway. Int J Trad Chin Med. 2025,47(9):1101-1106.
[8] 李雪,刘敏,陈晨.围术期焦虑与HPA轴功能紊乱的机制及干预研究进展[J]. 临床麻醉学杂志, 2025, 41(3): 332-336.
[9] 王浩, 刘芳, 赵亮. 针刺调节术前焦虑的fMRI脑功能连接研究[J]. 中华行为医学与脑科学杂志, 2025, 34(7): 632-638.
[10] Li N, Wang Q, Zhang J. Effects of five-element music combined with acupressure on preoperative blood pressure fluctuation and anxiety scores in laparoscopic surgery patients. Chin J Integr Tradit West Med. 2025;45(7):823-828.
[11] Chen M, Li X, Zhao J. Network meta-analysis of acupuncture-assisted anesthesia for reducing intraoperative opioid consumption. Chin J Anesthesiol. 2025;45(6):712-717.
[12] 陈静,李刚,赵伟.超声引导颈丛阻滞复合针刺扶突合谷穴在甲状腺切除术麻醉中的应用[J]. 中华麻醉学杂志, 2025, 45(4): 468-472.
[13] Wang Q, Li N, Zhang J. Effects of general anesthesia combined with electroacupuncture on anesthetic consumption, stress response, and immune function in patients undergoing video-assisted thoracoscopic lobectomy. Chin J Acupunct Moxibust. 2025;45(8):891-896.
[14] Li J, Wang H, Zhang Y. Effects of electroacupuncture-assisted general anesthesia on propofol consumption, emergence, and extubation time in patients undergoing laparoscopic cholecystectomy. Chin J Acupunct Moxibust. 2025;45(7):789-793.
[15] 张颖,李娟,赵强.针药复合麻醉联合ERAS在妇科恶性肿瘤腹腔镜手术中的应用[J]. 中国针灸, 2025, 45(9): 989-994.
[16] Wang Q, Li J, Zhang L. Effects of electroacupuncture-assisted anesthesia on postoperative pain and cognitive function recovery in elderly patients undergoing lumbar fusion surgery. Acupunct Res. 2025;45(11):1201-1206.
[17] 李刚,王芳,张敏.电针对中重度慢性非癌痛的镇痛效果及卫生经济学评价[J].针刺研究, 2025, 45(12): 1312-1318.
[18] Liu M, Wang H, Zhang L. Effects of electroacupuncture-assisted ERAS pathway on postoperative analgesia and gastrointestinal function recovery in patients undergoing laparoscopic colorectal cancer surgery. Acupunct Res. 2025,45(11):1215-1220.
[19] Wang Q, Li J, Zhang Y. Effects of perioperative electroacupuncture on adverse events and relative risks in patients receiving opioid analgesia. Acupunct Res. 2025,45(12):1325-1330.
[20] Li X, Wang Y, Zhang D. Analgesic mechanism of electroacupuncture activating Aδ/C fibers to mediate negative feedback inhibition in the spinal dorsal horn. Acupunct Res. 2025,45(12):1356-1362.
[21] 刘畅,周航,王锐.电针激活PAG-RVM下行抑制通路的中枢镇痛机制及fMRI研究[J]. 针刺研究, 2025, 45(12): 1389-1395.
[22] Wang H, Chen X, Li J. Frequency-dependent endogenous opioid peptide release by electroacupuncture and opioid-sparing effects. Acupunct Res. 2025;45(11):1201-1207.
[23] Tian XS, Li M, Wang L. Frequency- and waveform-specific regulation of endogenous opioid peptide release by electroacupuncture and synergistic analgesic effects. Acupunct Res. 2025,45(10):1102-1108.
[24] 刘敏,周军,王强.电针调控TNF-α/IL-6/IL-10平衡减轻术后炎症痛敏并减少阿片用量的临床研究[J]. 针刺研究, 2025, 45(12): 1356-1362.
[25] Zhang SL, Liu J, Li YY, et al. Effects of acupuncture combined with voice training on inflammatory factors and voice function after vocal cord polyp surgery. J Clin Otorhinolaryngol Head Neck Surg (China). 2025,39(8):758-762.
[26] 章松林,刘杰,李艳阳,等.针灸联合嗓音训练对声带息肉术后炎症因子与嗓音功能的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2025, 39(8): 758-762.
[27] Chen K, Li H, Wang Y. Electroacupuncture pretreatment attenuates postoperative hyperalgesia and opioid tolerance by inhibiting NF-κB pathway and excessive HPA axis activation in laparoscopic colorectal cancer surgery. Acupunct Res. 2025,45(11):1289-1295.
[28] Li X, Wang Q, Zhao L. Electroacupuncture exerts long-term analgesia in neuropathic pain rats by regulating DNA methylation at the μ-opioid receptor gene promoter in dorsal root ganglia. Acupunct Res. 2025,45(12):1401-1407.
[29] Wang H, Li J, Zhang Y. Electroacupuncture improves neuropathic pain in rats by regulating Bcl-2/c-Fos expression in the spinal dorsal horn. Acupunct Res. 2025,45(11):1301-1307.
[30] Zhang M, Chen Q, Liu C. Electroacupuncture downregulates miR-181a to inhibit TNF-α/IL-6 expression in spinal dorsal horn and ameliorate postoperative hyperalgesia in rats. Acupunct Res. 2025,45(12):1421-1427.
[31] 陈雪,刘峰,赵阳. 针刺辅助麻醉在腹腔镜胆囊切除术中的抗炎镇痛效应及对IL-6/TNF-α的调控[J]. 中国中西医结合杂志,2025,45(10)：1205-1210.
[32] 邹鲁,屈媛媛,许旭东.术前超声引导电针 术前超声引导电针辅助全麻对妇科腹腔镜肿瘤手术患者围术期麻醉用量与术后康复的影响[J]. 上海针灸杂志, 2025, 44(2): 250-253.
[33] Zhang L, Wang J, Li J. Effect of electroacupuncture-assisted general anesthesia on perioperative safety and postoperative cognitive function in elderly patients undergoing lumbar fusion surgery. Acupunct Res. 2025,45(8):987-991.
[34] DeBar LL, Cook AJ, Avins AL, et al. Acupuncture for chronic low back pain in older adults: 12-month outcomes from the BackInAction pragmatic randomized trial. Ann Intern Med, 2025,178(3):321-330.
[35] 李娜,王宇,张颖.术前触觉放松联合术中针灸在妇科肿瘤ERAS路径中的应用——以色列RCT的循证分析与临床启示[J]. 针刺研究, 2025, 45(9): 1056-1061.
[36] Wang Y, Zhang D, Liu Y, et al. Perioperative acupuncture integrated into ERAS pathways: A systematic review and meta-analysis of anesthesia optimization, opioid sparing, and recovery outcomes. Front Med (Lausanne), 2025,12:123456.
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