[Study on the analgesic efficacy of thumb-tack needling therapy in patients after gastric endoscopic submucosal dissection].

Abstract / Summary

To evaluate whether combining thumb-tack needle treatment with routine nursing can safely reduce pain after gastric endoscopic submucosal dissection (ESD). Seventy-eight patients after gastric ESD were randomized into an intervention group (n=39) and a control group (n=39), with 2 cases drop-off in the intervention group. Patients in the control group received postoperative conventional treatment. Patients in the intervention group received thumb-tack needle therapy at bilateral Zusanli (ST36) and Hegu (LI4) acupoints within 1 h after surgery in addition to conventional treatment, which lasted for 72 h. The primary outcome was the incidence of moderate-to-severe pain (visual analog scale [VAS] score ≥4) within 72 h after surgery. The secondary outcomes included pain intensity, analgesic usage rate, anxiety/depression score, numbers of gastrointestinal symptoms, surgery-related complications, and treatment-related adverse events. The incidence of moderate-to-severe pain was 21.6% (8/37) in the intervention group, significantly lower (absolute difference:-24.6%;OR:0.322;95% CI:0.118-0.879;P<0.05) than that in the control group (46.2% [18/39]). Compared with the control group, the intervention group showed reduced scores in the Short-Form McGill Pain Questionnaire at the 6th, 12th, and 24th hour after surgery (P<0.01), and the median VAS score decreased by 2-3 points compared to the control group(P<0.01, P<0.001). No statistical differences were observed between the two groups in analgesic usage rate, anxiety/depression score, numbers of gastrointestinal symptoms or surgery-related complications. Two patients (5.4%) removed the needles prematurely due to psychological reasons, which did not affect clinical outcomes. Thumb-tack needling therapy can effectively reduce the incidence of moderate-to-severe pain after gastric ESD and improve early postoperative pain symptoms, with a favorable safety profile. 目的: 评估常规护理基础上联合揿针治疗是否能安全降低胃内镜黏膜下剥离术（ESD）后疼痛。方法: 78例胃ESD后患者随机分为干预组39例（脱落2例）、对照组39例。对照组接受术后常规治疗，干预组在术后常规治疗基础上于术后1 h内选取双侧足三里、合谷行揿针治疗，持续72 h。主要结局指标为术后72 h内中重度疼痛发生率[视觉模拟量尺（VAS）评分≥4分]，次要结局指标包括疼痛强度，镇痛药物使用率，焦虑/抑郁评分，胃肠道症状、手术相关并发症及治疗相关不良事件发生例数。结果: 干预组中重度疼痛的发生率[21.6% （8/37）]显著低于对照组 [46.2%（18/39），绝对差异:-24.6%，OR:0.322，95% CI:0.118~0.879，P<0.05]。干预组术后6、12、24 h简化麦吉尔疼痛问卷评分较对照组降低（P<0.01），VAS评分中位数较对照组降低2~3分（P<0.01，P<0.001）。两组患者在止痛药使用率、焦虑/抑郁评分、胃肠道症状和手术相关并发症发生例数方面差异无统计学意义。2例患者（5.4%）因心理原因提前拔针，但未影响临床结局。结论: 揿针治疗能有效降低胃ESD后中重度疼痛发生率，改善早期疼痛症状，且安全性良好。.

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