目前

我院施行心脏二尖瓣闭式扩张术主要采用普鲁卡因静豚复合、吗啡静脉复合和针刺复合三种麻醉法

认为针刺复合法是这类手术可供选择的较好方法之一。现就采用本法的67例临床资料

将我们的方法和体会报道如下: 临床资料 67例中

男33例

女34例。年龄为18～50岁

40岁以上者6例。出现临床症状距手术时间最短一年

最长18年;10年以上者14例。心脏功能Ⅱ级47例

Ⅲ级18例

Ⅳ级2例。术前并有房颤者2例。手术This paper reports on the result of closed mitral commissurotomy of 67 cases under acupuncture anesthesia. The age of patients ranged 18～50 with 6 above 40 years. Symptoms lasted 1～18 years

14 cases being above 10 yeays. There were 20 patients with cardiac function Ⅲ or Ⅳ. The procedures of anesthesia consisted of: (1) Preoperatively 10 mg. morphine and 0.3 mg. Scopolamine; (2) Electric stimulation at two acupu- ncture points

"Hegu" and "Binao"; (3) Intercostal nerve block of 3 inter- costal spaces with about 10～15 ml of 1～2% procaine; (4) Conscious endo- tracheal intubation with controlled breathing. By observations on the heart rate

blood pressure

arterial blood gas analysis and the effect of acupuncture anesthesia

it was suggested that the actions of electric acupuncture were mainly in two aspects: (1) analgesia

with individual variations in intensity

would give a good anesthetic effect if it was coupled with electric stimulation

appropriate analgesic agents and intercostal nerve block. In the present series

there were 62 successful cases (92.5%)

and only 5 failure cases (7.5%); (2) It enhanced cardio- vascular functions. There was no serious arrhythmia except occasionally occurring extrasystole during direct operative stimulation to the heart. The incidence of low B. P. (lower than 80mmHg)and low pulse-pressure(20mmHg) was less frequent than in combined intravenous procaine anesthesia. Also there was no hypertension and tachycardia throughout the operation. This was consistent with the research findings from the Department of Physiology of the First Shanghai Medical College that electric acupuncture could alleviate the blood loss and the hypotension induced by the traction reaction of the visceral organs

and had a marked hypotension action on experimental acute hypertension. It could also inhibit the extra-systloe induced by stimulation of the hypothalamus. Considering the pathologico-physiology of pulmonary and circulatory system in mitral stenosis

after opening the chest

we used the controlled respiration for the patients. It was safe and its advantages were: (1) PaO_2 increased (above 300 mmHg)

PaCO_2 decreased (20.5～39.3 mmHg); (2) No mediastinal flutter; (3) Better maintenance of respiratory and circu- latory functions; (A) Oxygen consumption raduced due to excessive aute breathing; (5) Throughout the operation

patients appeared calm because there was no anoxemia. In conclusion

acupuncture anesthesia was the method of choice for closed mitral commissurotomy. But the technique of conscious endotracheal intubation must be performed skillfully and lightly. However

for nervous patients and patients with poor heart functions

acupuncture anesthesia should be used cautiously.