耳针麻醉目前已广泛应用于甲状腺手术

在对甲状腺癌患者施行颈淋巴组织整块切除(颈清扫)中

常因手术范围广、创伤大

顾虑效果不佳

而不愿采用。为此

我们收集本院在耳针麻醉下作颈清扫术15例

与同期普鲁卡因静脉复合麻醉下作颈清扫术27例作一比较

以进一步探讨耳针麻醉在颈清扫术中的应用价值。方法术前准备:常规作术时体位练习3～4天

每天适应1～2小时。术前用药:术前1小时常规应用苯巴比妥纳0.1克

阿托品0.5毫克。切皮前1515 cases of thyroid carcinoma were operated by formal standard radi- cal neck dissection under ear-acupuncture anesthesia. At the same time

27 cases were operated under general anesthesia for comparison. Method of ear-acupuncture anesthesia: Operation position exercise was done 3～4 days before operation

1～2 hours everyday. Points of ear-acu- puncture anesthesia were selected on the affected side for all cases. The following ear-points were applied: Jing

Jiao-gan

Fei

Neifenmi

or Shen. The needles were inserted 15 mins. before operation. The electric frequency of stimulation was 500 times per min. As a routine

Luminal 0.1g m and Atropine 0.5 mg were injected intramuscularly an hour before the incision of skin. 15 mins. before the operation Dolantine 50 mg (or Dolantine 1mg per Kg. body weight) was added intravenously. Among the acupuncture anesthesia group of 15 cases 4 were male and 11 female. The average age was 38.1 years old (18～60). The effect of acupuncture anesthesia graded according to the national standard was excellent (grade Ⅰ) in 7 cases (46.7%)

good (grade Ⅱ) in 6 cases (40.0%)

fine (grade Ⅲ) in 2 cases (13.3%)

the poor (grade Ⅳ) was absent. The effective rate (the combined rate of grade Ⅰ & Ⅱ) was 86.7%. Pathological studies showed predominantly papillary carcinoma in both groups. There was no operation mortality. The follow-up information was achieved in all patients. The 5-year survival rates were 100%. Comparing with the general anesthesia

ear-acupuncture anesthesia may have the following valuable points: 1. Adjuvant drugs for the anesthesia were simple during the operation. The doses were small. Anesthetic managements were easier. 2. During this whole course of operation the blood pressure was fai- rly stable

the pulse rate comparatively stationary and the circulatory function not affected. 3. There were no influences both on the time of the operation course and on the dosage of transfusion blood. 4. Particular anesthetic nursing was not needed after the operation. Administration of food was earlier. Recovery was more quickly. 5. The complication of the operation evidently reduced and if any they were milder. Particularly recurrent laryngeal nerve injury and compli- cations of respiratory tract could be avoided. Because the patients are conscious during the operation and the patient's speech may be examined at any moment

the recurrent laryngeal nerve injury could be avoided. Because tracheal intubation was not used

laryngospasm

edema of larynx and infection of lower respiratory tract could also be avoided. In view of a small portion of patients presenting incomplete analgesic effect under acupuncture anesthesia

a small quantity of 1% Procaine localy was necessary in order to complete analgesic effect. The results indicated that ear-acupunture anesthesia was a safe and effective anesthetic method to be used in formal standard radical neck dis- section for patients with thyroid carcinomas. It had many advantages and did not affect completeness of the operation.