摘要:1965年11月中旬,我院首次选用针刺麻醉进行开颅手技获得成功。10余年来,通过大量的临床实践。对各种不同部位的开颅手术,从穴位的筛选、刺激条件、辅助用药、手术操作的改进,到病人个体差异的调查等方面,做了一些工作,摸索出了一套比较完整的针麻开颅常规。至1979年6月底,共做针麻开颅手术2,017例,病种达30余种。实践证明,针麻应用于颅脑外科手术,主要优越性为病人神志清醒、生理功能保持正常,有1. In Beijing Xuan Wu Hospital, the first case of craniotomy under acupuncture anesthesia (A. A.)was successfully performed on November 18, 1965. By the end of June 1979, 2,017 cases of craniotomiesunder A. A. have been performed based on a great deal of clinical practice, craniotomies in variousregions, selection of suitable puncture points, choice of parameters of stimulation, the use of adjuvantdrugs, improvement of operative techniques and individual variability are discussed, and those factorsinfluencing the results of A. A. are studied and analyzec as well. 2. As to the results of operation under A. A. in cases of intracranial space-occupying lesions invarious regions, the percentage of excellence (excellent rate) was 82.07% in the cases in the frontal re-gions; the excellent rate in cases of acoustic tumours was 82% with early recovery and less postopera-tive complications in spite of the difficulties in the operation and deep location of the tumours, involv-ing the vital centers in the brain stem, for these tumours A. A. has been the method of choice of analge-sia so far. 3. It was found to be most important to select. patients in order to get good results of A. A. In 1972, 474 patients for operation under A. A. were chosen according to their individual variabilityand in 70-80% the effect forecast of A. A. proved to be correct. Then in 1973, 120 patients were chosenaccording to their skin-electricity, pain-threshold, cortioal function status and pattern dialecticallyclassified in the view of Chinese Traditional Medicine, the results of effect fore-cast was the same. Ifthe conditions for A. A. are improved, better results can be obtained. Good results should be expected in following conditions: (a) if the patient's cortical function status is stable and sound; (b) in patients with high pain-threshold; (c) in cases of "kidney deficiency" type, especially yang dificiency type according to the dialecticclassification in Chinese Traditional Medicine; (d) in patients eagerly desireing operation and being willing to accept A. A. and psychologicalcalm and quiet. 4. Troubles mostly often encountered in operation under A. A.: (a) imcompleteness of analgesia at the side of the scalp incision; (b) reactions to traction of the intracranial structures; (c) reactions to low intracranial pressure; (d) when the intracranial pressure is too high for the dura to be incised; (e) problems connected with bleeding and blood transfusion; (f) uncomfortable position. To all these problems attention should be paid as soon as possible. 5. Complications (incomplete statistics): (a) fainting during needling (collapse) 3 cases; (b) transient unconciousness during the exposure of the brain stem 3 cases; (c) intraoperative inhalation of vomitus in one case, when fasting was not observed. (d) epileptic seizures during operation 5 cases; (e) shock caused by severe bleeding and delayed blood transfusion 8 cases; (f) restlessness, uncooperative movements caused by unbearable position and prolonged operation6 cases; (g) complicatious in group under A. A. and in group under drug anesthesia (each 50 cases foracoustic nerves tumours): (I) In group under drug anesthesia there were 3 cases with lung infection, 5 cases with brain stemdamage and one case with secondary postoperative intracranial haemorrhage. (2) In group under A. A.,there was postoperative intracranial haemorrhage in one case and a mild lung infection in one case. (3)Before 1965 the percentage of cases of preservation of VII nervous was 49%, but in 1971, it was 72.1%.This increase of the percentage was due to the introduction of A. A. 6. In the end the authors point out that A. A. is one kind of the modern methods of anaesthesia,but can not replace all the other methods, and there are still several problems which should be studiedproperly. For more serious cases and prolonged operations andandfor those patients who are nervous and poor-ly tolorate pain it is better to use the combined A. A. (i. e. to use 150 ml of 0.1% Procaine for infiltra-tion of the scalp at the side of incision and to give tranquillizers in adequate dosage) in order to getbetter results. This combined method is worth recommending to improve the effects of A. A. and spreadits application, as it can be readily accepted by both patients and surgeons.
摘要:我院从1976年起,在完成全国协作组所规定的三组穴位临床研究任务之后,在临床上又自选扶突透翳风穴应用于颅脑手术,至1979年11月共施行了67例手术,针麻效果较良好。现资料报告如下:From January 1976 to November 1979, sixty-seven cranial operations were successfully performedwith acupuncture anesthesia by means of needling Yifeng (S. J. 17) through Futu (L. I. 18). Amongthe patients 48 were males and 19 females, their ages ranging from 16 to 67 years. The underlying dise-ases included tumors of the hypophysis, cerebellum, c-p angle, glioma, acoustic neuroma, metastatictumors, brain abscesses, intracranial hematonia, trigeminal neuralgia and lesions of the cranium or scalpetc. Patients chosen for acupuncture anethesia were those who were consciotis, non deaf-mute, withoutobvious mental disturbance and had been clearly diagnosed. Two 6 cm-needles were inserted at the points of Futu on both sides of the neck, to the depth ofthe deep fascia, with the needle being held 30-45 degrees to the skin surface and toward the points ofYifeng. After that the needles were fixed and connected to the out-put of G-6805 model stimulator.Electrical stimulation in consecutive wave-form, frequency 500/min, was delivered with the intensityincreased gradually and not beyond the patient's tolerance. The induction lasted half an hour. All pa-tients were given sodium luminal 0.1 gm intramuscularly 30 minutes before operation, and some of themreceived atropin 0.5 mg or scopolamin 0.3 mg by intramuscular injection. Before skin incision, as aroutine, Dolantin (1mg/kg body weight) was injected intravenously. Epinephrin 0.3-0.5mg diluted in NS 150-200ml was infiltrated into the hypodermis to len bleeding during the skin incision. The anesthesia results were evaluated in 4 grades according to the criterion put forward by theChina Acupuncture Anesthesia Coordination Group (CAAC). There were 28 cases for grade Ⅰ(41.8%),25 cases for grade Ⅱ(37.3%), Ⅱ cases for grade Ⅲ (16.4%), and the remaining 3 cases for gradeⅣ since they required other anesthetics to finish the operation. Hence 64 cases (95.5%) were consideredto be successful. Acting on the principle of channels and collaterals and considering the distribution of nerve seg-ments, the points of Futu and Yifeng on both sides of the neck were selected for anesthetic stimulationin operations of the anterior, middle and posterior cranial fossa. There were no significant differencesin the anesthetic results among these three regions of operation statistically (P>0.05) and none whencompared with the rssults of other three groups using (Quanliao, Ear acupuncture, and Body acupunc-ture, put forward by CAAC (P>0.05). Therefore, the method mentioned above is effective in cranialoperations. It has the advantages of passing through three Yang Channels in the hands and reachingthose in the feet directly or indirectly, all being near the operative area. Mereover it is simple, effec-tive, and easy to handle. The main problem to be solved is the incompleteness of analgesia, that is tosay, pain could be felt during skin incision. It demands further efforts to improve the operative steadi-ness accuracy, softness and quickness.
摘要:我院在1979年6月前共作甲状腺针麻手术482例,成功率99.5%,优良率79.0%。男性103例,女性379例。年龄最大73岁,最小16岁。病种有甲状腺腺瘤、甲状腺囊肿(包括腺瘤囊性变)和甲状腺机能亢进。手术方式为甲状腺次全切除。电麻仪用北航57-6或G6805,刺激频率;邻近穴100赫芝,远端穴5~10赫芝,均连续波,刺激强度以病员能耐受的最大刺激强度。针麻效果采用三级评定法,把原Ⅲ、Ⅵ级合并为Ⅲ级,482 cases of thyroid surgery were performed up to June 1979. The successful and excellent rateswere 99.5% and 79% respectively. Among the patients, 103 were male and 379 were female. The age of the patients ranged from 16- 73. According to the analysis of data, the analgesic effect of acupuncture anesthesia was to some extentclosely related to the needling points, age, kind of underlying disease, duration of operation and adju-vant drugs, but not related to sex. 1. Comparing the excellent and good rate between the groups of "Futu" "Hegu-Neiguan" as wellas "Zusanli-Shangjuxu" points by means of the X2 test, the X2 test, the X2 value was 5.46 (P>0.05) showing nostatistical significance. According to the analysis of the 1st and the 3rd grade rate in the above mention-ed groups, the former was in "Futu" group the highest, amounting to 38.7%; the Hegu-Neiguan groupranked 2nd, amounting to 31.9%; and the lowest was in the Zusanli-Shangjuxu group amounting to28.6%. The latter rate in both Futu and Hegu-Neiguan groups amounted to 20%, while in the Zusanli-Shangjuxu group the rate was comparatively lower (25%). 2. Comparing the analytic effect of acupuncture analgesia of different age groups the youth group,the middle aged group and the aged group, the middle-aged group was better than the other two groups,since the excellent rate was the examined by X2 value was 5.46 (P>0.05) showing nostatistical significance. According to the analysis of the 1st and the 3rd grade rate in the above mention-ed groups, the former was in "Futu" group the highest, amounting to 38.7%; the Hegu-Neiguan groupranked 2nd, amounting to 31.9%; and the lowest was in the Zusanli-Shangjuxu group amounting to28.6%. The latter rate in both Futu and Hegu-Neiguan groups amounted to 20%, while in the Zusanli-Shangjuxu group the rate was comparatively lower (25%). 2. Comparing the analytic effect of acupuncture analgesia of different age groups the youth group,the middle aged group and the aged group, the middle-aged group was better than the other two groups,since the excellent rate was the examined by X2 test; the X2 test; the X2 value of the middle aged-youth groups andthe middle-aged-aged groups were 30.27 and 12.05 respectively being statistically significant (P<0.01). 3. Comparing the analgetic effect of acupuncture analgesia according to the underlying diseases, thecysts, adenoma and hyperthyroidism, the X2 value of the middle aged-youth groups andthe middle-aged-aged groups were 30.27 and 12.05 respectively being statistically significant (P<0.01). 3. Comparing the analgetic effect of acupuncture analgesia according to the underlying diseases, thecysts, adenoma and hyperthyroidism, the X2 test showed that the X2 test showed that the X2 values for cyst-hyperthyroidismgroup and adenoma-hyperthyroidism group were 6.72 and 10.2 respectively, statistically very significant.For the cyst and adenoma group, the X2 values for cyst-hyperthyroidismgroup and adenoma-hyperthyroidism group were 6.72 and 10.2 respectively, statistically very significant.For the cyst and adenoma group, the X2 value was 0.65 with no statistical significance. 4. Comparing the surgical duration of over three hours with that of below 3 hours, the X2 value was 0.65 with no statistical significance. 4. Comparing the surgical duration of over three hours with that of below 3 hours, the X2 value was11.24, thus being statistically significant (P<0.01). 5. when comparing the analgetic effect of acupuncture analgesia using Adjuvant drug Dolatine alonewith that of the group using Dolatine combined with Scopolamine, the X2 value was11.24, thus being statistically significant (P<0.01). 5. when comparing the analgetic effect of acupuncture analgesia using Adjuvant drug Dolatine alonewith that of the group using Dolatine combined with Scopolamine, the X2 value was 8.42 being statisti-cally very significant (P<0.01). 1. It is considered that every needling point has its relative features. It tends to be that the anal-getic effect of adjucent points is better than that of the remote points. 2. It is considered that individual variations exist and the analgetic effect in middle aged people ismore stable than that in the youth and the aged. 3. It is considered that the analgesic effect is affected by adjuvant drugs. The analgesic effect ofusing Dolantine alone is better than using Dolantine combined with scopotamine. 4. It is also considered that the simpler the underlying disease, the easier the surgical operation,and the shorter the surgical duration, the better the effect of acupuncture analgesia. In short, inspite of the good effect of acupuncture analgesia in thyroidectomy, there still exists thedisadvantage of incomplete analgesia and many other factors that effect the results. If the appropriatepoints are well selected, and adjuvants applied resonably the surgical techniques are improved and the con-fidence of patients in acupuncture analgesia is fully encouraged, the analgesia effect can certainly beenhanced.
摘要:大量研究资料反复证明,脑内5-羟色胺(5-HT)能神经元系统在针刺镇痛中有着重要作用。激活或加强这个系统的神经传递,针刺镇痛效应得到提高;相反,破坏或减弱这个系统的神经传递,则针刺镇痛效应明显降低。我们以往的动物实验结果表明,胰岛素和氨茶碱在提高脑内5-HT含量的同时,可明显提高大白鼠的针刺镇痛效应。为了验证上述动物实验结果,并探索提高临床针麻效果的可能途径,我们用双盲法观察了胰岛素和氨茶碱对临床针麻效Eor the purpose of verifying the experimental result that insulin and aminophylline could enhancethe analgesic effect of acupuncture in rats, 326 cases of abdominal tuboligation under acupuncture anest-hesia were observed clinically. Preoperative forecast of the effect of acupuncture anesthesia was madein all cases. Operation began after 20-30 min. induction with electrical needling "Ciliao", bilaterally.The efficiency of acupuncture anesthesta was scored according to the national unified 4-grade system aswell as to the multi-physiological parameters (mainly plethysmogram, combined with respiration, elect-romyogram, GSR and perspiration). Furthermore, the efficiency of acupuncture anesthesia was compa-red with the preoperative forecast, and the rate of transformation of the efficiency of acupuncture ane-sthesia was calculated. The observations were carried out by a double-blind method. The cases were divided into 5 groups(Insulin 8 units s. c., Insulin 12 units s. c., Aminophylline 0.2 gm p. o., Aminophylline 0.3 gm p. o.and local anesthesia) with their respective controls. The control of insulin group received saline s. c. asplacebo, while in the case of aminophylline the placebo was vitamin B_1 p. o. The drugs and placeboswere administered 1 hour before the operation. The results indicate that administration of aminophylline 0.2 gm enhances signilicantly the efficie-ncy of acupuncture anesthesia. Thus, the rate of excellence (Grade I) (71.43%) was greater as compa-red with the control group (42.86%) in 4-grade system, while according to the multi-physiological para-mters the excellence-good rate (Grade I+II) (100%) was greater than that of the control group (86.67%).The rate of transformation of the efficiency of acupuncture anesthesia was also greater than its controlgroup. Similar results were obtained in the Aminophylline 0.3 gm group. On the contrary, in both thegroups of insulin 8 and 12 units the efficiency of acupuncture anesthesia was not greater significantlyas compared with the control groups.
摘要:关于针刺产生镇痛效应,究竟是一种生理现象,还是由心理因素所引起,国外曾有不同的看法。在心理因素中,暗示或催眠暗示的作用曾引起特殊的注意。此外,还有工作发现,针刺主要对痛的情绪成分有较大的抑制作用。我们过去工作已经表明,针刺能使痛刺激引起的大脑诱发电位的晚成分(潜伏期为200毫秒左右的正相波)受到抑制。根据药物试验,也观察诱发电位的这一成分与痛The experiment was a further study to evaluate the role of suggestive factor in acupuncture anal-gesia, using cerebral potentials evokad by pain stimulation as the index of pain. It was also for theexploration of the effect of SDT method applied to pain study. Among 38 normal healthy volunteer adults, 30 in experimental group were evenly divided intopositive and negative suggestive subgroups, and 8 served as the control. Word induction suggestionmethod was employed. The results indicated: 1) After acupuncture, significantly inhibited were theP_(200) amplitude of the evoked potential (P.10), but the criterion ofpain teport was not changed. The change of d' was somewhat correlated with the P_(200) eamplitude ofevoked potential (P
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Beijing Cerebral Surgery Acupuncture Research Group
摘要:针刺麻醉的大量临床实践和实验研究已经证明,针刺具有调整和镇痛作用。可作为麻醉的手段之一。但心理因素,如其中的暗示作用,在针麻中有何意义,还存在不同看法。国外有人认为,针麻就是一种催眠暗示性的麻醉,多数人意见相反,有人进而用实验证明其机理是不同的。我国于1973年即有工作看到,暗示感受性高的人This study attempts to clarify: 1) the effectivity of suggestion on cutaneous sensation (electric touch,electric pain); 2) the relation between suggestibility and the effects of acupuncture anesthesia. 53patients for lung resection were used as subjects. The results were as follows: 1. The suggestive stimuli were word induction and observation of the amplitude scale of the oscil-loscope. After suggestion, electric tough and pain threshold increased by an average of 28.1% and20.3% respectively (P<0.001). 2. The suggestibility of pain was highly correlated with the sensitivity of pain, and the suggesti-bility of electric touch and electric pain as a whole, being highly correlated with the sensitivity of the4 cutaneous sensations compounded, also showed that the more sensitive patients were the more sugge-stible ones (P<0.01), and that the compound cutaneous sensitivity negatively correlated with the act-ual acupuncture results. 3. The increment of suggestibility had no significant correlation with the effects of acupunctureanaesthesia (P>0.1), but it appeared that patients showing favourable effects were scmewhat more sug-gestible. 4. The degree of patient's trust in the operator and in acupuncture anesthesia had a high correlat-ion with suggestibility. Patients showing more trust were the more suggestible ones. The degree of trustitself had no significant correlation with the effect of acupuncture anesthesia, but there were more pa-tients showing trust among the group with good effects. 5. According to these results a view is given that suggestion is not the main factor which determi-nes the effect of acupuncture anesthesia, yet it exerts a moderate influence in increasing or decreasingthe effect.
摘要:我们通过动物实验观察到刺激猫牙髓的大脑皮层诱发电位具有疼痛成分,并且可为电针穴位所抑制,这些结果有待在人体进行观察。针刺对人体大脑皮层诱发电中长潜伏期的晚期成分的影响已有报导,而对该诱发电中短潜伏期的早期成分,即反应特异性传导系统者,尚无观察分析资料。本工作试图探讨人体痛和非痛刺激所引起的The feature of evoked cerebral potential (ECP) by pain and non-pain stimulation was studied.The effect of electroacupuncture on each element of ECP was analysed, and their clinical significancediscussed. A series of experiments were carried out on 15 normal subjectswith non-pain stimulationand pain stimulation plus electroacupuncture. The following results have been obtained. (1) Non-pain ECP is a multiphasic complex wave which generally consists of P_1, N_1, P_2, P_3, 4-5elements. As the confident limit is 95%, its lower limit ts 69.2% and upper limit is 100%. (2) Pain ECP is also a multiphasic complex which generally consists of P1, N1, P2, N2, P3,N3, P4, 6-7 elements. As the confident limit is 95%, its lower limit is 55.5% and upper limit is 100%. (3) Comparing pain ECP with non-pain ECP, the latency of P_1-P_3 5 elements of pain ECP decre-ases (P<0.05), its amplitude increases (P<0.05) and its wave form is still more complex. FollowingP_3 two new elements (N_3, P_3) appear. These two elements may be nonspecific indications of pain. (4) There is no significant change in the latency and amplitude of ECP by non-pain stimulatingthe little finger while electroneedling Hegu. No significant change in intensity and nature of nonpainsensation can be perceived by the stibjects. (5) Significant inhibitory effect of electro-acupuncture on the later elements ECP has been obser-ved (P<0.05 ), but there is no inhibitory effect on earlier elements-P_1, N_1 (P>0.1).
摘要:近年来,许多作者报告内源性鸦片样物质(Endogenons Opiate Like Substan-ces,OLS)可以抑制腺苷酸环化酸,使脑内环化-磷酸腺苷(cAMP)含量降低。设法提高脑内cAMP的水平,则可对抗吗啡的镇痛作用。现已证明,内源性鸦片样物质在针刺镇痛过程中具有重要作用。在针刺过程中,脑内鸦片样物质亦明显升高。我们实验室还发现,给大鼠脑室注射cAMP,Rats were given electroacupuncture for 30 minutes and decapitated for determination of cerebralcAMP. There was a significant reduction of cerebtal cAMP with the elevation of pain threshold afteracupuncture. The content of cerebral cAMP was also recovered when analgesia had been disappeared afterstopping acupuncture. Intraventricular injection of Naloxon, an opiate receptor antagonist, may comple-tely reversed the lowering of cerebral cAMP, but it failed to block acupuncture analgesia. It can be suggested from the above results that there was a complex mechanism in acupuncture anal-gesia besides its effect on the endogenous opiate like substances and cAMP.
摘要:《内经》中关于刺法之论述很多,并进行了分类,有九刺、十二刺、五刺等。《灵枢、官针》篇中更有巨刺法(九刺中之一种)。“巨刺者,左取右、右取左”,是指在病取右,右病取左。我们的工作曾初步观察到当刺激穴位时,同侧穴位灌流液中乙酰胆硷(ACh)含量增加。巨刺时到底对非针刺侧之组织有些什么影响,对非针刺侧之神经末梢之递质产生哪些变化,是值得探索的。本试验系前文工作之一部分,观察了巨刺对于对侧相应部位的穴位灌流液Ach含The present investigation was intended to ascertain whether the method of selecting acupunctur.points will exert infIuence over the ACh content of acupuncture point. The effect of Ju Ci on ACh cont-ent of the fluid perfused from the acupuncture point of the opposite side was observed and comparedwith that from the acupuncture point of the same side. It was revealed that the mean value of AChreleased from the acupuncture point of opposite side was lower than that from the same side. Their dif-ference bad highly statistical significance (t=3.192, P<0.01). Results showed that the ACh content ofacupuncture points may be influenced by different methods of selection and suggested that the methodsof selecting points for needling may be important for the purpose of getting better analgesic or therape-utic effect of acupunture.
摘要:汉防己具有一定的镇痛和肌松作用。把汉防己总硷和针刺合并应用,是否是一种有利于提高针刺麻醉效果的复合措施?我们用家兔单侧电针镇痛模型,观察了汉防己总生物硷对动物电针镇痛效果的影响。实验材料及方法以体重1~2公斤的普通健康家兔为实The whole alkaloids of Radix Stephaniae Tetrandrae (dose 15mg/kg body wt., i. v.) and the stimu-lation of unilateral acupuncture points "Shenshu" "Lianchu" raised the pain thresholds of the rabbit'sdigital webs about 30% higher than that of the control (34.4±6% and 37.3±3% respectively). The anal-gesic effect was significantly diminished, while the acupuncture was combining with an intravenousdose of the whole alkaloids. On the unpunctured side of the combination treatment cases, the pain threshold was higher than onthe punctured side. But in the cases treated with acupuncture alone, the pain thresbold was always higheron the punctured side. This reversion phenomenon and the significant diminution of pain threhold onthe punctured side of the combination treatment cases, indicate that the whole alkaloids of rad. stephaniaetetrandrae is an antagonistic in acupuncture analgesia. The mechanism underlying this antagonistic ef-fect is unknown.