摘要:我院将胃切除术病人分为针刺复合硬膜外麻醉(简称针药组)和硬膜外麻醉(简称对照组)各10例进行比较,从中探讨针刺复合麻醉下的针刺镇痛的效应。两组病例系随机交替进行。故两组性别、年龄和手术时间等均相近似(病种见表1)。除麻醉医生固定外,术者、病人以及手术方式等没有特别要求,均按常规进行。方法 (一)穴位和刺激方法穴位:至阳、脊中。刺激方法:脊中穴接正极,用G6805针The effects of combined acupuncture anesthesia in subtotal gastrectomy were observed. The atients were Prandomly divided into two groups, with 10 patients in each group. Combined acupuncture anesthesia with epidural anesthesia was used in one group(acupuncture plus epidural drug, AD) and epidural anesthesia in the other(control, C). Comparison was done betwe- en the two groups. The case, the sex and age of the patient, and the du- ration of operation were similar in the two groups. Apart from the ane- sthesiologists who were regular in the study, the patients, the operators and the operative patterns were not specially selected. The puncture sites for epidural anesthesia were at T8-T9 and the ca- theters were inserted in 3 cm upwards. The mixture of 1% lidocaine and 0.15% dicaine was used. The premedicatant was sodium luminal 0.1g. A- gain, dolantin 50-75 mg or mixture of dolantin and phenergan 2 ml was injected intravenously just before the incision. The acupuncture points used in AD group were Zhiyang and Jizhong. The total dosage of anesthetic used in each patient and the dosage used per hour were 13.9 ml and 5.3 ml respectively in the AD group and 29.1 ml and 10.4 ml in the C group. There were significant differences between the two groups (P<0.01). The differences in dosage were also found in the same age grade of the two groups(P<0.01). In the AD group, the me- an dosages were 14.6 ml in patients aged 27-45 and 13.2 ml tin those aged 46-65. In the C group, they were 28.0 ml and 29.57 ml respectively. The anesthetic effects were satisfied and were similar in the two groups. Besi- des one case of degree II in the AD group, the remainders were all belong to degree I. The dose of ephedrine used in each case was 11.5 ml in AD group and 20 ml in C group. By combined acupuncture anesthesia, not only the anesthetic effect was promoted but less dose of anesthetic was required, thence raising the safe- ty and reducing the complication during the anesthesia. which is particula- rly preferable for the severely ill patient. However, so far as the spla- nchno-dragging pain, the post-operative pain, or, air exhaust from bowels is concerned, the after-effect of acupuncture anesthesia was not fully ma- nifested in the AD group. The reasons for this may be follows: 1) the a- cupuncture points being just in the area that was blocked by epidural blo- ckade; 2) the patients, the cases being free from selection and the opera- tors and the patterns of operation being free from restriction, thus, more local anesthetics being required; 3) in some cases, the induction period be- ing not achieved thereby affecting the accumulation of acupuncture stimuli and the elaboration of acupuncture effects. We believe that is the combined acupuncture anesthesia done, the acu- puncture points snould be selected in the limbic areas outside the regional block. principally, the acupuncture sensation should be maintained throug- hout the duration and the effect of acupuncture could be elaborated fu- lly.
摘要:我们曾设想大脑皮层参与疼痛和针刺镇痛过程的调节机制除通过各种信息在皮层内发生整合作用外,尚有可能通过某些信息(包括针刺信息)激活皮层后产生的下行性作用。最近我们的工作表明以γ-氨基丁酸(GABA)滤纸施加于猫的大脑皮层体感Ⅱ区(SⅡ)后,电针对丘脑束旁核(Pf)伤害性反应的抑制效应被取消。在另一批实验中以2%利多卡因滤细施加于猫的SⅡ后,电针可取消丘脑中央中核(CM)的伤害性反应。这些结果提示SⅡ可能参与针刺镇痛的下行性调节。国内有资料报道刺激家兔大脑皮层体感Ⅰ区(SⅠ)可影响丘脑Pf及In our laboratory it was reported when GABA or 2% Lidocarine was placed on SII topically the acupuncture effect on nociceptive response of pf or CM neuron was abolished or decreased. This result suggested that the corticofugal modulation from SII may play a role in acupuncture ana- lgesia. In order to get further information about this problem. In the pre- sent study the effect of acupuncture on nociceptive response of pf neuro- ns which were observed on the background of SII glutaminized topically was investigated. The experiment was carried out on cats. The methods was as same as the previous work except glutamine was placed on the SII topically. The result showed on the background of SII glutaminized topically the discharge of majority of pf neurons induced by noxious stimlation might be inhibited by electroacupuncture "Zusanli" "Huantiao". The duration of acupuncture effect maintained for 10 minites. This inhibitory duration were longer than that of saline control group, but there were no statistical signi- ficance as compared in both. It was demonstrated from this experiment at least there was a difference between GABA and glutamine. The former exe- rted a decrease effect on acupuncture analgesia, while the later just exerted an opposite effect on it. Thus it may be considered that corticofugal infl- uence activated by acupuncture is involved in the modulation of nociceptive response of pf neurons.
摘要:我们以往的工作证明电针大鼠“足三里”可激活中缝大核(NRM)神经元,并抑制其伤害性反应。这种效应可被纳洛酮所翻转。NRM是下行抑制系统的主要起源部位又可看做脑内镇痛系统的最后驿站。它的活动的受脑内高位镇痛中枢的调控,在整体内发挥镇痛作用。我们以往研究了导水管周围灰质(PAG)和尾核对NRM的调控作用,看到损毁PAG和尾核头部后电针“足三里”的镇痛作用均明显减弱。代核为位于脑中线附近的结构,有吗啡受体及脑啡肽能神经纤维的分布。伏核微量注射吗啡可引起镇痛作Our previous work demonstrated that periaqueductal gray matter (PA G) and head of N. caudate participate in the effect of EA on neuron of N. raphe magnus (NRM), and the action involve in endorphin within them. N. accumbens (NAC) was a structure near the middle line of brain, in which there were some enkephalinergic fibers and opiate receptor. But it is unknown whether it participates in the effect of EA on neuron of NRM, a origin of the descending pain inhibitory system. To solve the problem the unit discharge of NRM in the rat was recorded extracellularlywith glass microelectrode, and the effect of EA on it was observed after lesion of bi- lateral NAC with electrolysis. The results were obtained as follows. 1. The effect of EA of "Zusanli" on the excitatory neurons of NRM (n=13) were observed. The increase of spontaneous discharge at o, 5 and 15 min and decrease of nociceptive response at o - 20 and 30 min a- fter EA for 5 mins was statistically significant. 2. After lesion bilateral N. accumbens, the effects of EA on the excitatory neuron in NRM (n=15) were obviously diminished. The spo- ntaneus discharge was only activated at o min, but at 5 - 30 min they all were approached the control level before EA. The nociceptive response was only lower than control at o min, and it was higher than control level at 5~30 min, even it was quite evident at 15~20 min. The data suggest N. accumbens participate in the analgesia induced by activation of EA on NRM neuron. 3. Aftter lesion of bilateral N. accumbens, the effect of injection (i.p.) of fentanyl on NRM neurons had not evident change. Nociceptive response was inhibited, and it was statistically significant at 15, 20 min. But the effect was lower than control group (7 excitatory neurons.) Sponta- neus discharge was also inhibited for a certain degree. The results showed that the influence of N. accumbens on effect of opiates was weaker than EA.
摘要:尾核不但参与躯体运动的调节,也和感觉机能有关。我们以往的工作表明,刺激大鼠尾核头部能够激活大多数中缝大核(NRM)神经元的自发放电和抑制其伤害性刺激诱发的反应;在尾核头部前区微量注射吗啡也能明显地抑制NRM神经元的伤害感受性反应;电针“足三里”穴激活NRM神经元自发放电和抑制伤害感受性反应的效应在电解损毁双侧尾核头部后明显降低。这些结果均表明,尾核头部参与对疼痛的调节和控制;其效应至少有一部分是通过脑Experiments were performed on the male rats (250-350g) anesthetized with urethane (1.0g/kg i. p). The unit discharge of nucleus raphe magnus (NRM) was extracellularly recorded with glass microelectrode. The influ- ences of naloxone and DA injected in the head of caudate nucleus on effect of electroacupuncture (EA) upon NRM neurons were observed. 1. Influence of naloxone microinjected in the head of caudate nucleus on effect of EA The firing rate of major NRM neurons was not altered and nociceptive response was slightly increased by the operation itself of microinjectng na- loxone in the head of caudate nucleus (n=10). But after injection of na- loxone (5μg/ 1μl on each side, n=17) into the caudate nucleus, the effect of EA on NRM neurons was clearly attenuated. The naloxone administrarion group was compared with the control group injected saline in the caudate nucleus (n=15), the reduction of inhibition of EA on the nociceptive re- sponse was statistically significant during 1-25 min. These results suggested that the effect of EA on NRM neurons could be abolished by local injecti- on of naloxone into the head of caudate nucleus and that OLS in this re- gion was involved in the acupuncture analgesia. 2. Influence of DA microinjected in the head of caudate nucleus on effect of EA The firing rate and its nociceptive response of major NRM neurons we- re unaffected by the operation itself of microinjecting DA into the caudate nucleus (n=12). The effect of EA on NRM neurons was not evidently attenuated following local injection of DA (4μg/1μl on each side. n=16) into the caudate nucleus, but the post-effect of EA was obviously shortened by DA. Compared with control group injected saline, the difference of noci- ceptive response in both was satistically significant during 10-15 min. These result suggested that the effect of EA on NRM neurons could be shortened by local injection of DA into the head of caudate nucleus and DA in this region played some antagonism on acupuncture analgesia.
摘要:在针麻原理研究中,已证明针刺镇痛与中枢神经递质有关,其中对5-羟色胺(5-HT)能神经系统的关系更为密切。然而在针刺镇痛后对动物各脑区5-HT含量的影响,各家报道并不完全一致。已有报道在电针后可使小白鼠皮层及丘脑中5-HT含量升高,为进一步阐明针刺镇痛与中枢5-HT能神经元系统的关系,本文用荧光法测定大白鼠针刺镇痛后纹状体及脊髓中5-HT及5-羟吲哚醋酸(5-HIAA)含量的变化,同时也观察了对去甲肾上腺素(NE)及多巴胺(DA)含量的影响。兹将初步结果报道如下:It is well established that the effect of acupuncture analgesia was relevant to the transmitters of CNS, especially to the serotoninergic neuronal system in the brain However, the reports about the effect of acupuncture on the serotonin (5-HT) levels in brain areas were varied. In order to further expose the relationship between acupuncture analgesia and serotninergic neuronal system in CNS, the present study estimates the changes of 5-HT and 5-hydroindole acetic acid (5-HIAA) levels in the striata and spinal cords in rats during acupuncture. At the same time we also observed the changes of levels of norepinephrine (NE) and dopamine (DA). Rats of either sex, weighing between 160-200g, were used. Electro- acuupuncture wes applied to the points on the upper and lower lips of rats corresponding to "Renzhong" and "Chengjing" in man respectively. The analgesia effects of electro-acupuncture were estimated the changes of pain threshlod by tial flick method. Rats were killed by decapitation, the striata and spinal cords were rapidly removed and then 5-HT, 5-HIAA, NE and DA measured were immediately by means of fluorometeric method. The results were obtained as follows: 1. Elevation of pain threshold in rats after electro-acupuncture was 341.02% (N=12. P<0.001). 2. The levels of 5-HT and 5-HIAA in striata of rats with electroacu- puncture increased by 14.70%. (N=11, P<0.05), 41.04% (N=7, P<0.01) as compared with the control group, and those in spinal cords were 18.13% (N =11, P>0.05) and 21.70%, (N=11 P<0.05), respectively. 3. The levels on NE in both tissues did not change significantly, while those of DA in striata, increased but there was no ststistical significance. The results suggest that both ascending and descending 5-HT pathways play an important role in the acupuncture analgesia.
摘要:穴位处痛阈的高低与该处皮肤组织内神经成份的数量及种类究竟有无关系?穴位皮肤局部神经成份及数量与该处电针诱导后对提高全身痛阈有无关系?假若穴位局部应用交感神经化学切断剂后对穴位处痛阈有无影响?这些问题都值得探讨。材料和方法本实验共选用21只雄性大白鼠。 (一)选用雄性大白鼠6只,用WQ-PE型痛阈测量仪于安静、稳压的情况下,每次按序测量相当于“足三里”、“环跳”、“涌泉”、“劳宫”、“承浆”和“人中”等六个The relationship between the pain threshold and acetylcholinesterase(A- ChE) or cholinesterase(ChE) positive nerves in the skin at acupoints of ma- le ratswas observed by means of histochemical methods. It was found that the more the AChE positive nerves including the endings, small trunks and ne- rves surrounding the arteriole in the skin at acupoint, the lower the local pain thresholds of the acupoint (measured at the acupoint-skin). After the acupoints were electro-acupunctured for 30 minutes, although there was a marked rise of general pain threshold measured at the rats' tail, the elevated level after needling the acupoints containing more AChE-positive nerve endings was lower than that after needling those containing less nervous elements. The results may imply that to elevate the general pain threshold of the rat does not need to choose the acupoint which is rich in AChE posi- tive nerves. If the sympathetic nerves in the skin of acupoint has been in- jured by 6-OHDA, a marked decrease of local pain threshold of skin can be estimated. This indicates that the peripheral sympathetic nerve may have certain effect on the afferent conduction of painful information.