经皮穴位电刺激对咪达唑仑镇静作用的影响

目的:探讨经皮穴位电刺激对咪达唑仑镇静作用的影响。方法:选择在我院择期椎管内麻醉行骨科下肢手术患者80例,随机分为两组:经皮穴位电刺激组和对照组,每组均40例。经皮穴位电刺激组在完成椎管内麻醉后开始给予经皮穴位电刺激,刺激参数频率2/100 Hz,波宽0.2~0.6 ms,调节刺激电流至患者可耐受的最大强度,穴位选择双侧合谷穴、内关穴,20 min后靶控输注咪达唑仑。对照组患者在相应穴位贴电极片,并连接刺激器,不予电刺激。对患者进行警觉/镇静(OAA/S)评分,依据脑电双频指数(BIS)调整咪达唑仑靶控输注浓度。观察并记录OAA/S评分首次为3分时的目标靶浓度(Ce)、BIS、咪达唑仑用量、平均动脉压(MAP)、血氧饱和度(SpO2)、心率(HR)及氟马西尼使用和不良反应发生情况。结果:经皮穴位电刺激组在OAA/S评分首次为3分时咪达唑仑效应室靶浓度较对照组低[(60.3±8.0)ng/mL vs.(66.8±8.5)ng/mL],经皮穴位电刺激组的咪达唑仑用量少于对照组[(4.9±0.6)mg vs.(5.3±0.5)mg],差异均有统计学意义(P<0.05);经皮穴位电刺激组术后应用氟马西尼12例,低于对照组的28例,差异有统计学意义(P<0.05);2组间BIS、SpO2、MAP、HR差异无统计学意义。结论:经皮穴位电刺激能够增强咪达唑仑的镇静作用,减少咪达唑仑用量。     

经皮穴位电刺激对不停跳冠状动脉搭桥术患者术后神经认知功能的影响

目的 探讨术中经皮穴位电刺激（TEAS）对不停跳冠状动脉搭桥术患者术后神经认知功能（PND）的影响。方法 不停跳心脏冠状动脉搭桥术患者82例,男59例,女23例,年龄55~85岁,BMI 18~29 kg/m²,ASA Ⅱ或Ⅲ级,随机分为两组：对照组（n=42）和TEAS组（n=40）。所有患者均行全凭静脉麻醉。术前在患者的内关穴、合谷穴、大椎穴贴上特定电极片,连接韩式穴位神经刺激仪。对照组电流设置为0 mA,TEAS组电流设置为患者可以忍受但不致疼痛的最大水平,电刺激持续时间为手术开始至术毕。于术前1 d（T0）和术后7 d（T4）时行神经心理学测试,包括一套组合的测试量表,根据Z-计分法评估患者是否发生PND。于T0、术后5 min（T1）、术后1 d（T2）、术后3 d（T3）时抽取静脉血5 ml,测定血清肿瘤坏死因子（TNF-α）、白细胞介素1（IL-1）、白细胞介素6（IL-6）、S100β、丙二醛（MDA）和总抗氧化能力（T-AOC）浓度。记录电刺激相关不良反应的发生情况。结果 T0时两组神经心理学测试差异无统计学意义,T4时TEAS组MMSE和HVLT明显高于对照组（P<0.05）。TEAS组PND发生率明显低于对照组[8例（20.0%）vs 17例（40.5%）,P<0.05]。T0时两组血清TNF-α、IL-1、IL-6, S100β、MDA和T-AOC浓度差异无统计学意义,T1时TEAS组TNF-α,IL-1和MDA浓度明显低于对照组(P<0.05),T1—T3时TEAS组IL-6和S100β浓度明显低于对照组 (P<0.05)。两组不同时点T-AOC浓度差异无统计学意义。两组均无一例电刺激相关不良反应。结论 冠状动脉搭桥术患者术中应用经皮穴位电刺激可减少全身炎症反应,降低术后神经认知障碍发生率。     

电针配合神经生长因子对脑缺血大鼠学习记忆能力的影响

Objective To observe the effect of nerve growth factor(NGF)and electro-acupuncture(EA) on learning and memory in rats with cerebral ischemia.Methods An experimental model of cerebral ischemiareperfusion was established in 40 rats,who were then randomly divided into a model group,a sham operated group,a NGF group,an acupuncture group and a NGF plus acupuncture group.Three weeks were allowed for the recovery of the blood-brain barrier lesion caused by ischemia-reperfusion before intravenous injection of NGF(10μg/kg,once daily for 15 days)via the vena caudalis.In the two acupuncture groups,this was administered in combination with EA at the Baihui(DU20)and Yamen(DU15)acupoints(frequency 100 Hz,2 mA,20 min/time,once daily for 15 days).Morris' water maze test was used to assess any changes in spatial learning and memory abilities.Results The ischemic rats showed significant learning and memory disorders compared with the sham-operated group.In the NGF group,the rats' learning and memory abilities did not impmve significantly compared with the model group and the EA group.Significantly better learning was observed in the NGF+EA group compared with the model group,the EA group and the NGF group.Conclusion NGF combined with EA can improve the learning and memory abilities of rats with learning and memory dysfunction caused by cerebral ischemia-repedusion.     

高压氧联合电针八髎穴对脊髓损伤神经源性膀胱患者尿动力学的影响

目的：分析高压氧（HBO）联合电针八髎穴治疗对脊髓损伤神经源性膀胱患者尿动力学的影响。方法：将60例脊髓损伤神经源性膀胱患者,按随机数字表法分成对照组20例、电针组20例、联合组20例,各组均接受常规膀胱功能训练,电针组增加电针治疗,联合组增加电针治疗及高压氧治疗,分别于治疗前和治疗8周后通过尿流动力学检查及排尿日记评价3组患者的膀胱功能,并进行统计学分析。结果：治疗前3组患者的充盈期逼尿肌压(Pdet)、膀胱顺应性（BC）、最大尿流率(Qmax)、残余尿量（RV）组间差异均无统计学意义。治疗8周后,3组患者BC及Qmax明显高于治疗前(均P＜0.05),Pdet及RV明显低于治疗前(均P＜0.05)。治疗后组间比较,电针组及联合组患者BC及Qmax明显高于对照组(均P＜0.05),Pdet及RV显著低于对照组(均P＜0.05);联合组BC及Qmax明显高于电针组(均P＜0.05),Pdet及RV显著低于电针组(均P＜0.05)。治疗后,3组患者日平均排尿次数、日平均尿失禁次数均明显少于治疗前(均P＜0.05),日平均单次尿量、下尿路症状（LUTS）评分均明显高于治疗前(均P＜0.05)。治疗后组间比较,电针组及联合组日平均排尿次数、日平均尿失禁次数均明显少于对照组(均P＜0.05),日平均单次尿量、LUTS评分均明显高于对照组(均P＜0.05);联合组日平均排尿次数、日平均尿失禁次数均明显少于电针组(均P＜0.05),日平均单次尿量、LUTS评分均明显高于电针组(均P＜0.05)。结论：高压氧联合电针八髎穴治疗能有效改善脊髓损伤神经源性膀胱患者尿动力学及排尿功能,提高生存质量,该方法值得临床推广。     

经皮穴位电刺激镇痛在乳腺癌根治术中的应用

目的 观察经皮穴位电刺激(Transcutaneous electrical acupoint stimulation,TEAS)用于乳腺癌根治术的镇痛效果.方法 择期行乳腺癌根治术患者60例,ASA分级Ⅰ或Ⅱ级,年龄30～60岁,体重50～80kg,采用随机数字表法,按1∶1比例分为对照组(GA组)和经皮穴位电刺激组(EA组),各30例.GA组在进行手术操作前,选择双侧合谷穴(LI4)、内关穴(PC6)和足三里(ST36)连接华佗电子治疗仪(V型),不进行穴位电刺激;EA组连接华佗电子治疗仪(V型)进行穴位电刺激30min.麻醉诱导:靶控输注异丙酚,血浆靶浓度4μg/ml,静脉注射芬太尼3μg/kg和维库溴铵0.1mg/kg.喉罩插管后行机械通气,维持PETCO2 35～45mmHg.麻醉维持:靶控输注异丙酚,血浆靶浓度2～4μg/ml,微量泵输注瑞芬太尼10～25μg·kg-1·h-1,维持Narcotrend在D2～E1 (46～20)之间,根据Narcotrend监测结果及血流动力学调整异丙酚和瑞芬太尼泵注速度.分别于电针前(T0)、电针结束时(T1)、诱导前(T2)、插管后5min(T3)、切皮前即刻(T4)、手术结束(T5)、拔管后即刻(T6)、拔管后5min (T7),记录HR、MAP、PETCO2、SpO2、Narcotrend数值.记录患者苏醒时间、拔管时间、术中麻醉药物瑞芬太尼和异丙酚用量、术后VAS评分及术后恶心呕吐(PONV)的发生率.结果 与GA组比较,EA组T3～T5时HR、MAP更平稳,瑞芬太尼用药量明显减少,苏醒时间、拔管时间缩短,PONV发生率降低(P＜0.05).结论 在乳腺癌改良根治手术中,TEAS复合全麻有良好的镇痛镇静作用,能减少麻醉药用量,减轻全麻术后的不良反应.     

中药穴位敷贴治疗儿童哮喘基础和临床研究现状

从基础研究和临床研究2个方面,包括中医理论研究、实验研究、总体疗效、改善症状、调理体质、疗程时间等,总结了中药穴位敷贴治疗儿童哮喘的研究现状。指出今后研究可设计大样本以便随机对照临床试验研究,同时可在穴位敷贴对儿童中医体质的改善方面开展,以期探讨穴位敷贴的中医作用机制。     

慢性粒细胞白血病的骨髓组织病理学研究

应用国产塑料包埋剂对23例慢粒慢性期患者进行了骨髓塑包切片的组织病理学研究,证明慢粒属于异质性疾病,分两类组织学亚型:即以粒系细胞极度增殖为主的粒细胞(GRAN)型和以粒系细胞—巨核细胞混合性增殖,且伴巨核细胞多形性与异位的粒细胞/巨核细胞(GRAN/MEG)型。本文对两型的其它组织学特点一并进行了讨论。     

大椎穴贴敷配合盐酸西替利嗪片治疗过敏性鼻炎60例临床疗效观察

目的观察大椎穴贴敷配合盐酸西替利嗪片治疗过敏性鼻炎的临床疗效。方法针对过敏性鼻炎患者60例为研究对象,根据就诊号先后次序排序后,再采用数字随机表将其分成治疗组和对照组,对照组采用盐酸西替利嗪片口服治疗,治疗组采用盐酸西替利嗪片口服治疗联合大椎穴穴位贴敷治疗,两组治疗前、后采用“症状量化评分表”量化症状,对比分析两组患者的治疗效果。结果治疗组总有效率93.3%,对照组总有效率90.0%。两组治疗量化结果显示:治疗后,患者过敏性鼻炎症状明显改善,治疗组治疗效果稍优于对照组,经过统计学软件SPSS 23.0分析,差异性存在统计学意义(P<0.05)。结论在采用不同治疗方法治疗过敏性鼻炎患者过程中,观察发现:贴敷大椎穴对鼻塞症状改善明显,能够补充口服盐酸西替利嗪片在缓解鼻塞上的不足,故选择采用安全易行的大椎穴贴敷联合盐酸西替利嗪片口服治疗过敏性鼻炎能够起到令人满意的治疗效果,在临床中值得推广使用。     

Effect of auricular point pressing therapy on postoperative pain of fracture: A protocol for systematic review and meta-analysis

Background:In clinical practices, postoperative fracture patients are often treated with analgesics. As one of the alternative therapies for nondrug analgesia, auricular point pressing has advantages of simple operation, easy to use, no injury and adverse reactions, and great potential for development. In this study, the effect of auricular point pressing therapy on postoperative pain of fracture was objectively evaluated through the method of meta-analysis, so as to provide evidence for clinical applications.Methods:PubMed, Web of Science, Cochrane Library, EMBASE, Wan fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, and Chinese Biomedical Literature Database were systematically searched and randomized controlled trials on auricular point pressing in the treatment of postoperative pain after fracture were includes. After independent literature screening, data extraction and quality evaluation by 2 researchers, the original data was retrieved, merged, and analyzed. RevMan 5.3 software was adopted for meta-analysisResults:This study could provide high-quality evidence to evaluate the effect of auricular point pressing therapy on postoperative pain of fracture.Conclusion:This systematic review explored whether auricular point pressing therapy is effective on the intervention of postoperative pain after fracture.OSF Registration Number:DOI 10.17605/OSF.IO/AZ4JQ.     

The clinical efficacy of acupoint sticking combined with massage to treatment functional dyspepsia: A protocol of systematic review and meta-analysis

Background:The objective of this meta-analysis was to summarize and identify the available evidence from studies to estimate the clinical value of acupoint sticking combined with massage (ASM) in the treatment of functional dyspepsia (FD), and provide clinicians with evidence on which to base their clinical decision making.Methods:This review will include all studies comparing clinical efficacy of ASM in the treatment of FD. The search strategy will be performed in 10 databases. We will not establish any limitations to language and publication status, published from inception to the August 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is alleviation of global dyspeptic symptoms, alleviation of individual dyspeptic symptoms, quality-of-life improvement, and safety. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software.Results:This study will summarize current evidence to assess the efficacy and safety of ASM in the treatment of FD.Conclusion:The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as studying the value of ASM.Registration number:INPLASY2020110072 (DOI number: 10.37766/inplasy2020.11.0072).