针药结合麻醉下行新声门再造术

自 1 996～ 2 0 0 0年在针药结合麻醉下作新声门再造术 30例 ,其针麻成功率为 97% ,新声门再造手术成功率达 93%。选用 30例曾于全麻下行喉再造的病人 ,其声门较窄 ,使呼吸道不够通畅 ,术后长期戴用气管套管 ,未能及时去管 ,故收治作新声门再造术。针麻方法采用两侧扶突、合谷穴。使用电针刺激 ,刺激频率为 6 0 0次 /ｍｉｎ ,强度以病人产生酸、胀、重、麻并以能耐受为度。针刺诱导时间为 2 0ｍｉｎ。辅助用药于术前 1 5～ 2 5ｍｉｎ分别肌肉注射哌替啶 1ｍｇ/ｋｇ,颅痛啶 6 0ｍｇ ,甲氧氯普胺 1 0ｍｇ。咽喉部粘膜表面喷 1 %地卡因 1～ 2ｍ…

Application of Acupuncture Anesthesia Combined with Analgesics to Neoglttis Reconstruction

30cases of new glottic reconstruction were performed under acupuncture anesthesia combined with drugs from 1996 to 2000. In these 30 cases of glottic stenosis after laryngeal reconstruction under general anesthesia, the lumen of the larynx was not much larger than was required for respiration. So all these patients tracheotomized could not be decannulated because of stenosis. A new glottic reconstruction under acupuncture anesthesia combined with drugs was performed in above mentioned 30 patients. Bilateral Futu (ST 32) and Hegu (LI 4) were punctured and stimulated electrically by setting the stimulating frequency of 100 Hz, a bearable strength and duration of 20 min after achieving sore, numb, heavy and distending needling sensations. Pethidine 1 mg/kg, rotundine 60 mg and metoclopramide 10 mg were given intramuscularly to each case as the supplementary medication 15 minutes before operation. Dicaine solution 1% was sprayed into the pharynx and larynx for topical anesthesia. During operation, the incision site of the skin was infiltrated with 0.5% procaine 10 mL. The anesthetic effects of acupuncture anesthesia were evaluated and attributed to: grade Ⅰ(excellent), grade Ⅱ(satisfactory), grade Ⅲ(fair) and grade Ⅳ(poor). According to the patency degree (the light type and the serious type) of glottis, the operative procedures were adopted correspondingly. We conducted quantitative measurement of the glottic width showing by laryngograph before and after operation. As to our experiences, the optimum width of the glottic lumen which is meticulously reconstructed under general anesthesia may be not accommodated the physiological path. Under the circumstances, glottic insufficiency or larynageal stenosis is often induced, resulting in an hypoventilation and often requiring an indwelling tracheotomy tube. Under acupuncture anesthesia, the patients were in conscious and physiological state thus the reconstructed new glottis may be easily achieved the physiological width. Of the 30 cases, 28 were male and 2 female ranging in age from 26 to 80 years. They suffered from glottic stenosis with the glottic width being less than 3 mm. So all these tracheotomized patients could not be decannulated because of respiratory insufficiency. New glottic reconstruction under combined acupuncture and medicinal anesthesia was performed by increasing the width of glottic lumen to about 4 mm～5 mm. 28 cases were successfully decannulated with normal respiratory function and 2 cases failed in removing the tracheal cannula. The success rate of operation was 93.3%. The success rate of this combined anesthesia was 97% including grade Ⅰ, 20 cases, grade Ⅱ, 9 cases, grade Ⅳ, 1 case. No complication occurred.