针刺复合硬膜外麻醉研究现状

针刺麻醉 (简称针麻 )为 2 0世纪 50年代我国医务工作者首创 ,并应用于临床 ,据统计临床试用百余种手术 ,记载针麻下施行手术 1 0 0余万例 ,同时进行大量的临床和药理研究 ,但临床实践显示针刺镇痛作用肯定 ,从麻醉角度要求针麻下施行手术又存在术中镇痛不全、肌肉紧张、内脏牵拉反应的不足 (即所谓三关 ) ,严重影响继续选用 ,为此 2 0世纪 70年代后期国内学者提出采用针药复合麻醉方法增强针麻麻醉效果 ,部分适宜针刺复合硬膜外麻醉手术 ,首先进行了研究取得成效 ,截止目前该项研究仍在继续 ,现仅就个人收集资料回顾如下。1 1 990年前针刺…

Progress in the Study on Acupuncture Combined with Epidural Anesthesia

Acupuncture anesthesia is created by Chinese medical workers first in 1950s'. Up to now, about more than 1000,000 cases of operation including above 100 types of operation have been conducted under acupuncture anesthesia in China. In order to solve the problems of incomplete analgesia, muscular tension and reactions of visceral pulling, from the late stage of 1970s', Chinese medical workers have been adopting acupuncture anesthesia combined with anesthetics to enhance analgesic effect for operation and achieved considerable achievements. 1. Research on acupuncture combined with epidural anesthesia before 1990. In 1979, National Acupuncture Anesthesia Subtotal Gastrectomy Corporation Group made a study program on acupuncture plus anesthetics compound anesthesia methods, etc. In 1981, the clinical effect of acupuncture plus anesthetics compound anesthesia was confirmed by the National Acupuncture Anesthesia Operation Academic Symposium. From that time on, acupuncture plus anesthetics compound anesthesia method begins. 2. Research on acupuncture combined with epidural anesthesia from 1991 to 1995. During "the 8th 5 years", clinical research on acupuncture combined with epidural anesthesia for renal transplatation, subtotal gastrectomy, abdominouterectomy, cholecystectomy, etc began. In addition, study on the conventional operating procedures for subtotal gastrectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics was brought into the "State 8th 5 years' Key Research Projects of Science and Technology". Results of acupuncture plus anesthetics compound anesthesia indicate that ①the analgesic effect is enhanced significantly and the operation conducted under painless state basically; ② the dose of anesthetics needed is decreased significantly; ③ physiological disorders induced during operation are fewer, and the time for urination after renal transplantation is advanced; but ④ the anesthetic methods should be simplified, the applied anesthetics types and their dosages are needed to be studied. 3. Research on acupuncture combined with epidural anesthesia from 1996 to 2000. Approved by Chinese State Ministry of Science and Technology and State Administration of TCM, "clinical and mechanism study on optimized acupuncture anesthetics compound anesthesia and analgesia" and "clinical research on acupuncture anesthesia combined with epidural administration of small dose of anesthetics" were brought into "the 9th 5 years' Key Research Projects of Science and Technology". Results display that ① generally, 4～6 acupoints are used every time and acupoint cutaneous electrical stimulation method is also applied; ② more physiological indexes and strict random control group are adopted; ③ the anesthetic effect of acupuncture combined with epidural anesthesia reaches that of routine epidural anesthesia (including the anesthetic blocked level); during operation, the patients keep quiet, have no pain or only slight pain reaction, muscular relaxation is satisfied and the visceral pulling reaction is light; ④ the dose of epidural anesthetics needed is decreased by above 30%; ⑤ during operation, the patient's life signs keep stable, and the operation is conducted smoothly and wins doctors' and patients' approval; ⑥ in line with the good anesthetic effect of acupuncture anesthetics compound anesthesia, plasma NE content is declined and the immunofunction is enhanced; and ⑦ the anesthetic methods should be simplified further and more convinced theories and clinical practice are needed.