针麻镇痛研究

回顾针麻镇痛的科研道路,可以分为几个阶段:(1)初期探索:1958年上海和西安有一部分医生将针刺技术应用于外科手术,试图不用麻醉药或减少麻醉药用量而完成外科手术,称之为针刺麻醉(针麻)。这一创新性临床实践,引起医学界的广泛兴趣。(2)临床推展:1965年开始全国许多医院进行仿效;20世纪70年代达到高潮,全国几乎所有医院全部开展针麻;进入20世纪80年代,临床应用针麻逐渐减少。(3)原理探讨:1965年开始,大量基础研究工作者参与进行人体和动物实验研究,从1970年开始的30年间,针麻镇痛研究论文持续发表,这些科研肯定了针刺镇痛疗效,并试图阐明其原理。1997年美国国立卫生研究院(NIH)举办针刺疗法听证会,证明针刺镇痛的有效性和科学性,导致国内和国际上加大了科研资助,针麻镇痛研究在全球广泛开展。(4)重点研究:2007年中国将针麻镇痛列为重点研究项目,在全国9个大医院进一步确定开展临床针麻镇痛的有效性及其相关原理的研究。确认了电针与手针有同样的镇痛效果,研制出了电针仪和经皮穴位电刺激仪器,临床实践证明其可以简化针麻镇痛步骤,便于在手术室推广应用。(5)理论总结:鉴于经络的实质尚待明确,但可以明确的是分布于穴位下的神经纤维是刺激"穴位"发挥镇痛作用不可或缺的重要成分,因此认为,可以用现代神经科学知识理解针麻实质。中国古老的针灸疗法与现代神经科学两者互相促进,提高并扩展了针刺相关疗法的临床应用,更好地实现为患者服务的目的。(6)回归现实:经过半个世纪的实践和发展,针刺具有镇痛作用的事实已得到国际科学界的认可,"针刺辅助麻醉"或"针药复合麻醉"已成为某些特定手术的首选麻醉技术。由于开展针麻镇痛研究而掀起的科研浪潮既促进了针刺疗法在全世界的应用,也推动了针灸疗法本身和神经科学的发展。但理论和实践的转化,基础和临床的交融,是永无止境的。半个世纪的实践值得加以总结,以便深入阐明原理,提高临床效果,纠正可能的错误。

Research on Acupuncture Anesthesia-analgesia

In the present paper,the author retrospects the historical developmental stages of acupuncture anesthesiaanalgesia from 1)preliminary exploration:the creative application of acupuncture therapy to surgery with lower dosage or without anesthetics began in Shanghai and Xi'an in 1958;2)clinical popularization:the acupuncture anesthesia-analgesia became popularized from 1965,peaked in 1970s' and declined from 1980s';3)mechanism study:from 1970 to 2000,a large quantity of research papers were published to confirm the validity of acupuncture analgesia(AA),and in 1997,NIH Consensus Conference for acupuncture was held,promoting the related research in the world;4)focused research:from 2007 to now,the acupuncture anesthesia-analgesia was listed as one of the key research program in China;5)theoretical summary:in view of the uncertainty of the scientific basis of the meridian system of traditional Chinese medicine,the nerve fibers distributed under the acupoint are now considered to be the indispensable components for AA,and the knowledge of modern neuroscience is competent to explain the underlying mechanism of AA;6)returning to reality:AA has been accepted by the international scientific community,and the"acupuncture-assisted anesthesia",or"compound acupuncture and anesthetics anesthesia"has been used as the first choice for some types of surgical operation.The research on acupuncture anesthesia-analgesia greatly facilitates clinical application of acupuncture therapy in the world,and also promotes the development of acupuncture therapy itself and neuroscience.However,the transformation between theory and practice and their mutual interaction are endless endeavor.Thus,a careful review of the half-centurylong practice of acupuncture anesthesia-analgesia is painstakingly necessary in order to clarifying the mechanisms,to raise the efficacy of clinical practice and to correct the possible errors referred to this concept.