腹部针麻手术效果术前预测指标的探讨

<正> 腹部针麻手术的成败与内脏牵拉反应和内脏痛有密切关系。我们根据针刺对机体的调整作用和针刺影响植物神经功能的理论,选择针刺内关、足三里穴,观察心率和肠咕噜声次数的变化与针麻效果的关系,较准确地选择针麻适应症,提高针麻手术效果。方法 (一)观察对象 1.受试者共212例,分观察组和对照组。观察组为腹部手术108例(包括子宫切除和胃大部分切除术)。对照组为颈、面部手术104例(包括甲状腺囊肿或肿瘤切除术,青光眼减压术等)。

APPROACH TO THE PREOPERATIVE PREDICTION ON THE EFFECT OF ABDOMINAL OPERATION UNDER ACUPUNCTURE ANESTHESIA

The clinical practice showed that the effect of acupuncture anesthesia on abdominal operations was often influenced by the visceral tractive rel- flex and the visceral pain. One of the important factors to chose the in- dications of acupuncture anesthesia and to improve its effect is to find out some methods which can be used to evaluate the visceral tractive reflex. According to the theory of relationship between viscera and channels of traditional Chinese medicine and the influence of needling points on the function of vegetative nervous system, we had a pre-operation evaluation of the effect of acupuncture anesthesia in patients, judging from parameters of changes of heart rates and times of gurgling sounds before and after needling Neiguan and Zusanli. 212 cases of two groups were selected. The patients in one group would receive abdominal operations, including total hysterectomy and subtotal gastrectomy. The others would receive operations on their necks and faces including local excision of thyroid cyst or adenoma and glaucoma decom- pression. 75% of them were females, 25% males; 90% 18~50 years old, 10% 51~60; 67% workers and cadres, and 33% peasants. All the tests were taken in laboratoies three hours after lunch within 1-3 days before opera- tion. The room temperature was 16-28℃. All the patients were free of arrhythmia, thydroidism or any acute intestinal diseases. Methods I. The patientes then their heart rates(pulse rates) were recorded with a polygraph for one minute as the fundamental value. 2. The times of gurgling sounds were recorded for two minutes with a stethoscope on an area of the abdomen(the right to the umbilicus). The average times of gurgling sounds in a minute were taken as the fundamental value. 3. strong stimulation was applied by inserting and twisting the need- les of two cun and three cun into Neiguan and Zusanli at the same side re- spectively. After the patients complained of the sensation of soreness, nu- mbness and distention, the needles were connected to an electric stimulator for induction. 10 minutes later the gurgling sounds were recorded, and another 10 minutes later the heart rates were recorded. 4. The sounds and rates recorded were compared with the fundamental values. Results 1. The effect of acupuncture anesthesia of 108 cases of abdominal opera- tions preliminarily showed that good results were obtained from those that their times of gurgling sounds inrcreased while their heart rates slowed down by needling the points(GradeⅠand GradeⅡ). On the contrary, poor results were obtained(Grade Ⅲ and Grade Ⅳ). There were some statistically significant differences(P<0.01). 2. Among the 104 cases of the operations performed on necks and faces, the changes of heart rates and times of gurgling sounds did not coincide with the effect of acupuncture anesthesia. By statistical analysis there was no significant difference (P>0.05). 3. During the first 10 minutes of induction period by needling Neiguan and Zusanli, the times of gurgling sounds obviously increased, but the heart rates did not change obviously; during the next 10 minutes, the heart rates changed clearly(mainly slowed down), and the times of gurgling sounds decreased, which was higher than the fundamental value. Control 31 cases of in patients without receiving acupuncture, who were suffer- ing from the four diseases as above, were observed with the same methods. Their heart rates and gurgling sounds did not change significantly (P> 0.05 ). Conclution 1. Needling Neiguan and Zusanli may change the times of gurgling sounds(mainly increasing)and the heart rates(mainly slowing down). 2. The good result is indicated by the slowing down of the heart rates and the increase of the times of gurgling sounds, whicn suggests that need- ling some points seems to modify the function of the vegetative nervous system. 3. Needling the relative points may change the visceral functions. These changes depend on the individuals obviously. 4. This study has provided a clue to pre-evaluating the effect of acu- puncture anesthesia on abdominal operations. It is valuable to further study.