针刺麻醉行甲状腺手术常用穴位的形态学研究

目的:探讨针麻行甲状腺手术常用穴位扶突穴、合谷穴及内关穴的感觉传入及其与甲状腺感觉传入在颈脊神经节的汇聚与整合,揭示针麻行甲状腺手术的形态学基础。方法:①实验用成年雄性Wistar大鼠24只,随机分为合谷穴、内关穴、扶突穴和甲状腺4组(每组6只),将辣根过氧化物酶(HRP)分别注入上述穴区及甲状腺内,观察穴位和甲状腺的感觉传入。②雄性Wistar大鼠18只随机分为甲状腺-扶突穴组、合谷-甲状腺组、内关-甲状腺组(每组6只),分别将荧光素碘化丙啶(PI)、双苯甲亚胺(Bb)注入上述3个穴位和甲状腺,观察穴位和甲状腺的传入感觉在脊神经节的汇聚及神经节细胞的分支投射。③雄性Wistar大鼠24只随机分为正常组、针刺组(每组12只),手针针刺以上穴位及"足三里"和非穴位,用免疫组织化学方法观察穴区局部缝隙连接蛋白43(Cx 43)表达。结果:①HRP结果显示,3个穴位与甲状腺的感觉传入在C 3-C 5脊髓节段存在汇聚与重叠。②扶突穴注入PI、甲状腺注入Bb,合谷穴注入PI、甲状腺注入Bb,内关穴注入PI、甲状腺注入Bb后,3组出现的单标记神经元分布的部位部分不同,但均在C 3-C 6的脊神经节观察到双标记神经元。③免疫组化染色结果显示,不同穴位针刺组Cx 43表达均高于正常对照组(P<0.05);各穴位处Cx 43的表达显著高于非穴位处(P<0.05);非穴位处针刺后Cx 43表达的变化与非针刺非穴位组比较差异无统计学意义(P>0.05)。结论:扶突穴、合谷穴、内关穴及甲状腺的传入投射在颈脊神经节存在汇聚与分支投射,为针麻行甲状腺手术提供了新的形态学依据,同时也证实穴位针刺可以调节穴位局部缝隙连接蛋白的表达以影响局部细胞间的信息交流。

Morpholonical Study on Commonly-used Acupoints for Thyroid Surgery under Acupuncture Anesthesia

Objective To study the morphologic structure,afferent projections of "Neiguan"(PC 6),"Hegu"(LI 4) and "Futu"(LI 18) acupoint regions so as to understand their underlying mechanisms in acupuncture anesthesia for thyroid surgery.Methods A total of 66 Wistar rats were used in the present study.① Horseradish peroxidase(HRP,10%,10 μL) was injected into PC 6,LI 4 and LI 18 acupoints and the thyroid area on the right side,respectively(n=6).② Propidium iodide(PI,10%,10 μL) or Bisbenzimide(Bb,5%,10 μL) was injected into above-mentioned 3 acupoints and the thyroid region on the right side,respectively(n=6).The numbers and percentages of the labeled neurons in the dorsal root ganglia(DRGs,C 1-C 8 and T 1) were observed under microscope.③ Cutaneous connexin(Cx) 43 immunoactivity of LI 18,PC 6,LI 4 and "Zusanli"(ST 36) regions and their individual non-acupoint regions(about 0.5 cm lateral to LI 18,PC 6,LI 4,and ST 36,n=12) was determined by immunohistochemistry.Results 1)HRP-labeled neurons after injection of HRP into LI 18 were found in DRGs of C 1-C 5,predominantly C 2-C 4,those from LI 4 found in DRGs of C 3-C 8,mainly C 5-C 7,those from PC 6 found in DRGs of C 3-T 1,chiefly C 5-C 8,and those from the thyroid region found in C 1-C 6,predominantly C 2-C 5,suggesting an overlap or convergence of afferent projections from the 3 acupoints and the thyroid regions being in C 3-C 5.2) After injection of PI into LI 18,LI 4 and PC 6,and Bb into the thyroid region,the percentages of PI-and Bb-labeled neurons in DRGs of C 1-C 8 and T 1 were from 46.4% to 50.0% and the percentages of the double labeled neurons were 3.8% in the LI 18-thyroid group,3.1% in the LI 4-thyroid group and 3.6% in the PC 6-thyroid group,respectively,suggesting a bifurcate innervation of DRG neurons between these acupoints and the thyroid region.3) In comparison with the individual non-acupuncture and non-acupoint subgroups,the immunoactivity of cutaneous Cx 43 in the LI 18,LI 4,PC 6,and ST 36 subgroups was upregulated considerably after acupuncture stimulation(P<0.05).Conclusion Neurons of DRGs of C 1-C 8 and T 1 innervating "Futu"(LI 18),"Hegu"(LI 4) and "Neiguan"(PC 6) and the thyroid gland have an overlap or convergence in DRGs of C 3-C 5 and a bifurcate innervation.Acupuncture stimulation may upregulate cutaneous Cx 43 expression in the acupoint regions.