【作者】 尹利华；

【导师】 李万瑶；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2002， 硕士

【摘要】 二十世纪五十年代开始，针刺麻醉应用于临床，并得到大力推广。但由于其镇痛强度不足等缺点，不能满足临床麻醉的需要，使其应用受到限制。而且一直没有较客观的指标评价针刺麻醉的镇痛效能，所以甚至有人对针刺麻醉持怀疑的态度。如何客观评价其效能是不得不思考的一个问题。 现代麻醉学中，常以呼气末气体中吸入全麻药的最低有效浓度(MinimumAlveolar Concentration，MAC)来客观地评价吸入全麻药的作用强度，并有人利用镇痛药减少吸入全麻药MAC的多少来评价镇痛药的作用强度。故本实验利用MAC客观地观察针刺在复合全身麻醉中的镇痛效能。并通过全身麻醉后再针刺，以观察全身麻醉对针刺镇痛效能的影响。全文分文献研究及实验研究两部分： 一、文献研究 本文简要地综述了中医学中麻醉的起源及发展历程，并例举了过去各个时期中医和针灸对麻醉学及其相关急救措施的主要贡献。探讨了针刺麻醉的现代起源与发展历程，针刺麻醉在临床上的分类法、操作注意事项及近十年来临床上的运用情况。近年来，关于针刺麻醉的研究主要是其临床运用，对其机理仅有少量报道。如何充分发挥针刺在现代麻醉中的作用及阐明其机理，是每个针刺麻醉工作者面临的现实问题。 二、实验研究 (一)研究目的： 1．利用麻醉药MAC客观地评价针刺在复合全身麻醉中的镇痛效能。 2．探讨针刺诱导后全麻与全麻后再针刺两组患者中针刺镇痛效能是否相同，以明确全麻对针刺镇痛效能是否有抑制作用。 3．观察不同中医证型患者所需全麻药MAC，为临床筛选针刺麻醉适宜对象提供参考。 4．观察针刺对患者术中的应激反应、术后炎症反应及胃肠功能恢复的调节作用。 (二)研究方法：本研究为前瞻性、随机对照研究。 将广东省中医院麻醉科69例直肠癌患者随机分为针刺诱导后全麻组(Acupuncture before General Anesthesia group，AGA组)、全麻后针刺组(GeneralAnesthesia before Acupuncture group，GAA组)及单纯全麻对照组(GeneralAnesthesia group，GA组)，通过对三组病人术中所需异氟醚MAC，血氧饱和度、呼出末二氧化碳浓度、心率、血压、血糖、术后外周血白细胞变化及肠鸣音和肛 99级硕士研究生 尹利华门排气恢复时间的观察而达到目的。 （三）研究结果： 1．AGA组、GAA组及GA组患者所需异氟醚MAC分别为1．35％及1．49％、1．64％，三者之间差异有统计学意义（P＜0刀1）。＊＊A组与OA组异氟醚相差0．29％，差异有统计学意义（P＜0刀1），与＊＊A组相差0．14％，差异亦有统计学意义（P＜0刀5）；0＊A组与＊A组异氟醚＊＊C相差0．15％，差异有统计学意义（k0刀5）。 2．AGA组湿热蕴结、气阴两虚及气滞血瘀型患者所需的异氟醚MAC分别为1．50％、1．22％及1．31％，差异有统计学意义（P＜0刀5）；OA组及＊＊A组三种证型之间差别无统计学意义。 3．三组患者术中血氧饱和度与呼出末二氧化碳浓度变化不大，均保持在良好的状态下：插管前后、手术开始切皮前后三组患者心率、平均血压均升高，＊A组变化差异有统计学意义（P＜0刀5或0刀1），而＊＊A组变化均无统计学意义。三组患者术中心率、平均血压变化均无统计学意义。三组患者术中血糖的升高幅度以AGA组最小，GAA组次之，GA组最大。 4．三组患者术后外周血白细胞以AGA组上升幅度最小，恢复最快，明显优于GA组。术后肠呜音及肛门排气恢复时间以AGA组最快，GAA组次之，GA组最慢。 （四）结论 1．针刺在复合全身麻醉下行直肠癌手术中确有一定麻醉镇痛效果，相当于0．29％的异氟醚，可相对减少异氟醚MAC17．68％。 2．全身麻醉后，患者意识完全丧失，再行针刺，仍有一定麻醉镇痛作用，相当于 of 5％的异氟醚，但较针刺诱导后再全麻中的针刺效能差，说明全麻对针刺效能有一定的抑制作用。 3．不同中医证型直肠癌患者中，针刺对气阴两虚型患者麻醉效果较佳，气滞血瘀型次之，湿热蕴结型欠佳。 4．针刺复合麻醉中针刺可减轻患者因麻醉及手术所致的应激反应及改善应激状态下糖代谢的异常。 5．针刺复合麻醉中针刺可减轻直肠癌手术患者术后炎症反应，并促进患者术后胃肠功能的早日恢复。 针刺对人体是一种整体性的调节作用，在复合全身麻醉中，不仅具有一定的麻醉镇痛作用，而且可以减轻麻醉及手术对患者所致的应激反应，改善患者术后炎症反应及促进患者胃肠功能的恢复。更多还原

【Abstract】 Study Background: Acupuncture had been used in clinical since the fifties of last century, and it was widely applied. But because acupuncture analgesia is incompletely, and can not well inhibit anti-drag reflect, muscle relaxation was not satisfactory, it can not meet the requirement of modern anesthesia. So its application has been limited. And there is no objective index in assessing the analgesia efficacy of acupuncture anesthesia. Somebody even holds suspicious attitude.The action intensity of anesthetic medicine was objectively evaluated by the minimum alveolar concentration (MAC) of trachea general anesthesia in modern anesthesia. And somebody assessed the action intensity of anesthetic analgesia medicine by decreasing MAC of anesthetic analgesia medicine. The study objectively assessed the analgesia effect of acupuncture combined general anesthesia with MAC. The article mainly divided into two parts, the literature investigation and experiment study.1. Literature investigationThe article briefly summarized the origin and development of anesthesia in the range of TCM, and explained the major dedication of acupuncture and TCM to anesthesia in every period in example. And it summarized the classifications, performance announcements and applied condition in clinic in recent ten years. In recent years, the major studies about acupuncture anesthesia focus on clinical application, the study about mechanism is few, but some reports have been found. How to fully exert the action and clarify the mechanism about acupuncture anesthesia is a realistic problem that every anesthetic worker faced with.2. Experimental research. Objective1. To evaluate objectively the analgesia effect of acupuncture combined general anesthesia with MAC.2.To make definite whether general anesthesia have inhibition on acupuncture, and to provide the basis for the application of acupuncture combined anesthesia in clinic.3.To investigate the general anesthesia MAC that patients with different syndromes needed, to provide reference to screening the suitable objects for acupuncture anesthesia in clinic.4.To investigate acupuncture regulatory actions about the stress during operation, the postoperative inflammations and the restoration of gastrointestinal functions.MethodThe study was prospective and random controlledSixty-nine patients undergoing rectal cancer surgery were divided into three groups in the hospital of Guangdong TCM, pure general anesthesia group (GA group), acupuncture before general anesthesia group (AGA group) and general anesthesia before acupuncture(GAA group). Through investigating the patients’ isoflurane MAC, SpOa, FETCO2, HR, BP, blood sugar, the change of extra-blood WBC, bowel sounds and the recovery time of passage of gas by anus during the operations in three groups to achieve the object.ResultsIThe results manifested: the need of isoflurane MAC in AGA, GAA, GA group was 1.35% 1.49% and 1.64% respectively. The isoflurane MAC of patients needed with accumulation of wet-heat, qi and yin deficiency, and accumulation of wet-heat in AGA group was 1.50%, 1.22% and 1.31% respectively. The difference was significant.2.Changes of the concentration of SpC^and FEiCC^were not obvious, the HR, MBP of patients in three groups were increased during pre-incubation, beginning skin-cutting. The change of GA group was significant (P<0.05 or 0.01), but the change of AGA group had not statistical significance. The change about HR and MBP of the patients in three groups were not significant during operation. The fluctuation of patients’ blood sugar was minimums in AGA group, the next was GAA group, and the most was GA group.3.In three groups, range of WBC count elevation in AGA group was the minimum, and the recovery more faster than those of other two groups; The recovery of bowel sounds and passage of gas by anus of post-operation was fastest in AGA group, and GAA group is secondly, GA group is most slowly.Conclusions1.Acupuncture combined general anesthesia had some anesthetic an更多还原