2 English Reference Acupuncture Anesthesia [2 1 Century Bilingual Dictionary of Science and Technology]
Acupuncture anesthesia [Chinese medicine terminology Committee] Terminology of Traditional Chinese Medicine (2004)]
Overview of acupuncture anesthesia [1]. It is an anesthetic method with analgesic effect developed on the basis of traditional acupuncture [2]. Patients can perform surgery in a conscious state [1], and there will be no anesthesia accidents and side effects [1], especially for those patients who are not suitable for drug anesthesia. Recovered quickly after operation. At present, it has been used in general surgery, neurosurgery, ophthalmology, otolaryngology, stomatology, thoracic surgery, orthopedics, obstetrics and gynecology, urology, pediatrics and so on, with a wide range of indications. Suitable for head, face, facial features, neck, chest, abdomen, limbs, etc. 100 [3]. It is also suitable for patients with liver, kidney and lung dysfunction, shock, and physical decline. , or allergic to * * * substances [3].
The classification of acupuncture anesthesia includes body acupuncture anesthesia, nasal acupuncture anesthesia, facial acupuncture anesthesia, lip acupuncture anesthesia, hand acupuncture anesthesia, foot acupuncture anesthesia, electroacupuncture anesthesia, water acupuncture anesthesia, etc. [3].
The development of acupuncture anesthesia is a new technology with analgesic and anesthetic effects developed on the basis of traditional acupuncture academic principles [3]. The research of acupuncture anesthesia began in 1950s. After the official announcement of 197 1 in China, more than 30 countries have carried out the clinical application and basic research of acupuncture anesthesia, which has been widely used in dozens of operations such as general surgery, brain surgery, thoracic surgery, ent, obstetrics and gynecology. The research of acupuncture anesthesia has promoted the development of pain physiology and anesthesiology, promoted the study of meridian essence and acupuncture principle, and become the frontier discipline of medicine, human science and life science.
6 Characteristics of Acupuncture Anesthesia Acupuncture anesthesia is based on the sensory transmission of meridians in the human body, and the analgesic regulation function of the body is mobilized and exerted through acupoint acupuncture. Acupuncture anesthesia does not need complicated instruments and equipment, and its operation is simple and safe [1]. If * * * is not used or used less during the operation, patients will not have anesthesia accidents and side effects of * * * [1]. It is especially suitable for patients who are not suitable for drug anesthesia. Because the patient feels dull or disappears when he is awake, his physiological function remains normal, but other sensory and motor functions remain normal, so he can actively cooperate with the operation [3][ 1]. Patients generally do not have nausea, vomiting and other reactions, postoperative pain is mild, you can eat early and exercise early. In addition, acupuncture can mobilize and enhance the body's disease resistance, and accelerate the postoperative rehabilitation process [1].
7 Problems to be Solved Acupuncture anesthesia is a new field of anesthesiology. At present, we are still summing up experience and strengthening theoretical research. There are still some problems to be solved, such as incomplete analgesia, unsatisfactory muscle relaxation and inability to completely control visceral traction reaction [3][ 1].
8 The principle of acupuncture anesthesia The essence of acupuncture anesthesia is analgesia rather than anesthesia, and its anesthetic effect is qualitatively different from real anesthesia, so some people advocate that acupuncture anesthesia is acupuncture analgesia. However, in the theory and practice of acupuncture, acupuncture analgesia has a wide range of functions and clinical applications, and is widely used to relieve or eliminate the existing pain. Surgery is just one of its many applications. However, acupuncture anesthesia is innovative, and there are special requirements for acupoint selection and acupuncture methods. The purpose is to improve the pain threshold of the body and achieve similar anesthetic effects. Therefore, this kind of analgesia is different from general acupuncture analgesia in connotation and extension.
Facts have proved that acupuncture can produce obvious clinical effects of acupuncture anesthesia because acupuncture points can produce the following five important basic functions:
① Analgesic effect;
② Anti-visceral traction reaction;
③ Anti-traumatic shock effect;
④ Anti-surgical infection;
⑤ Promote wound healing.
Indications of acupuncture anesthesia Acupuncture anesthesia has been applied to general surgery, neurosurgery, ophthalmology, otolaryngology, stomatology, thoracic surgery, orthopedics, obstetrics and gynecology, urology and pediatrics. And has a wide range of indications. Suitable for head, face, facial features, neck, chest, abdomen, limbs, etc. 100 [3]. It is also suitable for patients with liver, kidney and lung dysfunction, shock, and physical decline. , or allergic to * * * substances [3]. Such as thyroid, maxillary sinus, glaucoma, brain (anterior and posterior cranial fossa), total laryngectomy, lobectomy, subtotal gastrectomy, splenectomy, caesarean section, abdominal tubal ligation, prostatectomy, lateral meniscus resection, etc. [ 1].
It is generally believed that the anesthesia effect of head, face, neck and chest surgery is better [1], and there are many cases that are suitable for acupuncture anesthesia, which is suitable for patients with heart, liver, lung and renal insufficiency, as well as physical weakness and shock. Because of abdominal muscle tension, visceral traction reaction and other reasons, there are relatively few cases to adapt to acupuncture anesthesia, which needs to be strengthened.
Because acupuncture anesthesia is safe and has few side effects, it is beneficial to ensure the safety of patients during and after operation for those who are allergic to * * * substances, or those who cannot tolerate * * * substances due to liver, kidney and lung dysfunction, critical illness, shock and old age [1]. In order to better grasp, the effect of acupuncture anesthesia can be predicted before operation [1].
10 the specificity of acupuncture anesthesia points can be seen from the clinical research of acupuncture anesthesia and the experimental research of normal human and animal bodies. In the relationship between acupuncture points and acupuncture anesthesia or acupuncture analgesia, the specificity of acupuncture points is mainly manifested in the following four aspects:
① Different acupuncture points or different prescriptions have different anesthetic effects.
② The same acupoint or prescription has different analgesic effects on different parts of the body.
③ The same prescription has different effects on analgesia and physiological disorder.
④ There is a relationship of mutual reinforcement or mutual inhibition between acupoints. From the above four aspects, the anesthetic effect of acupuncture does have a certain relationship with the specificity of acupuncture points.
1 1 The operation of acupuncture anesthesia includes simple acupuncture anesthesia and acupuncture combined anesthesia.
Single acupuncture refers to applying a single method to acupoints, such as acupuncture or electrode plate, laser, acupressure and acupoint injection [1].
Acupuncture combined anesthesia, that is, acupuncture anesthesia is the main anesthesia, but also a small amount of drug anesthesia [1].
In clinical practice, according to the surgical site, surgical diseases, etc. According to acupoint selection along meridians, acupoint selection based on syndrome differentiation and local acupoint selection, appropriate acupoints are selected. After acupuncture, you can move the needle manually, or you can use electroacupuncture and acupoint injection. Sometimes a small amount of auxiliary drugs, such as sedation, analgesia, local anesthesia or drugs that can affect central neurotransmitters, are used appropriately. At present, there are still some problems in acupuncture anesthesia, such as incomplete analgesia, insufficient muscle relaxation and visceral traction reaction, which need to be further improved.
1 1. 1 Before the preoperative preparation, the medical staff involved in the operation analyzed and discussed the patient's condition, medical history and ideological situation, unified their understanding and determined the acupuncture anesthesia operation plan. Fully estimate the possible situation during the operation and prepare to take corresponding measures. Because the patient is awake during acupuncture anesthesia operation, it is necessary to introduce the significance, characteristics, methods, process and effect of acupuncture anesthesia to the patient before operation. At the same time, explain to the patient the discomfort that may occur during the operation, so that he can be psychologically prepared and know how to cooperate (such as taking a deep breath when opening the chest). ). Before operation, 1 ~ 3 needle test can be conducted on selected acupoints on the patient's body to understand the situation of "getting qi" and the degree of tolerance to acupuncture, so as to adopt appropriate * * * methods and give appropriate * * * doses during operation.
Before combined anesthesia, adjuvant drugs are generally given according to anesthesia routine. After the needle is inserted, twist induction 15 ~ 30 minutes, and most of them can start surgery. It is advisable to transport the needle manually during the operation to achieve the analgesic effect, and the patient can tolerate it [3]. You can also use electroacupuncture (called electroacupuncture to get drunk) [3].
1 1.2 according to the surgical site, surgical diseases, etc. Choose the appropriate acupoints by selecting acupoints along meridians, selecting acupoints based on syndrome differentiation and selecting acupoints locally [3].
1 1.2. 1 the principle of acupoint selection is that it is easy to get qi (preferably a feeling of soreness), without pain or bleeding, which is comfortable for patients and does not affect the operator's operation.
1 1.2.2 Fourteen meridians are the main acupoints. There are three specific options:
① Acupoint selection along meridians: according to the theory that the meridians are interlinked and the indications are accessible, the meridians and acupoints closely related to the incision site and the surgical organ are selected. For example, the tooth extractor Yangming Hegu point and Sanjian point; Sanyinjiao and Taichong points were selected for abdominal tubal ligation.
② Acupoint selection at the proximal end: select acupoints near the operation. For example, choose a cheek car and a big welcome point for tooth extraction; Choosing pulse points by caesarean section.
③ Acupoint selection according to neurological theory: There are two commonly used methods: one is to select points at the same segment (or near segment), such as floating map, Hegu and Neiguan in thyroid surgery; Secondly, selecting points according to the distribution of nerve trunk or directly selecting nerve trunk is widely used in orthopedic surgery. For example, choose Jiquan point or brachial plexus point (one needle on each side of axillary artery pulsation) for some upper limb operations; * * * The third and fourth lumbar nerves, femoral nerves, sciatic nerves, etc. Do some lower limb surgery; At zygomatic point, the second branch of trigeminal nerve, some head or brain operations were performed.
1 1.2.3 There are three ways to choose ear points.
① Choose acupoints according to the theory of Zangxiang: for example, "Lung governs fur", and lung acupoints can be selected when cutting skin; "The kidney governs the bone", and the kidney point can be selected for tendon cutting in orthopedics or thoracic surgery; Ophthalmic surgery of "opening the liver to the eyes" can take liver meridian points and so on.
② Selection of acupoints according to the surgical site: for example, selection of appendix acupoints during appendectomy; Selection of lung points in lung surgery: taking gallbladder points in gallbladder surgery, etc.
③ Selecting points according to the innervation and anatomical physiology of auricular points: for example, selecting mouth points and auricular root points for abdominal visceral surgery, because they are dominated by vagus nerve. Taking acupuncture points such as brain and lower limbs as common acupuncture points can improve the analgesic effect and reduce visceral reflex, which is guided by its physiological function. The above three acupoint selection methods can be used alone or in combination.
11.3 * * Methods ① Manual needle transport: body needles are usually inserted by twisting or twisting combination; Ear needles can only be screwed, not inserted. The needle feeding frequency is 120 ~ 200 times per minute, the twisting angle is generally 90 ~ 360 degrees, and the lifting range is 5 ~ 10 mm, so it is required to always be in the "on fire" state. Manual needle transport should be carried out evenly and stably, which is the basic skill of acupuncture anesthesia, and the strength can be adjusted according to the feeling of the operator's fingers. At the same time, because of the simple equipment, it is of great significance to carry out acupuncture anesthesia in remote rural areas and wartime environment.
② Electroacupuncture: The operation method is the same as electroacupuncture therapy. Acupuncture anesthesia generally adopts dense wave, the dose of * * should be moderate, and the patient can tolerate the intensity of * *.
③ Water acupuncture: the method of acupoint selection is the same as that of body acupuncture. Commonly used drugs include vitamin B 1, cryoprotectant, 10% glucose injection, angelica injection, corydalis yanhusuo injection, etc. Demerol can be diluted with normal saline. This method is often used in conjunction with manual needle transport or electroacupuncture. Others include acupuncture anesthesia, instrument compression anesthesia, and electrode plate anesthesia instead of acupuncture.
④ Inducing needle retention: pretreatment of acupoints for a period of time before operation is called induction. The induction time is generally about 20 ~ 30 minutes. It can be divided into general induction and key induction. The former is that each acupoint is transported in the order of acupoint prescription, and the time is slightly longer; The latter is to deliver needles to key acupoints five minutes before operation. * * * Operation should generally be light; But for some sensitive parts, acupuncture induction can be strengthened during operation; In some light surgical steps, needle feeding or power-on can be suspended to keep the needle still. For example, in brain surgery, you can leave a needle for a period of time after cutting the meninges.
1 1.4 The needle can be pulled out after the operation [3].
1 1.5 auxiliary drugs acupuncture anesthesia often requires a small amount of auxiliary drugs before and during surgery to improve the effect of acupuncture anesthesia and enable patients to operate under the safest and most favorable conditions. Commonly used drugs are sedatives, analgesics and anticholinergic drugs.
① Preoperative medication: Usually, phenobarbital sodium is injected 0. 1 g intramuscularly1hour before operation, and dolantin 50 mg is injected intramuscularly or intravenously 15 ~ 30 minutes before operation (some patients may not need it). In order to reduce the secretion of respiratory tract and digestive tract, atropine 0.5 mg or scopolamine 0.3 mg can be injected subcutaneously or intramuscularly 30 ~ 60 minutes before operation.
② Intraoperative medication. During the operation, sedatives, analgesics, local anesthetics or muscle relaxants can be added according to the patient's reaction and the specific situation of the operation. For example, before peritoneum is cut, great vessels are ligated or organs are strongly pulled, it is estimated that patients may react strongly, so 1% procaine can be used as local infiltration anesthesia in advance.
The timing of medication during operation should be appropriate, and it is best to use it before the patient may have a violent reaction, so as to achieve satisfactory results. The dosage of the medicine must also be appropriate. If the dose is too large, the patient may be in a hazy state, unable to clearly reflect the situation and lose the ability to cooperate with doctors.
The application of muscle relaxants should be more cautious and must be closely observed. Once an accident happens, effective measures should be taken to rescue it.
1 1.6 Common types of prescription surgery
Body acupuncture or ear acupuncture
operate
Correction of entropion and trichiasis
Clear eyes and closed valleys
Focus on sensing Jingming point before operation, without leaving needles, and use dense-wave electroacupuncture at Hegu point during operation.
exodontia
Hegutou Laogong; Or use ear acupuncture to treat toothache.
Induction for 20 minutes, the needle feeling can be slightly stronger before tooth extraction.
Tonsillectomy
Hegu
Induction for 20 minutes, continue to manually lose needles or use dense-wave electroacupuncture during the operation.
Thyroid surgery
Help the process (double), or take Hegu and Neiguan; Or use ear acupuncture on the lungs, Shenmen, screen room and neck.
Induction for 20 minutes, and continuous needle infusion or dense-wave electroacupuncture during operation.
Cranial surgery
Zygomatic jaw or add Jinmen and Taichong; Or use an ear needle; Lung, Shenmen penetrate kidney, lower limbs or brain.
Induction for 20 ~ 30 minutes, and needle infusion or electroacupuncture continued during the operation.
pneumonectomy
Hegu and Neiguan; Sanyang collaterals penetrate the door; Arms through shoulders; External customs permeate internal customs.
Induce for 20 ~ 30 minutes, and continue to keep needles or electroacupuncture during the operation. Patients should cooperate with slow and deep abdominal breathing.
Separation of two cusp valves
Hegu, Neiguan and Branch Ditch; Or use an ear needle; Lung, Shenmen, chest, heart and lower limbs
Induce for 20 ~ 30 minutes, and continue to keep needles or electroacupuncture during the operation. Patients should cooperate with slow and deep abdominal breathing.
Subtotal gastrectomy
Zusanli, Shangjuxu, Sanyinjiao; Zusanli, Yifeng, Shousanli and Qixue.
Induce for 20 ~ 30 minutes, bury the incision point and incision parallel line under the skin with a five-inch long filiform needle, about two needle gauge and six centimeters, and use pulsed electric dense wave.
tubal ligation
Sanyinjiao, Zhongjaw, Gongsun and Taichong; Or use ear acupuncture: lungs, Shenmen, screen room, genitals.
General induction lasts 15 minutes, and key induction lasts 10 minutes. Continue acupuncture or electroacupuncture during operation.
cesarean section
Tongmai, Zusanli and Sanyinjiao; Or use ear acupuncture: lung, Shenmen, abdomen, uterus.
Induction for 20 ~ 30 minutes, and needle infusion or electroacupuncture continued during the operation.
1 1.7 Precautions ① Acupuncture operation, whether manual needle transport or electroacupuncture, is suitable for moderate and strong induction that patients can tolerate and feel comfortable. Don't push too hard, if the patient feels uncomfortable, it will affect the effect of acupuncture anesthesia.
② The patient was awake during acupuncture anesthesia. Therefore, there is a high demand for surgical operation. One knife, one cut, one needle and one knot should be stable, accurate, light and fast to avoid repeated operations. The operating room should be quiet and don't talk loudly, so as not to cause patients to fidget and affect the operation.
③ Acupuncture anesthesia may also cause incomplete analgesia, muscle tension and visceral traction reaction. Therefore, in some cases or some surgical procedures, it is necessary to make preparations for intraoperative auxiliary medication, grasp the timing of medication, pay attention to controlling dosage and prevent side effects of drugs.
④ For some cases with complex focus, many adhesions or wide range of exploration, especially some difficult abdominal operations, the effect of acupuncture anesthesia is unstable, so be cautious.
12 The relativity of acupuncture anesthesia at acupoint is the same as the main function of acupoint, and the specificity of acupuncture anesthesia at acupoint is also relative. Show in:
① Different acupoints or prescriptions have certain influence on the same acupuncture anesthesia operation. For example, the prescription of acupuncture anesthesia points in thyroid surgery has two characteristics. First, the operation can be completed by selecting acupoints in different parts such as upper limbs, lower limbs, neck and ears, and even acupuncture in non-acupoints of lower limbs (not on the meridian line but with a sense of qi);
The other is the choice of different parts, and its acupuncture anesthesia effect is very different. For example, the neck (Futu point, both sides) is the best, followed by upper limbs (Hegu, Neiguan, both sides), or ear points (Shenmen, lung, sympathetic, neck, surgical side or both sides) are the worst. Another example is acupuncture anesthesia pneumonectomy, and more than 80 groups of acupoint prescriptions have been used nationwide. Acupoints can be operated in various parts of the body, but the effect is different. If there are reports, comparing the acupuncture anesthesia effects of acupuncture with multiple meridians and points, single point of upper limb (Sanyang Collateral) and lower limb point group, the first-and second-class rates are 74.8%, 85.7% and 50.0% respectively, and Sanyang Collateral Point is the best.
② The same acupoint or prescription has certain analgesic effect on all parts of the body. For example, acupuncture at Hegu point, Zusanli point, Hegu point plus Zusanli point and non-acupuncture points (but with strong acupuncture sensation) have analgesic effects on head, chest, abdomen, back and limbs; Acupuncture at nine ear points, such as Shenmen, lung, sympathetic, stomach, spleen, abdomen, triple energizer, subcortical and auricular apex, can significantly increase the pain threshold of eleven pain points in chest, upper abdomen and lower abdomen. Clinically, acupuncture at Hegu point and Neiguan point can also achieve successful results in head, neck, chest, abdomen and limb surgery.
③ Under the same conditions, the same acupoints or prescriptions have no absolute influence on various effects of acupuncture anesthesia. For example, the functional state of the body is different, and the acupuncture anesthesia effect of the same acupoint or prescription can be obviously different. Not only that, but the direction of acupuncture may be completely different with the different physical function. For example, acupuncture at the same group of acupoints has a booster effect on patients whose blood pressure drops to shock state before acupuncture anesthesia and a hypotensive effect on patients with hypertension.
Clinical effect of acupuncture anesthesia 13 Since acupuncture anesthesia was founded by 1958, it has been applied to almost all kinds of operations such as brain, facial features, neck, chest, abdomen, limbs and other cases of near-death shock, and the success rate can generally reach about 80% ~ 90%. But in different operations, the effect of acupuncture anesthesia is different. According to the statistics of tens of thousands of clinical cases of brain, glaucoma, thyroid, lung, stomach and uterus in China, the effects of acupuncture anesthesia can be divided into three categories:
The first kind of acupuncture anesthesia has a stable effect, which has passed the appraisal of provincial, municipal and ministerial achievements and has certain rules to follow. The operations that can be popularized include thyroid surgery, anterior cranial fossa surgery, anterior cervical surgery, caesarean section, tooth extraction, tubal ligation, pneumonectomy and so on.
The second kind of acupuncture anesthesia can be used as an anesthesia method, but the effect is unstable or close to the effect evaluation, such as radical maxillary sinus surgery, appendectomy, hysterectomy, strabismus correction, subtotal gastrectomy and so on.
The third kind of surgery with poor acupuncture anesthesia effect, such as limb orthopedic surgery and social surgery. All the clinical effects of acupuncture anesthesia have certain physiological limits and individual differences. Taking analgesia as an example, acupuncture at acupoints can only increase the pain threshold and pain tolerance threshold within a certain range and reduce the pain response. Therefore, the pain caused by surgical trauma can not be completely relieved by acupuncture alone, which is called incomplete analgesia. There are significant individual differences in the analgesic effect of acupuncture anesthesia.
As a clinical anesthesia method, acupuncture anesthesia still has insufficient muscle relaxation and visceral traction reaction. This is a deficiency, and sometimes appropriate drugs are needed to supplement it.
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