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SUMMARY

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SUMMARY

    SUMMARY

WorldJ.Acup-Mox.Vo1.11,No.3,September,2001?41?

    ;AcupunctureAnalgesia

    ;SUMMARYoFCLINICALSTUDYoNACUPUNCTURECoMBINED

    ;WITHEPIDURALANESTHESIAFoRCHoLECYSTECToMY

    ;QinBiguang(秦必光)LiuYingtao2(刘颖涛)LiChanggen.(李长

    )RenYachuan(任亚川)

    ;ZhangLanying(张兰英)AiZhongli(艾中立)PengXiaoyun.(彭小

    )BaiZhanyong4(白占勇)

    ;AffiliatedHospitalofChengduUniversityofTCMandPharmacy,Chengdu610072,China

    ;.TheSecondAffiliatedHospitalofHubeiMedicalUniversity,Wuhan430071, ;PFourthPeople’sHospitalofChongqing,Chongqing400014,

    ;4jangyouMunicipalPeople’sHospitalofSichuanProvince,Sichuan621700

    ;ABSTRACTObjective::

    ;Tostudyclinicaleffectandanestheticmethodofacupunctureanesthesiacombinedwith

    ;epiduraladministrationofsmalldoseofanestheticforcholecystectomy.Methods:Atotalof194casesofcholecystec-

    ;tomypatientswererandomlydividedintoacupuncturecombinedwithepidur

alanesthesiagroup(groupA,n66),

    ;acupoint-skinelectricalstimulationcombinedwithepiduralanesthesiagroup(groupB,n=63)andsimpleepidural

    ;anesthesiagroup(groupC,n=65).Observationswereconductedusingsingle-blandmethod.BilateralNeiguan(PC

    ;6)andZusanli(ST36)werepuncturedandstimulatedelectricallyingroupAandonlystimulatedelectricallyviacuta

    ;neouselectrodesingroupB.Epiduralanestheticusedwas15%Lidocaineandtheanestheticlevelwascontrolledto

    ;reachT4

    l1.Results:Theclass-l(excellent)ratesofgroupA,BandCwere75.76%,60.32%and13.85%respec-

    ;tively,showingsignificantdifferencesbetweengroupAandCandgroupBandC(P<0.001).Theinitialdose,doses

    ;ofeveryhourandeverycaseofgroupAandBwerelowerthanthoseofgroupC.ThedoseofeveryhourofgroupC

    ;was36.23%and3.75%higherthangroupAandBrespectively(P<0.001).suggestingthatacupunctureoracu

    ;point-skinelectricalstimulationcouldstrengthenanestheticeffectandreducethedoseofepiduralanesthetic.During

    ;operation,indexesoftheIifesignsasHR,MAP,RR,TV,MV,SpO,andECGkeptbasicallystableandallpatientsin

;groupApassedsurgicaloperationsafely.C——

    ;o

    ;n

    ;c

    ;lu

    ;s

    ;io

    ;n

    skinelectricalstimulationcombined ;:Acupunctureoracupoint

    ;withepiduralanesthesiacanbeusedasoneoftheanestheticmethodsforcholec

    ystectomy.

    ;KEYWORDSAcupunctureanesthesiaEpiduralcompoundanesthesiaChol

    ecystectomyClinicalstudyof

    ;anesthesia

    ;Onthebasisoftheresearchresultson

    ;acupuncturecompoundanesthesiaconducted ;from1998to2000[4_,theanestheticeffect

    ;andregularitiesofacupunctureanesthesiacorn

    ;binedwithepidura1administrationofsmal1dose ;ofanestheticsforcholecystectomyareanalyzed ;further.Hereisthesummary.

    ;1OBJECTSANDMETHODS

    ;1.1Selectionofcases194simplecholecystomy ;patients(AmericanASAIII)whowereclearly

    ;anddefinitelydiagnosedasbenigncholecystitis ;throughultrasonicexaminationandfluoroscopy ;andsignedonavolunteersubjecttableweresub

    ;jeetedintothepresentstudy.Beforeoperation, ;examinationsofhepaticandrenalfunctions, ;bloodroutineandurineroutine,ECGandchest ;fluoroscopyshowedbasicnorma1.Carcinomaof ;gallbladder,combinedcholepathy,secondary ;eholeeystomy,severecardiovasculardisease. ;shockandthosewhoagedabove65yearswere ;allexcluded.Themainsurgicaloperatorsand ;ThisworkwassupportedbyChineseState”9th5-years’’KeyProjectsofScienceandTechnologyGrant

    ;

    ;?

    ;42?World.Acup-Mox.Vo1.11,No.3,September,2001 ;anesthetistsweresamebasicallyfrombeginning ;totheendofthestudy.

    ;1.2Anestheticmethods

    ;1.2.1Groupingandacupointstimulatingme

;thods:

    ;These194patientswererandomlydivided ;into(basedonrandomtable)acupuncturecorn

    ;binedwithepiduralanesthesiagroup(groupA,

    skinelectricalstimulation ;n=66),acupoint

    ;combinedwithepiduralanesthesiagroup(group ;B,n=63)andsimpleepiduralanesthesiagroup ;(groupC,n=65).IngroupA,bilateralZusanli ;(ST36)andNeiguan(PC6)werepunctured. ;Afterachievingneedlingsensations,the ;acupunctureneedlehandlesinthetwoipsilateral ;acupointswereconnectedtoaLH202HType ;Han’sAcupunctureNerveStimulator(HANS)

    ;forstimulatingtheacupointsbysettingthestim

    ;ulatingparametersbeing:frequencyof2/15Hz, ;intermittentwaves,atolerableelectriccurrent ;strengthof23mAanddurationof1030

    ;min.IngroupB,theseacupointswereonly ;stimulatedelectricallywithfrequencyof2/15 ;Hz.intermittentwaves.electriccurrentof11

    ;13mAanddurationof1030minthroughtwo

    ;pairsofcutaneousplateelectrodes.IngroupC,

    ;thepatientsacceptedonlyepiduralanesthesia. ;1.2.2Methodsofepiduralanesthesia ;Inthese3groups,afterthepatientlied ;horizontally,apunctureneedlewithaductwas ;insertedintotheintervertebralspaceofT89or

    ;Tv——8forplacingthemedicineinjectionduct

    ;about3cmdeepbeneaththeduramatterwith ;theendtowardthehead.5mLof1.5%Iido

    ;caine(containingepinephrine1:200,000forpa

    ;tientswithoutcontraindications)wasinjectedin

    ;totheepiduralspace.Fiveminuteslater,the ;anestheticblockedlevelwastestedfirstwitha ;needle.Iftheblockedlevelreachedabove ;T411,thesurgicaloperationcouldbegintobe ;conducted,otherwise.4mLLidocainewassup

    ;plementedtitheanestheticblockedleveland ;anestheticeffectmetthedemands.Duringoper

    ;ation,ifthepatienthadanapparentpainreac

    ;tionorthedurationofadministrationofanes

    ;theticwasmorethan45min.4mLofLidocaine ;wasaddedagain.

    ;1.3Administrationofmedicinesbeforeanddur

;ingoperation

    ;About30minbeforeepiduralanesthesia, ;intramuscularinjectionofAtropine0.5mgand ;Iuminal0.1g/S0kgwasgiven.Tenminutes ;beforemakingskinincision,intravenousdripof ;Meperidine1mg/kgwasgiventothepatient, ;andifthedurationofoperationexceeded2 ;hours,Meperidine0.5mg/kgwassupplemen

    ;ted.

    ;1.4Indexesformonitoringpatient’sphysiologi—

    ;calfunction

    ;Duringanesthesia,patients’heartrate

    ;(HR),systolicbloodpressure(SBP),diastolic ;bloodpressure(DBP),meanarterialpressure ;(MAP),respirationrate(RR),tidalvolume ;(TV),minuteventilation(MV)volume,oxy

    ;gensaturationofblood(Sp02),ECG,andpar

    ;tialpatients’plasmacatecholamine(CA)con—

    ;centrationandT..1ymphocytesubgroupswerede.. ;termined.

    ;1.5Managementofanesthesia

    ;Intheprocessofanesthesia,ifSp02de

;creasedbybelow95%.02wasgiventothepa

    ;tientviamask.Whenhypotensionoccurred, ;Ephedrine15——30mgwasinjectedintravenous

    ;lY.IftheHRwaslowerthan60beats/min.At

    ;ropine0.250.5mgwasinjectedintravenous

    ;ly.Forrelievinggallbladdercardiacreflexand

    ;viscera-pullingreaction.0.5%Lidocaine5mL ;wasinjectedintotheCalot’striangleregion.Af—

    ;terfinishingtheoperation,theepiduralductwas ;removedandthepostoperativepainwastreated

    ;withintramuscularinjectionofMeperidine. ;1.6Standardsforassessingtheanestheticeffect ;ofacupuncturecombinedwithepiduralanesthe

    ;siaorsimpleepiduralanesthesiaforupperab

    ;

    ;WorldJ.Acup-Mox.Vo1.11,No.3,September,2001?43? ;dominaloperation(simplifieddescription): ;Theevaluationofgradingwasconductedby ;combinationofpatients,operatorsandanes

    ;thetists.ThedoseofadministeredDolantinwas ;1mg/kgwithin2hoursforeverygrade.

    ;GradeI(excellent):Duringoperation,the

    ;patientwascooperative,hadnooronlyaslight ;pain,mayexperiencedslightdiscomfortwhile ;theinternalorganswerepulling,andthemuscu

    ;larrelaxationwassatisfactory.Theoperation ;wasfinishedsmoothly.Epiduraladministrated ;Lidocaine:?5mL+4mL/initialdoses,and

    ;?additionaldose4mL/hr.

    ;GradeII(good):Duringoperation,thepa

    ;tientwascooperative,hadslightpainandocca

    ;sionaldiscomfortorgroanwhiletheviscerawere ;pulling,andthemuscularrelaxationwasall ;right.Theoperationwasfinishedbasically ;smoothly.EpiduraladministratedLidocaine:?

    ;5mL+4mL+4mL/initialdoses,and?addi

    ;tionaldose4mL/hr.

    ;Grade-Ill(poor):Duringoperation,the ;patientexperiencedobviouspain,viscerapulling

    ;reactionandstrikingmusculartension,butthe ;operationcouldmanagetobeaccomplished. ;Epiduraladministrated1idocaine:?5m1+4

    ;mL+4mL+4mL/initialdoses,and?addi

    ;tionaldose4mL/hr.

    ;Grade-IV(failed):Duringoperation,the ;patienthadseverepainreaction,wasirritable, ;andtheepiduraladministratedLidocaine:5mL ;+4mL+4mL+4mL+4mL/initialdoses.

    ;Theintervalforadding1.5%Lidocaine ;was45minandthatformixturesolution60 ;min.IfextraLidocaineneededtobeaddedin ;advance,thegradeofanestheticeffectwasat

    ;tributedtothelowerrank.

    ;1.7Statisticalanalysis:Datacollectedin ;thisstudyweretreatedwithSASSoftwarePro

    ;gramandexpressedasmean?SE.Statistical ;differencesamongdifferenttimeineverysingle ;groupandamonggroupswereanalyzedbyStu

    ;dent’st-testandChisquaretest.Significance

    ;wassetatP<0.05andextremesignificanceat ;P<0.005.

    ;2RESULTS

    ;2.1Comparisonofthebasicconditionsinthe3 ;groups

    ;Amongthe194cholecystomypatients,152 ;(78.36%)werelithiccholecystitis,21

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