Cooperative Group of Abdominal Total Hysterectomy under Acupuncture Anestaesia, Beijing, Sichuan, Shanghai, Hunan and Shanxi
The observation and analysis were made according to the clinical data of 95 cases of abdominal hysterectomy under acupuncture anesthesia and 29 cases under epidural anesthesia as control, and to some objective indices of physiology, biochemistry and differentiation of symptom complex of traditional Chinese medicine.
I. Method of anesthesia:
Selection of the points:
Cephalic acupuncture: Zhongjiao through to Xiajiao (both sides); Xiajiao through to Zhongjiao (both sides).
Corporal acupuncture:
Modified needling method of Ciliao (both sides); Wushu Through to Weidao (both sides).
Electrical stimulation was generated from Bei-Hang 57-6D acupuncture apparatus (Electro-stimulator) with a frequency of 100c./sec. Electric current strength is limited according to that tolerance by the patient. Adjuvants were administered according to the rule designed by the collaborating group.
II. Results of acupuncture anesthesia:
Rate of success 95.79%. Rate of grade I and II 81.05%. Rate of grade I 22.1%.
III. Data of clinical observations:
1. Results of acupuncture anesthesia were not influenced by patient's age, body weight, occupation and the size of the tumor.
2. Relationship between anesthesia effect and menstrual cycle: Among the 60 cases under acupuncture anesthesia, 17 cases operated in the earlier half of menstrual cycle, the grade I and II rate of anesthesia is 100%; 28 cases in the later half of menstrual cycle, the grade I and II rate 75.71% (P<0.01).
3. Observations on the postoperative analgesia:
Among 95 cases, 38.9% received analgesics after operation while 61.1% did not. In 29 cases under epidural anesthesia, 62.1% of them needed analgesics, 37.9% not. In the acupuncture anesthesia group, those of grades I,II,III and IV of anesthesia effect needed some analgesics postoperatively and the rate of administration was 33.3%, 38.9%, 50.0% and 75.0% respectively.
This implies that acupuncture still has an analgesic action after operation.
IV. Investigations of objective indices
1. Physiological indices:
(1) Fluctuation rate of finger vessel volume wave have some relationship to the anesthesia result. Cases of less fluctuation gave better results. Cases under epidural anesthesia all manifested small fluctuation rates.
(2) Cases complicated with cardiovascular diseases operated under acupuncture anesthesia did not show much changes in the physiological indices mentioned, they recovered well after operation and their excellent rate in anesthesia effect was 88.89%.
(3) ECG changes during operation are related to the anesthesia results. Most cases in grades III and IV showed ECG changes during operation (cases with ECG changes before operation not included). Sinus arrhythmia has been frequently observed and disappeared spontaneously 24 hours after operation.
In those cases complicated with cardiovascular diseases operated under epidural anesthesia, cyanosis of various degrees, coldness of extremities and changes in ECG were frequently seen. Blood pressure dropped, heart rate decreased and postoperative recovery was generally poor.
2. Observations on some biochemical indices:
The cellular and humoral immunity were investigated in 59 patients under acupuncture anesthesia and in 18 cases under epidural anesthesia.
(1) E-rosette formation and immune diffusion tests were used to estimate the rule of changes as well as the changes in IgG part of the immune globulin, before and after acupuncture induction. After induction both indices were found to be increased, and the amplitudes were parallel to the anesthetic effects (E-rossette formation index P<0.025, IgG index P<0.1 in grade I respectively). P values of above mentioned two indices were not significant in II and III grades of acupuncture anesthesia and in epidural anesthesia. It shows that acupuncture could elevate functions of immune system of the patients having excellent effect with acupuncture anesthesia.
(2) The adjusting action of acupuncture on immune system is related to the basic immunity level. The adjusting action is good if the basic level in immunity is low. The value of the two indices mentioned increased in larger amplitude (P<0.01) after induction and the results of acupuncture anesthesia were better.
(3) Observations on the typification by traditional Chinese medicine.
1. Patients belong to the weak type, or to the weaker ones in the complicated type often give better acupuncture anesthesia effects. The typification was carried out before operation.
2. Observations on the pulse condition during operation: Cases under acupuncture anesthesia in grades I and II have better recovery. There is marked significance in comparison with the grades III and IV (X{2}=9.42, P<0.01). In cases under epidural anesthesia, there are less changes in the pulse and tongue condition. But most of them experienced coolness in the forehead and fingers.
3. Observations on changes in the pulse and tongue condition and complexion 24 hrs. after operation: Changes of tongue and pulse condition were more frequently seen in the epidural anesthesia group than in the acupuncture anesthesia group. The complexion of the epidural group did not recuperate so well as that of the acupuncture group. The comparison shows X{2}=25.48, P<0.01. This explicated us that recuperation of the patients after operation under acupuncture anesthesia was better than that under epidural anesthesia.
The observation and analysis were made according to the clinical data of 95 cases of abdominal hysterectomy under acupuncture anesthesia and 29 cases under epidural anesthesia as control, and to some objective indices of physiology, biochemistry and differentiation of symptom complex of traditional Chinese medicine.
I. Method of anesthesia:
Selection of the points:
Cephalic acupuncture: Zhongjiao through to Xiajiao (both sides); Xiajiao through to Zhongjiao (both sides).
Corporal acupuncture:
Modified needling method of Ciliao (both sides); Wushu Through to Weidao (both sides).
Electrical stimulation was generated from Bei-Hang 57-6D acupuncture apparatus (Electro-stimulator) with a frequency of 100c./sec. Electric current strength is limited according to that tolerance by the patient. Adjuvants were administered according to the rule designed by the collaborating group.
II. Results of acupuncture anesthesia:
Rate of success 95.79%. Rate of grade I and II 81.05%. Rate of grade I 22.1%.
III. Data of clinical observations:
1. Results of acupuncture anesthesia were not influenced by patient's age, body weight, occupation and the size of the tumor.
2. Relationship between anesthesia effect and menstrual cycle: Among the 60 cases under acupuncture anesthesia, 17 cases operated in the earlier half of menstrual cycle, the grade I and II rate of anesthesia is 100%; 28 cases in the later half of menstrual cycle, the grade I and II rate 75.71% (P<0.01).
3. Observations on the postoperative analgesia:
Among 95 cases, 38.9% received analgesics after operation while 61.1% did not. In 29 cases under epidural anesthesia, 62.1% of them needed analgesics, 37.9% not. In the acupuncture anesthesia group, those of grades I,II,III and IV of anesthesia effect needed some analgesics postoperatively and the rate of administration was 33.3%, 38.9%, 50.0% and 75.0% respectively.
This implies that acupuncture still has an analgesic action after operation.
IV. Investigations of objective indices
1. Physiological indices:
(1) Fluctuation rate of finger vessel volume wave have some relationship to the anesthesia result. Cases of less fluctuation gave better results. Cases under epidural anesthesia all manifested small fluctuation rates.
(2) Cases complicated with cardiovascular diseases operated under acupuncture anesthesia did not show much changes in the physiological indices mentioned, they recovered well after operation and their excellent rate in anesthesia effect was 88.89%.
(3) ECG changes during operation are related to the anesthesia results. Most cases in grades III and IV showed ECG changes during operation (cases with ECG changes before operation not included). Sinus arrhythmia has been frequently observed and disappeared spontaneously 24 hours after operation.
In those cases complicated with cardiovascular diseases operated under epidural anesthesia, cyanosis of various degrees, coldness of extremities and changes in ECG were frequently seen. Blood pressure dropped, heart rate decreased and postoperative recovery was generally poor.
2. Observations on some biochemical indices:
The cellular and humoral immunity were investigated in 59 patients under acupuncture anesthesia and in 18 cases under epidural anesthesia.
(1) E-rosette formation and immune diffusion tests were used to estimate the rule of changes as well as the changes in IgG part of the immune globulin, before and after acupuncture induction. After induction both indices were found to be increased, and the amplitudes were parallel to the anesthetic effects (E-rossette formation index P<0.025, IgG index P<0.1 in grade I respectively). P values of above mentioned two indices were not significant in II and III grades of acupuncture anesthesia and in epidural anesthesia. It shows that acupuncture could elevate functions of immune system of the patients having excellent effect with acupuncture anesthesia.
(2) The adjusting action of acupuncture on immune system is related to the basic immunity level. The adjusting action is good if the basic level in immunity is low. The value of the two indices mentioned increased in larger amplitude (P<0.01) after induction and the results of acupuncture anesthesia were better.
(3) Observations on the typification by traditional Chinese medicine.
1. Patients belong to the weak type, or to the weaker ones in the complicated type often give better acupuncture anesthesia effects. The typification was carried out before operation.
2. Observations on the pulse condition during operation: Cases under acupuncture anesthesia in grades I and II have better recovery. There is marked significance in comparison with the grades III and IV (X{2}=9.42, P<0.01). In cases under epidural anesthesia, there are less changes in the pulse and tongue condition. But most of them experienced coolness in the forehead and fingers.
3. Observations on changes in the pulse and tongue condition and complexion 24 hrs. after operation: Changes of tongue and pulse condition were more frequently seen in the epidural anesthesia group than in the acupuncture anesthesia group. The complexion of the epidural group did not recuperate so well as that of the acupuncture group. The comparison shows X{2}=25.48, P<0.01. This explicated us that recuperation of the patients after operation under acupuncture anesthesia was better than that under epidural anesthesia.
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