Yan Huijin, Xu Chengtao, Liu Bochun, Zhao Huimin (Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences)
In order to evaluate and predict the individual variation related to the effect of acupuncture anesthesia, we observed 106 cases of subtotal gastrectomy under acupuncture anesthesia. Preoperative estimation was made on the following indices: symptomatic classification according to the dialectic methods of traditional Chinese medicine, digital plethysmogram, galvanic skin reflex, digital skin temperature, heart rate, pain threshold and pain tolerance threshold etc. Changes of the above indices after pain, cold, flashing light stimulation and electro-acupuncture induction were also evaluated. We found:
(1) The effect of acupuncture anesthesia was good and excellent in those patients, whose sympathetic activity was stable at rest. For example, the average number of digital pulse volume oscillations in Grade I (n=44) was 3.114±1.921 times, 5 min.{-1} in contrast to 5.729±3.461 times, 5min.{-1} in Grade II patients (n=41), the difference being statistically significant (P<0.001).
(2) Patient that showed light responses to pain and needling stimulation, that had quick convalescence would result in better effect of acupuncture anesthesia.
(3) The effect of acupuncture anesthesia was good and excellent in those patients who showed inhibition of sympathetic activity during acupuncture induction. For example, 20 minutes induction produced a decrease of the galvanic skin reflex of patients with Grade I anesthetic effect (n=47) by 0.57±0.2 mv, in contrast to an increase of 0.45±0.24 mv in Grade III patients (n=11). The difference between them was statistically significant (P<0.05).
(4) The higher the pain-threshold and threshold of pain tolerance, the better the effect of acupuncture anesthesia was.
(5) In patients undergoing subtotal gastrectomy, the effect of acupuncture anesthesia was better in "difficiency and coldness of spleen-stomach" than in "vital energy of liver attacking stomach" patients by Chinese Medical classification, 46 cases of 81 patients in the former group belonged to Grade I, and 30 cases and 5 cases to Grade II and Grade III respectively. There were 6, 13, 6 cases in 25 patients classified to Grade I, Grade II and Grade III accordingly in the latter group. The difference between this two types was statistically significant (P<0.005).
With the help of the above-mentioned indices, the effect of acupuncture anesthesia could be predicted. In case of classifying the results of acupuncture anesthesia into "good" or "bad", the coincidence rate of prediction was 92%. In case of classification into Grade I, II, III, IV, it was 82%. It is therefore concluded that there seems to exist a relationship between individual variation, especially the functional characteristics of the autonomic nervous system and the effect of acupuncture anesthesia.
In order to simplify the prediction procedure and facilitate its application in clinics, we used multifactor-analysis and identification-analysis to find out better indices for prediction of the effect of acupuncture anesthesia. Preliminary findings suggested that the number of digital pulse volume oscillation and pain tolerance threshold were in favor.
In order to evaluate and predict the individual variation related to the effect of acupuncture anesthesia, we observed 106 cases of subtotal gastrectomy under acupuncture anesthesia. Preoperative estimation was made on the following indices: symptomatic classification according to the dialectic methods of traditional Chinese medicine, digital plethysmogram, galvanic skin reflex, digital skin temperature, heart rate, pain threshold and pain tolerance threshold etc. Changes of the above indices after pain, cold, flashing light stimulation and electro-acupuncture induction were also evaluated. We found:
(1) The effect of acupuncture anesthesia was good and excellent in those patients, whose sympathetic activity was stable at rest. For example, the average number of digital pulse volume oscillations in Grade I (n=44) was 3.114±1.921 times, 5 min.{-1} in contrast to 5.729±3.461 times, 5min.{-1} in Grade II patients (n=41), the difference being statistically significant (P<0.001).
(2) Patient that showed light responses to pain and needling stimulation, that had quick convalescence would result in better effect of acupuncture anesthesia.
(3) The effect of acupuncture anesthesia was good and excellent in those patients who showed inhibition of sympathetic activity during acupuncture induction. For example, 20 minutes induction produced a decrease of the galvanic skin reflex of patients with Grade I anesthetic effect (n=47) by 0.57±0.2 mv, in contrast to an increase of 0.45±0.24 mv in Grade III patients (n=11). The difference between them was statistically significant (P<0.05).
(4) The higher the pain-threshold and threshold of pain tolerance, the better the effect of acupuncture anesthesia was.
(5) In patients undergoing subtotal gastrectomy, the effect of acupuncture anesthesia was better in "difficiency and coldness of spleen-stomach" than in "vital energy of liver attacking stomach" patients by Chinese Medical classification, 46 cases of 81 patients in the former group belonged to Grade I, and 30 cases and 5 cases to Grade II and Grade III respectively. There were 6, 13, 6 cases in 25 patients classified to Grade I, Grade II and Grade III accordingly in the latter group. The difference between this two types was statistically significant (P<0.005).
With the help of the above-mentioned indices, the effect of acupuncture anesthesia could be predicted. In case of classifying the results of acupuncture anesthesia into "good" or "bad", the coincidence rate of prediction was 92%. In case of classification into Grade I, II, III, IV, it was 82%. It is therefore concluded that there seems to exist a relationship between individual variation, especially the functional characteristics of the autonomic nervous system and the effect of acupuncture anesthesia.
In order to simplify the prediction procedure and facilitate its application in clinics, we used multifactor-analysis and identification-analysis to find out better indices for prediction of the effect of acupuncture anesthesia. Preliminary findings suggested that the number of digital pulse volume oscillation and pain tolerance threshold were in favor.
No comments:
Post a Comment