Zhang Shiyi, Zhao Lilan, Li Liqing, Zhuang Wenying, Jiang Luyun (Acupuncture Anesthesia Group, Longhua Hospital, Shanghai College of Traditional Chinese Medicine)
Xu Changsheng, Cao Jinshu (Surgical Department, Longhua Hospital, Shanghai College of Traditional Chinese Medicine)
Abundant experiences in acupuncture anesthesia showed that the effect of acupuncture anesthesia can be influenced by many factors. To investigate the role played by such factors and the relations between them in acupuncture anesthesia would help us to study the mechanisms of acupuncture anesthesia, and hence enhance its effectiveness. Therefore, taking thyroidectomy as an example, based on the data of the comprehensive clinical and physiological examinations before operation, the pain endurance by patients and their behaviors during operation, the patients were divided into three groups (I, II, III). Meanwhile, observations are made to see whether and how the effect of the acupuncture anesthesia may be altered by the patients' cooperation with anesthetist (or surgeon), and by the complexity of lesion, the selection of points and the manipulation of acupuncture.
Analysis of the results from 600 cases reveals (1) that the individual variance is the most important factor of all which affect the effectiveness of acupuncture anesthesia. In group I (excellent) 95.98% of cases show satisfactory anesthesia, while in group II (good) 68.7%, and in group III (poor) only 8.47% show satisfactory anesthesia. Among the three groups, there is exceedingly significant difference (p<0.001). In considering the individual variance, 96.77% of patients with good pain endurance show satisfactory anesthesia, compared with 75.6% in patients with moderate pain endurance, and 25% in patients with poor pain endurance. When patients make good co-operation with surgeon the rate of satisfactory anesthesia reaches 93.88%, as compared with 69.23% in normal co-operation and 19.35% in poor co-operation. Of all patients who show good tolerance to needling, 92.73% of cases achieve satisfactory anesthesia, as compared with 71.72% in moderate tolerance and 37.75% in poor tolerance. Observing the psychological state, in calm patients 89.02% of cases, in ordinary patients 73.73%, and in nervous patients 43% of cases result in satisfactory anesthesia; patients with high pain threshold show satisfactory anesthesia at 75%, as compared with 52.38% of the patients with low pain threshold. All factors mentioned above have given remarkable effect on the anesthesia (p<0.001). About the character of patients, in quiet patients 92.24% of cases, in ordinary patients 77.22% of cases, and in active patients 54.84% of cases have proved satisfactory anesthesia. 87.84% of patients with quiet response to pain stimulation, 74.45% with moderate response and 67.21% with keen response achieve satisfactory anesthesia. So, patients' character and response to pain have much to do with the effect on anesthesia (p<0.001 and p<0.05). However, factors such as sex, age, profession, stature and constitution of patients have not much to do with the effect. Consequently "individual variance" refers chiefly to physiological properties (pain endurance, tolerance to acupuncture) and psychological factors (emotion, co-operation); both of them are interrelated but not the same thing. (2) Concerning the co-operation of surgeon with anesthetist, good cooperation results in satisfactory anesthesia at 82.86%, as compared with 67.45% in ordinary co-operation and 60.87% in poor co-operation. As to the complexity of lesions, simple lesions result in satisfactory anesthesia at 82.76%, as compared with 74.60% in ordinary and 52.08% in complex ones. These differences are significant (p<0.001 and p<0.01). (3) Concerning the performance of acupuncture, under the condition of same group of patients accepting similar surgical procedures, there is relative speciality of points. Selection of adjacent points and of points in the same neural segment such as "Jiama", and "Head" from which the needle pierces to "Heart" (points of facial acupuncture), are superior to the selection of distal points according to the course of meridians, such as "Hegu" and "Jianshi". For instance, in group II by using the former points 90.63% of cases results in satisfactory anesthesia, as compared with 73.68% by using the latter points; in group III, 33.33% of cases obtain satisfactory anesthesia by the former points, while none by the latter points. If same points are adopted, no significant difference occurs between hand manipulation and electro-acupuncture, or between various induction periods longer than 15 minutes, or in varying intensities of electro-stimulation within the patients tolerance.
Xu Changsheng, Cao Jinshu (Surgical Department, Longhua Hospital, Shanghai College of Traditional Chinese Medicine)
Abundant experiences in acupuncture anesthesia showed that the effect of acupuncture anesthesia can be influenced by many factors. To investigate the role played by such factors and the relations between them in acupuncture anesthesia would help us to study the mechanisms of acupuncture anesthesia, and hence enhance its effectiveness. Therefore, taking thyroidectomy as an example, based on the data of the comprehensive clinical and physiological examinations before operation, the pain endurance by patients and their behaviors during operation, the patients were divided into three groups (I, II, III). Meanwhile, observations are made to see whether and how the effect of the acupuncture anesthesia may be altered by the patients' cooperation with anesthetist (or surgeon), and by the complexity of lesion, the selection of points and the manipulation of acupuncture.
Analysis of the results from 600 cases reveals (1) that the individual variance is the most important factor of all which affect the effectiveness of acupuncture anesthesia. In group I (excellent) 95.98% of cases show satisfactory anesthesia, while in group II (good) 68.7%, and in group III (poor) only 8.47% show satisfactory anesthesia. Among the three groups, there is exceedingly significant difference (p<0.001). In considering the individual variance, 96.77% of patients with good pain endurance show satisfactory anesthesia, compared with 75.6% in patients with moderate pain endurance, and 25% in patients with poor pain endurance. When patients make good co-operation with surgeon the rate of satisfactory anesthesia reaches 93.88%, as compared with 69.23% in normal co-operation and 19.35% in poor co-operation. Of all patients who show good tolerance to needling, 92.73% of cases achieve satisfactory anesthesia, as compared with 71.72% in moderate tolerance and 37.75% in poor tolerance. Observing the psychological state, in calm patients 89.02% of cases, in ordinary patients 73.73%, and in nervous patients 43% of cases result in satisfactory anesthesia; patients with high pain threshold show satisfactory anesthesia at 75%, as compared with 52.38% of the patients with low pain threshold. All factors mentioned above have given remarkable effect on the anesthesia (p<0.001). About the character of patients, in quiet patients 92.24% of cases, in ordinary patients 77.22% of cases, and in active patients 54.84% of cases have proved satisfactory anesthesia. 87.84% of patients with quiet response to pain stimulation, 74.45% with moderate response and 67.21% with keen response achieve satisfactory anesthesia. So, patients' character and response to pain have much to do with the effect on anesthesia (p<0.001 and p<0.05). However, factors such as sex, age, profession, stature and constitution of patients have not much to do with the effect. Consequently "individual variance" refers chiefly to physiological properties (pain endurance, tolerance to acupuncture) and psychological factors (emotion, co-operation); both of them are interrelated but not the same thing. (2) Concerning the co-operation of surgeon with anesthetist, good cooperation results in satisfactory anesthesia at 82.86%, as compared with 67.45% in ordinary co-operation and 60.87% in poor co-operation. As to the complexity of lesions, simple lesions result in satisfactory anesthesia at 82.76%, as compared with 74.60% in ordinary and 52.08% in complex ones. These differences are significant (p<0.001 and p<0.01). (3) Concerning the performance of acupuncture, under the condition of same group of patients accepting similar surgical procedures, there is relative speciality of points. Selection of adjacent points and of points in the same neural segment such as "Jiama", and "Head" from which the needle pierces to "Heart" (points of facial acupuncture), are superior to the selection of distal points according to the course of meridians, such as "Hegu" and "Jianshi". For instance, in group II by using the former points 90.63% of cases results in satisfactory anesthesia, as compared with 73.68% by using the latter points; in group III, 33.33% of cases obtain satisfactory anesthesia by the former points, while none by the latter points. If same points are adopted, no significant difference occurs between hand manipulation and electro-acupuncture, or between various induction periods longer than 15 minutes, or in varying intensities of electro-stimulation within the patients tolerance.
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