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zhen ci ma zui xia xing kai lu shou shu 2,017 li fen xi
Pages: 97-103
Year: Issue:  2
Journal: Acupuncture Research

Keyword:  开颅手术针麻辅助用药手术操作外科手术实践证明听神经瘤生命体征手术效果临床实践;
Abstract: 1. In Beijing Xuan Wu Hospital, the first case of craniotomy under acupuncture anesthesia (A. A.)was successfully performed on November 18, 1965. By the end of June 1979, 2,017 cases of craniotomiesunder A. A. have been performed based on a great deal of clinical practice, craniotomies in variousregions, selection of suitable puncture points, choice of parameters of stimulation, the use of adjuvantdrugs, improvement of operative techniques and individual variability are discussed, and those factorsinfluencing the results of A. A. are studied and analyzec as well. 2. As to the results of operation under A. A. in cases of intracranial space-occupying lesions invarious regions, the percentage of excellence (excellent rate) was 82.07% in the cases in the frontal re-gions; the excellent rate in cases of acoustic tumours was 82% with early recovery and less postopera-tive complications in spite of the difficulties in the operation and deep location of the tumours, involv-ing the vital centers in the brain stem, for these tumours A. A. has been the method of choice of analge-sia so far. 3. It was found to be most important to select. patients in order to get good results of A. A. In 1972, 474 patients for operation under A. A. were chosen according to their individual variabilityand in 70-80% the effect forecast of A. A. proved to be correct. Then in 1973, 120 patients were chosenaccording to their skin-electricity, pain-threshold, cortioal function status and pattern dialecticallyclassified in the view of Chinese Traditional Medicine, the results of effect fore-cast was the same. Ifthe conditions for A. A. are improved, better results can be obtained. Good results should be expected in following conditions: (a) if the patient's cortical function status is stable and sound; (b) in patients with high pain-threshold; (c) in cases of "kidney deficiency" type, especially yang dificiency type according to the dialecticclassification in Chinese Traditional Medicine; (d) in patients eagerly desireing operation and being willing to accept A. A. and psychologicalcalm and quiet. 4. Troubles mostly often encountered in operation under A. A.: (a) imcompleteness of analgesia at the side of the scalp incision; (b) reactions to traction of the intracranial structures; (c) reactions to low intracranial pressure; (d) when the intracranial pressure is too high for the dura to be incised; (e) problems connected with bleeding and blood transfusion; (f) uncomfortable position. To all these problems attention should be paid as soon as possible. 5. Complications (incomplete statistics): (a) fainting during needling (collapse) 3 cases; (b) transient unconciousness during the exposure of the brain stem 3 cases; (c) intraoperative inhalation of vomitus in one case, when fasting was not observed. (d) epileptic seizures during operation 5 cases; (e) shock caused by severe bleeding and delayed blood transfusion 8 cases; (f) restlessness, uncooperative movements caused by unbearable position and prolonged operation6 cases; (g) complicatious in group under A. A. and in group under drug anesthesia (each 50 cases foracoustic nerves tumours): (I) In group under drug anesthesia there were 3 cases with lung infection, 5 cases with brain stemdamage and one case with secondary postoperative intracranial haemorrhage. (2) In group under A. A.,there was postoperative intracranial haemorrhage in one case and a mild lung infection in one case. (3)Before 1965 the percentage of cases of preservation of VII nervous was 49%, but in 1971, it was 72.1%.This increase of the percentage was due to the introduction of A. A. 6. In the end the authors point out that A. A. is one kind of the modern methods of anaesthesia,but can not replace all the other methods, and there are still several problems which should be studiedproperly. For more serious cases and prolonged operations andandfor those patients who are nervous and poor-ly tolorate pain it is better to use the combined A. A. (i. e. to use 150 ml of 0.1% Procaine for infiltra-tion of the scalp at the side of incision and to give tranquillizers in adequate dosage) in order to getbetter results. This combined method is worth recommending to improve the effects of A. A. and spreadits application, as it can be readily accepted by both patients and surgeons.
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