针刺麻醉对甲状腺手术区域镇痛的机制

Mechanism of acupuncture anesthesia for analgesia of the operative region of thyroid gland

目的:探讨电针刺激合谷、内关穴位后在颈部区域产生镇痛的外周神经机制。方法:选择20名甲状腺疾病患者,志愿接受针刺麻醉,刺激双侧合谷、内关,刺激方式为连续波、刺激电压为6～8 V、频率为10～20 Hz,在刺激40 min后开始手术。在电针刺激前、刺激后10 min、20 min、30 min,监测耳大神经的潜伏期、传导速度、波峰幅度等电生理功能变化,同时测定痛觉变化。结果:电针刺激合谷、内关10 min、20 min、30 min后,痛觉明显降低(P<0.01),耳大神经潜伏期缩短、传导速度加快、波峰幅度增高,较刺激前有明显变化(P<0.01)。结论:①针刺合谷、内关在颈部区域可以产生较好的镇痛作用;②针刺合谷、内关可以引起支配颈部区域的神经电生理改变,表现为兴奋性增高;③支配合谷、内关穴位与颈部区域的神经可能属于同源神经。

Objective To probe into peripheral nervous mechanisms of analgesic effect of electroacupuncture （EA） at Hegu （LI 4） and Neiguan （PC 6） on cervical region. Methods Twenty cases of thyroid disease who wished to receive acupuncture anesthesia, were stimulated with electroacupunCture at bilateral Hegu （LI 4）, Neiguan （PC 6） in continued wave, intensity of 6--8 V, frequency of 10--20 Hz. After stimulation for 40 rain, the operation was made. Before EA stimulation, 10 min, 20 min and 30 rain after EA stimulation, changes of the physiological functions including latent period, conduction velocity, wave peak amplitude of great auricular nerve were monitored and changes of pain sense were detected. Results After EA given at Hegu （LI 4） and Neiguan （PC 6） for 10 rain, 20 min and 30 rain, the pain sense significantly decreased （P〈0. 01）, the latent period of great auricular nerve was shortened, and the conduction velocity was fastened and the wave peak amplitude raised with significant changes as compared with those before EA stimulation （P〈0; 01）. Conclusion EA at Hegu （LI 4） and Neiguan （PC 6） can produce a better analgesic effect on Cervical region; EA at H egu （LI 4） and Neiguan （PC 6） induces electro-physiologic changes of the nerve innervating the cervical region, showing increase of excitability;the nerves innervating Hegu （LI 4） and Neiguan （PC 6） and the nerves of cervical region possibly are homologous nerves.