布托啡诺超前镇痛联合右美托咪定与舒芬太尼PCIA对妇科腹腔镜手术患者机体免疫功能及炎症反应的影响

目的比较布托啡诺超前镇痛联合右美托咪定与舒芬太尼经患者自控静脉镇痛(PCIA)、布托啡诺超前镇痛PCIA对妇科腹腔镜手术患者机体免疫功能及炎症反应的影响。方法前瞻性选取2019年1月至2022年4月滁州市第一人民医院收治的80例行妇科腹腔镜手术患者,根据信封法将患者分为观察组(n=42)和对照组(n=38)。对照组术前采用布托啡诺超前镇痛PCIA,观察组术前采用布托啡诺超前镇痛联合右美托咪定与舒芬太尼PCIA。比较两组患者镇痛效果[视觉模拟评分法(VAS)评分]、术后苏醒时间、拔管时间、自主呼吸恢复时间、免疫功能(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、血清炎症因子[肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)]及术后不良反应。结果术后6、12、24 h,观察组患者VAS评分分别为(2.98±0.92)、(2.04±0.47)、(1.36±0.43)分,均低于对照组[(3.47±0.89)、(2.84±0.53)、(1.59±0.50)分],差异均有统计学意义(P<0.05)。观察组患者自主呼吸恢复时间、拔管时间以及苏醒时间分别为(43.78±5.40)、(120.89±10.14)、(3.01±0.64)min均短于对照组[(60.32±6.77)、(162.48±9.42)、(4.04±0.72)min],差异均有统计学意义(P<0.05)。术后24 h,两组患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)较术前均降低,但观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)分别为(53.88±1.87)%、(25.48±1.58)%、0.96±0.10,均高于对照组[(48.36±1.74)%、(20.82±1.33)%、0.72±0.06],差异均有统计学意义(P<0.05)。术后24 h,两组患者的TNF-α、CRP、IL-6水平较术前均降低,且观察组TNF-α、CRP、IL-6水平分别为(2.94±0.37)pg/mL、(10.54±1.66)mg/L、(1.88±0.29)pg/mL,均低于对照组[(4.03±0.47)pg/mL、(14.99±2.17)mg/L、(2.47±0.32)pg/mL],差异均有统计学意义(P<0.05)。两组患者术后总不良反应率比较,差异无统计学意义(P>0.05)。结论布托啡诺超前镇痛联合右美托咪定与舒芬太尼PCIA术后镇痛效果更好,免疫功能更高,炎症反应更小,值得在临床推广使用。

不同参数艾条温和灸红外辐射光谱特性研究

目的比较不同松紧度、不同存储时间、不同叶绒比艾条施灸时的红外光谱特性,为艾绒生产、存储及临床应用中的参数选择提供科学依据。方法应用高灵敏红外光谱检测系统,检测4种不同松紧度、5种不同存储年份(1年、2年、3年、5年、7年)、4种不同叶绒比(5:1、10:1、15:1和30:1)艾条红外光谱并进行对比分析。结果不同松紧度、不同存储年份、不同叶绒比艾条燃烧时特征红外光谱均为3.75mm;不同松紧度的艾条燃烧时所产生的红外光谱强度之间比较差异无统计学意义(P>0.05);3年陈和5年陈艾条温和灸的红外辐射强度显著大于1年陈和7年陈艾条(P<0.05),但3年陈和5年陈艾条、1年陈和7年陈艾条比较差异无统计学意义(P>0.05);不同叶绒比(5:1、10:1、15:1和30:1)艾条温和灸红外光谱比较差异无统计学意义(P>0.05)。结论从红外物理角度看,艾绒存储年限以3~5年为佳,5:1叶绒比艾绒已可满足临床需要,无需过分追求太高的叶绒比。

痛经患者关元、十七椎穴伏安特性研究

目的观察痛经患者月经周期关元、十七椎穴位伏安特性的变化规律,为临床选穴及穴位特异性研究提供试验证据。方法检测痛经组50例痛经患者非经期、经期、经后关元和十七椎的伏安曲线,分析痛经患者穴位伏安特性,并与对照组51例健康女性进行比较。结果痛经组非经期十七椎穴的增程伏安面积和惯性面积小于对照点(P<0.05),经期十七椎穴惯性面积小于对照点(P<0.05),经后十七椎穴增程伏安面积、惯性面积均小于对照点(P<0.05);痛经组非经期关元穴的减程伏安面积大于对照点(P<0.05)。对照组经后十七椎穴的增程伏安面积、惯性面积小于对照点(P<0.05)。非经期,痛经组关元穴增程伏安面积、减程伏安面积及惯性面积均大于对照组(P<0.05);经后,痛经组关元穴增程伏安面积、惯性面积大于对照组(P<0.05)。结论关元、十七椎穴具有明显的穴位特异性,并随人体生理病理状态的不同而有不同的表现;与健康女性比较,痛经患者关元、十七椎穴伏安特性在非经期和经后发生了显著变化。

甲状腺功能减退患者太渊穴伏安特性

目的观察甲状腺功能减退患者太渊穴伏安特性变化特征,为穴位功能特异性研究和穴位辅助诊断提供实验依据。方法应用智能型穴位伏安特性检测仪,检测35例甲状腺功能减退患者及40名健康志愿者双侧太渊穴和对照点的伏安曲线,并对其伏安面积和惯性面积进行对比分析。结果健康人双侧太渊增程伏安面积、减程伏安面积均显著小于对照点(P<0.01,P<0.05),右太渊的惯性面积显著小于对照点(P<0.05);甲状腺功能减退患者双侧太渊穴的增程伏安面积、减程伏安面积均显著小于对照点(P<0.05,P<0.01),而惯性面积与对照点比较差异无统计学意义(P>0.05);甲状腺功能减退患者双侧太渊穴的惯性面积均显著大于健康人(P<0.05)。结论甲状腺功能减退患者太渊穴伏安特性发生了明显改变,太渊穴是治疗甲状腺机能减退的有效穴位;穴位与脏腑的联系比非穴对照点与脏腑的联系更为密切。

嘌呤能信号和胞外核苷酸酶在疲劳中的作用及机制研究进展

疲劳是一种主观不适感,往往表现为多样的躯体和精神主诉;其不仅可发展为独立的疾病,也可作为多种疾病的症状,严重降低人们的生活质量。疲劳的发病机制复杂,近年来,中枢和外周神经递质水平改变和能量代谢异常被认为是其主要原因。ATP等嘌呤物质在细胞内主要参与躯体能量需求过程,而在细胞外则作为重要信号分子参与有效神经传递、神经元-胶质细胞相互作用、免疫反应和控制等,在疲劳研究中受到广泛关注。胞外ATP代谢进一步以浓度依赖的方式激活P1受体和P2受体,而胞外核苷酸酶通过释放受体配体控制嘌呤物质浓度,以终止或促进嘌呤信号通路。本文对嘌呤能信号和胞外核苷酸酶协同影响疲劳感受与发展的研究进展进行总结归纳,为疲劳发病机制的进一步研究及疲劳的有效防治提供依据。

激光针灸镇痛效应机制研究进展

激光针灸不会对机体造成疼痛和损伤,既可避免传统针刺给患者带来的恐惧、疼痛,又可避免传统艾灸引起的烟雾污染及对患者呼吸系统的不良刺激,开创了无痛无污染针灸疗法的新时期。因此,在一定程度上可以替代传统针灸。近年来激光针灸在临床上得到广泛的应用,尤其是在治疗骨、关节、软组织等引起的急慢性疼痛及功能障碍性疾病发挥了重要作用。对于激光针灸镇痛效应机制的实验研究目前主要涉及局部损伤组织、细胞及分子水平,包括多种炎性因子、神经肽和神经递质间的相互作用,并从痛感觉、痛情绪和痛认知3个维度研究疼痛机制。然而,激光针灸镇痛机制有待多层次、多水平的深入研究,深入的激光针灸镇痛机制的研究可促进激光针灸在炎性疼痛相关疾病的临床推广及应用。

甲状腺机能亢进患者穴位伏安特性研究

目的:观察甲状腺机能亢进(甲亢)患者与健康人大陵、神门、内关穴伏安特性的变化规律。方法:应用智能型穴位伏安特性检测仪检测56例甲亢患者与40名健康人大陵、神门、内关穴的伏安曲线,并进行比较分析。结果:甲亢患者左大陵穴的惯性面积显著大于健康人(P<0.01),甲亢患者右大陵穴的增、减程伏安面积均显著小于健康人(P<0.01)。甲亢患者左神门穴减程伏安面积和右神门穴的增程伏安面积显著小于健康人(P<0.01)。甲亢患者左内关穴减程伏安面积小于健康人(P<0.05)。结论:甲亢患者穴位的伏安特性较健康人发生变化,且对该疾病的反映主要体现在大陵穴。

清醒无束缚大鼠在针刺缓解急性踝关节炎性痛实验中的应用

目的:比较清醒无束缚方式和传统处理方式对大鼠针刺镇痛效应的影响差异,分析用自主行为指标评价针刺镇痛效应的可能性。方法:在比较不同处理方式的实验中,SD大鼠随机分为空白组、模型组、清醒无束缚针刺组、束缚针刺组、麻醉针刺组,每组6~9只。采用左侧踝关节注射完全弗氏佐剂(CFA)建立急性炎性痛模型。48 h后,各针刺组于同侧"足三里"处接受20 min针刺干预。分别于造模前、针刺治疗前和针刺治疗后30 min进行足底热和机械痛阈值测定。在自主行为测试实验中,SD大鼠随机分为空白组、模型组、清醒无束缚针刺组,每组11~12只。针刺方法同前。针刺结束后行旷场实验。结果:与空白组比较,CFA造模能显著降低各组大鼠机械痛阈值(P<0.001)和热痛阈值(P<0.001)。针刺干预后,与模型组比较,各针刺组大鼠的机械痛阈值和热痛阈值均明显升高(P<0.001,P<0.01);清醒无束缚针刺组机械痛阈值和热痛阈值明显高于束缚针刺组(P<0.05,P<0.01)和麻醉针刺组(P<0.01)。在旷场实验中,清醒无束缚针刺组大鼠爬壁次数较模型组显著增加(P<0.05),活动总路程和抑郁样行为虽有一定程度的改善,但与模型组比较,差异无统计学意义(P>0.05)。结论:和传统的束缚与麻醉比较,大鼠的清醒无束缚状态能更好地反映出针刺镇痛效应;和自主行为指标比较,痛阈能更好地反映出针刺镇痛效应。

陆氏针灸流派治疗糖尿病周围神经病变经验

陆氏针灸流派形成于清末民初,是目前我国在国内外影响最大的针灸流派之一,已被列入上海市及国家级非物质文化遗产名录。以"经脉元气说"、"全面切诊,重视肾气与胃气之虚实"、"识别标本,权衡缓急"、"习用毫针,重视手法"、"善用温针,辅以中药"为主要学术思想,从脾胃论治糖尿病周围神经病变,疗效显著。文章通过文献整理,从学术思想、取穴配穴、针刺方法及病例分析等方面探讨陆氏针灸流派治疗糖尿病周围神经病变的经验。

电针对大鼠吗啡条件性位置偏爱及腹内侧前额叶皮层谷氨酸能神经元激活的影响

目的:观察电针"足三里""三阴交"对吗啡成瘾大鼠条件性位置偏爱(CPP)及腹内侧前额叶皮层谷氨酸能神经元激活的影响,探讨针刺戒毒的中枢机制。方法:SD大鼠随机分为对照组、模型组、电针组,每组10只。大鼠进行吗啡CPP训练和测试(在偏爱箱给予大鼠腹腔注射吗啡10 mg/kg,连续3 d,非偏爱箱注射0.9%氯化钠溶液)。每日CPP训练前30 min以2 Hz/100 Hz电针大鼠"足三里""三阴交"20 min。实验第4天进行CPP测试。用Fos/谷氨酸囊泡转运体2(VGLUT2)荧光双标免疫组织化学法测定各组大鼠腹内侧前额叶皮层谷氨酸能神经元的表达,用多通道微阵列电生理系统测定腹内侧前额叶皮层放电频率和神经元激活情况。结果:与对照组比较,模型组大鼠吗啡CPP得分显著提高(P<0.01);腹内侧前额叶皮层Fos阳性细胞数、VGLUT2阳性细胞数及Fos/VGLUT2双标记阳性细胞增多(P<0.01,P<0.05)。与模型组比较,电针组大鼠吗啡CPP得分显著降低(P<0.01);腹内侧前额叶皮层Fos阳性细胞数、VGLUT2阳性细胞数及Fos/VGLUT2双标记阳性细胞减少(P<0.01,P<0.05);大鼠在偏爱箱/非偏爱箱的放电频率比值和激活神经元数量降低(P<0.001)。结论:电针抑制吗啡CPP行为可能与抑制腹内侧前额叶皮层谷氨酸能神经元的激活有关。

101例青年女性胸腹部骨度分寸测量报告

目的:检验现代女性胸腹部骨度分寸标准。方法:测量101例青年女性身高、体质量、胸腹部骨度分寸长度,将身高除以75计算同身寸,折合为实测骨度分寸后,与2006国标和《灵枢·骨度》中的胸腹部骨度分寸进行比较。结果:女性两乳之间和两喙突之间实测骨度分寸与2006国标一致,分别为8寸和12寸;脐中→耻骨联合上缘(曲骨)与《灵枢·骨度》一致,为6.5寸;胸骨上窝→剑胸结合中点(歧骨)小于9寸,歧骨→脐中大于8寸,两者的比值小于9︰8;胸骨上窝→剑突中(剑突底与剑突尖的中点)为9寸,且与剑突中→脐中的比值符合9︰8。结论:女性两乳之间和两喙突之间骨度分寸可沿用2006国标,脐中→耻骨联合上缘(曲骨)则遵循《灵枢·骨度》,剑胸结合中点(歧骨)建议改为剑突中。

Effect of Compound Laser Acupuncture-Moxibustion on Blood Glucose, Fasting Insulin and Blood Lipids Levels in Type 2 Diabetic Rats

Objective:To investigate the effect of compound laser acupuncture-moxibustion on blood glucose,fasting insulin and blood lipids levels in type 2 diabetes mellitus(T2DM)rats.Methods:Forty male Wistar rats were ran domly divided into 4 groups,in eluding the no rmal group,model control group,laser group and sham laser group(n=10 per group).The rats in the normal group were fed with a standard diet.Rats in other groups were fed with a high-sugar and high-fat diet for 4 weeks,then intraperitoneally injected with 1%streptozotocin to induce T2DM model.The laser group was irradiated by 10.6 μm and 650 nm compound laser on bilateral Pishu(BL 20),Shenshu(BL 23)and Sanyinjiao(SP 6)for 5 min,6 times a week for 5 weeks.The sham laser group received the same treatment as the laser group,but without laser output.The model control group and normal group were not treated.Blood glucose levels were measured before and after 1,2,3,4 and 5 weeks of treatment.The serum levels of fasting insulin,total cholesterol(TC),triglyceride(TG),low-density lipoprotein(LDL),and high-density lipoprotein(HDL)were analyzed after the last treatment.Results:The blood glucose levels in the model control group in creased duri ng the 5 weeks of treatment compared with the no rmal group(P<0.05),while those in the laser group were significantly lower than the model control group after weekly treatment(P<0.01 or P<0.05).After 1,2 and 3 weeks of treatment,the blood glucose levels in the laser group decreased obviously compared with the sham laser group(P<0.01 or P<0.05).Compared with the normal group,the levels of fasti ng in suli n,TC and LDL in the model control group notably in creased(P<0.01 or P<0.05),while their levels in the laser group were significantly lower than the model control group after 5 weeks of treatment(P<0.05 or P<0.01).However,no statistically significant differences were observed in TG or HDL levels among the 4 groups(P>0.05).Conclusion:The compound laser acupuncture-moxibustion of 10.6μm and 650 nm had positive effects on the regulati on of hyperglycemia and insulin resista nee in T2DM rats,which may be a potential treatment for T2DM,and also provide an alternative to the traditional acupuncture and moxibustion therapy.

A FLUID MECHANICS MODEL OF TISSUE FLUID FLOW IN LIMB CONNECTIVE TISSUE——A MECHANISM OF ACUPUNCTURE SIGNAL TRANSMISSION

This article explores the mechanisms of acupuncture meridians by determining characteristics of the tissue fluid flow in the connective tissue along meridians. Based on deep dissection of acupoints on the upper and lower limbs of the human body and micro and macro observation and measurement, a mathematical model of the flow of tissue fluid in interosseous membranes is constructed. It is shown that the signal transmission along acupuncture meridians may be determined by unique anatomical and physiological factors that govern the flow of tissue fluid in the connective tissue and involve mast cell degranulation. Our results provide a preliminary explanation of the phenomenon of the ＂de qi＂ sensation and the mechanism of acupuncture signal transmission along acupuncture meridians.

Determination of Temperature-time Curve of Two Mild Moxibustion Methods:Reinforcing and Reducing

Objective:To observe the specificity of reinforcing and reducing methods of mild moxibustion and explore its clinical significance.Methods:Thirty healthy students were selected and given reinforcing of mild moxibustion on the left Neiguan(PC 6)and reducing on the right Neiguan(PC 6)respectively.Temperature of the acupoint skin surface and the temperature-time curve were recorded by a digital thermometer.Results:In application of mild moxibustion on Neiguan(PC 6),there was a statistical difference in the temperature-increase section between reinforcing and reducing methods(P<0.01).The temperature-increasing section of the temperature-time curve in the reducing method was obviouslysteeper than that in the reinforcing method.In the period of0.5-3 min during moxibustion,the temperature of Neiguan(PC 6)was remarkably higher in the reducing than in the reinforcing(P<0.01).In the application of the reducing,the time for the temperature of Neiguan(PC 6)to increase to 40℃was remarkably advanced(P<0.05)and the rate of burning pain in the subjects was remarkably higher in the reducing method than in the reinforcing method(P<0.001).Conclusion:In comparison with the reinforcing method,the acupoint temperature increased more quickly in the application of reducing method and can produce obvious hot stimulation in a short period of time.In the application of the reinforcing method,the acupoint temperature increased mildly and could enhance the tolerance of the organism to the high temperature.

A LINEAR DYNAMIC MODEL DESCRIBING LYMPH CIRCULATION

The lymph circulation plays an important role in interstitial fluid balance, protein transport, and immune system. However, its mechanism is poorly understood, and associated pathologies are mostly untreatable. By following Sungawa＇s method of discussing the heart output, a hemodynamic model of lymph circulation was set up. The model was used to demonstrate how the lymphatic fluid formation, investigate the relationship between the lymph flow rate QL and physiological parameters, and explore how local massage influences QL Computer simulation results show that QL is linearly proportional to the interstitial fluid pressure P~, which is similar to experimental observations. Comparing the simulated value of QL during the massage of different frequency with the experimental data from Ikomi shows that they are identical, which indicates that the presented model is rational to explain the mechanism of massage treatment in traditional Chinese medicine （TCM）.

CO2 Laser Moxibustion for Knee Osteoarthritis: Study Protocol for A Multicenter, Double-Blind, Randomized Controlled Trial

Background:Knee osteoarthritis(OA)is a major cause of disability among the older adults.Few treatments are safe and effective.Moxibustion is commonly used in treating knee OA in Chinese medicine(CM).CO2 Laser moxibustion device is a substitute for traditional moxibustion,which mimics the effects of traditional moxibustion.More data are needed to support its application in knee OA.Objective:The trial aims to assess the effect and safety of CO2 laser moxibustion in patients with knee osteoarthritis compared with a sham control.Methods:This is a protocol for a multicenter,randomized,double-blind,placebo-controlled trial.A total of 392 participants were recruited and assigned to the CO2 laser moxibustion group and sham laser moxibustion group with a 1:1 ratio at 6 outpatient clinics in Shanghai,China.Participants in both groups received treatment at the affected knee(s)at the acupuncture point Dubi(ST 35)and an Ashi point.There were 3 sessions per week for 4 weeks,and an additional 20-week follow-up.Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)pain scores at week 4.Secondary outcomes were WOMAC function score,stiffness score and overall score,VAS pain,Short-Form heath survey(SF-36),and patients’global assessment.The serum levels of cytokines involved in progress of knee OA were explored.Safety was assessed during the whole trial.Masking effectiveness was assessed by both participants and treatment providers.Discussion:CO2 laser moxibustion device,designed as a substitute for CM moxibustion,is easy to use and control with no choking smoke and smell,and is a plausible method for double-blind research.This study would provide rigorous evidence for the effect and safety of CO2 laser moxibustion in treating knee OA.