The research shows that ABA/AAA has the following advantages: ① drugs enhance the analgesic effect of acupuncture. In most cases, the patient is awake but basically painless during the operation. ② The combination of acupuncture and medicine can save about 45%-54% of anesthesia dose in each operation, which can reduce adverse drug reactions and correspondingly save the same proportion of drug expenses. (3) Because of reducing the use of anesthetics and the overall adjustment of acupuncture itself, the circulatory and respiratory functions during operation are stable, the recovery time after operation is shortened, the complications are reduced, and the hospitalization time is shortened. ④ Some special advantages, such as the special role of acupuncture anesthesia in the reconstruction of new larynx, deep operation in brain functional area, kidney transplantation, etc. With the development of clinical medicine, these characteristics of ABA/AAA will be ignored.
Acupuncture-drug combined anesthesia is not a simple combination of acupuncture and anesthetic drugs. Acupuncture-drug combined anesthesia can only be called acupuncture-drug combined anesthesia with anesthetic which is not enough to complete the operation analgesia under normal circumstances. At present, research shows that some drugs with definite analgesic effect will differentiate when combined with acupuncture. Although most drugs have synergistic analgesic effect with acupuncture, a considerable number of drugs can antagonize or have no effect on acupuncture analgesia. According to the influence of drugs on acupuncture analgesia, researchers divide clinical analgesic anesthetics into three categories: one is drugs that antagonize acupuncture analgesia, called acupuncture anesthetics, and there are six drugs found so far, such as ketamine; There is a kind of drug that can increase the analgesic effect, which is called acupuncture anesthesia synergist. At present, there are 6 kinds of fentanyl/kloc-0. There is a class of drugs that have no effect on acupuncture anesthesia, which is called acupuncture anesthesia-free drugs. Three drugs have been observed, such as sulpiride.
At present, there are four commonly used methods of acupuncture combined with medicine anesthesia: the principle of acupoint selection is easy to get qi (good feeling of acid swelling), no pain, no bleeding, comfortable patient position and no influence on operator's operation. 2.2.2 Fourteen Meridians are the main acupoints. There are three specific options:
① Acupoint selection along meridians: according to the theory that the meridians are interlinked and the indications are accessible, the meridians and acupoints closely related to the incision site and the surgical organ are selected. For example, the tooth extractor Yangming Hegu point and Sanjian point; Sanyinjiao and Taichong points were selected for abdominal tubal ligation.
② Acupoint selection at the proximal end: select acupoints near the operation. For example, choose a cheek car and a big welcome point for tooth extraction; Choosing pulse points by caesarean section.
③ Acupoint selection according to neurological theory: There are two commonly used methods: one is to select points at the same segment (or near segment), such as floating map, Hegu and Neiguan in thyroid surgery; Secondly, selecting points according to the distribution of nerve trunk or directly stimulating nerve trunk is widely used in orthopedic surgery. For example, choose Jiquan point or brachial plexus point (one needle on each side of axillary artery pulsation) for some upper limb operations; Stimulate the third and fourth lumbar nerves, femoral nerves and sciatic nerves, and perform some lower limb operations; Stimulate the second branch of the zygomatic trigeminal nerve and do some head surgery or brain surgery.
There are three ways to select auricular points: auricular acupuncture.
① Selecting points according to the theory of Tibetan image: for example, lung governs fur, and lung points can be selected when cutting skin; The kidney dominates the bone, and the kidney point can be selected for rib cutting in orthopedics or thoracic surgery; The liver can be graded by opening the liver in eye surgery.
② Selection of acupoints according to the surgical site: for example, selection of appendix acupoints during appendectomy; Selection of lung points in lung surgery: taking gallbladder points in gallbladder surgery, etc.
③ Selecting points according to the innervation and anatomical physiology of auricular points: for example, selecting mouth points and auricular root points for abdominal visceral surgery, because they are dominated by vagus nerve. Taking acupuncture points such as brain and lower limbs as common acupuncture points can improve the analgesic effect and reduce visceral reflex, which is guided by its physiological function. The above three acupoint selection methods can be used alone or in combination. ① Manual needle transport: body needles are generally twisted needles or twisted needles combined with insertion; Ear needles can only be screwed, not inserted. The needle feeding frequency is 120 ~ 200 times per minute, the twisting angle is generally 90 ~ 360 degrees, and the lifting range is 5 ~10 mm. It is required to be in a neat state at all times. Manual needle transport should be carried out evenly and stably, which is the basic skill of acupuncture anesthesia, and the stimulation intensity can be adjusted according to the feeling of the operator's fingers. At the same time, due to the simple equipment, it is of great significance to carry out acupuncture anesthesia in remote rural areas and wartime environments.
② Electroacupuncture: The operation method is the same as electroacupuncture therapy. Acupuncture anesthesia generally uses dense waves, and the amount of stimulation should be moderate stimulation that patients can tolerate.
③ Water acupuncture: the method of acupoint selection is the same as that of body acupuncture. Commonly used drugs include vitamin B 1, cryoprotectant, 10% glucose injection, angelica injection, corydalis yanhusuo injection, etc. Demerol can be diluted with normal saline. This method is often used in conjunction with manual needle transport or electroacupuncture. Others include acupuncture anesthesia, instrument compression anesthesia, and electrode plate anesthesia instead of acupuncture.
④ Inducing needle retention: Stimulating acupoints for a period of time before operation is called induction. The induction time is generally about 20 ~ 30 minutes. It can be divided into general induction and key induction. The former is that each acupoint is transported in the order of acupoint prescription, and the time is slightly longer; The latter is to deliver needles to key acupoints five minutes before operation. Generally, the stimulation during surgery should be light; But for some sensitive parts, acupuncture induction can be strengthened during operation; For some less irritating steps in surgery, the needle can be suspended or electrified, and the needle can be left in a static state. For example, in brain surgery, you can leave a needle for a period of time after cutting the meninges.