| Objective:1. Literature search:Using quantitative and evaluation methods, acupuncture methods in recent years domestic auxiliary intravenous anesthesia related literature searched, organized, analyzed, evaluate acupuncture auxiliary intravenous anesthesia and analgesic effects on the cardiovascular system to guide the research, clinical study.2. Clinical research(1)Through auricular paste the pressure therapy assisted intubation general anesthesia research, observation of general anesthesia surgery anesthesia dosage;(2) The use of simple and effective auricular acupressure therapy, in the treatment of perioperative give continuous, auxiliary analgesic effect was observed;(3) Observe the auricular acupressure body recovery after the intervention, to study the method of anesthesia and surgical trauma and postoPerative complications;(4) Explore whether the act through the neurotransmitter, inflammation reaction, anti-oxidative stress promote the body to adapt to anesthesia and surgery, in order to expand the auricular acupressure range of applications;(5) Based on the research results, summed up a simple and effective auricular point sticking and pressing assisted intubation anesthesia method of operation.Methods:1. Literature search:With "acupuncture" OR "acupuncture" AND "intravenous anesthesia" OR "TIVA" AND "random" as the search strategy, electronic retrieval CBM, CNKI, VIP, Wanfang database, which includes Chinese HowNet journal literature databases, full-text database of important meetings, title of dissertation database; Can not obtain the full text, and then supplemented by hand searching of Guangzhou University of Chinese Medicine library archive database. According to inclusion and exclusion criteria select the appropriate literature, meta-analysis.2. Clinical research(1)Grouping method:the SPSS18.0random sequence generation module the subjects were divided into three groups:①the auricular comfort control group (control group),40cases;②auricular acupressure group (ear group),40cases;③ear before and after the patch group(auricular group2),40.(2) Experimental Procedure:①All patients admitted to hospital blood tests (blood, beta-EP, TNF-alpha, MDA).②At the same time give Chinese dialectical type. Can be divided into qi depression to blood stasis, qi deficiency to blood stasis, the wet stasis network type.③The day before surgery observed in patients with ear, with the thumb and forefinger and pulling the pinna, visual examination in plenty of natural light from the inside out, from the top down, to observe whether there are breaks in the skin, desquamation. Ear detector, select on both sides of the door of God, subcortical, endocrine, ear, lung, spleen, uterus and pelvic auricular probe in the hole area the most sensitive point.Auricular GrouP1:75%alcohol routine disinfection ears, taping and pressing bead. Using magnetic stickers by mechanical pressure and magnetic field effects to stimulate the auricular. Ear pressure to the thumb, index finger, the patient is asked to press the point intensity from light to heavy, a loose-tight, thus producing the feeling of acid, hemp, swelling, pain, heat, local redness, fever, the patient can tolerate the limit. The surgery operation every30minutes, press1, press ear every time a frequency of60beats/min,30seconds per hole, firmly and evenly. Postoperative pressing auricular, press5times a day (wake up in the morning, three meals a day after meals and before going to bed),3days after the removal of auricular. Be taken to prevent tape wet and pollution, for those who are allergic to tape-for-allergy tape.Auricular two groups:the in the Auricular paste of pressure parts of the ear face stickers and other operations with the ear of a group.Control group:the selected auricular area applicator with the same appearance, the number of non-bead tape will not be any stimulus, other operations above.④Preoperative preparation:all patients30minutes before regular injection of phenobarbital sodium (luminal)0.1grams,0.5mg atropine. Extraction of3ml venous blood was allowed to stand after the burglary.⑤Routine after the opening of the vein connected to the multi-function monitor (Marquette EA-GLE3000), and connect the EEG depth of awareness the monitor (the Germany of Narcotrend-compact) to monitor patients undergoing sedation depth, blood pressure, electrocardiogram, finger pulse oxygen saturation, the etC02and other parameters. Surgery tracheal intubation, ventilator (Drager Fabius GS, Germany), induced by drugs:Propofol, sufentanil, cisatracurium; Maintenance medication: propofol, according to need surgery to requires sufentanil. Maintain the patient’s heart rate, blood pressure, fluctuations in the level of±15%, EEG Narcotrend value of40-60. Intraoperative intravenous infusion of sodium lactate Ringer’s injection infusion rate unified8ml·kg-1H-1, such as blood loss, the supplementary crystal blood loss:liquid colloid1:1. surgery to be patient awake extubation, returned to the ward.⑥Surgical procedure:three groups of patients underwent laparoscoPic surgery. Anesthesia after routine disinfection of the abdomen and vulva, vagina, placed catheter and uterine manipulator (asexual life cycle is not Placed the uterine manipulator). Patient supine position, pneumoPeritoneum, in navel piercing veress needle into the peritoneal cavity, connected automatic CO2pneumoperitoneum,1～2L/min flow rate of CO2inflatable, inflatable1L, adjust the patient’s position to the first low-hiphigh (approximately15to25°tilt), continue inflatable, intra-abdominal pressure of12mmHg, unplug the veress needle, place the laparoscopic connected CO2pneumoperitoneum, surgery to maintain intra-abdominal pressure12mmHg, open the cold light source, see pelvic vision. And then select the type of the position of the point2,3 puncture according to the type of surgery demand for intraperitoneal the profiler and tumor resection. The end of the surgery, with0.9%sodium chloride injection flush pelvic check no bleeding, no visceral injury, put the best intra-abdominal CO2, remove the laparoscopic trocar sheath and the puncture site, suture the puncture.⑦Record surgical procedures in patients at each time point (include:burglary, the induction of anesthesia, intubation, pneumoperitoneum, surgery over) heart rate, mean arterial pressure;⑧Intraoperative infusion of propofol, fentanyl, based on the heart rate, blood pressure, EEG index adjusted to a suitable depth of anesthesia.heart rate and.blood pressure was maintained at about15%of the underlying value, the EEG index control at40-60.⑨When surgery over to draw3ml venous blood, send the Patient to return to the ward,(3)Obvervational index①The general clinical data records:name, age, weight, TCM syndromes and syndromes performance, ASA classification, diagnosis, surgical approach.②The State-Trait Anxiety Inventory (STAI) were the day before surgery, the third postoPerative day, see the appendix to evaluate auricular acupressure role in the adjustment of the emotional state of body consciousness.③Recorded before anesthesia, induction of anesthesia, surgical incision, the separation of the tumor, surgery, after the first day of each period, heart rate (HR), mean arterial pressure (MAP) to evaluate the auricular acuPressure role in the adjustment of the body’s heart and lung function.④VAS Record:Record patients with intraoperative propofol, sufentanil dosage were recorded24hours after the pain visual analog scale (VAS score), recording the third postoperative day resting occurrence of pain, to evaluate the ear auxiliary analgesic effect.⑤Recovery of gastrointestinal function observed:Record preoperative and postoperative24hours the number of bowel sounds per minute, and the first bowel movement after the first time the exhaust to evaluate auricular functional recovery of the body to adjust the role of the digestive system. ⑥Third postoperative day review of biochemical indicators to evaluate physiological changes auricular adjustment function.⑦By enzyme-linked immunosorbent assay (ELISA) detection of tumor necrosis factor (TNF-a), beta-endorPhin (beta-EP); thiobarbituric acid (TBA) malondialdehyde (MDA) content. To proven auricular point sticking and pressing analgesia, oxidative stress mechanism.Results:1. Literature search:The evaluation included a total of11RCT,710subjects. Mostly small trials, and methodological quality is not high, there are four randomized study refers only to the refers to "single-blind". The Meta analysis, display and simple acupuncture auxiliary intravenous anesthesia intravenous anesthesia endotracheal intubation compares the hemodynamic effects of advantages, other advantages can not be determined at each time point, suggesting that acupuncture on the body has a protective effect during stress. Use of narcotic drugs to determine the impact of superiority, suggesting that acupuncture on the body assisted sedation analgesia, reducing the use of narcotic drugs.2. Clinical research(1)The comparison of the three groups the patient’s age, weight, ASA classification, surgical approach, TCM-difference between the groups was not statistically significant (P>0.05), comparable between the groups.(2)Three groups of cases the depth of sedation index difference was not statistically significant (P>0.05).(3) Patients in the three groups comparison of the amount of anesthetic propofol dose difference was not statistically significant (P>0.05), sufentanil differences among the three groups was statistically significant (P<0.05), and compared with the control group, group1and to respectively reduced by15.50%and22.73%. In each group various syndromes sufentinal dose comparative difference was not statistically significance (P>0.05).(4)Patients at each time Point of the heart rate, mean arterial pressure between groups difference was not statistically significant (P>0.05), heart rate and arterial blood pressure in surgery at each time point a slight change, but had no significant effect.(5) Three groups of patients status-trait anxiety inventory (STAI)score, group1and2scores than the control group, two groups of traits questionnaire (T-AI) score, no statistically significant difference between the groups (P>0.05); Three groups of patients preoperative S-AI score difference was not statistically significant (P>0.05), after three group scores were lower itself with the preoperative group difference was statistically significant (P<0.01), the difference between the three groups was statistically significant (P<0.05), postoperative ear scores were lower than the control guoup,2group and the difference was statistically significant (P<0.05), while group1and2difference was ststistically significant (P>0.05).Compare various syndromes in each group showed no significant difference (P>0.05).(6)Compared with the control group, auricular group1and2after the first day of pain VAS score difference was statistically significant (P<0.05), but VAS score difference between two trail groups was not statistically significant (P>0.05).Occurrence of pain on the third day after surgery compared with three statistically significant difference between the group (P<0.05). Compare various syndromes in each group showed no significant difference (P>0.05)7)Compared with the control group the auricular group1and group2bowel sounds preoperative difference was not statistically significant (P>0.05), but after the first day differences were statistically significant (P<0.05), were compared with the control group, ear1,2flatus, defecation time in advance, the difference was statistically significant (P<0.05), indicating that the auricular points therapy can promote intestinal peristalsis, helping the body as soon as possible to restore the digestive function. The syndrome in each group, the difference was not statistically significant (P>0.05), described auricular points therapy for various syndromes can be sused, without specificity.(8)Compared with control group, group1and2were no statistically significant difference in leukocyte (P>0.05), but were increased after surgery than before surgery, and extent of the control group is biggest, followed by group1, group2at least, explain the occurrence of auricular point therapy postoperative inflammation inhibitory trend.(9) ComPared with the control group, the absolute neutrophil count, neutrophil percentage auricular group1difference was not statistically significant (P>0.05), group2difference was statistically significant (P<0.05),(10)LymPhoid myeloid absolute value, the absolute value of the mononuclear granulocytes, hemoglobin, sodium, potassium, glucose concentrations among the three groups showed no significant difference (P>0.05).(11)Compared with the control group, ear1,2group the beta endorphins preoperative difference was statistically significant among the three groups after surgery, the difference was not statistically significant (P>0.05). Auriclar point therapy can make beta endorphin levels, which play the role of pain.(12)Among the three groups of tumor necrosis factor levels, the difference was not statistically significant (P>0.05).(13) Between the three grouPs of malondialdehyde content, the difference between the groups was statistically significant (P<0.05). Auriclar points therapy against oxidative stress, resistance to cell damage.Conclusion:This study shows that auricular magnetic auxiliary analgesia in laparoscopic surgery and perioperative role in the adjustment of body functions is sure. Pre-surgery can alleviate Patient stress, fear, anxiety, anti-pain system to start by adjusting the beta endorphins in the body, tumor necrosis factor and MDA, resist oxidative stress, to maintain the stability of the body, and reduce intraoPerative anesthesia Drug use. Promote patients with bowel movements, for the first time in advance exhaust, defecation, adjust gastrointestinal function, helps the body fast recovery after surgery. |
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