IJC:针刺麻醉用于开放性心脏手术

美国权威心脏病学综合性杂志《国际心脏病杂志》刊登了上海中医药大学附属曙光医院周嘉等医生撰写的《当代中国针刺麻醉心脏直视手术》论文，由于该杂志的影响因子达到6.802，该篇论文成为了近五年来SCI收录论文中关于针刺麻醉临床型研究排名第一的文章。其关于“体外循环心脏直视手术中采用针药复合麻醉能减少术后并发症及医疗费用”的研究结论正受到国际同行的高度关注。

    担任曙光医院副院长、心胸外科主任的周嘉医师率领研究团队，自2006年7月至2010年10月，对100例针药复合麻醉下心脏手术的患者与同期全麻下行心脏手术的100例患者进行比较，针药复合麻醉组的患者术前均在指导下行腹式呼吸锻炼，手术前15-20分钟针刺双侧三组特选穴位进行诱导，手术开始时和术中仅给予少量镇静和镇痛药物，术中患者始终保持浅睡眠状态下的自主呼吸，整个手术过程不用气管插管，两组病人心内直视操作均按相同的常规方法进行。研究结果显示：二组均无手术死亡，与全麻相比，针药复合麻醉病人麻醉药用量可减少1/3-1/4，术后肺部感染减少近50％，重症监护时间减少1 /3，医疗费用可减少20％。

    周嘉医生团队此次选取的心脏手术病种均为先天性心脏病和心脏瓣膜疾病，病人年龄平均51.3岁，年龄最大的74岁，手术均取得成功。不同于我国早期针刺麻醉手术单纯使用针灸的做法，周嘉研究团队采用的针灸及静吸复合麻醉下体外循环心内直视术，使病人处于浅睡眠自主呼吸状态，消除了早期针麻手术给病人带来的恐惧和不利的心理影响，更加符合医学伦理。手术过程中病人生命体征始终平稳，对脏腑起到较好的保护作用。因此，该针药复合麻醉的改进技术成为了针刺麻醉研究的创新点。

    由于该篇论文中涉及的研究不仅再次证明了针刺麻醉的真实有效，而且对于减少术后并发症和降低医疗费用的程度进行了准确统计，使得同样面临日益高涨医疗费用问题的诸多国际同行投来关注的目光。《国际心脏病杂志》编辑Tsung cheng对该篇文章倾注了很多心血，因为这位编辑本人也曾亲眼目睹过针刺麻醉手术，他为该篇论文配发了编者按，并在其中回顾了针刺麻醉下心内直视手术的过去、现在和未来，他认为该篇论文“具有里程碑意义”，同时相信“针刺麻醉，不但在中国，而且在世界范围内，必将拥有一个光明的前景。”

原始来源:International Journal of Cardiology,2011,150(1):12-16

英文摘要:

Background

Although the use of acupuncture anesthesia for open heart surgery, which was introduced in China four decades ago, has declined in recent years, there is a renewed interest in it in contemporary China due to the escalating medical costs associated with open heart surgery. This study was aimed to determine whether a combined acupuncture–medicine anesthesia (CAMA) strategy reduces early postoperative morbidity and medical costs in patients undergoing open heart operation under cardiopulmonary bypass.

Methods

From July 2006 to October 2010, CAMA was applied in 100 patients undergoing open heart surgery in comparison with another 100 patients under the conventional general anesthesia (GA). For all the CAMA patients, an abdominal breathing training program was practiced for the 3 consecutive days prior to operation. About 15 to 20min prior to surgical incision, acupuncture needles were inserted into the bilateral points ZhongFu, LieQue, and XiMen. During operation, patients were kept on spontaneous breathing. Endotracheal intubation was not employed but only prepared as a standby. The narcotic drugs, fentanyl and midazolam, were intravenously injected but in very low doses as compared to GA. Open heart procedures were performed routinely in both groups.

Results

Compared with the GA patients, the CAMA patients had a less usage of narcotic drugs (p<0.001), less postoperative pulmonary infection (p<0.05), shorter stay in intensive care unit (p<0.05), and a lower medical cost (P<0.05).

Conclusions

A combined acupuncture–medicine anesthesia strategy reduces the postoperative morbidity and medical costs in patients undergoing open heart surgery under cardiopulmonary bypass.