- 學位論文
良導絡量測系統應用於評估麻醉病患之穴位刺激作用
The Application of A System of Ryodoraku Neurometric Patterns to Evaluation of the Effects from Various Stimulations on the Acupuncture Points of Anesthetized Patients
摘要
摘 要 經絡學說是中醫醫學基礎理論重要的一環。近來發表的針灸臨床和實驗研究論文已達數萬篇，獲得許多重要的結論。以往在針灸現代化方面的文獻，大都未提及麻醉藥物及神經阻斷方法對人體經絡生理效應和良導絡值變化的影響。 運用物理學方法評估針灸效應，可以從經絡中發現電性及能量的變化規律。研究顯示，傳統針刺、電針療法、雷射針灸和超音波針灸四種刺激方式皆能有效的提升十二經絡之良導值，且四種方式之刺激效果大致相同。 本研究的主要目的是運用傳統針刺、電針療法、雷射針灸和超音波針灸刺激人體穴位，透過改變麻醉及神經阻斷方法和藥物，以電腦良導絡經絡檢測系統觀察麻醉病患的生理效應和良導絡值變化。探討四種針灸方式刺激穴位與經絡後訊息傳遞的可能途徑和機轉，並且作為運用穴位刺激於麻醉臨床工作的依據與基礎。 研究方法以每組各6位麻醉病患為受測者，分別刺激相應穴位及重覆記錄血壓和脈搏速度並量測良導絡值。實驗分組如下：(1)第一組刺激穴位為『內關』穴， 麻醉方法分別採取 a. 全身麻醉 b. 臂神經叢阻斷術； (2)第二組刺激穴位為『足三里』穴， 麻醉方法分別採取a. 全身麻醉 b. 脊髓麻醉。再依刺激穴位方法分為四組： (1) 針刺組，採留針法刺激，時間為5分鐘；(2) 電針組，以3Hz的電針刺激，時間為5分鐘；(3) 雷射針灸組，所採用之輸出功率為10mW，連續波輸出，刺激時間5分鐘；(4) 超音波針灸組，其探頭中心頻率為2.25MHz，連續波輸出，功率為0.7watts/cm2，刺激時間為5分鐘。在麻醉及穴位刺激前後，均使用良導絡經絡檢測系統量測紀錄手腳左右二十四個代表點電性數值並記錄血壓和脈搏速度。最後將所蒐集之數據，以統計方法分析麻醉及刺激前、後良導絡值的改變情形並比較結果，並與相關文獻做比較。 研究結果發現，以良導絡量測系統評估麻醉病患，發現接受全身麻醉患者之良導絡值表現為全身二十四經呈現降低(p<0.05)，良導絡值和血壓與脈搏速度皆受全身麻醉藥物抑制；接受臂神經叢阻斷術患者之良導絡值並無顯著變化(p>0.05)；接受脊髓麻醉之部分患者下肢經絡的良導絡值呈現降低(p<0.05)。麻醉患者經傳統針刺、電針療法、雷射針灸和超音波針灸四種方式刺激體表穴位後，其良導絡平均值無顯著變化(p>0.05)，顯示麻醉及神經阻斷方法和藥物可能減弱針灸刺激穴位的良導絡效應。 本研究的實驗結果提示我們，運用良導絡量測系統監測經絡變化，可以用來研究穴位刺激對接受麻醉及手術病患的作用。此外，未來可能可以運用良導絡量測系統來監測全身麻醉的深度。
並列摘要
Abstract The meridian theory is an important part of the basic theory of Traditional Chinese Medicine. Recently, thousands of published clinical and experimental acupuncture papers achieved many important conclusions. Most of the previous papers about modernization of acupuncture did not mention the influences of the anesthetics and the nerve blockade on the human physiological effects and the Ryodoraku values of the meridian. The change regularity of electricity and energy in the meridian can help evaluating the acupuncture effects by physics. Results of the studies showed that four kinds of stimulation, which included needle acupuncture, electric needle acupuncture, laser acupuncture and ultrasonic acupuncture could effectively promote the Ryodoraku values of the meridians and the stimulation effects were similar. The goal of this study was to observe the influences of the anesthetics and the nerve blockade on the human physiologic effects and the Ryodoraku values of the meridians induced by stimulating acupuncture points with needle acupuncture, electric needle acupuncture, laser acupuncture and ultrasonic acupuncture. Then we could explore the possible pathway and mechanism of acupuncture and set up the basis for applying acupuncture in the anesthetic practice. The study selected 6 patients randomly for each group. The stimulated acupuncture points and the anesthetic procedures were grouped as followings: (1) the patients of the first group were stimulated on Neiguan (PC6) under general anesthesia or brachial plexus nerve blockade; (2) the patients of the second group were stimulated on Zusanli (ST36) under general anesthesia or spinal anesthesia. The methods of stimulation included: (1) needle acupuncture, needle stimulation for 5 minutes; (2) electric needle acupuncture, needle with 2 Hz electric stimulation for 5 minutes; (3) laser acupuncture, laser stimulation with 10mW output for 5 minutes; (4) ultrasonic acupuncture, ultrasonic stimulation with 2.25 MHz for 5 minutes. The Ryodoraku device was used to measure the conductivity of meridians before and after each kind of stimulation and the pulse rate and blood pressure were recorded simultaneously. The statistical methods were used to analyze the data. The results showed that (1) the Ryodoraku values of the 24 selected acupuncture points of the patients generally decreased prominently when the pulse rate and blood pressure were stabilized after receiving general anesthesia (p<0.05); (2) the Ryodoraku values of the 6 selected acupuncture points over the blocked arms of the patients were not affected by brachial plexus nerve blockade (p>0.05); (3) the Ryodoraku values of the 12 selected acupuncture points over the lower legs of some patients generally decreased after receiving spinal anesthesia (p<0.05). The results also revealed that the effects of the four kinds of stimulation on the Ryodoraku values of the correlated acupuncture points of the anesthetized patients were variably masked by the anesthetic procedures. The study concluded that monitoring the Ryodoraku values of the meridians could be applied to evaluate the effects of the stimulation on the acupuncture points of the anesthetized or operated patients. The system of Ryodoraku neurometric patterns might be potentially used to monitor the anesthetic depths of the patients under general anesthesia.