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This paper summarized Professor ZHANG Yunling's experience in the treatment of amyotrophic lateral sclerosis （ALS） from emphasis on both spleen and kidney. It is considered that the characteristic of ALS manifested as overlap of atrophy-flaccidity disease and convulsive disease， and the core pathogenesis are the deficiency of spleen and kidney and the inner pathogenic qi. ZHANG advocated that ALS should be treated from tonifying both the spleen and kidney， as strong spleen and kidney led the latent pathogen at peace. Usually applied Huangqi （Astragalus mongholicus）， Baizhu （Atractylodes macrocephala） combined with Taizishen （Pseudostellaria heterophylla）， fried Yiyiren （Coix lacryma-jobi）， Doukou （Myristica fragrans） and Sharen （Wurfbainia villosa） to tonify the middle and replenish qi， ascend lucidity and descend turbidity to invigorate the spleen； Roucongrong （Cistanche deserticola）， Tusizi （Cuscuta chinensis） combined with Shanyao （Dioscorea oppositifolia）， Shanzhuyu （Cornus officinalis） and prepared Dihuang （Rehmannia glutinosa） are used to support the fire and nourish the water， so as to replenish the spleen. The empirical formula regarded invigorateing the spleen and replenishing the kidney as the core therapeutic principle throughout the treatment of the whole process， which aimed at extinguishing inner wind and pacifying latent pathogen when treating the root.
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Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.Methods Forty patients of both sexes,aged 18-67 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with Mallampati physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic lobectomy,were divided into 2 groups (n =20 each) using a random number table method:general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+GS).Anesthesia was routinely induced and maintained,a laryngeal mask was placed,and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation,and visual analogue scale score was maintained＜4 points.In group TE+GS,Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave,frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP),heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia,immediately after start of operation,during thoracic exploration,immediate after lobectomy,and at 30 min and 1 h after lobectomy.The intraoperative MAP,HR,and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol,norepinephrine,epinephrine,and blood glucose in serum (by enzyme-linked immunosorbent assay).The highest value of PETCO2,the lowest value of SpO2,and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay,time to first flatus,ambulation time,occurrence of nausea and vomiting,chest tube drainage time,development of surgical complications,length of postoperative hospital stay and hospitalization expenses were recorded.Results MAP,HR and RR all fluctuated within the normal range,and no clinically significant events occurred in two groups.Compared with group GS,the highest value of PETCO2 was significantly decreased,the lowest value of SpO2 was increased,the MAP and HR were decreased,the consumption of propofol and remifentanil was decreased,the cortisol,norepinephrine,epinephrine,and blood glucose concentrations in serum were decreased,the time to first flatus,ambulation time,chest tube drainage time and length of postoperative hospital stay were shortened,and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE +GS (P＜0.05).Conclusion TEAS can reduce the amount of opioids consumed in the perioperative period,effectively inhibits intraoperative stress responses,and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.
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Objective@#To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.@*Methods@#Forty patients of both sexes, aged 18-67 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Mallampati physical status Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy, were divided into 2 groups (n=20 each) using a random number table method: general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+ GS). Anesthesia was routinely induced and maintained, a laryngeal mask was placed, and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation, and visual analogue scale score was maintained<4 points.In group TE+ GS, Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave, frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP), heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia, immediately after start of operation, during thoracic exploration, immediate after lobectomy , and at 30 min and 1 h after lobectomy.The intraoperative MAP, HR, and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol, norepinephrine, epinephrine, and blood glucose in serum (by enzyme-linked immunosorbent assay). The highest value of PETCO2, the lowest value of SpO2, and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay, time to first flatus, ambulation time, occurrence of nausea and vomiting, chest tube drainage time, development of surgical complications, length of postoperative hospital stay and hospitalization expenses were recorded.@*Results@#MAP, HR and RR all fluctuated within the normal range, and no clinically significant events occurred in two groups.Compared with group GS, the highest value of PETCO2 was significantly decreased, the lowest value of SpO2 was increased, the MAP and HR were decreased, the consumption of propofol and remifentanil was decreased, the cortisol, norepinephrine, epinephrine, and blood glucose concentrations in serum were decreased, the time to first flatus, ambulation time, chest tube drainage time and length of postoperative hospital stay were shortened, and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE+ GS (P<0.05).@*Conclusion@#TEAS can reduce the amount of opioids consumed in the perioperative period, effectively inhibits intraoperative stress responses, and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.
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Objective To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.Methods Fifty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 35-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective laparoscopic radical resection of colorectal cancer,were selected and divided into 2 groups (n =28 each) using a random number table method:general anesthesia group (group G) and TEAS combined with general anesthesia group (group TG).In group TG,patients received continuous TEAS at bilateral Neiguan,Hegu,Zusanli,Shangjuxu and Xiajuxu acupoints from 30 min before anesthesia induction until the end of surgery,with a frequency 2/100HZ,disperse dense waves,intensity the maximum current that could be tolerated (3-8 mA).After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated,and combined intravenous-inhalational anesthesia was used to maintain anesthesia in both groups.Peripheral venous blood samples were collected when entering the operating room (T1),at the end of operation (T2),and at 24 and 72 h after operation (T3,4) for determination of intestinal fatty acid binding protein (I-FABP) and diamine oxidase (DAO) in palsma using enzyme-linked immunosorbent assay.Quality of Recovery-9 (QoR9) was used to assess the postoperative quality of recovery at 24 h before surgery (T0),T3 and T4.Results The concentrations of plasma I-FABP and DAO were significantly higher at T2 and T3 than at T1 in G and TG groups (P＜0.05).Compared with the baseline at T0,QoR-9 scores were significantly decreased at T3 and T4 in G and TG groups (P＜0.05).Compared with group G,the concentrations of plasma I-FABP at T2-T4 and DAO at T2 and T3 were significantly decreased,and QoR-9 scores were increased at T3 and T4 in group TG (P＜0.05).Conclusion TEAS can attenuate intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.
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Objective To compare the effects of transcutaneous electrical acupoint stimulation ( TEAS) combined with general anesthesia and epidural block combined with general anesthesia on the re-covery of patients undergoing laparoscopic radical resection of colorectal cancer. Methods Eighty-four pa-tients of both sexes, aged 35-64 yr, with body mass index of 18-25 kg∕m2 , of American Society of Anes-thesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colorectal cancer, were divided into 3 groups (n=28 each) using a random number table method: general anesthesia group (group G), TEAS combined with general anesthesia group (group TG), and epidural block com-bined with general anesthesia group ( group EG) . In group TG, patients received continuous TEAS of bilat-eral Neiguan, Hegu, Zusanli, Shangjuxu and Xiajuxu acupoints starting from 30 min before anesthesia in-duction until the end of surgery at a frequency of 2∕100 HZ and intensity of 3-8 mA with disperse-dense waves. In group EG, an epidural catheter was placed at L1,2 and advanced for 3 cm in the epidural space in cephalad direction, 2％ lidocaine 3 ml was given as a test dose, 0. 375％ ropivacaine 6-10 ml was injected into the epidural space, the level of anesthesia was adjusted to T6 , and then 0. 375％ ropivacaine 5 ml∕h was infused to the epidural space until the end of operation. Patients were endotracheally intubated after rou-tine induction of general anesthesia and mechanically ventilated, and combined intravenous-inhalational an-esthesia was used to maintain anesthesia. The Quality of Recovery ( QoR-15) score was recorded on 1 day before surgery and 1-3 days after surgery. The development of nausea and vomiting, cognitive decline and requirement for rescue analgesics was recorded within 3 days postoperatively. The intraoperative consump-tion of remifentanil and propofol, vasoactive drugs, extubation time, time of PACU stay, time of passing flatus and length of postoperative hospital stay were recorded. Results Compared with group G, the con-sumption of remifentanil was significantly decreased, the QoR-15 scores were increased at 1-3 days after surgery, the incidence of nausea and vomiting and cognitive decline was decreased, and the extubation time, time of passing flatus and length of postoperative hospital stay were shortened in group TG and group EG ( P<0. 05) . Compared with group TG, the intraoperative requirement for vasoactive drugs was signifi-cantly increased in group EG ( P<0. 05) . Conclusion TEAS combined with general anesthesia and epi-dural block combined with general anesthesia have the comparable effect on the recovery of patients undergo-ing laparoscopic radical resection of colorectal cancer, however, the former one provides more stable hemo-dynamics during surgery.