Postoperative gastrointestinal disorder (POGD) was a common complication after surgery under anesthesia. Strategies in combination with Traditional Chinese Medicine and Western medicine showed some distinct effects but standardized clinical practice guidelines were not available. Thus, a multidisciplinary expert team from various professional bodies including the Perioperative and Anesthesia Professional Committees of the Chinese Association of Integrative Medicine (CAIM), jointly with Gansu Province Clinical Research Center of Integrative Anesthesiology/Anesthesia and Pain Medical Center of Gansu Provincial Hospital of Traditional Chinese Medicine and WHO Collaborating Center for Guideline Implementation and Knowledge Translation/Chinese Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Center/Gansu Provincial Center for Medical Guideline Industry Technology/Evidence-based Medicine Center of Lanzhou University, was established to develop evidence-based guidelines. Clinical questions (7 background and 12 clinical questions) were identified through literature reviews and expert consensus meetings. Based on systematic reviews/meta-analyses, evidence quality was analyzed and the advantages and disadvantages of interventional measures were weighed with input from patients' preferences. Finally, 20 recommendations were developed through the Delphi-based consensus meetings. These recommendations included disease definitions, etiologies, pathogenesis, syndrome differentiation, diagnosis, and perioperative prevention and treatment.

目的:观察和评价针灸结合倒走训练治疗对脑卒中膝过伸患者的临床疗效.方法:共纳入2020年1月～2021年8月就诊于本院脑卒中膝过伸患者120例,采用随机数字表法分为针灸治疗组、倒走训练组、针灸结合倒走训练组三组各40例.针灸治疗组采用单纯针灸治疗,穴位选取患侧内膝眼、外膝眼、血海、粱丘、阳陵泉、委中、足三里、悬钟;倒走训练组采用倒走训练法治疗;针灸结合倒走训练组采用针灸结合倒走训练法进行治疗.依据治疗前后的膝伸展角度观察临床有效率,于治疗前、治疗后测量膝关节伸展位活动度(ROM),以此评价临床疗效,并采用Holden功能性行走分类评分量表比较治疗前后及各组治疗方法对膝过伸患者行走功能的改善.结果:针灸治疗组、倒走训练组总有效率差异无统计学意义(P>0.05),针灸结合倒走训练组高于针灸治疗组(P<0.05)、倒走训练组(P<0.05).治疗后,三组患者的膝关节ROM均较治疗前降低(P<0.05),且针灸结合倒走训练组治疗后的膝关节ROM显著低于针灸治疗组(P<0.05)、倒走训练组(P<0.05),但针灸治疗组、倒走训练组膝关节ROM差异无统计学意义(P>0.05).治疗后,三组患者的Holden步行功能分级均较治疗前改善(P<0.05),且针灸结合倒走训练组治疗后的Holden步行功能分级显著优于针灸治疗组(P<0.05)、倒走训练组(P<0.05),但针灸治疗组、倒走训练组Holden步行功能分级差异无统计学意义(P>0.05).结论:针灸结合倒走训练能够有效治疗脑卒中后膝过伸并能够改善脑卒中后膝过伸的膝关节ROM.

目的:应用系统评价/Meta分析方法评价经皮穴位电刺激对老年髋关节置换术后认知功能的影响.方法:系统检索PubMed、Cochrane library、Web of science、Embase、CBM、CNKI、VIP及WanFang数据库中关于经皮穴位电刺激用于髋关节置换手术的研究,时间从建库至2020年10月7日.由2名研究人员背靠背同时筛选文献,提取数据,使用Cochrane风险偏倚评估工具评价纳入研究的质量,并采用RevMan 5.3软件进行Meta分析.结果:共纳入5项随机对照研究,共计344例受试患者,Meta分析结果显示:试验组术后1天简易智能量表(mini-mental state examination,MMSE)评分和术后3天MMSE评分的下降程度、术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率、术后肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和白细胞介素1β(interleukin-1β,IL-1β)的上升水平均低于对照组(P＜0.05).两组患者术后白细胞介素6(interleukin-6,IL-6)的上升水平差异无统计学意义(P＞0.05).结论:经皮穴位电刺激可降低老年髋关节置换术患者POCD的发生率,抑制术后早期炎性因子的释放.

OBJECTIVE:To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) at different times on the stress response during anesthesia and operation in the patients undergoing open posterior lumbar surgery.METHODS:A total of 94 patients undergoing open posterior lumbar surgery were randomly assigned to preoperative TEAS group(32 cases), intraoperative TEAS group(31 cases) and sham-TEAS group(31 cases). The same anesthetic method was used in the patients of 3 groups. Four electrodes were attached to the bilateral Hegu (LI4) and Neiguan (PC6) and connected to the electronic acupuncture instrument when patients entered the operation room. In the preoperative TEAS group, the patients received TEAS (10 to 20 mA) for 30 min before the anesthetic induction. TEAS (15 mA) was provided immediately when the operation starts till the end of ope-ration for the patients of the intraoperative TEAS group. In the sham-TEAS group, the electronic acupuncture instrument was switched on during the whole procedure of operation, but no electric current was output. Separately, at the moment of entering the operation room (T0), before endotracheal intubation (T1), at the time of endotracheal intubation (T2), 10 min after skin resection (T3), at the end of surgery (T4), recovery from anesthesia (T5) and at the time of extubation (T6), the heart rate (HR) and mean arterial pressure (MAP) were recorded. Using ELISA, the concentrations of epinephrine (E), norepinephrine (NE), dopamine (DA), cortisol (Cor) in serum were assayed at T0, T3, and T4; and blood glucose was tested with blood sugar paper at the same time points.RESULTS:Compared with T0 of the same group, HR was increased at T2 and decreased at T3 of the patients in the sham-TEAS group and the intraoperative TEAS group (P<0.05). Compared with the sham-TEAS group at the same time points, HR was decreased at T2 and increased at T3 of the patients in the preoperative TEAS group (P<0.05), and it was decreased at T6 of patients in the intraoperation TEAS group (P<0.05). HR was reduced at T2 in the preoperative TEAS group when compared with the intraoperative TEAS group. Compared with T0 of the same group, MAP was elevated at T2 and reduced at T3 and T4 in the sham-TEAS group (P<0.05); it decreased at T3, T4 and T5 in the preoperative TEAS group (P<0.05); it rose at T2 and was reduced at T3, T4 and T5 in the intraoperative TEAS group (P<0.05). When compared with the sham-TEAS group at the same time points, MAP decreased at T2 in the preoperative TEAS group (P<0.05), and at T6 in the intraoperative TEAS group (P<0.05). MAP was reduced at T2 and elevated at T6 in the preoperative TEAS group in comparison with the intraoperative TEAS group (P<0.05) at the same time points. Compared with T0 of the same group, the contents of E was increased at T3 in the sham-TEAS group and the intraoperative TEAS group (P<0.05); it was increased in all of the three groups at T4 (P<0.05); the contents of NE, DA, Cor and the blood glucose were increased at T4 in the sham-TEAS group (P<0.05). Compared with the sham-TEAS group at the same time points, the contents of E, DA at T3 and T4 and Cor at T3 in serum of the preoperative TEAS group were decreased (P<0.05); and the contents of E, NE, DA and Cor at T4 in the intraoperative TEAS group were decreased (P<0.05).CONCLUSION:TEAS-assisted general anesthesia can better maintain the stability of HR and MAP during anesthesia and operation in patients undergoing open posterior lumbar surgery, and reduce surgical stress response.

目的:研究急性主动脉夹层(AAD)患者血清D-二聚体(D-D)水平与其分型及预后的相关性.方法:选取2020年1月-2021年12月河西学院附属张掖人民医院收治的90例AAD患者,按Stanford分型将患者分为A组和B组.Stanford A型为A组(n=48),Stanford B型为B组(n=42).比较两组血清D-D水平和预后.分析ADD分型与血清D-D水平的相关性.结果:两组入院前及入院后1、12 h,A组血清D-D水平均高于B组,差异均有统计学意义(P<0.05).A组入院24 h死亡率为39.6％,高于B组的19.0％,差异有统计学意义(P<0.05).血清D-D水平与AAD严重程度呈正相关(P<0.01).结论:Stanford A型急性主动脉夹层患者血清D-D水平相较于Stanford B型明显升高,且血清D-D水平越高提示AAD患者病情越严重,死亡风险越高.

全膝关节置换术后疼痛剧烈,影响患者身心健康及术后关节功能恢复.经皮穴位电刺激是一种非药物和非侵入性治疗方法,因其安全无创伤、操作简单、患者接受度高而成为研究热点.本文回顾近几年相关研究,将经皮穴位电刺激对膝关节置换术后疼痛的疗效、穴位选择、参数设定予以综述,以便临床参考.

肩痹属中医学"痹病"范畴,以肩周疼痛和功能障碍为主要临床症状,严重影响人们的日常生活和工作.经筋理论作为中医经络系统的一部分,在指导临床治疗的过程中发挥着不可替代的作用.文章从内外两个因素阐明肩痹的病因病机,通过对经筋生理功能和病候特点的阐述,说明经筋理论与肩痹的生理、病理联系,并对近年以经筋理论为基础论治肩痹的文献进行整理归纳,试阐明以经筋理论为指导原则治疗肩痹的特点及其优势,以期为肩痹的临床治疗拓宽思路,更好地发挥经筋理论的指导作用.

糖尿病作为一种慢性病,其并发症众多,严重危害国民身体健康,本文从中医证型、刺激方式、针刺机理等方面进行整理,以便于糖尿病前期在中医治未病理论指导下对患者进行针刺干预,尽早截断病程.

目的 观察电针联合全身麻醉对腰椎后路开放手术患者围术期血流动力学及应激反应的影响.方法 选择择期行腰椎后路开放手术患者180例,男68例,女112例,年龄18～70岁,ASAⅠ或Ⅱ级.随机分为三组:电针组(A组)、非经非穴组(B组)和对照组(C组),每组60例.麻醉诱导前,A组予双侧合谷、内关穴电针治疗30 min;B组取上肢2个非经非穴点予电针刺激;C组不予电针治疗.三组麻醉方法 相同,术后予PCIA.记录术中丙泊酚、瑞芬太尼用量,术后24、48 h镇痛泵累积用量,电针治疗前(T0)、麻醉诱导前(T1)、气管插管即刻(T2)、切皮时(T3)和缝皮结束即刻(T4)的HR、MAP.检测T0、T3、T4时肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)、皮质醇(Cor)及血糖浓度.结果 A组术中瑞芬太尼用量明显少于B组,术后48 h镇痛泵累积用量明显少于B组、C组(P<0.05);与T0时比较,T2、T3时A组、C组与T2时B组HR明显增快,MAP明显升高(P<0.05);T1时B组HR明显快于A组,T3时B组HR明显慢于A组、C组,T2、T3时A组、B组MAP明显低于C组(P<0.05).T3时A组DA浓度明显低于C组,T4时A组E浓度明显低于B组、C组.与T0时比较,T3、T4时三组Cor和血糖浓度明显升高(P<0.05).T3、T4时A组、T4时B组Cor浓度明显低于C组(P<0.05).结论 电针联合全身麻醉有利于维持腰椎后路开放手术患者围术期血流动力学稳定,减轻急性应激反应,减少麻醉镇痛药用量,与非经非穴电针刺激比较,疗效更优.

短刺法是《灵枢·官针》十二刺法之一,临床应用广泛,疗效确切.笔者通过分析并总结短刺法的操作方法及临床应用范围,探索其与针刺"至骨"的关系,以拓宽短刺法疾病的适用范围,为临床应用提供参考.

目的:探讨“醒脑开窍”针法对大脑中动脉闭塞(MCAO)大鼠不同时相细胞黏附分子1(ICAM-1)和基质金属蛋白酶-9(MMPs-9)mRNA表达的影响.方法:将144只大鼠随机分为实验组和对照组,再按照灌注4 h、缺血1d、7d、20d各分为4个亚组,每组18只大鼠,采用Z-Longa法对各组实验大鼠进行神经功能评分,每组评分3次,求其平均值;采取逆转录聚合酶链法(RT-PCR)测定分歧时间点ICAM-1 mRNA及MMPs-9 mRNA表达量的改变.结果:不同时间点两组大鼠神经功能缺损评分:对照组4 h(2.78±0.38)、1 d(2.32±0.48)、7 d(1.98±0.35)、20 d(1.58±0.25),实验组4 h(2.50±0.46)、1 d(2.26±0.39)、7 d(1.62 ±0.40)、20 d(1.10±0.35),实验组表达降落明显快于对照组,两组不同时间点神经功能缺损评分差异有统计学意义(P＜0.05);对照组大鼠ICAM-1表达,造模后4h(3.134±0.839)、1 d(3.673±1.742)、7d(3.802±1.781)及20 d(3.408±1.876),实验组造模后4h(2.641±0.565)、造模后1 d(2.447±0.785)、7 d(1.868±0.505)及20 d(1.747±0.775),相应时相比较均P＜0.05;对照组大鼠MMPs-9表达,造模后4 h(2.420±0.928)、1 d(2.898±0.419)、7d(2.696±0.857)及20 d(2.506±0.602),实验组造模后4 h(2.130±0.715)、1 d(1.982±0.351)、7d(1.837±0.751)及20 d(1.802±0.587),相应时相比较均差异有统计学意义(P＜0.05).结论:“醒脑开窍”针法可有效改善局灶脑缺血再灌注损伤大鼠神经功能缺损症状,促进神经功能恢复,并且通过抑制血清及脑组织中炎症因子ICAM-1、MMPs-9的表达,从而发挥脑保护作用,针刺时间越早、周期越长,疗效越明显.

目的:通过对比传统线栓法与改良线栓法法的存活率,为MCAO大鼠模型制备提供一种更稳定的造模方法.方法:选取50只雄性SD大鼠,分为实验组25只,对照组25只,实验组予改良线栓法,对照组予传统线栓法,造模成功后分别予生理盐水灌胃,对比造模成功率、神经功能缺损评分、20天存活率.结果:模型制备成功率实验组为96.0％(24/25),对照组为92.0％(23/25),2组比较差异无统计学意义(P>0.05).2组神经缺损功能评分各分比率接近,差异无统计学意义(P>0.05).20天存活率实验组为66.67％(16/24),对照组为31.9％(9/23),2组比较差异有统计学意义(P<0.05).结论:改良线栓法制备MCAO大鼠模型存活率高于传统线栓法制备MCAO大鼠模型存活率.

脾瘅属于现代医学"糖尿病前期"范畴,指介于正常血糖与糖尿病之间的可逆阶段,及时发现糖尿病高危人群和糖尿病前期人群,并进行有效干预是预防糖尿病发生的关键.该文阐述了针灸疗法对糖尿病前期治疗的研究进展,希望在现代医学防治糖尿病前期的基础上,提供积极可行的针灸疗法的中医理论依据,更好地发挥中医优势.

目的 分析针刺缓解术后疼痛相关随机对照试验(RCT)的研究现状.方法 检索PubMed、Cochrane、Embase、Web of Science、CBM和CNKI数据库,获取从建库至2019年5月收录的相关文献.结果 纳入针刺缓解术后疼痛的RCT文献共198篇,研究者主要来自中国(66.7％),多分布于麻醉科(30.3％)、针灸科(12.9％)、肛肠科(6.5％).电针(46.5％)最为常用,针刺穴位多选用合谷(30.3％)、足三里(25.3％)和内关(18.7％).92.4％的研究证实针刺可以缓解术后疼痛;仅8.6％的研究提及试验注册;37.4％的研究提及针刺操作者资质.电针缓解术后疼痛的有效率高于手捻针,而在减少镇痛药用量、延缓首次用药时间及降低术后不良反应发生率方面,其有效率均低于手捻针.73.7％的研究因样本量估算不达标而被评估为高偏倚风险.结论 针刺缓解术后疼痛的RCT在试验注册、操作者资质、针刺操作细节等方面报告率较低,不同针刺技术缓解术后疼痛各具优劣,后续研究可参考CONSORT 2010和STRICTA提高证据报告质量,同时开展不同针刺技术的疗效比较研究,以寻找最佳镇痛方案.