针麻和针刺镇痛是中医针灸研究领域最有标志性的成果之一，为针灸走向世界做出了重要的贡献。大量的临床实践已证明，针药复合麻醉下开颅手术具有麻醉药用量少、术中生理功能干扰小、术中患者可保持清醒合作利于神经功能监测、术后并发症少、恢复快、医疗费用降低等优势。但针麻发生机制的物质基础和中医理论仍不十分清楚。使用现代先进的科研方法和技术对此进行深入、系统地研究，阐明针药复合麻醉的内在机理，将有助于针麻得到国内外医学同行的进一步认可和广泛应用。 本研究采取随机、双盲、对照科研设计，由多学科参与用血氧水平依赖（BOLD）的磁共振功能成像（fMRI）、磁共振弥散张量成像（DTI）、介质频谱分析、药物靶控输注技术、皮质电刺激技术、神经电生理学监测、神经功能评分、二维聚丙烯酰胺凝胶电泳-质谱技术、液体芯片-飞行时间质谱技术、高效液相色谱分析、免疫荧光等现代先进的研究手段，以规范化的指标（观察参数）控制体系，系统评价电针或经皮刺激穴位和非穴位复合短效麻醉和镇痛药物用于清醒和非清醒开颅手术的麻醉效果、神经内分泌反应、生理功能干扰、麻醉和手术并发症、术后康复等情况，科学分析镇痛、镇静、神经功能变化、机体康复、与穴位和非穴位、局部和远端取穴电刺激以及麻醉镇痛药物作用的物质基础和内在联系，为中医理论提供科学依据和证据。同时总结出“针药复合清醒开颅手术的操作规范”和“针药复合全麻开颅手术的操作规范”，为开颅手术穴位针刺复合麻醉在国内外的推广应用奠定基础。Abstract Acupuncture and acupuncture analgesia are the most important achievements of traditional Chinese medicine studies. It has been demonstrated that acupuncture combined with general anesthesia used in craniotomy can reduce anesthetic requirements, alleviate the disturbance of physiological function, keep patients’ consciousness in order to cooperate neural-functional monitor, decrease postoperative complication, improve postoperative recovery and reduce medical cost.. However, the material basis and the theory of acupuncture were still unclear. In the past twenty years, we ever took charge of many researches about acupuncture such as the “The study of acupuncture anesthesia and acupuncture” of the 7th/8th /9th Five Years Programs for Science and Technology Development of China, “Research on acupuncture analgesia in signal transduction pathway of brain functional imaging” of the National Natural Science Foundation, “The use of acupuncture anesthesia in the resection of the gliomas in cerebral functional area” of Beijing traditional Chinese medicine science and technology project. On the basic of these researches, we designed this randomized, double-blinded sham-controlled study, used many modern methods such as blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI), magnetic resonance diffusion tensor imaging (DTI), medium frequency spectrum analysis, drug target controlled infusion technology, electric cortical stimulation technology, neural electrophysiological monitoring, neural function score, two-dimensional polyacrylamide gel electrophoresis and mass spectrometry, an so on. We systematic evaluated the effects of electroacupuncture or percutaneous stimulation of acupoints combined with short acting anesthetics on neuroendocrine response, physiological function, anesthesia and operation complication, postoperative rehabilitation. So as to scientific analyze the material basis and the internal connection within analgesia, sedation, nerve function changes, the rehabilitation of patients and acupoints stimulation and analgesic effect of anesthesia. We provide modern, scientific, convincing evidence for the traditional Chinese medicine theory of "acupoint", "principle and point", "syndrome differentiation". At the same time we tried to summarize the guideline of "acupuncture and medicine anesthesia in awake craniotomy" and "acupuncture and medicine anesthesia in craniotomy operation practices", so as to lay the foundation for the application of acupuncture anesthesia in neurosurgical operation at home and abroad.
NSTRS
