疼痛反射区封闭治疗肾绞痛的临床疗效观察

目的观察疼痛反射区封闭治疗肾绞痛的临床疗效。方法将直径〉9 mm的结石导致肾绞痛100例患者随机分为治疗组与对照组各50例。治疗组采用疼痛反射区利多卡因封闭,对照组采用臀部肌内注射阿托品和哌替啶,记录治疗后镇痛开始起效时间和疼痛缓解时间,并观察不良反应。结果治疗组与对照组镇痛开始起效时间分别为（0.3±0.1）min和（11.2±2.6）min,疼痛缓解时间分别为（0.5±0.2）min和（27.1±3.8）min。两组比较有显著性差异。结论疼痛反射区封闭治疗肾绞痛是一种快速方便缓解肾绞痛的有效方法。     

平阳霉素与肝素钠治疗睑黄瘤疗效对比观察

目的:观察皮内注射平阳霉素治疗睑黄瘤的临床疗效及患者满意度。方法:将122例(239眼)睑黄瘤患者按数字表法分为对照组和观察组,观察组61例(120眼)皮内注射药物以平阳霉素为主,对照组61例(119眼)皮内注射肝素钠治疗,对比两组疗效、安全性及治疗满意度。结果:观察组治愈率、好转率、复发率分别为96.67%、3.33%、3.45%,与对照组的94.96%、5.04%、4.42%比较,差异无统计学意义(P0.05)。观察组治愈所需注射次数、时间分别为(1.37±0.23)次、(38.36±6.44)d,均低于对照组的(6.59±1.34)次、(46.13±9.38)d,差异有统计学意义(P0.05)。两组均未出现较严重不良反应,观察组疼痛程度、负面情绪评分均低于对照组,美观满意度、综合评价评分均高于对照组,差异有统计学意义(P0.05)。结论:平阳霉素皮内注射治疗睑黄瘤安全性高、疗效确切,与皮内注射肝素钠相比其耗时短、痛苦轻,且患者负面情绪低、满意度高,值得临床推广应用。     

双氯芬酸钠联合阿托品用于肾绞痛镇痛的效果观察

为探讨双氯芬酸钠、阿托品联合用于肾绞痛镇痛的疗效。将 2 30例肾绞痛病人随机分为 3组 ,观察组 (92例 )肌内注射双氯芬酸钠加阿托品 ;对照 1组 (6 5例 )单纯肌内注射双氯芬酸钠 ,对照 2组 (73例 )肌内注射阿托品 ,观察镇痛程度及治疗后不良反应。结果镇痛效果观察组与对照 1组比较 ,差异无显著性意义 (P >0 .0 5 ) ,但在镇痛有效级别上差异有显著性意义 (P <0 .0 1) ,对照 2组镇痛效果明显低于上述两组 ;不良反应观察组与对照 1组类似 ,与对照 2组比较 ,恶心、呕吐、眩晕等不良反应明显减少。提示双氯芬酸钠联合阿托品用于肾绞痛镇痛效果确切 ,不良反应少。     

腕踝针治疗肾绞痛的临床有效性及安全性研究

目的：探讨腕踝针治疗肾绞痛患者的临床有效性和安全性。方法：选取120例肾绞痛患者，随机数字表法随机分为腕踝针组和对照组各60例。腕踝针组运用腕踝针治疗，对照组肌注酮咯酸氨丁三醇治疗。比较两组的等待治疗时间、不同时间段的治疗效果、总体疗效、24 h内疼痛复发率、不良反应等指标。结果：腕踝针组的等待治疗时间为（1.18±0.45） min，短于对照组的（5.17±3.89） min(P<0.001);VAS评分方面，在治疗后即刻、0.5 h、2 h、5 h，腕踝针组疼痛评分均低于对照组（P<0.05）；腕踝针组总有效率为98.33%，对照组为93.33%，差异无统计学意义（P=0.210）；不良反应方面，腕踝针组发生率（3.33%）较对照组（16.67%）低，差异有统计学意义（P=0.010）。结论：腕踝针组和对照组都能降低肾绞痛的疼痛评分；但腕踝针等待治疗的时间更短，可迅速缓解肾绞痛，且不良反应小，值得临床推广应用。     

地佐辛对腹腔镜胆囊切除术复苏期及术后疼痛的影响

目的:探究地佐辛对腹腔镜胆囊切除术复苏期及术后疼痛的影响。方法:腹腔镜胆囊切除术患者120例,按随机数字表法分为观察组和对照组各60例。均给予常规麻醉,手术结束前30 min,观察组以0.1 mg/kg的剂量静脉注射地佐辛,对照组注射同等剂量的生理盐水。比较两组麻醉苏醒时间和拔管时间,麻醉苏醒后VAS评分,苏醒后躁动程度评分和不良反应。结果:与对照组相比,观察组苏醒时间与拔管时间没有明显差异(P0.05);观察组在麻醉苏醒后的0.5 h、1 h、2 h、4 h时的VAS评分分别为(2.91±0.52)、(2.53±0.30)、(1.91±0.29)、(1.54±0.37)分,均低于对照组的(4.61±0.61)、(3.69±0.49)、(3.02±0.41)、(2.81±0.38)分,差异有统计学意义(P0.05)。观察组在苏醒即刻及苏醒后10 min、20 min、30 min时的躁动程度评分分别为(1.91±0.52)、(1.62±0.49)、(0.91±0.45)、(0.37±0.16)分,均低于对照组的(2.46±0.56)、(2.15±0.44)、(1.96±0.52)、(1.01±0.39)分,差异有统计学意义(P0.05)。对照组8例出现不良反应,发生率为13.33%;其中3例恶心,2例呕吐,2例头晕,1例寒战。观察组2例出现不良反应,发生率为3.33%;其中1例恶心,1例呕吐。观察组不良反应率比对照组有所降低(P0.05)。结论:预防性静脉注射地佐辛,不会影响腹腔镜胆囊切除术麻醉效果,可有效缓解术后疼痛,改善复苏期躁动与不良反应的发生率。     

关元穴附近热敏灸联合穴位按压治疗肾绞痛

目的 观察热敏灸联合穴位按压治疗肾绞痛临床疗效. 方法 将122例患者随机分为两组,治疗组64例,对照组58例.在患者肾绞痛发作时,治疗组使用美元穴附近热敏灸联合穴位按压止痛,对照组使用单纯穴位按压止痛.若止痛无效则加用杜冷丁肌注止痛,观察两组患者疗效,并对两组患者起效时间,疼痛缓解维持时间,杜冷丁总量进行统计. 结果 两组间疗效治疗组优于对照组,治疗组在总有效率、疼痛缓解维持时间、杜冷丁使用总量等方面有优势(P＜0.05). 结论 关元穴附近热敏灸联合穴位按压能更有效缓解肾绞痛,同时减轻医务工作者劳动强度.     

不同止痛药物治疗输尿管结石并肾绞痛疗效观察

目的 对比观察不同止痛药物治疗输尿管结石合并肾绞痛的疗效。方法 回顾性分析2020年3月至2022年11月青岛滨海学院附属医院急诊科收治的157例输尿管结石合并肾绞痛患者的临床资料,按照用药不同,分为4组:A组采用酮咯酸氨丁三醇注射液+消旋山莨菪碱注射液治疗;B组采用地佐辛注射液+消旋山莨菪碱注射液治疗;C组采用哌替啶注射液+消旋山莨菪碱注射液治疗;D组采用间苯三酚注射液+消旋山莨菪碱注射液组治疗。观察各组患者疼痛缓解情况,疼痛缓解时间,不良反应发生率等情况。结果 A组、B组、C组的疼痛评分改善情况优于D组,D组止痛药物起效时间较其他各组更长,A组和D组不良反应发生率低于B组和C组,差异均有统计学意义(均P<0.05)。结论 酮咯酸氨丁三醇注射液和消旋山莨菪碱注射液组合治疗输尿管结石合并肾绞痛止痛效果好,起效时间短,不良反应发生率低。     

肾绞痛患者体外冲击波碎石术最佳治疗时机探讨

目的 寻找伴有肾绞痛的输尿管结石行体外冲击波碎石术(extracorporeal shockwave lithotripsy,ESWL)的最佳治疗时机.方法 跟踪观察行ESWL的伴有肾绞痛的输尿管结石患者505例,按肾绞痛发作至ESWL的时间间隔分为三组:A组(肾绞痛发作时行ESWL,或急诊ESWL)123例;B组(肾绞痛缓解后3～6d内行ESWL)162例;C组(肾绞痛缓解7d后行ES-WL)220例.观察三组一次碎石成功率、2周结石排净率、再发肾绞痛率及肾内感染发生率并进行比较.结果 A组所有患者经ESWL治疗约5～ 15 min肾绞痛症状明显缓解或消失,绞痛缓解率100％.虽然A组、B组的1次碎石成功率、2周结石排净率均优于C组,差异均有统计学意义(P＜0.05),但A组与B组比较,均无显著差异(P＞0.05).而A组术后再发肾绞痛率和并发肾内感染率分别为50.4％和17.1％,明显高于B组的4.9％和5.6％以及C组的6.8％和5.9％,差异均有统计学意义(P＜0.01).结论 输尿管结石伴有肾绞痛患者应尽早行ESWL治疗,疼痛缓解率高,但应用ESWL的最佳治疗时机为肾绞痛缓解后3～6d内.     

山莨菪碱联合双氯芬酸钠栓治疗肾绞痛效果观察

目的:探讨用山莨菪碱联合双氯芬酸钠栓治疗肾绞痛的疗效。方法:将150例肾绞痛患者随机分成两组观察组(88例),对照组(62例),观察组用山莨菪碱联合双氯芬酸钠栓镇痛,对照组用山莨菪碱和阿托品镇痛,比较两组镇痛效果与不良反应。结果:观察组镇痛效果明显高于对照组,不良反应明显低于对照组(P<0.01)。结论:山莨菪碱联合双氯芬酸钠栓治疗肾绞痛镇痛效果明显优于山莨菪碱和阿托品。     

布托啡诺联合罗哌卡因在硬膜外分娩镇痛中的效果观察

目的探讨布托啡诺联合罗哌卡因用于硬膜外分娩镇痛中的效果。方法选择90例接受硬膜外分娩镇痛的产妇,均在第一产程开始时实施硬膜外麻醉镇痛。随机分为2组,各45例。观察组应用布托啡诺联合罗哌卡因。对照组使用芬太尼联合罗哌卡因。比较2组镇痛起效时间、镇痛至宫口开全时间、麻醉期间出现的不良反应及新生儿Apgar评分。结果观察组镇痛起效时间短于对照组,不良反应低于对照组,差异均有统计学意义(P0.05)。2组镇痛至宫口开全时间及新生儿Apgar评分,差异无统计学意义(P0.05)。结论布托啡诺联合罗哌卡因用于硬膜外分娩镇痛,镇痛起效快、不良反应少,镇痛效果满意。     

核素肾动态显像法测定肾小球滤过率在老年肾癌患者中的应用

目的：探讨核素肾动态显像法测定肾小球滤过率（GFR）在老年肾癌患者中的临床应用价值.方法：回顾性分析30例老年肾癌患者术前及术后1个月应用99锝-二乙三胺五乙酸（99TC-DTPA）肾动态显像法测定GFR的结果,对健侧肾及术侧残肾进行手术前后的比较,观察其代偿性变化.结果：肾根治性切除组术后健侧肾GFR为（57.6±11.8）ml/min,较术前健侧肾（41.2±7.4）ml/min增加39.8%,但与术前双肾GFR（74.9±12.8）ml/min比较则下降了23.1%.肾部分切除组术侧残肾GFR为（27.8±4.8）mI/min,较术前（36.5±6.4）ml/min减少23.9%,健侧肾GFR手术前后比较差异无统计学意义.结论：采用核素肾动态显像法测定GFR在评估老年肾癌患者分肾功能、选择手术方式及监测术后肾功能方面有重要临床价值.     

肾脓肿机化误诊为肾肿瘤

肾脓肿在其机化的晚期,就其影象学表现,不管是尿路造影、超声显象,或是在CT 扫描上,与肾实质肿瘤坏死的鉴别比较困难。     

Early Assessment of Renal Resistance Index and Long-Term Renal Function in Renal Transplant Recipients

Background. The effect of the intrarenal arterial resistance index (RI) on long-term renal functions is not well known. We examined the predictive value of intrarenal RI on long-term allograft outcomes. Methods. We retrospectively investigated 121 stable renal transplant recipients, followed for a mean of 63.21?±?19.9 months after renal transplant. Patients with complications during the first six months after transplant were not included. Color Doppler ultrasonography was done to calculate the intrarenal RI within the first four weeks after transplant. Results. Older recipient age, high pulse pressure, active smoking, and proteinuria were associated with a higher intrarenal RI. Multivariate analyses revealed that renal RI and donor age were independent predictors of allograft outcome. Kaplan-Meier estimates of cumulative graft survival were significantly worse in patients who had an RI of 0.7 or more than they were in patients who had an RI of less than 0.7 (p?=?.005). Development of chronic allograft nephropathy (CAN) was significantly higher in patients who had an RI of 0.7 or more (p?=?.02). Conclusions. Renal RI determined within the first month after renal transplant predicts long-term allograft function and development of CAN in renal transplant recipients.     

Urologist-Acquired Renal Access for Percutaneous Renal Surgery

Objectives. In most endourology programs an interventional radiologist is employed to acquire renal access for percutaneous renal surgery. Over the last 13 years the senior endourologist at Oregon Health Sciences University has acquired access without employing a radiologist. We report our experience with urologist-acquired renal access for percutaneous renal surgery in 522 cases.Methods. We reviewed the records of all patients at our hospital who underwent percutaneous renal surgery between August 1983 and December 1996 with renal access being obtained in the operating room by a urologist.Results. Four hundred fifty-six patients underwent 522 procedures. Indications for percutaneous renal surgery were renal and proximal ureteral calculi (n = 516), retained ureteral stent (n = 3), and intrarenal collecting system tumor (n = 3). We were successful in gaining access to 513 of 522 kidneys (98.3%). Access was obtained via a subcostal approach in 344 procedures, over the 12th rib in 152 procedures, over the 11th rib in 15 procedures, and transabdominally in 2 procedures. Sixty-five patients (12.7%) required a second or multiple sites to facilitate complete removal of calculi. Our overall complication rate was 15.3%. Blood transfusion was required in 5.4% of the cases, ileus developed in 1.9%, pneumothorax in 1.1%, intraoperative hydrothorax in 1.1%, postoperative pleural effusion requiring aspiration in 0.9%, and septic shock in 0.9%. Our overall success rate for stone removal was 94.5%.Conclusions. In our experience, the urologist is able to safely and effectively obtain percutaneous access to the collecting system for percutaneous renal surgery as a one-stage procedure without the aid of interventional radiologists.     

Renal Adenoma Associated with Renal Cyst Formation

We report a renal adenoma associated with renal cyst formation in a 49-year-old male. A small renal mass inside a right renal cyst was discovered incidentally by ultrasonography. A right nephrectomy was performed. A pathologic examination revealed a well-differentiated, benign papillary tumor which was composed of slightly eosinophilic cells. We therefore diagnosed this patient as having a renal adenoma with hemorrhage.