自制复方表面麻醉凝胶在静脉穿刺镇痛中的应用

[目的]观察自制复方表面麻醉凝胶制剂在静脉穿刺中的镇痛效果.[方法]将利多卡因、丙胺卡因、丁卡因及羧甲基纤维素按组方要求配制成凝胶制剂.将自制的复方表面麻醉凝胶或外观性状相同的安慰剂分别用于实验组和对照组慢性肝病病人静脉穿刺前,15 min后常规消毒皮肤并进行静脉穿刺,采用视觉模拟评分法(VAS)进行疼痛评分.[结果]实验组疼痛程度低于对照组,两组均未出现不良反应.[结论]复方表面麻醉凝胶制剂可有效减轻病人静脉穿刺导致的疼痛,且安全性好.     

丁卡因溶剂表面麻醉用于男性病人留置导尿的效果观察

[目的]观察丁卡因溶剂表面麻醉用于男性病人留置导尿的效果。[方法]将90例男性留置导尿病人随机分为观察组和对照组,每组45例,对照组采用液状石蜡润滑尿管后常规导尿,观察组采用丁卡因溶剂表面麻醉后留置导尿。比较两组病人首次插管成功率、插管疼痛程度及满意度、插管前后病人平均动脉压和心率。[结果]观察组病人首次插管成功率、插管满意度高于对照组;观察组病人插管疼痛程度低于对照组;两组病人导尿后平均动脉压和心率均有不同程度的升高,观察组病人平均动脉压和心率低于对照组。[结论]丁卡因溶剂表面麻醉用于男性病人留置导尿,可提高首次插管成功率、减轻病人的不适感。     

盐酸利多卡因凝胶在立体定向头架安装中的应用

[目的]观察盐酸利多卡因凝胶在立体定向头架安装术中局部麻醉的作用。[方法]将126例接受立体定向手术病人随机分为两组,对照组采用常规2%利多卡因注射液局部浸润麻醉,然后安装立体定向头架;试验组术前1h以头架穿刺点为中心涂以盐酸利多卡因凝胶,涂抹后局部用贴膜覆盖,安装立体定向头架时再用2%利多卡因注射液局部浸润麻醉,然后安装立体定向头架。比较两组病人疼痛程度、收缩压和心率的变化。[结果]试验组病人疼痛程度显著降低(P<0.05),收缩压和心率升高等变化幅度显著小于对照组(P<0.05)。[结论]立体定向头架安装前涂以盐酸利多卡因凝胶,明显减轻病人的疼痛程度,减小收缩压和心率的变化,保证头架安装的顺利进行。     

盐酸利多卡因凝胶在男性留置导尿中的应用

[目的]探讨盐酸利多卡因凝胶用于男性留置导尿的效果.[方法]将82例需留置导尿的男性病人分为两组,实验组插管前尿道内注入盐酸利多卡因凝胶,对照组按常规操作方法插管.观察两组病人插管时疼痛程度、一次插管成功率.[结果]实验组病人疼痛轻、一次插管成功率高,两组比较差异有统计学意义.[结论]盐酸利多卡因凝胶应用于男性导尿术可减轻病人疼痛,提高插管的一次成功率.     

利多卡因凝胶在术前静脉穿刺置管术中的应用效果观察

[目的]探讨利多卡因凝胶涂抹对术前静脉穿刺置管术的影响及效果。[方法]选择手术前静脉留置针穿刺保留且意识清楚病人160例,分为观察组和对照组各80例,观察组在静脉留置针穿刺前以2%盐酸利多卡因凝胶涂抹皮肤,2min后再行穿刺置管术;对照组常规静脉留置针穿刺。观察两组病人一次穿刺成功率、病人的疼痛度、满意度。[结果]两组病人一次穿刺成功率比较差异无统计学意义(P0.05),穿刺时疼痛度和满意度比较,差异有统计学意义(P0.05)。[结论]术前静脉穿刺置管时应用2%盐酸利多卡因凝胶涂抹皮肤能缓解穿刺时疼痛,提高病人满意度,无药物不良反应发生。     

尿管导引器及盐酸丁卡因凝胶在前列腺增生患者导尿中的应用

目的：探讨尿管导引器及盐酸丁卡因凝胶在前列腺增生患者导尿中的应用效果。方法：采用随机抽样法将78例老年前列腺增生患者分为观察组40例和对照组38例。导尿时，观察组使用尿管导引器及盐酸丁卡因凝胶辅助导尿；对照组按照常规方法导尿。结果：观察组疼痛程度、一次插管成功例数和插管时间明显优于对照组，两组比较有极显著性差异（P〈0．01）。结论：应用尿管导引器及盐酸丁卡因凝胶辅助导尿可提高前列腺增生患者一次插管成功率，缩短插管时间，减轻患者痛苦，值得临床推广使用。     

舒泰凝胶在女性膀胱镜检查中的应用

[目的]探讨尿道表面麻醉时女性膀胱镜检查病人的影响。[方法]将70例女性膀胱镜检查病人随机分为观察组和对照组，观察组以含1％盐酸丁卡因的舒泰凝胶作为润滑剂，对照组以无菌液状石蜡作为润滑剂，观察两组病人在检查中的疼痛情况及检查后排尿时疼痛、不适症状。[结果]观察组检查中疼痛程度及检查后疼痛、不适症状均较对照组明显减轻（P〈0．01）。[结论]舒泰凝胶作为尿道黏膜麻醉剂，可以明显减轻病人在膀胱镜检查中的疼痛及检查后排尿疼痛、不适等症状。     

米索前列醇配伍盐酸奥布卡因凝胶在未产妇人工流产术前中的应用

目的:探讨米索前列醇配伍盐酸奥布卡因凝胶在未产妇人工流产术前中的应用效果.方法:将2011年1月至2012年1月在我院门诊自愿要求人工流产的早期妊娠未产妇女100例随机分为观察组和对照组各50例,观察组于人工流产术前采用米索前列醇配伍盐酸奥布卡因凝胶进行药物软化宫颈及局部麻醉后行人工流产术,对照组按常规人工流产术进行,比较两组的镇痛效果、宫颈扩张情况及人工流产综合征发生情况.结果:观察组有效镇痛率、宫颈扩张有效率和人工流产综合征发生率分别为90％、90％和40％,均显著低于对照组的16％、30％和90％,(P均＜0.01).结论:米索前列醇配伍盐酸奥布卡因凝胶在未产妇人工流产术前应用可明显松弛宫颈,术中镇痛效果确切,降低人流综合征的发生率,且操作简便,安全性好,建议临床推广应用.     

尿管导引器及盐酸丁卡因凝胶在前列腺增生患者导尿中的应用

目的:探讨尿管导引器及盐酸丁卡因凝胶在前列腺增生患者导尿中的应用效果.方法:采用随机抽样法将78例老年前列腺增生患者分为观察组40例和对照组38例.导尿时,观察组使用尿管导引器及盐酸丁卡因凝胶辅助导尿;对照组按照常规方法导尿.结果:观察组疼痛程度、一次插管成功例数和插管时间明显优于对照组,两组比较有极显著性差异(P<0.01).结论:应用尿管导引器及盐酸丁卡因凝胶辅助导尿可提高前列腺增生患者一次插管成功率,缩短插管时间,减轻患者痛苦,值得临床推广使用.     

盐酸丁卡因胶浆在导尿操作中的应用

目的探讨盐酸丁卡因胶浆在导尿操作中应用的临床效果。方法选择需要导尿的患者100例,按就诊次序单双号分为观察组和对照组,每组50例,分别使用盐酸丁卡因胶浆和无菌石蜡油润滑尿管后进行导尿,观察两组患者自述的疼痛感觉。结果观察组自述疼痛感觉较对照组减轻,两组比较差异有统计学意义（P〈0.05）。结论在导尿过程中使用盐酸丁卡因胶浆尿道局部使用和润滑尿管后导尿的方法 ,可起到较好的局部麻醉和润滑作用,明显减轻患者在导尿过程中的疼痛,值得推广应用。     

气管镜介入联合局部丝裂霉素C治疗气管切开术后气道狭窄的临床研究*

目的比较气管镜介入联合局部丝裂霉素C与气管镜介入治疗气管切开术后气道狭窄的疗效。方法将38例气管切开术后气道狭窄患者随机分为两组,观察组和对照组各19例。观察组采用气管镜介入联合局部丝裂霉素C,对照组采用气管镜介入治疗术。观察两组咳嗽、呼吸困难症状,治疗次数、住院时间和治疗费用。结果观察组患者咳嗽症状积分、VAS评分较对照组低(P0.05),两组患者呼吸困难程度差异无统计学意义(P0.05)。观察组再治疗次数、住院时间和治疗费用低于对照组(P0.05)。结论气管镜介入联合局部丝裂霉素C治疗气管切开术后气道狭窄的疗效优于气管镜介入。     

Comparison of topical anaesthesia methods for venous cannulation in adults.

A prospective, randomized clinical trial was performed in order to assess the efficacy and side-effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation. The study was double-blinded to the degree that the methodologies allowed. One hundred and fifty healthy adults undergoing elective surgery were allocated at random to five groups: EMLA cream, ethyl chloride spray, intracutaneous infiltration with 2% lidocaine, placebo cream and no treatment. Venipuncture was performed with a 18G cannula on the dorsal side of the hand. Puncture pain and pain caused by the topical treatment itself were measured using a visual analogue scale (VAS, range: 0-100 mm). Haemodynamic response, difficulties in performing the puncture and side-effects were recorded. All analgesic techniques were well tolerated. Haemodynamic response and degree of puncture difficulty showed no differences among the groups. Puncture pain (median mrnVAS) following infiltration (1.0) and EMLA (10.0) was significantly lower than no treatment (30.0) or placebo (30.0). The benefit of local infiltration was altered by injection pain (11.5). Spray did not significantly lower puncture pain (26.5) and, in addition, was associated with discomfort (10.5). In adults, EMLA cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation. Local lidocaine infiltration is impaired by applicational pain, whereas spraying the puncture site with ethyl chloride has no analgesic benefit.     

A blinded, randomized, paired, placebo-controlled trial of 20-minute EMLA cream to reduce the pain of peripheral IV cannulation in the ED

A eutectic mixture of local anesthetics (EMLA) in cream from has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 45 to 60 minutes before the painful procedure. The purpose of this study was to determine whether a 20-minute application of EMLA is useful in reducing the pain of routine peripheral intravenous cannulation in the emergency department (ED). A blinded, randomized, placebo-controlled, paired trial compared the pain of intravenous cannulation in both hands of study subjects: one hand was treated with 20-minute EMLA cream and the other hand was treated with 20-minute placebo cream. Forty subjects identified the more painful hand and scored pain measurements of each hand using a 10-cm visual analog scale. These data failed to demonstrate any significant benefit of EMLA compared with placebo. EMLA is not useful for intravenous cannulation when used for 20-minute application times. There may be more effective and less costly ways of reducing the pain of intravenous cannulation that patients would prefer.     

调强适形放疗联合热疗治疗介入后原发性肝癌的临床疗效

目的观察调强适形放疗联合热疗治疗介入后原发性肝癌的临床疗效,并探讨放疗剂量及毒副反应。方法 2009年3月至2011年8月收治的44例原发性肝癌患者,所有患者均已行2～4周期介入治疗,介入治疗后采用非随机对照研究的方法,按患者意愿分为2组,2组年龄、性别、卡氏评分、Childpugh分级、肿瘤直径、介入周数比较,差异均无统计学意义(P均>0.05)。放疗组20例患者采取单纯调强适形放疗;联合组24例患者采取调强适形放疗联合深部聚焦热疗,每次均于放疗结束后2h内进行。结果联合组肿瘤消退有效率(CR+PR)79.2%(19/24),其中CR33.3%(8/24),PR45.8%(11/24);放疗组肿瘤消退有效率50.0%(10/20),其中CR20.0%(4/20),PR30.0%(6/20)。联合组有效率高于放疗组,差异有统计学意义(P<0.05)。各种治疗毒副反应发生率2组比较差异无统计学意义。结论调强适形放疗联合热疗较单纯放疗可显著提高介入后原发性肝癌的局部有效率,是治疗原发性肝癌的有效手段,且不增加毒副反应。     

A comparison of EMLA cream and amethocaine gel for topical cutaneous analgesia in children

The efficacy of EMLA cream and amethocaine gel was compared using application times of greater than 60 minutes. Eighty eight patients received EMLA cream and 89 received amethocaine gel. Pain during venous cannulation was assessed by a single observer using a four point observational scale. Sixty nine (78%) patients in the amethocaine group underwent pain-free venepuncture compared with 46 (52%) patients in the EMLA cream group (p<0.001). No serious side effects occurred in any patient. As well as having a faster onset of action, amethocaine gel also appears to be a more effective analgesic than EMLA cream prior to venous cannulation in children.     

双灌注介入疗法治疗中晚期肝癌36例疗效观察

目的探讨双灌注介入疗法治疗中晚期肝癌的价值。方法对72例确诊肝癌病例随机分为对照组和观察组,分别行单纯肝动脉灌注化疗栓塞术（TACE）和双灌注介入疗法,并按《实体瘤疗效评价标准》统计其疗效差别,进行回顾性分析,总结双灌注介入疗法的应用价值。结果单纯行肝动脉灌注化疗栓塞术组总有效率为61.1%,行双灌注介入疗法组总有效率为77.8%。两组间比较差异有统计学意义（P〈0.05）。结论双灌注介入疗法比单纯行肝动脉灌注化疗栓塞术效果更加稳定确切,在不增加治疗副作用的前提下,达到了类似肝动脉-门静脉双途径介入治疗的目的,且减少了肝动脉-门静脉双途径介入治疗术后的不良反应和并发症,提高了患者的生活质量,延长了患者的生存期。     

LET versus EMLA for Pretreating Lacerations: A Randomized Trial

OBJECTIVE: To compare the anesthetic efficacy of EMLA cream (eutectic mixture of local anesthetics) with that of LET solution (lidocaine, epinephrine, tetracaine) for pretreating lacerations prior to lidocaine injection. METHODS: This was a randomized, double-blind clinical trial in a convenience sample of 60 patients aged 1 to 59 years with traumatic lacerations. Eligible wounds were uncomplicated, clean lacerations < or = 6 hours old. Finger and toe lacerations were excluded. At the time of initial presentation to triage, patients were randomized to LET or EMLA. A nurse applied the topical anesthetic into the laceration with a 5-mL syringe. A physician assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. Supplemental lidocaine was then infiltrated through the wound edges and the pain of infiltration was recorded by the patient (or guardian) on a 100-mm visual analog scale marked "most pain" at the high end. A sample of 44 patients had 90% power to detect a 20-mm difference in injection pain (two-tailed alpha = 0.05). RESULTS: Sixty patients were randomized to LET (29) or EMLA (31). Median age was 8.5 years; 23% were female. Most lacerations were facial and closed with sutures. There was no difference in baseline characteristics between groups. More wounds treated with LET were anesthetic to a needlestick than wounds treated with EMLA (73% vs 40%, p = 0.01); however, there was no between-group difference in the median pain of lidocaine infiltration (LET-12 mm vs EMLA-13 mm, p = 0.89). CONCLUSIONS: Pretreatment of simple lacerations with LET or EMLA at the time of patient presentation results in similar amounts of pain of subsequent local infiltration of lidocaine     

尿激酶双重溶栓联合机械性碎栓治疗急性脑梗死患者的护理

目的探讨尿激酶双重溶栓治疗急性脑梗死患者的安全可行性及护理。方法对发病6h以内的9例急性脑梗死患者（研究组）,用90万U尿激酶溶于100ml生理盐水中静脉滴注,同时行3DDSA检查确定梗死的脑动脉及溶栓部位,采用微导丝机帻陛碎栓及小剂量尿激酶颅内动脉溶栓;同期治疗的16例（对照组）用120万U尿激酶溶于120ml生理盐水中静脉滴注。结果研究组中基本治愈6例,显效1例,有效2例,无效0例,显效率为77．8％,总有效率为100％;对照组分别为2,1,5,8例,显效率为18．75％,总有效率为50％。显效率和总有效率两组相比,差异有统计学意义（P〈Q05）。研究组术后欧洲脑卒中评分法（ESS）（77．50±0．71）分,对照组为（62．25±5．95）分,两组比较差异有统计学意义（P〈0.05）。结论6h以内的急性脑梗死患者,采用双重溶栓联合机械性碎栓,能使闭塞的动脉尽陕开通,安全有效,是一种可行的治疗方式。护理组建立绿色通道,积极为溶栓争取时间,并严密观察病睛变化,做好溶栓患者的护理,可取得较好疗效。     

动脉压迫止血带在经股动脉行介入治疗患者中的应用

目的观察动脉压迫止血带在经股动脉行介入治疗患者中的应用效果。方法 2009年12月至2010年2月,按随机数字表法将经股动脉行介入治疗的200例患者分为实验组和对照组（各100例）,实验组患者术后采用动脉压迫止血带止血,对照组患者术后采用手法压迫结合绷带＂8＂字形加压包扎止血。观察并比较两组患者的并发症发生情况、止血时间及肢体制动时间。结果实验组患者并发症的发生率、止血时间及肢体制动时间均显著低于或短于对照组患者,差异有统计学意义（均P〈0.05）。结论动脉压迫止血带用于经股动脉行介入治疗中止血,具有并发症发生率低、可在直视下有效止血、操作简便、节时省力等优点,是较为理想的止血方法,值得在临床推广应用。     

中西医结合治疗盆腔静脉淤血综合征疗效观察

【目的】使用补肾活血中药结合导管介入治疗盆腔静脉淤血综合征（PCS）,观察其近期及远期效果,并检测血液流变学水平。【方法】将50例PCS患者随机分为两组：观察组（n=25）行补肾活血中药结合导管介入,对照组（n=25）仅用导管介入。【结果】两组总有效率分别为72％和68％,差异无统计学意义（P〉0．05）,治疗组血液粘度改善情况优于对照组。随访1年后,治疗组复发1例,对照组复发3例。【结论】两组近期效果相近,但治疗组远期效果好,复发率低。