无针麻醉包皮环切术(附88例报告)

目的:探讨新的应用于包皮环切手术的麻醉方法及效果。方法:门诊包皮环切术178例,分A、B两组,随机选择麻醉方法行神经阻滞麻醉,观察麻醉及手术治疗效果,其中A组88例,接受无针麻醉;B组90例,接受传统阻滞麻醉。结果:术后对照观察,在视觉模拟疼痛评分、麻醉剂量、起效时间、手术切口的愈合等方面A组均优于B组,统计学上有显著性差异(P0.01)。结论:无针麻醉下行包皮环切术具有麻醉药用量小、痛苦少、起效快、真正无痛、使用方便等优点,值得临床推广。     

七氟醚复合小剂量芬太尼在小儿包皮环切术麻醉的应用

目的：探讨七氟醚复合小剂量芬太尼在小儿包皮环切术麻醉的安全性和有效性。方法：80例择期行包皮环切术的患儿随机分为观察组和对照组,各40例。观察组采用七氟醚吸入复合小剂量芬太尼静注复合全麻,对照组全凭吸入七氟醚全麻。记录两组患几睫毛反射消失时间、清醒时间、术后苏醒期、镇静、苏醒后即刻及术后1h的的疼痛情况,记录两组患儿的不良反应。结果：两组惠儿生命征均平稳。观察组患儿睫毛反射消失时间较对照组显著缩短（P〈0．01）,手术时间、术毕清醒时间两组间对比差异无统计学意义（P〉0．05）;疼痛评分：观察组患儿苏醒即刻显著优于对照组（P〈0．01）,但术后1h两组间差异无统计学意义（P〉0．05）;躁动评分及镇静评分：观察组均显著优于对照组（P〈0．01）;两组均未出现呼吸抑制、喉痉挛和气道梗阻等并发症。结论：七氟醚复合小剂量芬太尼用于小儿包皮环切术全身麻醉,起效快,生命体征稳定,术后疼痛、躁动少,是一种安全、效果确切的麻醉方式。     

包皮环切术中一次性包皮环切缝合器的应用价值研究

目的:探讨一次性包皮环切缝合器治疗包皮环切术临床价值,以期丰富治疗方法。方法:选取2010年11月至2016年7月146例包皮环切术患者为研究对象,分成两组,对照组73例,传统方法切除;观察组73例,一次性包皮环切缝合器切除。观察术后在手术时间、创口愈合时间和并发症等指标变化情况。结果:观察组在手术时间、出血量、VAS评分(术后24h和术后3d)、切口愈合时间均显著优于对照组,但手术费用显著高于对照组,两组比较有统计学意义(P0.05);对照组术后1周包皮无水肿占27.4%、中度水肿24.65%,切口美观度满意率41.1%、不满意率13.7%,观察组术后1周包皮无水肿占53.42%、中度水肿6.85%,切口美观度满意率67.12%、不满意率1.37%,两组比较差异显著(P0.05);对照组总并发症发生率为26.03%,观察组为2.74%,两组比较差异显著(P0.05)。结论:一次性包皮环切缝合器治疗包皮环切术恢复时间快、并发症少,但费用高。     

商环包皮环切术与CO_2激光包皮环切术临床比较研究

目的:比较商环包皮环切术与CO_2激光包皮环切术治疗包茎、包皮过长的临床应用效果。方法:门诊1280例包茎、包皮过长患者,672例行商环包皮环切术,608例行CO_2激光包皮环切术,20~30岁年龄段中行商环包皮环切术共557例为商环组(A组),行CO_2激光包皮环切术542例为CO_2激光组(B组),比较两组两种治疗方法的手术时间、医疗费用、切口愈合时间;比较两组术后并发症如切口出血、切口疼痛、包皮水肿、切口裂开以及切口愈合外观。结果:商环组(A组)与CO_2激光组(B组)手术时间分别为(5±2)min、(24±5)min;医疗费用分别为(985±47)元、(472±39)元,这两项两组比较差异有统计学意义(P0.05)。术后24h内切口疼痛评分分别为(7.3±1.5)、(2.5±0.7)分;术后24h的切口出血A、B组发生率分别为0%(0/557)、0.74%(4/542),这两项两组比较差异有统计学意义(P0.05)。术后包皮水肿A、B组发生率分别为5.21%(29/557)、4.06%(22/542);术后切口裂开A、B组发生率分别为3.23%(18/557)、2.40%(13/542),这两项两组比较无统计学意义(P0.05)。切口愈合时间A组(18±5)d,B组(16±4)d,两组比较差异无统计学意义(P0.05)。切口愈合外观A组愈合好的比例占99.46%(554/557),B组愈合好的比例占8.86%(48/542),两组比较差异有统计学意义(P0.05)。结论:商环包皮环切术手术操作简单,手术时间短,术后并发症相对少,切口愈合更美观,符合就诊者愿望与需求,值得推广。     

包皮环扎术与普通包皮环切术的临床应用比较

目的:对比分析包皮环扎术与传统包皮环切术的优缺点及手术并发症发生率。方法:对131例包皮患者行包皮环扎术,另对87例患者行普通包皮环切术。比较两组患者的手术时间、失血量、术中疼痛评分、术后24h疼痛评分和切口愈合时间等,统计环扎组拆环疼痛评分。结果:包皮环扎组和包皮环切组手术时间分别为(7.0±2.2)min、(27.3±3.3)min;出血量分别为(0.4±0.2)m L、(4.5±1.3)m L;手术时疼痛评分分别为(0.24±0.53)分、(0.28±0.57)分;术后24h疼痛评分分别为(1.52±0.62)分、(1.64±0.70)分;环扎组拆环时疼痛评分(2.85±1.68)分;环扎组切口完全愈合时间为(16.8±0.8)d;环切组切口完全愈合的时间(7.2±0.7)d。其中,两组手术时间、术中出血量和愈合时间差异有统计学意义(P0.05),术中及术后24h疼痛评分无统计学意义(P0.05)。结论:包皮环扎术是对传统包皮环切术的简化和改进,具有手术时间短、出血少、并发症少等优点,适合各级医院开展。     

一次性包皮环切缝合器与吻合器治疗包皮过长和包茎的临床对比研究

目的:探讨一次性包皮环切缝合器与吻合器治疗包皮过长和包茎的临床对比研究。方法:选择我院2014年3月至2016年12月期间收治的包皮过长、包茎患者102例,根据手术方法不同分为缝合组53例与吻合组49例。缝合组采用一次性包皮环切缝合器治疗,吻合组采用一次性包皮环切吻合器治疗。比较两组手术时间、创口愈合时间、外观满意度、失血量,术中和术后24h VAS评分,及术后并发症情况。结果:缝合组手术时间长于吻合组,创口愈合时间快于吻合组,外观满意度优于吻合组,均有统计学差异(P0.05);而两组失血量比较无统计学差异(P0.05);两组术后24h VAS评分较术中增加,有统计学差异(P0.05);缝合组术后24h VAS评分低于吻合组,有统计学差异(P0.05);缝合组并发症发生率(5.66%)低于吻合组(22.45%),有统计学差异(P0.05)。结论:一次性包皮环切缝合器治疗包皮过长和包茎效果优于一次性包皮环切吻合器,具有重要研究意义,值得进一步推广应用。     

崔氏简易包皮牵扩器治疗小儿包茎的临床效果

目的对临床无法行包皮环切术的包茎患儿采用崔氏简易包皮牵扩器治疗,观察其治疗效果。方法选取2019年5月恩施土家族苗族自治州民族医院泌尿外科/男科门诊诊治的60例包茎患儿作为研究对象,采用简单随机法分为观察组(n=30)和对照组(n=30)。对照组使用传统包皮扩张法,观察组使用崔氏简易包皮牵扩器进行扩张。观察两组手术时间、疼痛情况、包皮水肿及术后临床效果。结果观察组手术时间短于对照组,术后水肿率低于对照组,术后治愈率高于对照组,差异均具有统计学意义(P0.05);术后1年两组复发率比较,差异无统计学意义(P0.05);观察组术中疼痛程度评分低于对照组,差异具有统计学意义(P0.05)。结论崔氏简易包皮牵扩器治疗小儿包茎具有手术时间短、术后水肿率低、治愈率高的特点,且患儿疼痛程度较轻,临床效果较好。     

口服曲马多超前镇痛联合盐酸利多卡因在包皮环切术中的应用

目的：包皮环切术是治疗包茎、包皮过长的常用方法,但局部麻醉时和术后短期内常出现较为剧烈的疼痛,本文研究探讨口服曲马多超前镇痛在包皮环切术中的止痛效果。方法：选取包皮过长患者665例,按就诊顺序随机分为对照组（传统手术／商环环切）和曲马多组（传统手术／商环环切）,其中对照组325例（70／255）,曲马多组340例（72／268）。对照组直接予1％的盐酸利多卡因10ml行阴茎根部阻滞麻醉,曲马多组术前1h口服曲马多100mg后再予1％的盐酸利多卡因10ml行阴茎根部阻滞麻醉,以阻滞麻醉时疼痛评分、手术时疼痛评分、术后1h疼痛评分、术后2h疼痛评分、术后3h疼痛评分、术后24h疼痛评分对口服曲马多超前镇痛效果进行评估。结果：曲马多组（传统手术／商环环切）在局麻时、术后1h、术后2h的疼痛评分明显低于对照组（传统手术／商环环切）,有显著性差异（P〈0．05）。而对照组中,商环环切组在术后1h、术后2h、术后3h、术后24h疼痛评分明显低于传统手术组,差异有统计学意义（P〈0．05）。结论：术前1h口服曲马多可有效减轻包皮环切术麻醉时及术后短期内的疼痛,商环包皮环切术较传统手术在术后疼痛方面更具优势。     

复方利多卡因乳膏表面麻醉在治疗尿道口尖锐湿疣中的应用

目的：探讨复方利多卡因乳膏表面麻醉在二氧化碳激光治疗尿道口尖锐湿疣的麻醉效果及安全性。方法：选择尿道口尖锐湿疣患者40例,随机分为两组;治疗组20例,应用复方利多卡因乳膏表面麻醉;对照组20例,应用2%盐酸利多卡因注射液局部浸润麻醉。观察两组患者使用二氧化碳激光治疗尖锐湿疣时的麻醉效果及不良反应。结果：治疗组麻醉起效时间平均为（17.86±6.42）分钟,有效率90%,未见不良反应发生;对照组麻醉起效时间平均为（2.25±0.97）分钟,有效率100%,麻醉时所有患者在注射部位均出现不同程度疼痛、渗血和肿胀等副作用。两组麻醉起效时间差异具有统计学意义（t=10.762,P〈0.001）,而麻醉有效率差异无统计学意义（2=0.533,P〉0.05）。结论：复方利多卡因乳膏表面麻醉在二氧化碳激光治疗尿道口尖锐湿疣中麻醉效果满意,手术视野清晰,不良反应少,值得临床推广。     

人体组织粘合剂与传统缝合方法行包皮环切的疗效比较(附500例报告)

目的:对比研究人体组织粘合剂与传统缝合方法对包皮环切切口的治疗效果。方法:门诊包皮环切手术1000例随机分成A、B两组,A组500例包皮切口应用人体组织粘合剂粘合,B组500例应用可吸收线或丝线间断缝合,观察闭合切口时间、切口疼痛率、术后水肿情况、切口愈合分级等指标。结果:在关闭切口时间、切口疼痛率方面A组与B组差异有显著性(P<0.05)。在术后水肿情况、切口愈合分级方面两组差别无显著性(P>0.05)。结论:应用人体组织粘合剂行包皮环切术具有许多优点,值得临床广泛推广。     

Local anesthesia in dermatology

Local and regional anesthetic procedures are an integral part of daily dermatological practice. Safe and effective analgesia in skin and soft tissues is crucial for otherwise painful diagnostic or therapeutic interventions. Tumescent local anesthesia allows for pain‐free interventions that previously had to be done by using general anesthesia. Older patients with multiple co‐morbidities are especially suited for local anesthetic procedures, because they may significantly reduce surgical risks. For dermatologists, the knowledge of mode of action and toxicity of local anesthetics, as well as the emergency management of their potential complications, is essential.     

Comparison of topical anesthesia and subcutaneous infiltration anesthesia with regard to effect of plasma skin regeneration system

The plasma skin regeneration (PSR) system is a safe device for skin regeneration, which is usually carried out under local anesthetic to control the pain. Topical anesthesia and subcutaneous infiltration anesthesia are the common and safe anesthetizations. This study was undertaken to evaluate the effects of PSR after using topical anesthetization as compared with subcutaneous infiltration anesthesia, thereby inquiring into the effect of subcutaneous infiltration anesthesia in PSR and increasing electivity for clinical work. 14 Sprague Dawley rats were randomly utilized in this experiment. After adequate sedation and depilation, the rat's back was randomly divided into three experimental regions marked as A, B, and C. A and B were treated with lidocaine cream and lidocaine hydrochloride, respectively, before PSR. C was treated solely with PSR without any anesthesia. Biopsies were taken from all treatment sites at 4 and 30 days after treatment to observe the skin necrosis and thickness of new collagen fiber. Histopathologic examination was performed by observers blinded to the treatment conditions. In this analysis, there was a statistically significant reduction (P < 0.01) in the skin necrosis and thickness of new collagen fiber in the topical anesthesia group compared with that in the other two groups, while a statistically significant increase (P < 0.01) in the subcutaneous infiltration anesthesia group. The results suggest that subcutaneous infiltration anesthesia group showed a deeper range of tissue effects via the treatment of PSR as compared with the topical anesthesia and the control groups. Meanwhile, the effect of the topical anesthesia was the lowest. So we conclude that subcutaneous infiltration anesthesia for PSR treatment was superior to that of the topical anesthesia.     

腰麻及硬膜外麻醉联合应用于产科分娩镇痛的临床探讨

目的:观察腰-硬联合麻醉用于分娩镇痛的临床疗效。方法:选取在我院分娩的120例产妇作为研究对象,根据分娩镇痛方法的不同,将其分为研究组和对照组,各60例,对照组采用持续硬膜外麻醉,研究组采用腰-硬联合麻醉,比较两组的镇痛效果、分娩结局等。结果:两组的顺产率、镇痛效果比较无显著性差异(P0.05);研究组的麻醉起效时间显著短于对照组,罗哌卡因总用量显著少于对照组,P0.05。研究组的麻醉起效时间为(3.5±1.2)min,对照组为(15.1±5.5)min;研究组的罗哌卡因总用量为(9.7±4.1)mg,对照组为(20.1±7.5)mg。研究组的麻醉起效时间显著短于对照组,罗哌卡因总用量显著少于对照组,P0.05,t值分别为15.96、9.42,差异均具有统计学意义(P0.05)。结论:在产科分娩镇痛中采用腰-硬联合麻醉,具有起效迅速、镇痛效果好、麻药用量少等优点,能够有效减轻产妇分娩过程中的痛苦,值得推广应用。     

Buzzing away the pain: Using an electric toothbrush for vibration anesthesia during painful procedures

Many dermatologic procedures are painful and traumatic, for both pediatric patients and providers alike. Vibration anesthesia has recently been discussed as an effective method for reducing pain associated with injections, but some vibration machines can be cost prohibitive for providers. We describe how to employ an electric toothbrush as an inexpensive and effective option to provide vibration anesthesia during painful pediatric procedures.     

外伤性颅内血肿清除术的丙泊酚瑞芬太尼静脉麻醉

目的观察丙泊酚-瑞芬太尼静脉麻醉,在外伤性颅内血肿手术中应用的效果。方法外伤颅内血肿清除术219例,分靶控输注Ⅰ组;静吸复合Ⅱ组。丙泊酚、瑞芬太尼靶浓度为1.5～3mg/L和2～3μg/L。Ⅰ组丙泊酚按5∶4∶3方案,即5、4、3mg/(kg.h)间隔10min;瑞芬太尼(0.33±0.04)μg/(kg.min)输注。Ⅱ组芬太尼常规诱导气管插管后,1%～2%异氟醚吸入维持,间断应用芬太尼。观察气管插管反应、麻醉效果、副作用。结果两组麻醉效果相同(P>0.05),均可抑制气管插管反应(F=5.161,P<0.001),麻醉程度比较差异有统计学意义P<0.05。副作用发生率差异无统计学意义P>0.05,术中无知晓。结论丙泊酚瑞芬太尼靶控输注与芬太尼静吸麻醉效果一致、安全有效。适用于外伤性颅内血肿清除术的麻醉。     

Estimated beginning time of local anesthesia effectiveness in forced cold air application: A preliminary study

Background: The literature has reported that forced cold air anesthesia decreases the discomfort effect of various laser therapies. The aim of this preliminary study was to determine the average beginning time of the local anesthetic effect of the forced cold air application when it is applied to all body surfaces except the face. Materials and methods: A total of 52 participants (26 females and 26 males) were included in this study. During application of the forced cold air, the beginning time of local anesthesia effectiveness for each volunteer was determined by giving painful stimuli. The results were then analyzed statistically. Results: The mean beginning time value of the local anesthesia was 52.88 (ranging between 30 and 60) seconds in the female group and 56.34 (ranging between 30 and 60) seconds in the male group. The mean beginning time value of the local anesthesia was 54.61 (ranging between 30 and 60) seconds in both genders. There was no statistical difference between the two groups (Z = ? 0.834, p = 0.404). Conclusion: Forced cold air anesthesia—which is a quick, safe, cost-effective, and practical local anesthesia method—seems to be useful and effective when used alone in laser treatment.     

The evidence for reducing the pain of administration of local anesthesia and cosmetic injectables

Administration of injections, whether local anesthetic or cosmetic injectable, can result in significant distress and discomfort to patients. This review explores factors that can alleviate anxiety and pain associated with injections including cosmetic injectables. We highlight that many techniques used to reduce pain have only been reported based on anecdotal evidence and small series. The techniques that have been reported to reduce pain, by randomized controlled trials, include pretreatment with topical local anesthetic agents and combined cosmetic injectables with local anesthetics.     

Awareness during anesthesia: Current status in Japan

Intraoperative awareness is the explicit recall of sensory perceptions during general anesthesia. I presume the epidemiology and characteristics of intraoperative awareness from these surveys in Japan. A questionnaire survey was conducted via the Internet. The first survey was conducted in 2008. Our survey showed 17% of anesthesiologists experienced definite or possible awareness. The second survey was conducted to evaluate the first survey in detail in 2008. A total of 172 anesthesiologists answered. The total number of reported anesthetic cases was 85156. Twenty-four cases of definite or possible awareness were reported by 21 anesthesiologists. The most surprising finding was total intravenous anesthesia (TIVA) was used in 21 of the 24 cases. The third survey was conducted in 2011 as a continuous survey. Six cases of definite or possible awareness were reported by six anesthesiologists (7%). Two cases were maintained by TIVA, and 2 cases were sevoflurane. The survey showed 76% anesthesiologists routinely use bispectral index (BIS) for TIVA, but for sevoflurane only 27% anesthesiologists routinely use BIS. The incidence of intraoperative awareness decreased in the third survey. The continuous survey revealed the current status of daily anesthesia and the results might be used to prevent the awareness during general anesthesia.     

Leg ulcer progression caused by topical anesthesia with EMLA® cream

While treating a 63‐year‐old woman with leg ulcerations, we observed an unusual phenomenon. A wound débridement was planned to remove adherent necrotic material.After topical anesthesia with a lidocaine‐prilocaine mixture (EMLA^® cream) a hemorrhagic,livid margin area developed around the ulcer 90 minutes after application.The area turned necrotic over days and the center was débrid‐ed. A more detailed history revealed that similar necrosis had occurred previously when EMLA^® cream had been employed.We interpreted the current event,as well as the past episodes,as a pathological reaction of the small cutaneous blood vessels to EMLA^® cream. The history also revealed an overlap connective tissue disease with microvascular impairment. After exposure to the topical anesthetics, the pre‐damaged cutaneous blood vessels presumably produced a critical ischemia with subsequent necrosis. Based on this case, we recommend careful use of EMLA^® cream with frequent monitoring for necrosis when treating patients with a known disorder of microcirculation.