常用局部麻醉技术

1 局部麻醉概述 1.1 局部麻醉的概念麻醉作用只限于躯体某一局部的麻醉方法,称为局部麻醉,简称局麻.产生局部麻醉作用的药物称为麻醉剂,又称麻药.外科临床实际工作中最常用的局部麻醉有局部浸润麻醉、区域阻滞麻醉和神经阻滞麻醉3种方法.     

眼部药物智能控释系统研究进展

药物智能控释系统又称刺激-响应型药物控释系统,是近年药物剂型研究的热点,通过外加磁场、超声波、光等刺激,以及温度、酸碱度等控制,结合相应的高分子材料,达到药物的靶向、实时可控、定量定向给药。眼部的药物智能控释系统研究起步较晚,目前主要仍为基于原位凝胶给药体系的控释系统,其他如磁场、超声、光等外加刺激控释系统仍在起步阶段。精准的靶向治疗是医学发展的必然要求,因此药物精准控释也是未来较为理想的给药方式。本文综述眼部的药物智能控释研究,为眼部给药研究提供参考。     

利多卡因局部麻醉用于股动脉鞘拔管

经皮冠状动脉腔内成形术 (ＰＴＣＡ )和支架术是目前冠心病治疗的有效手段[1] ,术后股动脉鞘管通常留置 3ｈ～ 10ｈ ,但在拔除股动脉鞘管和压迫止血时 ,常发生与疼痛有关的迷走神经反射 ,严重时可导致死亡、急性血栓闭塞等。我们采用利多卡因局部麻醉可减少股动脉鞘拔管时副反应 ,现报告如下。1　资料与方法1.1　对象与方法　自 1999年 3月— 2 0 0 0年 3月连续行ＰＴＣＡ或支架术 3 10例。按手术日 (每周二、四两次手术 )分为两组 ,周二手术病人在拔除股动脉鞘管前使用 2 %利用卡因 5ｍｌ沿股动脉鞘管两侧注入 ,5ｍｉｎ后拔管 (局麻组 )。…     

已经出版的药物控释载体材料的临床应用相关文章：

缓释、控释药用高分子材料的临床应用 曾春香。张斯汉． 2010．14（21）：3939—3942 关键词：缓释药物;控释药物;高分子材料;药物载体;临床应用     

局部麻醉和硬膜外麻醉用于腹股沟疝无张力修补术的效果分析

将我院收治的68例腹股沟疝患者随机分为对照组和观察组,对照组给予硬膜外麻醉后行无张力疝修补术。观察组给予局部麻醉后行无张力疝修补术。比较两组的手术时间、术中出血量、麻醉效果、麻醉药物应用情况等。结果观察组手术时间、术中出血量、住院费用均显著少于对照组,差异有统计学意义（P〈0.05）。观察组下床活动时间显著早于对照组,差异有统计学意义（P〈0.05）。观察组术后并发症发生率显著低于对照组,差异有统计学意义（P〈0.05）。临床行腹股沟疝无张力修补术时,应主张行局部麻醉,可显著减少手术时间,减少术后并发症发生率,尤其适合基层医院推广应用。     

七氟醚复合局部麻醉用于小儿阑尾手术的麻醉体会

小儿阑尾手术一般时间短,麻醉选择多数是采用氯胺酮麻醉,或复合其他的麻醉方式.其术后苏醒时间长,伴有恶心、呕吐、烦躁发生率高等,临床存在明显的不满意.七氟醚吸入诱导及苏醒恢复较快,在加用局部麻醉后,麻醉总体平稳,效果确切.本院2008年1月～2010 年4月应用此联合麻醉方法取得一定经验,现总结如下.     

植入式药物缓释系统在骨缺损修复中的研究进展

植入式药物缓释系统的载体多源于植骨材料.现对目前国内外应用较为广泛的植骨载体材料从生物学特性、释药规律、承载的药物种类等方面在骨缺损修复中的研究及应用进行综述.     

常用局部麻醉技术

1概述1.1局部麻醉的概念麻醉作用限于躯体某一局部的麻醉方法,称为局部麻醉,简称局麻。产生局部麻醉的药物称为麻药。常用的局麻方法有局部浸润麻醉、神经阻滞麻醉和区域阻滞麻醉。另外,近年又出现了局部肿胀麻醉技术,主要用于脂肪抽吸,也是局部麻醉的一种。局麻简便易行,安全性大,并发症     

局部浸润麻醉患者的护理

1.1盐酸普鲁卡因(procaine)毒性较小，注射给药后1～3min起作用，可维持30～45min，加用肾上腺素后维持时间可延长20％。过量应用可引起中枢神经系统和心血管反应。有时可引起过敏反应，故用药前应作皮肤过敏试验，但皮试阴性仍可发生过敏反应。对本药过敏可用利多卡因代替。     

Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial

Objectives To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia. Methods This was a randomized controlled trial in a university‐based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged ≥8 years with finger lacerations were enrolled. After standard wound preparation and 15‐minute topical application of lidocaine‐epinephrine‐tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100‐mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann‐Whitney U and chi‐square tests. A sample of 52 patients had 80% power to detect a 15‐mm difference in pain scores. Results Fifty‐five patients were randomized to digital (n= 28) or local (n= 27) anesthesia. Mean age (±SD) was 38.1 (±16.8) years, 29% were female. Mean (±SD) laceration length and width were 1.7 (±0.7) cm and 2.0 (±1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between‐group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] =?17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI =?19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI =?3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group. Conclusions Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing.     

局部麻醉伴或不伴清醒镇静行超声支气管镜检查的对照研究

目的:比较局部麻醉伴或不伴清醒镇静方式用于支气管内超声引导下经支气管针吸活检(EBUS-TBNA)时患者的满意度、耐受度及安全性等,以筛选更合适的麻醉方法。方法:将行EBUS-TBNA检查的60例患者随机分为局部麻醉伴清醒镇静组(A组)和单纯局部麻醉组(B组),每组30例。通过术前记录、术中观察、术后问卷和随访的方式观察患者对操作的满意度和耐受度、操作的安全性和诊断的准确性。结果:与B组比较,A组EBUS-TBNA术前、术中、术后血氧饱和度明显降低(P0.05);收缩压在EBUS-TBNA术前和术中略有降低(P0.05);两组患者的满意度和耐受度、并发症的发生率、诊断准确率差异无统计学意义。结论:对在门诊行EBUS-TBNA的患者可采用单纯局部麻醉的方式,患者的满意度和耐受度、操作的安全性、诊断的准确性较高。     

指外伤单点皮下阻滞与传统皮下阻滞局麻效果比较的随机对照试验

目的比较对指外伤患者行单点皮下注射指神经阻滞与传统指神经阻滞两种不同麻醉方法的麻醉效果。方法选择伤及1或2个手指的指外伤患者,用抛硬币法随机分为传统皮下阻滞组和单点皮下阻滞组。由同一试验人员实施所有麻醉,对患者及结果评估者设盲,采用符合方案集(PP)分析和意向性治疗(ITT)分析比较两种不同方法在麻醉过程中所引发的疼痛程度(10cm视觉模拟评分)、麻醉起效时间和麻醉失败率。结果共纳入指外伤患者93例(109指),其中传统皮下阻滞组51例(61指),单点皮下阻滞组42例(48指)。除2例(3指)分别因醉酒和语言障碍未能评价结局指标外,PP分析及ITT分析均显示,两种麻醉方法在麻醉过程中引发的疼痛、麻醉起效时间及麻醉失败率方面差异无统计学意义(P﹥0.05)。结论单点皮下阻滞与传统的指神经阻滞方法的效果相当,且操作更简单,适用于指外伤患者的手指掌指横纹以远掌侧及中末节背侧的麻醉。对于损伤累及手指近节背侧或拇指背侧的患者则需要辅以指背神经阻滞。     

局部浸润麻醉下包皮环扎术2452例报告

目的：探讨包皮环扎术临床应用的方法、效果。方法：应用包皮环扎器治疗包茎及包皮过长2452例。结果：平均手术时间7.5分钟,随访1824例,平均脱环时间14.5天。包皮切缘光滑,柔软,整齐,自然上翻。结论：包皮环扎术安全、快捷、效果好,适宜治疗各年龄段包茎、包皮过长,局部浸润麻醉适用于包皮手术。     

Drug Delivery Systems

Abstract:   Intrathecal drug delivery (IDD) is a proven and effective treatment alternative in carefully selected patients with chronic pain that cannot be controlled by a well-tailored drug regime and/or spinal cord stimulation (SCS), and may be specifically trialed in patients who fail to respond to SCS. While the lack of randomized controlled trials is often perceived as a limitation of IDD, many studies attest to the efficacy of this therapy, and a number are large-scale and with follow-up periods of up to five years. Good to excellent pain relief is achieved in many patients who have failed more conservative therapies, and there is often a reduced need for analgesia. The advent of patient-controlled analgesia allows flexibility of dosing according to the patient's needs. Consequently, quality of life improves in many patients and the majority express satisfaction with treatment. Some patients are able to return to work. The benefits of IDD (including a potent analgesic response with a more stable therapeutic drug level, decreased latency, increased duration of action, and decreased pharmacological complications) mean that side effects such as nausea, vomiting, sedation, and constipation are reduced. In addition, IDD demonstrates long-term cost-effectiveness when compared to conventional pain therapies, addressing a concern that affects many physicians in clinical practice today.     

糖尿病肾病的药物治疗进展

糖尿病肾病是糖尿病的慢性并发症,严重危害人们的生活质量,早期治疗可逆转和延缓其进展。其主要药物为血管紧张素转化酶抑制剂和AT1受体拮抗剂类、钙拮抗剂、他汀类调脂药、PPAR-r激动剂、抗凝药与抗血栓形成药、抗氧化剂和生长抑素类。还可采用祖国中医学治疗。     

Nitrogen Diffusion into Closed Anesthesia Systems

Objective. In order to reduce losses of gases through plastic components and to reduce nitrogen accummulation during closed system anaesthesia we investigated either 10 sets of anaesthetic tubing made of silicon as used in standard clinical practice and 10 sets made of latex, which are not used anymore due to concerns about latex allergies. The results were compared to each one set made of conventional industrial rubber. Methods. Anaesthetic tubings were connected to ventilators with low fresh gas losses, suitable for closed system anaesthesia. For nitrogen measurements, a mass spectrometer was used.The fresh gas flow was set to exceed losses by leakages and the amount of gases, extracted from the system by the mass spectrometer. Results. Highest accumulation of nitrogen was found using tubings made of silicone. Conclusion. If closed anaesthetic systems in the future will be used in intensive care therapy or in case of long lasting procedures in which closed system anaesthesia is proceeded, materials other than silicone should be investigated to avoid regular purging of system and consecutive losses of gas mixtures.     

Video-Assisted Thoracoscopy is Feasible Under Local Anesthesia

Video-assisted thoracoscopy (VAT) is usually performed under general anesthesia (GA). We performed an analysis to determine whether multithoracoport VAT under local anesthesia (LA) is feasible.Methods: Forty-five VAT under LA were performed in 34 men and 11 women (mean age 46.8 years) in the endoscopy room.Results: The waiting time for VAT under LA was 0.5-6h on working days. There were no major complications during or after the VAT. In 9 patients, pleural malignancy was diagnosed, and in 7 patients suspected malignancy was excluded. In 5 patients we found bacterial empyema, of whom 4 had diathermic adhesiolysis during VAT. In 4 patients, the clinical diagnosis was tuberculosis by exclusion, and in 2 patients no conclusive diagnosis could be drawn. VAT influenced treatment policy 15 times, and in 17 pneumothorax patients talc poudrage was performed during the procedure.Conclusion: VAT under LA is safe, effective, logistically simple, and requires no long waiting times. No conversion to GA was necessary.     

两种不同局麻方法在经直肠前列腺穿刺活检术中的镇痛效果比较

目的：比较经直肠超声引导前列腺神经阻滞术和直肠内灌注2％利多卡因凝胶在前列腺穿刺活检术中的镇痛疗效。方法：160例接受经直肠超声引导13点前列腺系统穿刺活检术的患者随机分为A、B两组。A组患者84例，在经直肠超声引导下，于前列腺基底部，左、右两侧精囊与前列腺交接处分别注射1％利多卡因5ml，B组患者76例，于活检前5min直肠内灌注2％利多卡因凝胶10ml。采用视觉模拟评分（VAS）评估两组患者在穿刺活检术中的疼痛程度。结果：两组患者在平均年龄（t=0．73）、PSA水平（t=0．34）和前列腺体积（t=0．55）的差异无显著性（P〉0．05），具有可比性。A组患者VAS评分0～3分者76例，4～5分者6例，6～10分者2例。B组患者则分别为48例、18例、10例。两组患者平均疼痛评分（VAS）分别为1．2分、2．6分，差异具有高度显著性意义（t=4．73，P〈0．01）。两组患者均未出现局麻药的不良反应。结论：经直肠超声引导前列腺神经阻滞术的镇痛疗效明显优于直肠内灌注2％利多卡因凝胶，值得临床推广应用。