高流量氧疗湿化对干燥综合征继发肺纤维化患者的护理研究

目的：探讨高流量湿化氧疗治疗干燥综合征继发肺间质纤维化的临床临护理措施。方法：回顾性分析我院自 2010年 5 月—2017 年 12 月期间收治的 39 例干燥综合征继发肺间质纤维化患者。其中 2010 年 5 月—2015 年 9 月期间收治的 20例患者给予常规呼吸疾病综合治疗护理设为对照组 20 例。2015 年 10 月—2017 年 12 月期间收治的 19 例患者在常规呼吸疾病综合治疗护理基础上予高流量湿化氧疗护理治疗设为观察组 19 例。回顾性分析两组患者在治疗开始前、开始后 24 h、48 h 呼吸频率、动脉血气分析及痰液黏稠度的改善情况。结果：两组患者年龄、性别、病程等一般情况比较无统计学差异（P>0.05）。两组在治疗开始前呼吸频率、动脉血气分析结果比较差异无统计学意义（P>0.05）；两组在治疗开始后 24 h呼吸频率、pH、PaCO2 无统计学差异（P>0.05），比较 PaO2（86.33±7.23），（90.43±7.56）有统计学差异（P<0.05）。两组在治疗开始后 48 h 呼吸频率比较差异无统计学意义（P>0.05），比较 pH、PaO2、PaCO2 差异有统计学意义（P<0.05）。两组患者组内比较对照组治疗开始前、开始后 24 h、48 h 呼吸频率、pH、PaCO2、PaO2 比较有统计学差异（P<0.05）；观察组治疗开始前、开始后 24 h、48 h 呼吸频率、pH、PaCO2、PaO2 比较有统计学差异（P<0.01）。两组患者在治疗开始前组间比较痰液黏稠度无差异统计学意义（P>0.05），24 h、48 h 后组间比较痰液黏稠度差异有统计学意义（P<0.01）。结论：高流量湿化氧疗结合呼吸道治疗干燥综合征继发肺间质纤维化的患者，疗效肯定，安全可靠，值得推广应用。     

经鼻高流量氧疗临床麻醉规范应用专家共识（2023版）

经鼻高流量氧疗（high-flow nasal cannula oxygen therapy,HFNC）是一种通过专用的非密封性鼻塞导管持续为患者提供恒定吸入氧浓度和恒定温湿度的高流量氧疗方式。快充式经鼻湿化高流量通气技术（transnasal humidified rapid-insufflation ventilatory exchange, THRIVE）是HFNC其中的一种,仅提供纯氧,可在更短时间内达到高流量。在ICU等科室,HFNC已用于呼吸衰竭等危重症的治疗,但其在麻醉领域的应用尚未普及。无呼吸氧合技术是指对于无自主呼吸和没有行人工通气的患者,在气道开放的情况下,使用高流量氧气进行被动氧合的技术,在麻醉领域中具有重要意义。因HFNC具有高流量高浓度给氧的功能且有极好的无呼吸氧合效应,目前已与面罩吸氧、鼻导管吸氧、高频喷射通气以及有创机械通气等共同成为临床麻醉常用的供氧和通气方式。

2019年中华医学会呼吸病学分会发布了《成人经鼻高流量湿化氧疗临床规范应用专家共识》,2021年中国医师协会急诊医师分会发布了《急诊成人经鼻高流量氧疗临床应用专家共识》,上述共识对HFNC在临床治疗中的应用有一定的指导作用,但麻醉领域侧重于HFNC 无呼吸氧合效应在气道管理中的应用。为了规范国内HFNC 在临床麻醉中的合理应用,中华医学会麻醉学分会气道管理学组参照国内外相关文献,结合临床实际需求撰写本共识,以期为临床麻醉领域应用 HFNC 提供参考。     

经鼻高流量氧疗在患儿麻醉中的应用进展北大核心CSCD

经鼻高流量氧疗(HFNC)是一种无创的呼吸支持技术。在国外,HFNC作为持续气道正压通气系统(CPAP)的替代治疗方法,最早被应用于重症监护室的患儿中,以改善患儿肺部功能,治疗呼吸系统疾病。近年来HFNC逐渐被应用于患儿麻醉领域中。HFNC能够增加呼吸暂停时间,用于患儿麻醉围插管期,可以保证患儿的氧合,提高插管成功率。HFNC可以持续高流量供氧,且不占用患儿气道,在气道操作手术中应用时可以为术者提供充足的操作空间,同时缓解麻醉科医师在患儿缺氧时的紧张焦虑。HFNC可以提供持续的气道正压,应用于患儿麻醉围拔管期,能够有效地促进肺复张,预防和治疗拔管后肺部并发症。然而HFNC应用时有其自身的局限性,如何更充分有效地应用HFNC仍需大量临床随机对照研究来论证。     

西地那非与持续气道正压通气对伴有阻塞性睡眠呼吸暂停的ED患者的治疗比较

为了评价西地那非和持续气道正压通气（CPAP）对同时伴有勃起功能障碍（ED）和阻塞性呼吸睡眠暂停（OSA）患者的治疗效果，并评估患者和配偶的治疗满意度，Perimenis等进行了一项研究，研究入选40例患者，其中20例接受西地那非100mg，治疗12周，另20例在夜间睡眠时接受CPAP治疗。通过性交的成功率来评估治疗效果，通过患者和配偶回答勃起功能障碍治疗满意度评估量表中问题1来评估治疗的满意度。     

急性重型颅脑损伤术后脑氧耗指标以及预后的研究

目的 研究急性重症颅脑损伤术后患者脑氧耗指标以及预后的影响。方法 采用前瞻性随机对照研究方法 。纳入研究对象53例，观察组（镇静组）28例，对照组25例。研究两组患者术后转入重症监护室（ICU）后生命体征变化情况，以及0 h、24 h、48 h、72 h脑氧耗指标，计算颈内动脉与颈内静脉血氧含量差（AVDO2）、脑氧摄取率（CERO2），追踪分析近期预后、远期预后。结果 观察组在入ICU后24 h、48 h、72 h的心率（HR）、呼吸频率（R）、平均动脉压（MAP）明显低于对照组（P<0.05）。24 h、48 h、72 h的AVDO2,CERO2，观察组均低于对照组，P<0.05。近期预后即两组患者28 d病死率比较无显著性差异。两组的远期预后即术后6个月预后良好率无显著差异。结论 镇静治疗可以降低急性重型颅脑损伤术后患者脑氧消耗，效果确切，但对近、远期预后无明显改善作用。     

纳洛酮早期应用于心肺脑复苏中的疗效观察

目的探讨纳洛酮在早期心肺脑复苏中的治疗效果。方法45例心脏骤停患者随机分为两组：治疗组（23例）予纳洛酮治疗及常规复苏治疗,对照组（22例）仅予常规复苏治疗,观察两组患者的自主循环恢复率、自主呼吸恢复率、意识恢复时间、复苏成功率及48h存活率。结果治疗组自主循环恢复19例（82．61％）、自主呼吸恢复13例（56．52％）、意识恢复时间（35．0±12．5）min、复苏成功12例（52．17％）及48h存活12例（52．17％）,与对照组[分别为11例（50．（）0％）、6例（27．27％）、（48．0±11．8）min、5例（22．73％）、4例（18．18％）]比较差异均有统计学意义（P＜0．05）。结论纳洛酮早期应用于心肺脑复苏疗效显著且安全。     

小剂量氢吗啡酮复合纳布啡用于胃肠道手术后患者自控静脉镇痛的效果

目的 对比小剂量或无背景剂量氢吗啡酮复合纳布啡用于胃肠道手术后患者自控静脉镇痛（PCIA）的效果。

方法 选择择期行胃肠道手术的患者147例，男105例，女42例，年龄18～80岁，BMI 18～35 kg/m²，ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组：小剂量氢吗啡酮组（SD组，n=76）和无背景剂量氢吗啡酮组（ND组，n=71）。术后48 h内行PCIA，镇痛药配方为氢吗啡酮10 mg、纳布啡40 mg，加生理盐水稀释至100 ml。镇痛泵参数设患者自控镇痛2 ml，锁定时间10 min，SD组设背景剂量1 ml/h，ND组无背景剂量。记录术后24和48 h静息和活动（咳嗽）时VAS疼痛评分、镇痛泵总按压次数和有效按压次数、镇痛泵用药量、术后48 h内补救镇痛情况和补救止吐情况、术后首次肛门排气时间和术后住院时间。使用线性回归模型进行敏感性分析探讨两种术后镇痛方案在性别、年龄、手术部位和手术方式等不同亚组治疗效果的差异，并分析不同亚组间的交互作用。记录恶心呕吐、头晕、嗜睡、呼吸抑制、瘙痒等不良反应发生情况。

结果 与ND组比较，SD组术后24和48 h静息和活动时VAS疼痛评分明显降低(P<0.01)，镇痛泵总按压次数和有效按压次数明显减少（P<0.01），镇痛泵用药量明显升高（P<0.01），术后48 h补救镇痛率明显降低（P<0.05）。两组术后48 h补救止吐率、术后首次肛门排气时间和术后住院时间差异无统计学意义。亚组分析显示行开腹手术的患者更能从小剂量PCIA镇痛方案中获益。两组术后48 h恶心呕吐、头晕和嗜睡发生率差异无统计学意义。两组无一例发生呼吸抑制和瘙痒。

结论 与无背景剂量比较，采用氢吗啡酮0.1 mg/h复合纳布啡0.4 mg/h的小剂量PICA输注模式用于胃肠道手术后镇痛效果更佳，且不增加术后不良反应。     

梗阻型胆源性胰腺炎内镜治疗时机的选择

目的探讨梗阻型胆源性胰腺炎内镜治疗的时机与疗效。方法回顾性分析360例梗阻型胆源性胰腺炎内镜治疗的资料。根据发病后内镜治疗时间分为两组：急诊内镜（EE）组168例，即在发病48h内急诊行内镜逆行性胰胆管造影术（ERCP）、内镜下乳头括约肌切开（ES）／或取石术、鼻胆管引流术（ENBD）；延期内镜（DE）组192例，在早期非手术治疗基础上于发病48h后延期行上述内镜治疗。结果两组内镜治疗总成功率为96．9％。EE组在发病后腹痛缓解时间、血淀粉酶、血胆红素、白细胞计数恢复正常的时间以及平均住院时间显著低于DE组（P〈0．05～0．001）。重症胆源性胰腺炎急诊内镜治疗并发症总发生率显著低于DE组（9．6％vs28．9％，P〈0．05），两组间病死率差异无显著性（P〉0．05）；轻症患者两组间并发症发生率、病死率差异亦无显著性（P〉0．05）。结论重症梗阻型胆源性胰腺炎应在发病48h内行急诊内镜治疗；轻症患者如早期非手术治疗无效或出现急性胆道感染症状，亦应争取及时行急诊内镜治疗。     

无创持续气道正压通气治疗COPD患者的护理问题与措施

目的探讨无创持续气道正压通气（CPAP）纠正慢性阻塞性肺疾病（COPD）患者严重呼吸衰竭的护理要点。方法对使用无创CPAP救治的68例COPD患者护理中．密切观察其病情变化,依据其心理不适、漏气、气道分泌物引流不畅等护理问题采取针对性护理措施。结果68例中,60例效果满意．顺利脱机;8例行气管插管,改有创通气。结论无创CPAP能迅速纠正COPD患者的重度缺氧和二氧化碳潴留,提高其生活质量,而及时发现护理问题并采取有效措施可有效保证治疗效果。     

超声引导下竖脊肌平面阻滞对多发性肋骨骨折非手术患者呼吸功能和镇痛效果的影响

目的 探讨竖脊肌平面阻滞（ESPB）对多发性肋骨骨折非手术患者呼吸功能和镇痛效果的影响。
方法 选择2018年5月至2019年11月创伤性多发性肋骨骨折非手术患者81例,男48例,女33例,年龄40～70岁,BMI＜35 kg/m ²,ASA Ⅰ或Ⅱ级。按照是否行ESPB将患者分为两组,ESPB组（E组,n=39）和非ESPB组（N组,n=42）。E组于入院当日或次日在超声引导下行ESPB,N组未行任何神经阻滞,仅给予胸带外固定及静脉滴注地佐辛5 mg。记录入院后24、48和72 h的用力肺活量（FVC）和VAS疼痛评分,记录入院后24 h内、入院后24～48 h和48～72 h时段内地佐辛用量。记录气胸、神经损伤、血肿、穿刺部位感染等并发症发生情况。
结果 与入院后24 h比较,入院后48和72 h E组FVC明显升高（P＜0.05）,VAS疼痛评分明显降低（P＜0.05）。入院后48和72 h E组FVC明显高于N组（P＜0.05）,VAS疼痛评分明显低于N组（P<0.05）。与入院后24 h内比较,入院后24～48 h和48～72 h E组地佐辛用量明显减少（P＜0.05）。入院后24～48 h和48～72 h E组地佐辛用量明显少于N组（P＜0.05） 。E组未出现气胸、神经损伤、血肿、穿刺部位感染等并发症。
结论 超声引导下ESPB能改善肋骨骨折非手术患者肺活量,提高镇痛效果,临床应用安全有效。     

The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: A systematic review and meta-analysis

Study objectiveTo evaluate the effectiveness of supplemental oxygen therapy and high-flow nasal cannula (HFNC) therapy in patients with obstructive sleep apnea (OSA) in different clinical settings to assess its application to surgical patients in the postoperative setting.DesignA systematic search was conducted on MEDLINE and other databases from 1946 to December 16th, 2021. Title and abstract screening were conducted independently, and the lead investigators resolved conflicts. Meta-analyses were performed using a random-effects model and are presented as mean difference and standardized mean difference with 95% confidence intervals. These were calculated using RevMan 5.4.Patients1395 and 228 OSA patients underwent oxygen therapy and HFNC therapy respectively.InterventionsOxygen therapy and HFNC therapy.MeasurementsApnea-hypopnea index (AHI), oxyhemoglobin saturation (SpO₂), cumulative time with SPO₂ < 90% (CT90).Main resultsTwenty-seven oxygen therapy studies were included in the review, with ten randomized controlled trials (RCT), seven randomized crossovers, seven non-randomized crossovers, and three prospective cohorts. Pooled analyses showed that oxygen therapy significantly reduced AHI by 31% and increased SpO₂ by 5% versus baseline, and CPAP significantly reduced AHI by 84%, and increased SpO₂ by 3% versus baseline. CPAP was 53% more effective in reducing AHI than oxygen therapy, but both treatments had similar effectiveness in increasing SpO₂. Nine HFNC studies were included in the review, with five prospective cohorts, three randomized crossovers, and one RCT. Pooled analyses showed that HFNC therapy significantly reduced AHI by 36% but did not substantially increase SpO₂.ConclusionsOxygen therapy effectively reduces AHI and increases SpO₂ in patients with OSA. CPAP is more effective in reducing AHI than oxygen therapy. HFNC therapy is effective in reducing AHI. Although both oxygen therapy and HFNC therapy effectively reduce AHI, more research is needed to draw conclusions on clinical outcomes.     

Effect of High-Flow Nasal Cannula Oxygen Therapy on Pediatric Patients With Congenital Heart Disease in Procedural Sedation: A Prospective,Randomized Trial

ObjectivesThe study was conducted to compare the outcome of high-flow nasal cannula (HFNC) oxygen therapy with conventional oxygen therapy through a simple oxygen mask for pediatric patients with congenital heart disease during percutaneous intervention while under procedural sedation.DesignProspective, randomized and controlled trial.SettingA Cantonese cardiac center in China.ParticipantsTwo hundred American Society of Anesthesiologists classification II pediatric patients were enrolled from April 25, 2018 to November 28, 2018.InterventionsPatients scheduled for percutaneous closure of a heart defect under deep sedation with propofol, midazolam and fentanyl by an anesthesiologist were randomized (1:1) to receive oxygen therapy through a simple oxygen mask or through the HFNC system.Measurements and Main ResultsThe primary outcome was the lowest oxygen saturation (SpO₂). Secondary outcomes included the incidence of hypoxia (SpO₂ < 90%), requirement for noninvasive respiratory support, change in the gastric antrum area and other adverse events. Blood gas analysis results also were compared. Oxygen therapy through the HFNC system improved the lowest SpO₂ (99% [94%-100%]), as compared with the mask group (99% [72%-100%]), p < 0.001. Seven patients out of 99 (7.1%) in the mask group had hypoxia or required bag-mask ventilation, whereas no such patient was reported in the HFNC group, p < 0.001. There were no differences between the groups in terms of gastric distention, procedure length, total propofol dose, atropine use or other complications.ConclusionWhen compared with simple mask oxygenation, HFNC could reduce the incidence of desaturation, the need for airway assisted ventilation and risk of carbon dioxide retention without causing hemodynamic instability or gastric distention. It is effective for pediatric patients with non-cyanotic congenital heart disease who require procedural sedation.     

Central Haemodynamics and Oxygen Transport During CPAP With and Without Mandatory Ventilations

Ten patients, subjected 16 h earlier to open-heart surgery (aortocoronary bypass and/or aortic valve replacement), were studied during the weaning period after postoperative mechanical ventilation. Central haemodynamics and oxygen transport were assessed along with total oxygen consumption during continuous positive airway pressure with four mandatory ventilations per minute (mode CPAP+IMV) and, subsequently, during CPAP alone.
During the two modes of ventilation, airway pressure was adjusted to be equal during the spontaneous inspiratory phases. All parameters of haemodynamics, oxygenation and oxygen consumption were found to be essentially satisfactory and unchanged during both modes of ventilation. Our observations suggest that, as the parameters studied were unaltered with the change from CPAP+IMV to CPAP, the use of ventilatory support for these patients during the weaning period (in the form of four mandatory ventilations per minute) appears, in terms of central haemodynamics and oxygen transport, to be well tolerated in cases where adequate spontaneous ventilation is in doubt.     

High flow nasal cannula outside the ICU provides optimal care and maximizes hospital resources for patients with multiple rib fractures

BackgroundHigh flow nasal cannula (HFNC) use reduces work of breathing and improves oxygenation for patients with hypoxemic respiratory failure. Limited prior work has explored protocolized use of HFNC for trauma patients outside the Intensive Care Unit (ICU). The purpose of this study is to describe and evaluate use of HFNC for patients with rib fractures when therapy was standard of care on all floors of the hospital.MethodsIn 2018, the study hospital expanded use of HFNC (AIRVO; Fisher Paykel, Auckland, NZ) to all floors of the hospital, making it available in the ICU, Emergency Department (ED), and on general inpatient floors. The study group included adult patients with three or more rib fractures who received HFNC at any location in the hospital (Phase 2: January 2018-December 2019). The study group was compared to a historical control group when HFNC was available only in the ICU (Phase 1: March 2013-July 2015). Patients were excluded from the study if they received invasive mechanical ventilation prior to HFNC. Primary outcomes were mechanical ventilation rates, ICU days, length of hospitalization, and mortality.ResultsDuring the study period, 63 patients received HFNC, with 35% of patients (n = 22) receiving the duration of therapy outside the ICU. When compared to the control group (N = 63), there were no significant differences in total hospital days (9 vs. 9, p=.64), mechanical ventilation (19% vs. 13%, p=.47), or mortality (3% vs. 5%, p = 1.00). Twenty-seven percent of patients (n = 17) in the study group avoided the ICU during hospitalization.ConclusionsFindings suggest that HFNC therapy can be safely initiated and managed on all hospital floors for patients with multiple rib fractures. Making the therapy available outside the ICU may reduce healthcare resource use without adversely affecting patient outcomes.     

High flow nasal oxygen in acute respiratory failure

Use of high flow nasal cannula oxygen (HFNC) is increasingly popular in adult ICUs for patients with acute hypoxemic respiratory failure. This is the result of the successful long-term use of HFNC in the neonatal field and recent clinical data in adults indicating beneficial effects of HFNC over conventional facemask oxygen therapy. HFNC rapidly alleviates symptoms of respiratory distress and improves oxygenation by several mechanisms, including deadspace washout, reduction in oxygen dilution and in inspiratory nasopharyngeal resistance, a moderate positive airway pressure effect that may generate alveolar recruitment and an overall greater tolerance and comfort with the interface and the heated and humidified inspired gases. Indications of HFNC are broad, encompassing most if not all causes of acute hypoxemic respiratory failure. HFNC can also provide oxygen during invasive procedures, and be used to prevent or treat post-extubation respiratory failure. HFNC may also alleviate respiratory distress in patients at a palliative stage. Although observational studies suggest that HFNC might reduce the need for intubation in acute hypoxemic respiratory failure; such a reduction has not yet been demonstrated. Beyond this potential additional effect on outcome, the evidence already published argues in favor of the large use of HFNC as first line therapy for acute respiratory failure.     

Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques

BACKGROUND: Pulmonary complications are frequently seen after thoracoabdominal resection of the oesophagus. The aim of this study was to compare the effects of two different breathing exercise regimens applied in the immediate postoperative period on the risk of pulmonary insufficiency after thoracoabdominal resection. METHODS: Seventy patients undergoing thoracoabdominal resection for cancer of the oesophagus and cardia were randomized after operation to breathing exercises by inspiratory resistance-positive expiratory pressure (IR-PEP) (n = 36) or continuous positive airway pressure (CPAP) (n = 34). The study groups were well matched for all relevant clinical and demographic data. RESULTS: Respiratory function deteriorated significantly immediately after operation; the lowest values of forced vital capacity and peak expiratory flow were measured during the first postoperative day and oxygen saturation was lowest on days 4-6. Significantly fewer patients in the CPAP group required reintubation and prolonged artificial ventilation (P < 0.05). There were minor non-significant differences between the study groups with respect to respiratory and other postoperative variables, usually in favour of CPAP. CONCLUSION: Provision of CPAP in the immediate postoperative period decreased the risk of respiratory distress requiring reintubation and the need for artificial ventilation compared with breathing exercises by IR-PEP.     

Ibuprofen vs. acetaminophen vs. ibuprofen and acetaminophen after arthroscopically assisted anterior cruciate ligament reconstruction

BACKGROUND AND OBJECTIVE: The analgesic potency of non-steroidal anti-inflammatory drugs and acetaminophen are still being debated. We have assessed the relative analgesic effect of ibuprofen, acetaminophen or the combination of both after orthopaedic surgery. METHODS: Sixty-one ASA I patients, scheduled for an elective anterior cruciate ligament reconstruction under general anaesthesia were randomized, in a double blind fashion, into one of three groups. The ibuprofen group (n = 17) received ibuprofen 800 mg orally 1 h before operation and again at 6 and 12 h after the initial dose. The acetaminophen group (n = 20) received of acetaminophen 1 g orally at the same time intervals. The combination group (n = 24) received both ibuprofen 800 mg and acetaminophen 1 g. Surgery was performed under general anaesthesia with propofol and fentanyl for induction and maintenance with propofol and nitrous oxide in oxygen. The patients were monitored for 24 h thereafter, and the following variables were assessed: pain by visual analogue and verbal scales, need for rescue intravenous opioid analgesia (i.e. ketobemidone) and adverse events. RESULTS: The ibuprofen group and the combination group experienced significantly less pain during the first 6 h after surgery than the acetaminophen group using the visual analogue and the verbal scales. The acetaminophen group also had a significantly higher average consumption of opioids during the first 6 and 24 h. There were no significant differences between the ibuprofen group and the combination group in respect of experienced pain or consumption of rescue analgesia. The incidence of side-effects, postoperative haemoglobin concentration and renal function, judged by creatinine clearance, were identical between the groups. CONCLUSION: Ibuprofen 800 mg thrice daily reduced pain to a greater degree than acetaminophen 1 g thrice daily, after anterior cruciate ligament reconstruction under general anaesthesia. The combination of acetaminophen and ibuprofen did not provide any superior analgesic effect.     

An evaluation of morphine and oxymorphone administered via patient-controlled analgesia (PCA) or PCA plus basal infusion in postcesarean-delivery patients

The analgesic efficacy and adverse effects of morphine and oxymorphone in 32 patients who received traditional patient-controlled analgesia (PCA) following cesarean delivery were compared with those in 32 other patients receiving the same agents via PCA plus basal opioid infusion (PCA + BI). All patients were operated upon during epidural anesthesia with 2% lidocaine and 1:200,000 epinephrine to achieve a T4 sensory level. Upon first complaint of pain in the recovery room, patients were given a titrated iv loading dose of the assigned opioid until comfortable and were then provided with a programmable PCA device. Group I (PCA) consisted of two subsets in which incremental boluses of morphine (1.8 mg, n = 16) or oxymorphone (0.3 mg, n = 16) could be self-administered via conventional PCA. Patients in group II (PCA + BI) received a basal infusion of morphine (0.6 mg/hour, n = 16) or oxymorphone (0.1 mg/hour, n = 16) in addition to self-administered boluses of 1.8 and 0.3 mg, respectively. Patients were evaluated for 24 h following initiation of analgesic therapy, and 10-cm visual analog scales (VAS) were utilized at selected intervals to assess pain at rest, pain during movement, and satisfaction with therapy. The level of sedation and incidence of nausea/vomiting and pruritus were also recorded. Patients utilizing PCA + BI noted significant reductions in resting pain scores with oxymorphone and decreased pain during movement with both opioids when compared with individuals using PCA alone (P less than 0.05). There were no significant differences between treatment groups in 24-h dose requirements or patient satisfaction with therapy (P = ns).(ABSTRACT TRUNCATED AT 250 WORDS)     

超前镇痛护理理念用于食管癌患者术后镇痛

目的探讨超前镇痛护理理念对食管癌患者术后疼痛控制的影响。方法随机将188例食管癌手术患者分为常规镇痛组(n=93)和超前镇痛组(n=95)。常规镇痛组实施常规镇痛护理,即术前行疼痛知识宣教,术后应用Prince-Henry评分法定时评估患者疼痛,根据评分行针对性镇痛护理;超前镇痛组实施超前镇痛护理,即在前者基础上增加术前超前镇痛知识宣教,术后在执行各临床操作前行预见性疼痛评估,根据评分行预见性镇痛处理。比较两组患者术后24h、48h、72h疼痛评分,术后首次下床活动时间,肺部并发症发生率。结果两组术后24h、48h、72h疼痛评分比较,干预主效应P<0.05;超前镇痛组下床活动时间较常规镇痛组显著提前,肺部并发症发生率显著低于常规镇痛组(P<0.05,P<0.01)。结论超前镇痛护理理念对食管癌患者术后疼痛控制有积极的作用,有利于患者早日康复。