Relationships between pain intensity and heart rate variability in patients after abdominal surgery: a pilot study

Background  A link between postoperative pain intensity and heart rate variability (HRV) had not been well established. This study aimed to investigate the correlation between post-operative pain intensity and HRV.

Methods  The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009–November 2009. The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain. HRV was measured as the standard deviation of normal RR interval, and by power spectral analysis that included high frequency (HF), low frequency (LF), very low frequency power, and LF/HF ratio.

Results  A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P <0.05). The correlation of the standard deviation of normal RR interval, high frequency, very low frequency value and patient’s age were negative (P <0.05). The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P <0.05).

Conclusions  The multidimensional pain assessment tool (SF-MPQ) reflects better the patients’ post-operative pain than the single-dimensional assessment tool (VAS). HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.

     

Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor

Background  Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.

Methods  A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years, with a mean age of (34±3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.

Results  All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation. The patients were satisfied with the cosmetic results of the surgery.

Conclusion  The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.

     

Clinical characteristics and therapeutic strategies of atypical meningioma

Background  Atypical meningioma accounts for about 4.7% to 7.2% of all kinds of meningiomas, which is invasive with a relatively high recurrence and mortality. The objective of this study was to investigate the clinical manifestations and therapeutic strategies of atypical meningioma.

Methods  A total of 74 patients who underwent surgical treatment and pathologically confirmed for atypical meningioma in Neurosurgery Department of Beijing Tiantan Hospital from January 2003 to December 2008 were enrolled in this study. The characteristics of the tumors as well as therapeutic regimens and follow-up data were reviewed. After surgery, 56 patients underwent radiotherapy. Patients were followed up for about 3.5 years (range, 0.5–6.0 years), and 58 patients completed follow-up.

Results  Of the 58 patients who completed follow-up, good recovery was found in 30, neurological dysfunction in 15, and death in 13. Of the 58 patients, 21 had recurrent meningioma and 18 underwent a second surgery.

Conclusions  Atypical meningioma is difficult to manage, with a high recurrence rate and poor survival. The extent of tumor resection and histological grade are the key determinants of outcome. Radiation therapy can be used as an adjunctive treatment after total or partial resection.

     

Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study

Background  Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few. The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) or GCS alone.

Methods  The study was performed on 108 patients who were randomly assigned to two groups. The first group received GCS before the operation and IPC during the operation (IPC+GCS group). The second group received GCS before the operation (GCS group). To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures, the incidence of adverse reactions was assessed.

Results  The morbidity associated with DVT was 4.8% (5/104) in the IPC+GCS group and 12.5% (14/112) in the GCS group. There were significant statistical differences between the two groups. There were no adverse effects in either group.

Conclusions  The therapeutic combination of GCS and IPC was more effective than GCS alone for thrombosis prevention in high-risk patients undergoing gynaecological pelvic surgery, and there were no adverse effects in either group.(No. ChiCTR-PRC-10000935).

     

Prevalence and risk factors of chronic post-thoracotomy pain in Chinese patients from Peking Union Medical College Hospital

Background  In clinical practice, the mechanisms underlying chronic post-surgical pain (CPSP) remain insufficiently understood. The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients. The secondary goal was to determine whether the difference between pre- and post-operative white blood cell (WBC) counts could predict the prevalence of CPSP after thoracotomy. The impact of chronic pain on daily life was also investigated.

Methods  We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010. Statistical comparisons were made between patients with or without CPSP.

Results  Results were ultimately analyzed from 466 qualified patients. The overall incidence of CPSP was 64.5%. Difference between pre- and post-operative WBC counts differed significantly between patients with or without CPSP (P <0.001) and was considered as an independent risk factor for the development of CPSP following thoracotomy (P <0.001). Other predictive factors for chronic pain included younger age (<60 years, P <0.001), diabetes mellitus (P=0.023), acute post-operative pain (P=0.005) and the duration of chest tube drainage (P <0.001). At the time of interviews, the pain resulted in at least moderate restriction of daily activities in 15% of the patients, of which only 16 patients had paid a visit to the doctor and only three of them were satisfied with the therapeutic effects.

Conclusions  Chronic pain is common after thoracotomy. WBC count may be a new independent risk factoring surgical patients during peri-operative period. Besides, age, diabetes mellitus, acute post-operative pain, and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.

     

Clinical and histopathologic features of biofilm-associated chronic rhinosinusitis with nasal polyps in Chinese patients

Background  Biofilms have given new insights to the understanding of pathogenesis of chronic rhinosinusitis (CRS). However, the link between biofilms formation and local inflammatory response remains poorly defined in CRS with nasal polys. The aim of this study was to determine the potential association of the presence of biofilms in the nasal mucosal tissues with clinical features in Chinese patients, which had CRS with nasal polyps (CRSwNP).

Methods  A total of 19 patients with CRSwNP and 12 patients with non-CRS were subjected to endoscopic surgery and their nasal mucosal tissue specimens were examined histologically and by scanning electron microscopy (SEM). Their demographic and clinical features were recorded.

Results  Thirteen (68.4%) out of the 19 specimens from patients with CRSwNP, but none from control patients, were positive for biofilms that displayed typical characteristics of bacterial and fugal structures. The presence of biofilms in the nasal mucosal tissues was associated with significantly greater values of purulent nasal discharge and preoperative Lund-Kennedy scores, higher levels of serum total IgE and percentages of subjects with endoscopic surgery (ESS) history in patients with CRSwNP, and more severe inflammation in the nasal mucosal tissues of patients with CRSwNP.

Conclusion  Our study demonstrated the presence of biofilms in the nasal mucosal tissues of many patients, contributing to the understanding of the pathogenic process of CRSwNP in Chinese patients.

     

机器人辅助腔镜手术在甲状腺外科的应用现状与前景

Objective  Robot-assisted endoscopic surgery has been increasingly accepted because of its unique three-dimensional vision and precise simulation-based technology. However, the utilization of robotic systems in thyroid surgery is limited. We conducted a systematic review to assess the application and development of robot-assisted endoscopic surgical technique in thyroid surgery.

Data sources  Articles published in PubMed before June, 2011 about robot-assisted endoscopic surgery were selected.

Study selection  Original articles and critical reviews selected were related to robot-assisted (thyroid) surgery or endoscopic thyroid surgery, and a total of 3540 relevant articles were retrieved and 34 were finally cited.

Results  Robot-assisted operation of benign thyroid diseases were successfully performed, although the operation time is too long to exhibit its advantages. Nevertheless, the superiority of robot-assisted endoscopic surgical technique compared to conventional endoscopic surgery in the treatment of thyroid carcinoma were obvious, since robotic radical thyroidectomy with central and lateral neck lymph node dissection could be achieved while maintaining operative results and cosmetic outcomes equivalent to or better than conventional endoscopic surgery. Furthermore, the learning curve duration of robot-assisted endoscopic thyroid surgery was shorter than that of conventional endoscopy, especially for the novices without any endoscopic surgical basis.

Conclusion  Robot-assisted endoscopic thyroid surgery, with its safety, feasibility, thoroughness, cosmetic benefits, and ability to overcome the limitations of conventional endoscopic surgery, will be further improved and applied, and is worthy of attention.

     

Clinical experience of 3T intraoperative magnetic resonance imaging integrated neurosurgical suite in Shanghai Huashan Hospital

Background  Intraoperative magnetic resonance imaging (iMRI) dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI (<1.0T). This paper reports the clinical experience with a 3T iMRI-integrated neurosurgical suite in Huashan Hospital, Shanghai, China.

Methods    From September 2010 through March 2012, 373 consecutive patients underwent neurological surgery under guidance with 3T iMRI. A retrospective analysis was conducted regarding clinical efficiency.

Results  All surgery in the 373 patients was safe. The ratio of gross total resection for cerebral gliomas (n=161) was increased from 55.90% to 87.58%. The ratio of benefit in extent of resection was 39.13%. One hundred and fifty eight of the 161 glioma patients accomplished follow-up at 3 months postoperatively. Twenty of 161 patients (12.42%) suffered from early motor deficit after surgery. Late motor deficit was however observed in five of 158 patients (3.16%). Twenty-one of 161 patients (13.04%) had early speech deficit and late speech deficit was only observed in six of 158 patients (3.80%). The ratio of gross total resection for pituitary adenomas (n=49) was increased from 77.55% to 85.71%. The ratio of benefit in extent of resection was 10.2%. There were no iMRI-related adverse events even for patients who underwent awake craniotomy.

Conclusion  The 3T iMRI integrated neurosurgical suite provides high-quality intraoperative structural and functional imaging for real-time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.

     

Bleb-associated endophthalmitis treated by sclera patch graft, vitrectomy and endoscopic cyclophotocoagulation

Background  Bleb-associated endophthalmitis (BAE) is a rare but severe complication of trabeculectomy with poor outcome. Various surgical methods were explored to treat such patients. However, there is no defined protocol. The aim of this study was to describe a new combined operation, and to demonstrate the outcome of the treatment.

Methods  Nine patients with BAE were enrolled in our study. The combined operation including pars plana vitrectomy (PPV), sclera patch graft (SPG) and endoscopic cyclophotocoagulation (ECP) was used to treat these patients.

Results  In the follow-up of 18–24 months, all patients with the endophthalmitis were cured, the useful visual acuity was preserved in 7 patients, and the intraocular pressure (IOP) of 8 patients was controlled just after first operation, only one needed another trans-scleral cyclophotocoagulation.

Conclusion  This combined operation is a useful method for treating the patients with BAE, with SPG and vitrectomy to control the endophthalmitis and ECP to balance the postoperative IOP.

     

Is the European System for Cardiac Operative Risk Evaluation useful in Chinese patients undergoing heart valve surgery?

Background  The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is one of the most widely used risk models for the predicting mortality after cardiac surgery. The aim of this study was to validate the EuroSCORE model for predicting operative mortality in heart valve surgery on a Chinese multicenter database and comparing the performance of EuroSCORE with our new risk stratification system, the Sino System for Coronary Operative Risk Evaluation (SinoSCORE).

Methods  Data from patients undergoing heart valve surgery between January 2007 and December 2008 were retrospectively collected, from 43 hospitals in China. The EuroSCORE and the SinoSCORE were calculated for each patient. Mortality was defined as any in-hospital death. Area under the receiver operating characteristics curve (AUC) was used to study the discriminatory abilities of the models. The Hosmer-Lemeshow (H-L) goodness-of-fit test was used to study the calibration of the predictive models.

Results  A total of 15 367 patients were analyzed. For the entire cohort, the observed mortality was 2.34%, the predicted mortality was 3.71% (additive), 3.19% (logistic) and 3.66% (SinoSCORE). AUC was 0.747 for SinoSCORE, 0.699 additive and 0.696 for logistic EuroSCORE. Calibration of SinoSCORE and additive EuroSCORE was good (H-L: P=0.250 and P=0.051, respectively), but the logistic EuroSCORE model had a poor calibration (H-L: P<0.05). The discriminatory ability and calibration of the SinoSCORE were good in low- and high-risk patients. However, the discriminatory ability of the EuroSCORE model was poor in all risk deciles.

Conclusions  The EuroSCORE does not accurately predict mortality in Chinese patients with heart valve surgery, and the SinoSCORE is superior to the EuroSCORE at predicting in-hospital mortality in Chinese heart valve surgery patients.

     

影响骨科术后疼痛的相关因素:北京40所医院调查

目的分析比较北京地区影响患者骨科手术后疼痛程度分布的相关因素。方法采用横断面研究,利用方便抽样及整群抽样的方法,涉及到北京市辖区范围内80所三级医院及128所二级医院当中的20所三级医院和20所二级医院。参与调查者主要完成已设计好的疼痛问卷。本次研究共涉及与骨科术后疼痛程度分布可能相关的10种因素,包括患者年龄、性别、受教育程度、职业、嗜好、地域分布、经济状况、既往慢性疼痛史、术前患者关心的问题及术前患者对疼痛的认识程度等人口学特征及术前相关心理状态等。结果统计结果表明,性别、受教育程度、饮酒嗜好、地域分布、经济状况及既往慢性疼痛病史与骨科术后疼痛程度的分布无明显相关性(P>0.05)。而年龄、职业及吸烟嗜好的不同在术后疼痛的程度分布上有显著差异(P<0.05)。在患者术前相关心理状态方面,患者术前对于术中及术后的疼痛是否关心与术后疼痛程度的分布无明显相关性(P>0.05),而患者对于术后疼痛的认识程度却与术后疼痛的发生有关(P<0.05)。同时,术前、术后的疼痛宣教也会影响到术后疼痛的发生程度。结论本研究提示,影响骨科术后疼痛的因素是多方面的,如果在各方面均加以注意,会对患者的手术后疼痛有很好的改善。而术前对于患者的疼痛宣教显得尤为重要。     

An audit of aspects of informed consent and pain relief in general surgical units of korle bu teaching hospital

SummaryThere is the need to adequately inform patients about their disease, treatment options, surgery and post-operative complications. Adequate pain relief after surgery leads to less morbidity. Two important aspects of surgical practice are being addressed in this paper, the need for informed consent and post operative pain relief.A questionnaire survey was carried out in 100 patients on the four general surgical wards of the Korle Bu Teaching Hospital, just before they were discharged from hospital. They were asked what they knew or had been informed about their diagnosis, operation and complications of surgery. On pain relief, patients were asked about their experiences on the first post-operative day and what relief they had from analgesics.Twenty four did not know the diagnosis and 36 were not told what operation they were going to have before surgery. Although 75 were eventually told what operation they had, only 64 said they knew the operation. Sixty eight did not know what to expect after surgery; 87 did not know about possible complications. On the first post-operative day there was significant pain (scores 4 and 5) felt by 24 patients at rest and 46 on movement. The most frequently prescribed analgesic was pethidine.Patient information in General surgery at the Korle Bu Teaching Hospital is unsatisfactory. Post-operative analgesia is also poor. There is the need for surgeons to either train doctors to administer consent or administer it themselves. Anaesthetists should assume a leading role in managing post-operative pain.     

Appropriateness of primary total hip and knee replacements in regions of Ontario with high and low utilization rates.

OBJECTIVE: To compare the appropriateness of case selection for primary hip and knee replacements between two regions in Ontario: one with a high population-based utilization rate and one with a low rate. DESIGN: Random audit of medical records sampled from hospital discharge abstracts, with subsequent implicit and explicit criteria-based assessments of the appropriateness of surgery. STUDY POPULATION: People aged 60 years or over who underwent elective, single-joint, non-fracture-related, primary hip or knee replacement between Apr. 1, 1992, and Mar. 31, 1993, at one of seven hospitals in a high-rate region (comprising Brant, Huron and Oxford countries) or one of eight hospitals in a low-rate region (comprising the cities of Scarborough and Toronto). INTERVENTIONS: Structured review of hospital medical records, with additional review of information from surgeons and family physicians' office charts if necessary. Three physicians reviewed patient data and rated the preoperative pain level and functional status of patients, with agreement among at least two reviewers. The proportion of inappropriate cases was then assessed according to explicit criteria defined by a multidisciplinary panel using the delphi process. Profiles of each case were also subjected to independent implicit review by two rheumatologists and two orthopedic surgeons. OUTCOME MEASURES: Proportion of joint replacements deemed inappropriate in the high- and low-rate regions according to either the explicit criteria or the implicit review, as well as preoperative pain levels and functional status of patients in the high- and low-rate regions. RESULTS: Hip replacements were more common among patients sampled in the low-rate region than among those in the high-rate region (57.3% v. 39.3%; p < 0.002), although the patients' baseline characteristics, including severity of preoperative pain and dysfunction, were otherwise similar between the regions. Inappropriate surgery, determined by explicit criteria, was equally uncommon in the two regions (6.4% and 6.1%). On implicit review, the two rheumatologists rated fewer cases as appropriate than did the two orthopedic surgeons (63.0% v. 80.0%; p < 0.001); however, the proportion of cases rated as inappropriate by the subspecialists was similar in the high- and low-rate regions (11.4% and 11.0%, respectively, by the rheumatologists, and 6.3% and 10.4%, respectively, by the orthopedic surgeons). CONCLUSIONS: Patients selected for primary hip or knee replacement are similar in the high- and low-rate regions of Ontario. Inappropriate use of this procedure does not account for the high rate of surgery in some areas. Further studies will be required to determine which other factors account for the regional variations in the utilization rates and whether there is underservicing in low-rate areas.     

失误病例网络数据库的建立及102例失误病例总结

目的 建立失误病例网络数据库,共享失误病例,吸取教训,促进临床工作的开展,避免或减少医源性失误的发生.方法 建立网络失误病例数据库,由所有中华骨科网骨科医生用户自行上传所遇到的临床失误病例.统计此数据库自2006年8月25日到2007年12月31日运行1年余所收集的失误病例.结果 典型病例102份,其中治疗过程中存在明显失误的病例:内固定导致失误87例、外固定导致失误5例、保守治疗导致失误7例、关节置换失误3例.按照医方、患方和不确定因素三大方面总结:涉及到医方治疗过程中的失误67例,无确定因素导致的失误31例,患者方面因素导致的治疗失误4例.失误病例资料来源:一级医疗机构失误病例6例、二级医疗机构失误病例76例、三级医疗机构失误病例20例.结论 失误病例网络数据库的建立有助于收集积累不同医疗单位所发生的失误病例,供临床骨科医生学习和避免类似失误的发生.临床新技术新业务的开展(新型内固定材料的使用,关节及脊柱手术的开展等)应该经过良好的培训及认证.     

在基层医院举办骨科短训班的实践和思考

为向基层骨科医生提供更为实用、便捷的继续医学教育（continuing medical education,CME）,扩大专家讲师及主办医院在区域内的学术影响力,2001年6月至2017年10月,科室利用周末时间,与基层医院合作举办了9场为期1~1.5 d,以专家讲课形式为主的骨科短训班。主题以创伤骨科为主;专家讲师以国内、省内知名医院的骨科专家为主,结合主办医院的专家;共有1200余名当地县区乡的骨科、外科医生学员参加学习培训,取得了良好的社会效果。提示与地级市医院合作举办骨科短训班,精选培训班主题,适当控制会期时间和讲师人数,可以在耗费比较少的行政会务资源的前提下,取得满意的社会效益。     

South Australian carotid endarterectomy study

OBJECTIVE: To determine the operative morbidity and mortality of carotid endarterectomy in South Australia. DESIGN: This was a prospective study on consecutive patients already selected independently by their treating clinicians for carotid endarterectomy. Patients were assessed before and after the operation by independent neurologists. SETTING AND PARTICIPANTS: The study involved all patients undergoing carotid endarterectomy in South Australia in public and private hospitals over the 20-months period of the study. All vascular surgeons agreed to participate. INTERVENTION: Two hundred and thirty-nine carotid endarterectomies were performed on 223 patients, always as primary procedures. MAIN OUTCOME MEASURES: Patient characteristics, angiographic findings and indications for surgery were documented before the operation by neurologists who then carried out postoperative assessments and determined neurological status at discharge. Follow-up at six and twelve months was by letter and telephone enquiry to general practitioners or direct to patients. RESULTS: The perioperative death and stroke rate was 6.3% including one stroke after angiography and before endarterectomy. Fourteen patients (5.9%) had strokes after the operation and three died as a result (1.3%). Three patients had reversible ischaemic neurological deficits. In 58 asymptomatic patients, operative morbidity was 3.4%. However, in 42 patients who had had a stroke before the operation, there were seven who had operative complications (16.7%). Neurological complication rates for individual surgeons varied from 0 to 13.8%. In the subsequent 12 months, follow-up of 214 patients revealed nine additional deaths (three known to be caused by stroke, four not caused by stroke and two of unknown cause) and six more cerebral infarctions (involving both operated and unoperated sides), an annual mortality plus stroke morbidity rate of 4.2%-5.1%. CONCLUSIONS: The morbidity and mortality of carotid endarterectomy in South Australia is acceptable by world standards but is high in the subgroup with a preceding stroke. In this audit, carotid endarterectomy had an average risk at least equal to one year of untreated carotid artery disease and did not diminish the expected stroke and death incidence after one year.     

Chinese Orthopedic Surgeons’ Practice Regarding Postoperative Thromboembolic Prophylaxis after Major Orthopedic Surgery

Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009. Results Totally, 208 surgeons (71.0%) responded, successfully completing the questionnaire. Of them, 57.6% respondents selected combined basic, mechanical, and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients’ special conditions and needs upon discharge. "Safety" was the most repeated and emphasized factor during VTE prophylaxis. Conclusions Multimodal thromboprophylaxis is frequently used after major orthopedic surgery. Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery. Thromboprophylaxis regimen varies for discharged patients.     

舒芬太尼复合氟比洛芬酯用于老年骨科手术术后镇痛

目的观察舒芬太尼复合氟比洛芬酯静脉输注用于老年骨科患者手术后镇痛的效果、不良反应及对血清白细胞介素6（IL-6）的影响。方法择期行骨科手术老年患者40例,ASAⅡ—Ⅲ级。其中男22例,女18例,年龄65—79岁。将40例患者随机分为A、B组,每组20例。2组患者术后镇痛均使用一次性恒速输注泵。A组镇痛泵配方为：氟比洛芬酯100mg＋舒芬太尼1．5μg／kg＋昂丹司琼0．2mg／kg＋生理盐水,共120ml。B组镇痛泵的配方为：舒芬太尼2μg／kg＋昂丹司琼0．2mg／kg＋生理盐水,共120ml。2组患者分别在手术结束前10min给予芬太尼1μg／kg并随后接镇痛泵。2组患者的麻醉诱导和维持均相同。记录术后2、4、8、12、24h疼痛视觉模拟评分（VAS评分）、镇静评分、不良反应和血清IL-6的变化水平。结果2组患者镇痛效果均较满意,各时间点VAS评分组间比较差异无统计学意义（P〉0．05）。B组患者恶心、呕吐、过度镇静、呼吸抑制和心动过缓等不良反应的发生率明显高于A组（P〈0．05或P〈0．01）,术后4、8和12h IL-6水平均高于A组（P〈0．05）。结论舒芬太尼复合氟比洛芬酯静脉持续输注用于老年骨科患者术后镇痛效果满意,不良反应较少,可以抑制术后过度炎性反应。     

肺血栓栓塞症的继续医学教育效果评价

目的评价采用不同形式对肺血栓栓塞症（简称肺栓塞）规范化诊断与治疗的继续医学教育效果。方法对19家医院（9家3级医院,10家2级医院）的医务人员进行了四个层次的肺栓塞规范化诊治的培训：通过举办学习班对100名临床一线医生进行培训;采用学习班结合病例专题讨论和专家现场点评方式,培训了60名临床骨干医生;采用学习班结合实际操作和结果判读的形式分别对放射科医生和超声科医生进行培训。结果培训结束后,临床一线医生肺栓塞规范化诊治问卷调查正确率从培训前的55％,提高至78％（P〈0．001）;骨干医生培训后模拟肺栓塞诊治正确率从培训前的71％提高至88％（P〈0．001）;放射科医生肺栓塞规范化影像学诊断技能考核合格率由培训前的65％提高至85％（P=0．041）;超声科医生规范化超声诊断技能考核合格率由培训前的70％提高至90％（P=0．014）。结论采用学习班的形式对提高肺栓塞规范化诊治意识有显著效果,而采用多种形式如学习班结合病例讨论与专家点评,或结合实际操作及结果判定的形式,对医生实践技能的培训效果较好。     

口腔颌面部术后疼痛调查及镇痛治疗

目的观察疼痛干预在口腔颌面部手术术后镇痛效果,探讨不同手术方式术后疼痛程度。方法对93例口腔科手术患者按照不同的手术切口类型分组后,进行术后36内疼痛的调查及使用镇痛药物治疗效果的记录。结果口内切口组以中度疼痛为主,颌面颈部切口组以轻度疼痛为主,口内外交通切口组以中度疼痛为主,皮瓣移植多切口组以重度疼痛为主。给予干预后,中度疼痛的患者疼痛基本都能缓解至轻度疼痛,重度疼痛下降至中度疼痛和轻度疼痛。结论不同手术方式术后给予奥尔芬镇痛,镇痛效果显著。