腹股沟韧带上髂筋膜间隙阻滞在膝关节表面置换术后镇痛的临床应用

目的 探讨超声引导下髂前上棘旁持续性髂筋膜间隙神经阻滞在全膝关节表面置换术后镇痛的临床效果。方法 择期全膝关节表面置换术患者采用随机数字表法,依据纳入标准及剔除标准分为3组:腹股沟韧带上组(U组)31例、腹股沟韧带下组(D组)30例、股神经组(F组)30例,按照双盲设计完成研究。记录三组患者股神经、股外侧皮神经及闭孔神经感觉阻滞情况;视觉模拟评分(VAS)测定静息状态和运动状态下疼痛情况;改良Bromage评分测定患肢肌力情况;记录首次下床活动时间;计算术中舒芬太尼用量和七氟烷用量;记录术后补救镇痛次数;采用WHO标准评定恶心呕吐情况。结果 三组患者股神经均阻滞成功(P>0.05),U组与D组患者股外侧皮神经阻滞均优于F组(P<0.05),U组闭孔神经阻滞均优于D组与F组(P<0.05)。术后U组4h、6h、12h、24h静息状态下VAS评分分别为1(0,1)分、2(1,2)分、4(3,4)分、3(3,4)分,均优于D组2(1,2)分、3(2,3)分、5(4,5)分、4(4,5)分和F组2(2,3)分、3(2,3)分、5(5,6)分、4(4,5)分,差异有统计学意义(...     

不同入路髂筋膜腔阻滞对全髋关节 置换术后镇痛的比较

目的 比较垂直和水平腹股沟平面入路行髂筋膜腔阻滞对全髋关节置换术后镇痛的影响。方法 40 例全身麻醉下行单侧全髋关节置换术的患者,术前30 min 随机在超声引导下行垂直腹股沟平面入路（实验 组）或水平腹股沟平面入路（对照组）髂筋膜腔阻滞,分别注射0.25% 罗哌卡因30 ml。术后采用静脉患者自 控镇痛（PCA）,记录术后2、6、12、24、36 和48 h 静息时视觉模拟疼痛评分（VAS）、PCA 追加次数及不良反应。 结果 实验组术后2、6、12 和24 h 的VAS 评分低于对照组（P <0.05）,实验组的PCA 追加次数在6 ～ 12 h 和 12 ～ 24 h,也低于对照组（P <0.05）;两组恶心、呕吐发生率差异无统计学意义（P >0.05）。结论 垂直腹股 沟平面入路行髂筋膜腔阻滞对全髋关节置换术后镇痛效果优于水平入路,这可能与药液向头端扩散增加,更 充分阻滞了手术区域内股外侧皮神经、股神经的痛觉分布有关。     

不同路径超声引导下髂筋膜间隙阻滞在老年全髋关节置换手术中的效果比较

目的比较不同穿刺路径超声引导下持续髂筋膜间隙阻滞在老年全髋关节置换手术中的应用效果。方法收集2019年10月至2022年4月浙江中医药大学附属金华中医院骨科行全髋关节置换手术的老年患者100例,按穿刺入路的不同分为研究组和对照组,每组50例。研究组经超声引导下行内侧入路方式穿刺置管,对照组经超声引导下行外侧入路方式穿刺置管。比较两组患者术中及术后情况（手术时间、术中出血量、输液量、舒芬太尼用量、拔管时间、首次下床活动时间、镇痛泵按压次数、其他镇痛药物使用率）、术后24、48h疼痛视觉模拟评分（VAS）、置管相关情况（包括重新固定导管率、超声成像时间、置管时间、置管深度、罗哌卡因用量等）及神经阻滞效果满意率。结果研究组舒芬太尼用量、拔管时间、首次下床活动时间、镇痛泵按压次数以及其他镇痛药物使用率均明显少于对照组（均P＜0.05）,两组患者术后48h的VAS评分较术后24h明显下降（均P＜0.05）。研究组重新固定导管率、罗哌卡因用量、置管时间、置管深度等均明显优于对照组（均P＜0.05）。研究组术后24、48h股外侧皮神经以及闭孔神经阻滞满意率明显高于对照组（均P＜0.05）。结论内外侧入路持续髂筋膜间隙阻滞均能为患者提供良好的术后镇痛,促进患者术后恢复,内侧入路路径行髂筋膜间隙阻滞术操作时间短,镇痛药物使用量少,股外侧皮神经以及闭孔神经阻滞满意率高。     

超声引导下胸椎旁神经阻滞用于胸腔镜手术患者术后镇痛疗效观察

目的 探讨胸椎旁神经阻滞用于胸腔镜手术患者术后镇痛的效果.方法 全麻下行单侧胸腔镜手术患者50例,随机分为静脉镇痛组(PI组)与胸椎旁阻滞组(PT组),各25例.PT组采用超声引导胸椎旁神经阻滞镇痛,PI组舒芬太尼静脉输注镇痛.观察并记录术后l、3、6、12、24及48 h静息状态和活动状态下的VAS评分;记录术后48h内恶心、呕吐、嗜睡、皮肤瘙痒等不良反应及舒芬太尼用量和镇痛泵按压次数.结果 两组术后1～24h在静息和活动状态下VAS评分差异均有统计学意义(均P＜0.05);两组镇痛泵按压次数、舒芬太尼输注总量及补救镇痛次数差异均有统计学意义(均P＜ 0.05).结论 超声引导下胸椎旁神经阻滞镇痛具有效果良好、操作简单及安全等优点,适用于胸腔镜手术患者的术后镇痛.     

右美托咪定在老年髋关节置换术后的应用效果分析

目的 探讨右美托咪定辅助自控镇痛用于老年髋关节置换术后的镇痛效果和对睡眠质量的影响.方法 选择2017年2月至2019年12月在马鞍山市人民医院超声引导腹股沟上髂筋膜间隙阻滞联合全身麻醉下行髋关节置换术的60例老年患者,采用随机数字表法,分为对照组(舒芬太尼1.5μg/kg)与试验组(舒芬太尼1.5μg/kg+右美托咪定1.5μg/kg),每组30例.观察比较两组患者术后情况,并进行统计学分析.结果 与对照组比较,试验组患者术后同一时间段NRS评分低,Ramsay镇静评分高,差异均有统计学意义(P<0.05);术后不同时间的NRS评分随时间推移有升高趋势,Ramsay镇静评分随时间推移有下降趋势,差异均有统计学意义(P<0.05);两组患者术后睡眠评分比较,差异有统计学意义(P<0.05).术后睡眠评分随时间的推移有下降的趋势,术前及术后不同时间的睡眠评分差异有统计学意义(P<0.05).试验组患者首次下床活动时间为(27.23±8.54)h,术后补救舒芬太静脉镇痛使用量和恶心、呕吐等不良反应发生率明显降低,均优于对照组,差异有统计学意义(P<0.05).结论 右美托咪定多模式镇痛应用于老年髋关节置换术后的镇痛效果显著,减少患者不良反应发生率,明显改善患者术后睡眠质量,提高满意度.     

超声引导髂腹股沟/髂腹下神经阻滞在斜疝手术的应用

目的 观察超声引导行髂腹股沟/髂腹下神经阻滞在斜疝手术麻醉中的临床应用.方法 择期行斜疝手术患者60例,年龄58-70岁,ASAⅠ ～Ⅱ级.随机分为两组(n=30).组Ⅰ采用超声引导法,组Ⅱ采用体表标志法实施骼腹股沟/髂腹下神经联合阻滞.采用盲法即未告知术者麻醉采用何种方法,由同一位手术医生完成手术.两组术中均泵注瑞芬太尼辅助镇痛,必要时予局麻药浸润.观察并记录:麻醉时间;瑞芬太尼及利多卡因用量;术后24小时镇痛效果;及局部麻醉部位有无血肿等并发症,结果 采用超声引导法术中瑞芬太尼用量,需加用利多卡因的次数和总量较体表标志法少(P＜0.01),同时表现出良好的术后镇痛效果,术后24小时曲马多用量组Ⅰ较组Ⅱ少(P＜0.05).结论 超声引导下行髂腹股沟神经/髂腹下神经阻滞应用于老年患者斜疝手术时,麻醉效果确切、安全、可靠,并且能提供良好的术后镇痛效果.     

髂筋膜腔隙阻滞在髌骨手术术后镇痛的应用

<正>髂筋膜腔隙阻滞(fascia iliaca compartment block,FICB)最早由Dalens[1]报道作为替代3合1神经阻滞的方法,它能有效阻滞股外侧皮神经和股神经,现作为下肢神经阻滞主要方法之一,广泛用于下肢手术术后患者的镇痛。舒芬太尼作为芬太尼的衍生物,是一种μ阿片受体高选择性激动药,镇痛效价为芬太尼的10倍,临床已用于术后硬膜外和静脉镇痛,但用于患者静脉自控镇痛(patient-controlled analgesia,PCA)中不设置背景剂量,文献少见报道[2]。本文观察髂筋膜腔隙阻滞以及舒芬太尼在髌骨手术术后镇痛中的作用。     

腰骶丛神经阻滞与髂筋膜间隙阻滞在全髋关节置换术中镇痛效果比较

目的 比较全身麻醉复合腰骶丛神经阻滞（lumbosacral plexus block, LPB）与髂筋膜间隙阻滞（fascia iliaca compartment block, FICB）在全髋关节置换术中镇痛效果。方法 选择择期行全髋关节置换术患者150例,采用随机数字表法随机分为： 全身麻醉复合腰骶丛阻滞组(LPB组,n=50),全身麻醉复合髂筋膜间隙阻滞组（FICB组,n=50）和单纯全身麻醉组（G组,n=50）。3组患者全身麻醉诱导和维持用药相同,术后采用持续静脉自控镇痛（patient controlled analgesia, PCA）至术后48h。全身麻醉诱导前LPB组行超声引导下腰骶丛神经阻滞,FICB组行超声引导下髂筋膜间隙阻滞。记录术中舒芬太尼使用量,术后1、8、12、24、48h患者静息状态下疼痛视觉模拟评分（visual analogue scales, VAS）,术后不良反应和患者满意度,神经阻滞操作时间、操作时VAS评分及穿刺成功率。结果 LPB组和FICB组术中舒芬太尼用量,术后帕瑞昔布钠使用人次明显少于G组（P<0.05）。LPB组和FICB组在术后1、8、12、24、48h VAS评分明显低于G组（P<0.05）。LPB组和FICB组48h患者的满意度明显高于G组（P<0.05）。LPB组在术后8、12、24h的VAS评分明显低于FICB组。LPB组操作时间明显长于FICB组（P<0.05）,穿刺成功率明显低于FIBC组（P<0.05）。结论 超声引导下腰骶丛神经阻滞与髂筋膜间隙阻滞应用于全髋关节置换术均可以取得良好的镇痛效果,腰骶丛神经阻滞镇痛效果更佳且镇痛时间更长,但腰骶丛神经阻滞操作难度较大,失败率较高。     

超声引导股外侧皮神经-股神经阻滞在老年患者PFNA术的应用

目的 探讨超声引导下股外侧皮神经-股神经阻滞在老年患者股骨近端防旋髓内钉(PFNA)术的麻醉效果及安全性.方法 选择2017年4月至2019年9月在西部战区总医院行PFNA术的老年患者68例,采用计算机随机数表分为神经阻滞联合喉罩全身麻醉组(NL组)与单纯喉罩全身麻醉组(L组).观察两组患者心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO2)的变化;记录手术结束后瑞芬太尼用量;比较入麻醉复苏室(PACU)时视觉模拟评分法(VAS)评分及不良反应情况.结果 在切皮、术毕和喉罩拔除时,L组HR、MAP均明显高于NL组(P<0.05);两组各时间点SpO2无明显差异(P>0.05).NL组术中瑞芬太尼用量明显少于L组,停药后苏醒时间明显短于L组(P<0.05),苏醒期躁动、嗜睡发生率及入PACU时VAS评分均明显低于L组(P<0.05).结论 超声引导下股外侧皮神经-股神经阻滞联合喉罩全身麻醉可安全用于老年患者PFNA术,为老年患者提供了较理想的麻醉方式.     

舒芬太尼联合罗哌卡因用于老年全髋关节置换术后硬膜外自控镇痛的观察

目的 探讨舒芬太尼联合罗哌卡因用于老年全髋关节置换术后硬膜外自控镇痛(PCEA)的效果.方法 将84例行全髋关节置换术的老年患者分为Ⅰ～Ⅳ组,各21例.Ⅰ组予0.2％罗哌卡因,Ⅱ、Ⅲ及Ⅳ组在此基础上分别联合0.5、0.75及1.0 mg/L舒芬太尼行术后PCEA.记录镇痛开始后4、8、16及24h视觉模拟评分(VAS)、Ramsay评分、不良反应及用药总量.结果 Ⅱ组患者VAS评分均显著低于Ⅰ组(P＜0.05),Ⅲ组与Ⅳ组各时点VAS均为0.Ⅱ组患者镇痛药物总量低于Ⅰ组(P＜0.05),Ⅲ组与Ⅳ组镇痛药物总量均较Ⅱ组低(P＜0.01).各组患者Ramsay评分及不良反应发生率差异无统计学意义(P＞0.05).结论 0.2％罗哌卡因联合0.75 mg/L舒芬太尼可安全有效地用于老年人全髋置换术后PCEA.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.