右美托咪定与依托咪酯对胃癌全麻根治术后镇痛的疗效及其对感染和血流动力学影响

目的 探讨右美托咪定与依托咪酯对胃癌全麻醉根治术后镇痛疗效及对感染和血流动力学影响。方法选择我院2016年7月至2020年7月收治的139例患者,随机分为观察组(n=70)和对照组(n=69)。对照组予依托咪酯诱导麻醉,观察组联合右美托咪定麻醉。比较两组疼痛评分、感染情况及血流动力学变化。结果 麻醉后,两组疼痛评分均显著下降(t=11.259,P=0.000;t=8.524,P=0.000);且观察组疼痛评分显著低于对照组(t=11.690,P=0.000)。观察组感染发生率为5.71%,明显低于对照组的17.39%(χ2=4.652,P=0.031)。用药及拔管时,对照组心率均低于观察组(P0.05);收缩压、舒张压比较,差异无统计学意义(P0.05)。结论 右美托咪定与依托咪酯对胃癌全麻醉根治术后麻醉镇痛疗效良好,可有效降低疼痛,维持血流动力学稳定,降低感染发生率。     

Can we reduce morphine use in elderly,proximal femoral fracture patients using a fascia iliac block?

Proximal femoral fractures are becoming increasingly common with an ageing population. Many patients have multiple comorbidities increasing their risk of opiate complications. 40 consecutive patients presenting with a proximal femoral fracture to a trauma centre in the UK were given either a Fascia Iliaca Block (FIB) with oral analgesia or just oral analgesia to control their pre-operative pain. Numeric pain scores and morphine consumption were used as outcome measures. Patients receiving a FIB had significant reduction in their pain scores compared to patients only receiving oral pain relief. There was also a significant reduction in both the actual oral morphine taken and the renal calculated level of morphine products in the group receiving the FIB. Patients undergoing a FIB required almost 50 mg less oral morphine pre-operatively. Nerve blocks should be used routinely to help pre-operative pain in proximal femoral fracture patients and to reduce the amount of morphine products prescribed. This prevents potential opiate complications in a highly susceptible cohort of patients often suffering with impaired renal function as a co-morbidity.     

止血镇痛冰块的研制及临床应用效果观察

目的 寻找扁桃体摘除术后局部止血镇痛的有效方法。方法 自行研制了止血镇痛冰块(下称药冰)。100例扁桃体摘除术后患者(观察组)术后2小时起含化药冰,每1～2小时1次,每日8～12次;对照组(50例同期行扁桃体摘除术的患者)术后2小时舌根部含化冰淇淋或雪糕。观察两组术后出血疼痛、伤口愈合等情况。结果 观察组术后疼痛明显减轻,24小时出血量少,进食情况较好,与对照组相关指标比较,P均<0.01。结论药冰制作简单、价格低廉、无异味,止血、镇痛、促伤口愈合效果可靠,优于传统方法。     

无线镇痛泵系统的应用效果探讨

目的：探讨和评价无线镇痛系统在术后镇痛中的应用效果。方法选择2011年8月—2012年2月收治的200例行择期手术的患者,随机分为试验组和对照组,每组100例。试验组采用无线镇痛系统行术后皮下自控镇痛（PCSA）,对照组采用普通的全自动注药泵行术后皮下自控镇痛。观察患者的满意度、VAS评分、麻醉医生的被回叫率及恶心呕吐、头晕、呼吸抑制和皮肤瘙痒等不良反应发生率。结果两组在患者满意度、术后48 h 的 VAS评分和被回叫率方面差异有统计学意义。结论无线镇痛泵系统在功能上作了大量的修改与补充,在提高镇痛质量的同时能减轻医务人员的工作量。     

帕瑞昔布不同给药方式对开腹术后镇痛及胃肠功能恢复的影响

目的：观察帕瑞昔布钠联合芬太尼静脉自控镇痛（PCA）不同给药方式在开腹术后应用的有效性和安全性。方法择期开腹手术患者75例,随机分为单次给药组（S组）、多次给药组（M组）和对照组（C组）,每组25例。S组于手术结束前30 min静注帕瑞昔布钠40 mg,术后12 h、24 h静注生理盐水10 ml;M组在相应时间给予帕瑞昔布钠40 mg;C组在相应时间给予生理盐水,术后所有患者接受PCA治疗。观察术后6 h、12 h、24 h、48 h的VAS评分,0～12 h、12～24 h、24～48 h镇痛泵有效按压次数和芬太尼用量、首次排气、排便时间、Ramsay评分、恶心呕吐发生情况。结果三组术后各时点VAS评分差异无统计学意义（P＞0.05）;M组镇痛泵有效按压次数和芬太尼总消耗量显著低于S组和C组（P＜0.05）;胃肠功能恢复时间M组早于S组和C组（P＜0.05）;三组不良反应差异无统计学意义（P＞0.05）。结论开腹手术术后采用帕瑞昔布钠多次给药联合芬太尼静脉自控镇痛,镇痛效果明确,芬太尼消耗量降低,胃肠功能恢复较快。     

The evaluation and management of urolithiasis in the ED: A review of the literature

Background

Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage.