下颌后缩畸形的联合功能矫治及固定矫治

目的探讨第Ⅰ期采用双阻板矫治器(twin block appliance,TBA)联合肌激动器矫治生长发育期下颌后缩畸形,第Ⅱ期进行固定矫治的临床效果。方法1例下颌后缩的骨性Ⅱ类错患者,第Ⅰ期第1阶段采用TBA矫治,使上下颌骨呈骨性Ⅰ类关系;第2阶段采用肌激动器使后牙建。第Ⅱ期采用直丝弓矫治技术排齐牙齿、整平曲线、以及调整磨牙至中性关系并维持之。结果第Ⅰ期第1阶段,TBA矫治后下颌后缩得到纠正,上下颌骨呈骨性Ⅰ类关系,前牙覆盖变小,面型明显改善;第2阶段肌激动器可使后牙建良好,并能维持第1阶段达到的牙、颌关系;第Ⅱ期直丝弓矫治结束时牙齿排列整齐、曲线平整、磨牙呈中性关系。结论矫治下颌后缩畸形,TBA联合肌激动器较使用单一功能矫治器有明显的优势;必要时,应作Ⅱ期固定矫正。     

Effect of combination of preoperative ibuprofen/acetaminophen on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis

Introduction

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of the combination of preoperative ibuprofen/acetaminophen on the success of the inferior alveolar nerve (IAN) block in patients with symptomatic irreversible pulpitis.

Methods

One hundred endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, identical capsules of either a combination of 800 mg ibuprofen and 1000 mg acetaminophen or placebo 45 minutes before the administration of a conventional IAN block. Access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on access or initial instrumentation.

Results and Conclusions

The success rate for the IAN block was 32% for the combination ibuprofen/acetaminophen group and 24% for the placebo, with no significant difference (P = .37) between the 2 groups. For mandibular posterior teeth, a combination dose of 800 mg ibuprofen and 1000 mg acetaminophen given 45 minutes before administration of the IAN block did not result in a statistically significant increase in anesthetic success in patients with symptomatic irreversible pulpitis.     

A prospective, randomized single-blind study of the anesthetic efficacy of frequency-dependent conduction blockade of the inferior alveolar nerve

Introduction

The purpose of this prospective, randomized single-blind study was to evaluate the degree of pulpal anesthesia obtained with frequency-dependent conduction blockade of the inferior alveolar nerve (IAN).

Methods

Eighty adult volunteers randomly received two IAN blocks: an IAN block followed by continuous electrical stimulation for 3 minutes of the first molar or lateral incisor for six cycles over a time period of 64 minutes; an IAN block followed by mock electrical stimulation using the same cycles. The IAN blocks were administered at two separate appointments spaced at least 1 week apart in a crossover design. An electric pulp tester was used to test for anesthesia of the first molar and lateral incisor. Anesthesia was considered successful when two consecutive 80 readings were obtained within 15 minutes, and the 80 reading was recorded through the 60th minute.

Results

The anesthetic success rate for the stimulated IAN block was 35% and 48% for the lateral incisor and first molar, respectively. For the mock stimulated IAN, success was 18% for the lateral incisor and 62% for the first molar. There was no significant difference between the two IAN block techniques.

Conclusions

We concluded that the stimulation of nerves in the presence of local anesthesia (frequency-dependent nerve block) did not statistically increase the success rate of pulpal anesthesia for an IAN block.     

超声引导下坐骨神经阻滞麻醉在下肢骨折手术中的应用效果

目的 探讨超声引导下坐骨神经阻滞麻醉在下肢骨折手术中的应用效果.方法 将50例下肢骨折手术患者按照入院先后顺序分为对照组与研究组,每组25例.对照组给予神经刺激仪引导下坐骨神经阻滞麻醉,研究组给予超声引导下坐骨神经阻滞麻醉.比较两组的麻醉效果.结果 研究组的苏醒时间,拔管时间,运动、感觉神经阻滞起效时间短于对照组,运动、感觉神经阻滞维持时间长于对照组(P<0.05).拔管30 min后,两组的VAS评分均降低,且研究组低于对照组(P<0.05);拔管10 min后,两组的Ramsay镇静评分均降低,且研究组低于对照组(P<0.05).麻醉30 min后,两组的血糖、皮质醇、白细胞介素-6水平均升高,但研究组低于对照组,差异具有统计学意义(P<0.05).两组的不良反应总发生率无显著差异(P>0.05).结论 超声引导下坐骨神经阻滞麻醉可缩短下肢骨折手术患者苏醒时间,拔管时间,运动、感觉神经阻滞起效时间,延长运动、感觉神经阻滞维持时间,减轻麻醉应激反应,且安全性较高.     

结肠内支架在乙状结肠癌及直肠癌梗阻治疗中的应用

目的 探讨结肠内支架治疗直肠癌、乙状结肠癌梗阻的疗效和意义.方法 自2001年1月至2005年12月,共收治22例左侧大肠癌梗阻的患者,在内镜及X线辅助下进行了结肠内支架治疗.结果 22例患者结肠内支架置入均获成功,无一例发生肠穿孔、大出血.10例出现骶尾部疼痛,5例有少量血便,支架脱落2例.结论 结肠内支架治疗作为直肠癌、乙状结肠癌术前梗阻解除或晚期复发肿瘤的姑息治疗均能达到梗阻解除、避免肠造瘘术、改善患者生活质量的效果.     

单侧腹横肌平面阻滞缓解男性全身麻醉后导尿管相关膀胱不适的效果

目的：探讨超声引导下单侧髂腹股沟腹横肌平面阻滞（TAPB）缓解男性全身麻醉后导尿管相关膀胱不适（CRBD）的效果。方法：选择全身麻醉术后在麻醉复苏室（PACU）留置期间出现重度CRBD男性患者62 例,随机分为对照组（C组）和TAPB组（T组）。C组予以静脉注射舒芬太尼0.15 μg/kg,T组在超声引导下使用0.375%罗哌卡因10 mL行单侧髂腹股沟TAPB。采用4 分制评估法评价治疗后0.5 h、1 h、2 h和6 h CRBD的严重程度,当CRBD评级为中重度时,予以静脉注射曲马多1 mg/kg作为补救措施,记录生命体征,并观察患者有无恶心、呕吐、眩晕、镇静过度、呼吸抑制等不良反应。结果：T组中重度CRBD发生率在治疗后0.5 h、1 h、2 h和6 h均显著低于C组（P ＜0.05）。与C组相比,T组治疗后镇静过度和呼吸抑制的发生率显著降低（P ＜0.05）,需要静脉注射曲马多作为补救措施的患者也明显减少（P ＜0.05）。结论：应用0.375%罗哌卡因行单侧髂腹股沟TAPB可降低男性患者全身麻醉术后CRBD的严重程度,并减少镇痛药的使用以及不良反应的发生。     

四种多模式镇痛方案对全膝关节置换术后康复影响的回顾性分析

目的 回顾性分析四种多模式镇痛方案对全膝关节置换术后患者康复的影响。方法 通过提取电子病历系统中的数据,回顾性分析2015年4月至2020年4月行初次单侧全膝关节置换术的537例骨关节炎患者,采用四种多模式镇痛方案：A组耳穴贴压联合股神经阻滞,B组耳穴贴压联合隐神经阻滞,C组塞来昔布联合股神经阻滞,D组塞来昔布联合隐神经阻滞。统计术前一般资料及术后第1、3、7天VAS评分、股四头肌肌力、匹兹堡睡眠质量指数（PSQI）量表评分、膝关节主动活动度。结果 四组术前一般资料比较差异无统计学意义。术后第3和7天,A组和B组的VAS评分均比C组和D组低。A组和C组股四头肌肌力在术后第1和3天明显比B组和D组差。A组和B组术后第1、3、7天PSQI量表评分均低于同时间段的C组和D组。A组和B组术后第1和3天膝关节主动活动度比C组和D组大。结论 全膝关节置换术患者采用耳穴贴压联合单次收肌管隐神经阻滞更能有效缓解术后疼痛,改善睡眠,促进早期功能锻炼,达到快速康复的效果。     

罗哌卡因复合不同剂量地塞米松行肌间沟臂丛神经阻滞在患儿上肢手术后的镇痛效果

目的 观察罗哌卡因复合不同剂量地塞米松行肌间沟臂丛神经阻滞（ISBPB）对患儿上肢骨折手术后镇痛效果的影响。
方法 选择上肢骨折手术患儿73例,男46例,女27例,年龄3～7岁,ASA Ⅰ或Ⅱ级。随机分为三组：单纯罗哌卡因组（R组,n=24）、罗哌卡因复合地塞米松0.1 mg/kg组（D1组,n=24）和罗哌卡因复合地塞米松0.2 mg/kg组（D2组,n=25）,三组药液容量均为0.3 ml/kg。患儿在麻醉后行超声引导下ISBPB,均保留自主呼吸。记录痛觉阻滞时间、运动阻滞时间、阻滞后24 h内镇痛药物（布洛芬混悬液、氢吗啡酮）的使用情况。记录膈神经阻滞、Horner综合征、声带麻痹、阻滞侧感觉异常等术后并发症的发生情况。
结果 D2组痛觉阻滞时间明显长于R组（P＜0.05）。R组和D1组痛觉阻滞时间差异无统计学意义。三组运动阻滞时间差异无统计学意义。D1组和D2组阻滞后24 h内布洛芬混悬液使用次数、氢吗啡酮使用率明显低于R组（P＜0.01）,D1组和D2组差异无统计学意义。三组膈神经阻滞率差异无统计学意义。三组术后未出现其余并发症。
结论 与单纯罗哌卡因比较,0.25%罗哌卡因复合地塞米松0.1 mg/kg和0.2 mg/kg可安全应用于患儿肌间沟臂丛神经阻滞,减轻术后疼痛;复合地塞米松0.2 mg/kg时明显延长镇痛时间。