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1.
IntroductionPregnancy in spinal cord injured patients has specific issues that must be carefully addressed. However, guidelines for their management are scarce.MethodsA systematic review of the literature regarding the anaesthetic management during delivery of pregnant patients with cervical spinal cord injury was performed on the electronic databases of PubMed (Medline) and Cochrane.ResultsA higher incidence of preterm birth and caesarean delivery were seen. Anaesthetic management was diverse, although most pregnant patients received epidural analgesia. Autonomic dysreflexia symptoms were present in 51% of pregnancies.ConclusionTimely management of these patients could possibly reduce caesarean and preterm delivery rates, avoid or minimize common complications, as well as reduce costs. An early reference to anaesthesiology consultation and a multidisciplinary approach is recommended.  相似文献   
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目的:观察氟比洛芬酯联合氢吗啡酮在老年髋/膝关节置换术(THA/KTA)后患者自控静脉镇痛(PCIA)中的应用效果。方法:选取接受THA/KTA的70例老年患者作为研究对象,按照随机数字表法分为对照组和观察组各35例。术后对照组予以盐酸氢吗啡酮注射液镇痛,观察组在对照组的基础上联合氟比洛芬酯注射液镇痛,比较两组术后4、12、24、48 h视觉模拟评分法(VAS)评分,术前及术后24 h炎性因子[白细胞介素(IL)-6、IL-1β、肿瘤坏死因子-α(TNF-α)]水平,以及不良反应发生率。结果:术后12、24、48 h时,观察组VAS评分均明显低于对照组,差异有统计学意义(P<0.05);术后24 h,观察组IL-6、IL-1β、TNF-α水平均明显低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:氟比洛芬酯联合氢吗啡酮应用于老年THA/KTA术后患者自控静脉镇痛中,可降低术后VAS评分和炎性因子水平,效果优于单纯氢吗啡酮镇痛。  相似文献   
4.
陈贻人  郑雅静  陈樱 《天津医药》2022,50(11):1209-1212
目的 评估静脉注射氟比洛芬酯联合纳布啡用于眼眶减压术患者的术后镇痛效果。方法 纳入拟行眼眶减压术的患者共计120例,根据随机数字表法分为氟比洛芬酯组(F组)、纳布啡组(N组)和氟比洛芬酯联合纳布啡组(F+N组),每组40例。所有患者于手术结束后即刻静脉注射镇痛药物。F组患者静脉注射氟比洛芬酯100 mg;N组患者静脉注射纳布啡0.1 mg/kg;F+N组患者静脉注射上述2种药物。使用数字评价量表(NRS)和Ramsay镇静评分评估3组患者返回病房后即刻(T0)、术后2 h(T2)、术后12 h(T12)的疼痛和镇静情况。记录患者术后24 h内低血压、恶心、呕吐、寒战、呼吸抑制、瘙痒等不良反应发生情况。结果 最终共纳入116例患者,F组、N组、F+N组分别纳入38例、38例、40例患者。F+N组患者T0时点、T2时点NRS评分显著低于F组和N组患者(P<0.05),3组患者T12时点NRS评分的比较差异无统计学意义(P>0.05)。3组患者T0、T2、T12时点Ramsay镇静评分的比较差异均无统计学意义(P>0.05)。3组间低血压、恶心、呕吐、寒战、呼吸抑制及瘙痒发生率比较差异无统计学意义(均P>0.05)。结论 术中静脉注射氟比洛芬酯联合纳布啡能够为眼眶减压术患者提供良好的术后镇痛效果且安全性较高。  相似文献   
5.
胡俊  黄菲  刘丹  阚智勇  杨文庆  徐小琴 《西部医学》2021,32(9):1369-1373
【摘要】 目的 探讨不同剂量羟考酮通过患者硬膜外自控镇痛(PCEA)与患者静脉自控镇痛(PCIA)用于前列腺术后的镇痛效果。 方法 选取在2018年1月~2020年1月期间于我院行前列腺术的210例患者,采用随机数字表法将患者分成A1、A2、A3、B1、B2、B3 6组,每组各35例。其中A1、A2、A3组术后镇痛采用PCIA方案,分别使用0.6mg/kg、0.8mg/kg、1.0mg/kg的羟考酮+托烷司琼10mg+0.9%氯化钠溶液至100mL;B1、B2、B3术后镇痛采取PCEA方案,分别使用0.6mg/kg、0.8mg/kg、1.0mg/kg的羟考酮+托烷司琼10mg+0.9%氯化钠溶液至100mL。比较手术前(T0)、术后6h(T1)、术后12h(T2)、术后24h(T3)及术后48h(T4)6组患者的生命体征、视觉疼痛模拟评分(VAS)及不良反应的发生情况。 结果 各组患者在不同时间点的MAP、HR及SPO2的水平比较差异无统计学意义(P>0.05)。B1、B2、B3组患者分别在T1、T2、T3、T4时间的VAS评分显著低于A1、A2、A3组(均P<0.05),A2、A3组患者分别在T1、T2、T3、T4时间的VAS评分显著低于A1组(均P<0.05),B2、B3组患者分别在T1、T2、T3、T4时间的VAS评分显著低于B1组(均P<0.05)。B1、B2、B3不良反应的发生率分别显著低于A1、A2、A3组(均P<0.05)。B1、B2不良反应的发生率显著低于A2、A3组(P<0.05),且A3组不良反应的发生率显著高于A1、A2,B3组的不良反应的发生率显著高于B1、B2组(均P<0.05)。 结论 对前列腺手术患者术后,不同剂量羟考酮PCEA的镇痛效果及不良反应发生率均显著优于不同剂量羟考酮的PCIA,且当羟考酮的剂量为0.8mg/kg时,效果最佳。  相似文献   
6.
Widespread adoption of intrathecal morphine into clinical practice is hampered by concerns about its potential side-effects. We undertook a systematic review, meta-analysis and trial sequential analysis with the primary objective of determining the efficacy and safety of intrathecal morphine. Our secondary objective was to determine the dose associated with greatest efficacy and safety. We also assessed the impact of intrathecal morphine on respiratory depression. We systematically searched the literature for trials comparing intrathecal morphine with a control group in patients undergoing hip or knee arthroplasty under spinal anaesthesia. Our primary efficacy outcome was rest pain score (0–10) at 8–12 hours; our primary safety outcome was the rate of postoperative nausea and vomiting within 24 hours. Twenty-nine trials including 1814 patients were identified. Rest pain score at 8–12 hours was significantly reduced in the intrathecal morphine group, with a mean difference (95%CI) of −1.7 (−2.0 to −1.3), p < 0.0001 (19 trials; 1420 patients; high-quality evidence), without sub-group differences between doses (p = 0.35). Intrathecal morphine increased postoperative nausea and vomiting, with a risk ratio (95%CI) of 1.4 (1.3–1.6), p < 0.0001 (24 trials; 1603 patients; high-quality evidence). However, a sub-group analysis by dose revealed that rates of postoperative nausea and vomiting within 24 hours were similar between groups at a dose of 100 µg, while the risk significantly increased with larger doses (p value for sub-group difference = 0.02). Patients receiving intrathecal morphine were no more likely to have respiratory depression, the risk ratio (95%CI) being 0.9 (0.5–1.7), p = 0.78 (16 trials; 1173 patients; high-quality evidence). In conclusion, there is good evidence that intrathecal morphine provides effective analgesia after lower limb arthroplasty, without an increased risk of respiratory depression, but at the expense of an increased rate of postoperative nausea and vomiting. A dose of 100 µg is a ‘ceiling’ dose for analgesia and a threshold dose for increased rate of postoperative nausea and vomiting.  相似文献   
7.
目的观察舒芬太尼复合右美托咪定用于喉部分切除术后患者自控静脉镇痛(PCIA)的效果。方法选择全麻下行喉部分切除术患者60例,男44例,女16例,年龄35~65岁,ASAⅠ或Ⅱ级。采用随机数字表法分为两组:舒芬太尼组(S组)和舒芬太尼复合右美托咪定组(SD组),每组30例。术毕行PCIA,S组配方为舒芬太尼1.5μg/kg;SD组配方为舒芬太尼1.5μg/kg+右美托咪定5μg/kg,两组均用生理盐水配成100 ml,背景输注速度2 ml/h,单次剂量1 ml,锁定时间15 min。记录术后4、8、12、24 h的VAS疼痛评分、Ramsay镇静评分、术后24 h内舒芬太尼用量、补救镇痛例数、咳嗽次数、吸痰次数及吸痰时躁动数、睡眠时间以及术后PCIA期间切口出血、心动过缓、肺部感染、呼吸抑制等不良反应。结果两组术后不同点VAS疼痛评分均≤4分。与S组比较,SD组术后不同时点VAS疼痛评分明显降低,Ramsay镇静评分明显升高,术后24 h内舒芬太尼用量明显减少,咳嗽发生次数及吸痰时躁动明显减少,术后当日睡眠时间明显延长(P<0.05)。两组术后切口出血及肺部感染发生率差异无统计学意义。两组均无补救镇痛,未见心动过缓、呼吸抑制发生。结论舒芬太尼复合右美托咪定PCIA用于喉部分切除术后镇痛效果确切,且能明显减轻患者气道反应,减少舒芬太尼用量,减少术后刺激性咳嗽次数,降低吸痰时躁动发生,有利于患者恢复。  相似文献   
8.
ObjectiveTo evaluate differences in postoperative pain control and opioids requirement in thoracic surgical patients following implementation of an Enhanced Recovery after Thoracic Surgery protocol with a comprehensive postoperative pain management strategy.Material and MethodsA retrospective analysis of a prospectively maintained database of patients undergoing pulmonary resections by robotic thoracoscopy or thoracotomy from January 1, 2017, to January 31, 2019, was conducted. Multimodal pain management strategy (opioid-sparing analgesics, infiltration of liposomal bupivacaine to intercostal spaces and surgical sites, and elimination of thoracic epidural analgesia use in thoracotomy patients) was implemented as part of Enhanced Recovery after Thoracic Surgery on February 1, 2018. Outcome metrics including patient-reported pain levels, in-hospital and postdischarge opioids use, postoperative complications, and length of stay were compared before and after protocol implementation.ResultsIn total, 310 robotic thoracoscopy and 62 thoracotomy patients met the inclusion criteria. This pain management strategy was associated with significant reduction of postoperative pain in both groups with an overall reduction of postoperative opioids requirement. Median in-hospital opioids use (morphine milligram equivalent per day) was reduced from 30 to 18.36 (P = .009) for the robotic thoracoscopy group and slightly increased from 15.48 to 21.0 (P = .27) in the thoracotomy group. More importantly, median postdischarge opioids prescribed (total morphine milligram equivalent) was significantly reduced from 480.0 to 150.0 (P < .001) and 887.5 to 150.0 (P < .001) for the thoracoscopy and thoracotomy groups, respectively. Similar short-term perioperative outcomes were observed in both groups before and following protocol implementation.ConclusionsImplementation of Enhanced Recovery after Thoracic Surgery allows safe elimination of epidural use, better pain control, and less postoperative opioids use, especially a drastic reduction of postdischarge opioid need, without adversely affecting outcomes.  相似文献   
9.

目的 分析程控间歇脉冲输注联合患者自控硬膜外分娩镇痛模式下产妇发生爆发痛的相关因素。
方法 选择行分娩镇痛的产妇215例,年龄20~45岁,孕期≥37周,单胎头位,ASA Ⅱ或Ⅲ级。行硬膜外穿刺置管后接入电子镇痛泵,参数设置:0.08%罗哌卡因+舒芬太尼0.4 μg/ml,负荷剂量15 ml,脉冲剂量10 ml/h,单次追加剂量8 ml,锁定时间30 min,极限量30 ml/h。当产妇出现爆发痛时给予0.125%罗哌卡因+舒芬太尼0.4 μg/ml共10 ml追加,根据产妇是否发生爆发痛分为两组:爆发痛组和无爆发痛组。记录产妇一般情况和分娩镇痛相关指标。采用单因素方差分析和二分类Logistic回归分析筛选爆发痛的相关因素。
结果 93例(43.2%)产妇发生爆发痛。与无爆发痛组比较,爆发痛组产间发热率明显升高、分娩镇痛满意度明显降低(P<0.05)。两组器械助产率差异无统计学意义。Logistic回归分析显示,硬膜外镇痛中断、镇痛15 min后NRS评分增加和第一产程时间延长是发生爆发痛的独立相关因素。
结论 镇痛15 min后NRS评分增加、硬膜外镇痛中断、第一产程时间延长是硬膜外分娩镇痛后发生爆发痛的独立相关因素。  相似文献   
10.
Phrenic-sparing analgesic techniques for shoulder surgery are desirable. Intra-articular infiltration analgesia is one promising phrenic-sparing modality, but its role remains unclear because of conflicting evidence of analgesic efficacy and theoretical concerns regarding chondrotoxicity. This systematic review and meta-analysis evaluated the benefits and risks of intra-articular infiltration in arthroscopic shoulder surgery compared with systemic analgesia or interscalene brachial plexus block. We sought randomised controlled trials comparing intra-articular infiltration with interscalene brachial plexus block or systemic analgesia (control). Cumulative 24-h postoperative oral morphine equivalent consumption was designated as the primary outcome. Secondary outcomes included visual analogue scale pain scores during the first 24 h postoperatively; time-to-first analgesic request; patient satisfaction; opioid-related side-effects; block-related adverse events; and any indicators of chondrotoxicity. Fifteen trials (863 patients) were included. Compared with control, intra-articular infiltration reduced 24-h postoperative analgesic consumption by a weighted mean difference (95%CI) of −30.9 ([−38.9 to −22.9]; p < 0.001). Intra-articular infiltration also reduced the weighted mean difference (95%CI) pain scores up to 12 h postoperatively, with the greatest reduction at 4 h (−2.2 cm [(−4.4 to −0.04]); p < 0.05). Compared with interscalene brachial plexus block, there was no difference in opioid consumption, but patients receiving interscalene brachial plexus block had better pain scores at 2, 4 and 24 h postoperatively. There was no difference in opioid- or block-related adverse events, and none of the trials reported chondrotoxic effects. Compared with systemic analgesia, intra-articular infiltration provides superior pain control, reduces opioid consumption and enhances patient satisfaction, but it may be inferior to interscalene brachial plexus block patients having arthroscopic shoulder surgery.  相似文献   
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