多功能套针浮刺疗法治疗神经根型颈椎病——一项随机对照观察研究＊

目的 评价多功能套针浮刺疗法对神经根型颈椎病的临床疗效。方法 选取256例神经根型颈椎病患者，按随机数字表法分为观察组与对照组各128例。观察组应用多功能套针浮刺疗法进行干预，对照组为常规针刺治疗。两组患者均治疗7天。分别于治疗前后观察两组患者的简化McGill疼痛问卷（SF-MPQ）、国际标准颈椎功能障碍指数（NDI）和田中靖久颈椎病症状20分法量表评分，并于治疗结束后3个月观察复发率。结果 两组患者治疗后的SF-MPQ量表评分、NDI量表评分及田中靖久颈椎病症状20分法评分与治疗前相比均有改善（P<0.05），且观察组优于对照组（P<0.05）；两组患者于治疗后3个月随访，SF-MPQ量表评分与治疗后相比均有改善，且观察组优于对照组（P<0.05）；观察组临床疗效总有效率为96.88%，愈显率为81.25%；对照组总有效率为78.13%，愈显率为46.88%，观察组优于对照组（P<0.05）。结论 应用多功能套针浮刺疗法治疗神经根型颈椎病临床疗效显著，见效较快，可有效降低其复发率，且作用稳定，效果持久，值得临床推广应用。     

Filiform needle acupuncture for allergic rhinitis: A systematic review and meta-analysis

BackgroundFiliform needle acupuncture (FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in the treatment of allergic rhinitis (AR).ObjectiveTo evaluate the efficacy, safety, cost-effectiveness, and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture, no treatment, and conventional medication.Search strategyEight electronic databases were systematically searched from inception to October 14, 2021. Additional studies were acquired from clinical trial registration platforms and reference lists.Inclusion criteriaRandomized controlled trials were included if they compared FNA with either sham acupuncture, no treatment or conventional medication for AR.Data extraction and analysisTwo researchers extracted data independently of each other using a predesigned data acquisition form, and results were cross-checked after completion. The primary outcome was symptom score (Total Nasal Symptom Score or Visual Analogue Scale), and the secondary outcomes were the AR control questionnaire, quality of life (QoL) score (Different versions of Rhinoconjunctivitis Quality of Life Questionnaire), medication score (use of rescue medication), mental health score, total IgE, adverse event rate, clinical economic indicators, and patient satisfaction score. Standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval was used to calculate the effect size for continuous data, while risk ratio with 95% CI was used for dichotomous data.ResultsThirty studies were included in this review. Compared with sham acupuncture, FNA significantly reduced the symptom score (SMD: ?0.29 [?0.43, ?0.15]), AR’s impact on QoL (SMD: ?0.23 [?0.37, ?0.08]) and medication score (SMD: ?0.3 [?0.49, ?0.11]). Compared with no treatment, FNA dramatically reduced the symptom score (SMD: ?0.8 [?1.2, ?0.39]) and AR’s impact on QoL (SMD: ?0.82 [?1.13, ?0.52]). There were no increased rates of adverse events with FNA compared to sham acupuncture and no treatment. FNA increased patient satisfaction and may be cost-effective. Most pieces of evidence from the above two comparisons were of high confidence. Moreover, FNA significantly outperformed conventional medication in reducing the symptom score (SMD: ?0.48 [?0.85, ?0.1]) and displayed a lower rate of adverse events, but the quality of evidence was very low.ConclusionFNA is an effective and safe intervention for AR and can help with symptom relief, QoL improvement, reducing medication usage, and increasing patient satisfaction. Further studies are needed to verify its cost-effectiveness and superiority over conventional medication and the best therapeutic strategies.     

Manejo anestésico de las pacientes embarazadas tetrapléjicas durante el parto: una revisión sistemática

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.     

Obstetric analgesia and anaesthesia in SARS-CoV-2-positive parturients across 10 maternity units in the north-west of England: a retrospective cohort study

Since the start of the COVID-19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS-CoV-2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS-CoV-2 across 10 hospitals in the north-west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS-CoV-2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID-19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64–1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6–96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64, 95%CI 1.19–2.22; p = 0.002); of Asian ethnicity (OR 1.54, 1.04–2.28; p = 0.03); to deliver prematurely (OR 2.16, 95%CI 1.47–3.19; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16–2.12; p = 0.008); and a higher critical care utilisation rate both pre- (8% vs. 0%, p = 0.001) and post-delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83–6.52; p = 0.001). Eight neonates tested positive for SARS-CoV-2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78–1.57; p = 0.55). In women with COVID-19, non-neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID-19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.     

Patients' expectations,experience and acceptability of postoperative analgesia: a nested qualitative study within a randomised controlled trial comparing rectus sheath catheter and thoracic epidural analgesia

Adequate postoperative analgesia is a key element of enhanced recovery programmes. Thoracic epidural analgesia is associated with superior postoperative analgesia but can lead to complications. Rectus sheath catheter analgesia may provide an alternative. In a nested qualitative study (within a two-year randomised controlled trial) focussing on the acceptability, expectations and experiences of receiving the interventions, participants (n = 20) were interviewed 4 weeks post-intervention using a grounded theory approach. Constant comparative analysis, with patient and public involvement, enabled emerging findings to be pursued through subsequent data collection. We found no notable differences regarding postoperative acceptability or the experience of pain management. Pre-operatively, however, thoracic epidural analgesia was a source of anticipatory fear and anxiety. Both interventions resulted in some experienced adverse events (proportionately more with thoracic epidural analgesia). Participants had negative experiences of the insertion of thoracic epidural analgesia; others receiving the rectus sheath catheter lacked confidence in staff members' ability to manage the local anaesthetic infusion pump. The anticipation of the technique of thoracic epidural analgesia, and concerns about its impact on mobility, represented an additional, unpleasant experience for patients already managing an illness experience, anticipating a life-changing operation and dealing with concerns about the future. The anticipation of rectus sheath catheter analgesia was not associated with such anxieties. Patients' experiences start far earlier than the experience of the intervention itself through anticipatory anxieties and fears about receiving a technique and its potential implications. Complex pain packages can take on greater meaning than their actual efficacy in relieving postoperative pain. Future research into patient acceptability and experience should not focus solely on efficacy of pain relief but should include anticipatory fears, anxieties and experiences.     

The Newborn Infant Parasympathetic Evaluation (NIPE™) monitor predicts post-operative pain in children undergoing day-procedures: A prospective observational study

BackgroundPain assessment is essential for the administration of appropriate analgesia. Currently, clinicians use surrogate methods, such as heart rate or behavioural pain scales, to estimate pain in neonates and infants. The Newborn and Infant Parasympathetic Evaluation (NIPE™) monitor aims to provide an objective numeric value (NIPE index) of pain through a continuous assessment of the patient's parasympathetic activity. The aim of this study was to determine if the intraoperative NIPE index monitoring could predict postoperative pain in neonates and infants.MethodsThis prospective observational pilot study included neonates and infants undergoing elective day-surgical procedures (n = 50). Intraoperatively, NIPE indices at 0 (NIPE₀), 10 (NIPE₁₀), 20 (NIPE₂₀), 30 (NIPE₃₀) minutes and at completion of surgery (NIPEe), were recorded; the median NIPE index (NIPEm) was calculated for the entire procedure. Postoperative Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were calculated by the nursing staff blinded to the intraoperative NIPE indices.ResultsLinear regression documented an association between the NIPEm and postoperative FLACC score at 0 (r = 0.31, p = 0.03) and 10 min (r = 0.36, p = 0.01). No significant associations were observed for FLACC scores at 20 (r = 0.21, p = 0.2) and 30 min (r = 0.36, p > 0.9). Multiple regression analysis revealed that intraoperative NIPE₁₀, NIPE₂₀, NIPE₃₀ and NIPEe also predicted the FLACC score at 0 min (p = 0.003).ConclusionThe intraoperative NIPE index is predictive of pain in the immediate postoperative period. This association was lost at 20 min likely due to nursing intervention to administer analgesia. NIPE monitoring could be useful in facilitating postoperative pain management in infants.Level of evidenceII.Type of studyStudy of Diagnostic Test.     

加味黄芪桂枝五物汤联合醒脑开窍针刺法治疗脑卒中后肩手综合征的临床观察

目的:观察加味黄芪桂枝五物汤联合醒脑开窍针刺法治疗脑卒中后肩手综合征(SHS)的临床疗效及对神经源性炎症介质和血液流变学指标的影响。方法:将148例患者随机按数字表法分为对照组和观察组各74例。两组口服双氯芬酸钠缓释片,75 min/次,1次/d,连续2～4周;肿胀明显,口服醋酸泼尼松片,10 min/次,1次/d,连续1～2周。并采用醒脑开窍针刺法,1次/d,6次/周;对照组口服脑心通胶囊,4粒/次,3次/d,观察组内服加味黄芪桂枝五物汤,1剂/d。两组疗程均为连续治疗4周。进行对治疗前后肩手综合征评估量表(SHSS)评分,记录疼痛、肿胀消失时间;进行治疗前后Fugl-Meyer功能量表上肢部分评分(U-FMA),日常生活活动能力(ADL)评分和气虚血瘀证评分;检测治疗前后降钙素基因相关肽(CGRP),P物质(SP),缓激肽(BK)水平和血液流变学指标。结果:观察组患者的临床疗效优于对照组(Z=2. 106,P0. 05);观察组SHSS量表的感觉、自主神经、运动3个维度评分和SHSS总分均低于对照组(P0. 01);观察组疼痛、肿胀消失时间均短于对照组(P0. 01);观察组患者U-FMA,ADL评分均高于对照组(P0. 01),气虚血瘀证评分低于对照组(P0. 01);观察组CGRP水平高于对照组(P0. 01),SP和BK水平均低于对照组(P0. 01);观察组的全血黏度(高切、低切)、血浆黏度、纤维蛋白原和血小板聚集率等均低于对照组(P0. 05)。结论:在西医常规治疗的基础上,内服加味黄芪桂枝五物汤配合醒脑开窍针刺疗法可减轻SHS严重程度和中医临床证候,缩短病程,改善上肢运动功能,并可抑制神经源性炎症反应,改善血液流性,提高患者的日常生活活动能力和临床疗效。     

《经穴解》学术特色及学术影响探析

《经穴解》为明末清初齐鲁针灸医家岳含珍所著,全书学术特色鲜明:从分经辨证、病候辨证、人迎寸口脉辨证三方面了阐述了经络辨证的价值,积极探讨经络与脏腑之间的联系。注重经络辨证与脏腑辨证相结合;从腧穴的主治功能、经脉循行交会与气血盛衰的关系、地理方位等多角度对书中穴名进行解释,可以窥探分析穴位的气血盛衰,提供了认知腧穴的基本思路;以“五脏互藏”理论为指导阐述腧穴主治病证,体现了其从整体辨证论治、注重经络与脏腑关联的学术特点,揭示了脏腑之间的复杂联系。该书论述全面细致,阐释深入简出,为现代针灸临床提供借鉴,促进了齐鲁医学的传承与发展。