醒脑开窍配合通调督脉法治疗小儿脑性瘫痪临床研究

目的：观察醒脑开窍配合通调督脉法治疗小儿脑性瘫痪的临床疗效。方法：20例小儿脑性瘫痪患者予醒脑开窍配合通调督脉法治疗作为治疗组，对照组15例采用常规治疗，分析治疗前、后脑电图变化及临床疗效。结果：醒脑开窍配合通调督脉法组同治疗前及对照组相比，脑电图正常者增多，临床总有效率显著提高。结论：醒脑开窍配合通调督脉法治疗小儿脑性瘫痪能够明显改善患者脑电图情况，并有增强疗效的作用。     

揿针疗法联合脉冲射频术治疗老年人带状疱疹后遗神经痛的疗效观察

目的 评价揿针疗法联合脉冲射频(PRF)术对老年患者带状疱疹后遗神经痛(PHN)的治疗效果。方法 选择带状疱疹后遗神经痛老年患者90例,随机分为对照组和研究组,对照组患者行背根神经节PRF治疗,研究组在对照组的基础上联合揿针疗法。观察两组患者诊疗前(T₀)、诊疗后1周(T₁)、诊疗后2周(T₂)、诊疗后4周(T₃)、诊疗后8周(T₄)的匹兹堡睡眠质量指数(PSQI)、疼痛数字评分(NRS)、普瑞巴林日用量。结果 与对照组比较,研究组患者T₁～T₄的NRS、PQSI、普瑞巴林日口服量明显降低(t分别=2.41、2.95、7.48、7.41、2.02、6.43、10.83、13.34、2.36、1.90、2.84、4.87,P均<0.05)。对照组和研究组患者T₁～T₄的NRS、PQSI、普瑞巴林日口服量均明显低于T₀(P均<0.05)。结论 揿针疗法联合PRF...     

针刺联合右美托咪定对老年股骨粗隆骨折患者术后早期认知功能的影响

<正>术后认知功能障碍(postoperative cognitive dysfunction,POCD)是老年骨折手术患者常见的并发症^[1]。手术方法、麻醉过程、术后镇痛、术后睡眠质量都与POCD相关。特别是术后睡眠质量与POCD密切相关^[2]。研究显示,术中应用右美托咪定可改善患者术后睡眠质量,从而改善POCD^[3]。     

影响慢性肾功能衰竭患者腰麻时效因素的分析

慢性肾功能衰竭患者行臂丛神经阻滞与肾功能正常患者比较,麻醉维持时间明显缩短[1].本研究旨在观察行腹膜透析置管术的慢性肾病（CKD）5期[2]患者与肾功能正常患者腰麻前后各指标的不同, 以探讨如何应对影响CKD患者麻醉时效的因素.     

罗哌卡因腰麻对腹膜透析置管术患者炎症因子的影响

目的:对比腰麻和局部麻醉下行腹膜透析置管术患者围手术期白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)、血糖(BS)的变化.方法:将实施腹膜透析置管术的终末期肾病患者40例按病因配对分为腰麻组(SA组)和局部麻醉组(LA组),SA组和LA组患者分别在腰麻和局部麻醉下行腹膜透析置管术,分别于术前、术毕和术后6h采血测IL-6、TNF-α、hs-CRP、BS,记录患者切皮时、进腹后和术毕时的视觉模拟评分(VAS)及手术时间.结果:两组患者术前、术毕血清IL-6、TNF-α、hs-CRP差异无统计学意义(P＞0.05).与术前比较,LA组术后6h血清IL-6、TNF-α、hs-CRP升高(P＜0.05).与LA组比较,SA组术后6h血清IL-6、TNF-α、hs-CRP降低(P＜0.05).两组患者术前、术毕、术后6 hBS值差异无统计学意义(P＞0.05).与LA组患者比较,SA组患者手术切皮时、进腹后、手术结束时VAS评分低,手术时间短(P＜0.01).结论:与局部麻醉比较,腰麻下行腹膜透析置管术可明显减轻患者围术期疼痛,缩短手术时间,减少IL-6、TNF-α、hs-CRP的产生.     

神经刺激器引导颈部椎旁阻滞夹脊穴埋线治疗椎动脉型颈椎病对椎基底动脉血流的影响

目的：研究神经刺激器引导颈部椎旁阻滞夹脊穴埋线治疗CSA的疗效。方法：选择CSA患者90例,采用数字随机表法分为颈夹脊穴埋线组(埋线组)、神经刺激器引导颈部椎旁阻滞组(颈椎PVB组)和神经刺激器引导颈部椎旁阻滞夹脊穴埋线组(埋线+颈椎PVB组),每组30例。每组2周治疗一次,4周为一个疗程,于治疗前及治疗结束后分别进行经颅多普勒超声(TCD)检查,检测指标包括收缩峰期血流速度(Vp)、舒张末期血流速度(Vd)、平均血流速度(Vm)。结果：三组治疗前后椎基底动脉Vp、Vm、Vd组间比较差异显著(P<0.05);三组治疗前后椎基底动脉Vp、Vm、Vd差值比较,埋线组与颈椎PVB组比较,差异不显著(P＞0.05),埋线+颈椎PVB组与其它两组比较差异显著(P<0.05)。结论：神经刺激器引导颈部椎旁阻滞夹脊穴埋线治疗CSA,能明显降低异常升高的椎基底动脉Vp、Vm及Vd,改善椎基底动脉血流。     

Relieving throat and opening orifice acupuncture therapy for the post-stroke dysphagia

Objectives: To observe the effectiveness of acupuncture therapy for relieving throat and opening orifice on dysphagia due to different brain infarct sites.Methods: According to the random number table, 128 patients with post-stroke dysphagia were divided into group A(63 cases, intervention with deglutition training and acupuncture) and group B(65 cases,intervention with simple deglutition training). The conventional treatment and deglutition rehabilitation training in neurology department were used in the two groups. In group B, according to patient's condition, the rehabilitation trainings, such as respiration and neck movement range were used selectively.In group A, on the base of deglutition training, acupuncture therapy for relieving throat and opening orifice was supplemented. The acupoints included Sìshéncōng(四神聪EX HN 1),Bāihuì(百会GV 20), Tàiyang(太阳EX-HN5) bilateral, Fēngchi(风池GB 20) bilateral and Shésānzhēn(舌三针).Electrostimulator was attached on EX-HN 1, bilateral GB 20 and Shesanzhen(舌三针). Needles were retained for 30 min in each treatment. The treatment was given once a day, 5 treatments a week and the treatment for 3 weeks as 1 course. After 6 weeks of treatment, the deglutition ability scale developed by Fujishima Ichiro was adopted to determine the therapeutic effects and observe the score increase for dysphagia related to brain infarct sites before and after treatment.Results: In assessment after 6-week treatment, the improvements of deglutition ability were different corresponding to different brain infarct sites in group A. Specially, the improvements in the patients with dysphagia related to cerebral hemisphere infarction in group A were better than group B(8.68 ±1.12 vs7.32 ±0.91, P0.05), followed by the improvements in the patients with dysphagia related to internal capsule/basal ganglia/diencephalon infarction(6.53 ±0.65 vs 6.36 ±0.84, P0.05). Regarding the therapeutic effects in comparison of the two groups, the total effective rates in dysphagia related to cerebral hemisphere infarction were different between the two groups significantly(96.67% vs 82.75%, P 0.05), as well as in the patients related to internal capsule/basal ganglia/diencephalon infarction(88.89% vs 66.67%,P0.05). The therapeutic effects were not different in the patients related to cerebral stem and cerebella infarction between the two groups(P0.05).Conclusion: The acupuncture therapy for relieving throat and opening orifice combined with deglutition training achieves the satisfactory therapeutic effects on dysphagia induced by cortical infarction in stroke.However, a large sample and multicentral clinical trial with this therapy is needed for a further argument so that this therapy is likely promoted in clinical practice in future.     

超声引导下胸部神经阻滞对乳腺癌根治术患者应激反应及炎症细胞因子的影响

目的探讨超声引导下胸部神经阻滞对乳腺癌根治术患者应激反应及血清炎症细胞因子表达的影响。方法选取2019年在该院行乳腺癌根治术的120例患者为研究对象,按照随机数表法将其分为两组,即超声引导胸部神经阻滞组(P组)和空白对照组(C组),每组各60例。两组患者均接受乳腺癌根治手术,且在术前均给予氟比洛芬酯1 mg/kg。其中P组患者经全麻诱导后,给予患者0.375%罗哌卡因30 ml,在超声引导下胸部神经阻滞;C组患者不给予胸部神经阻滞。对比两组麻醉前及术后24 h的应激反应、术前及术后48 h的炎症指标、术后不同时间段的视觉模拟疼痛评分(VAS)、不良反应发生情况。结果两组患者在麻醉前应激反应指标相比,差异均无统计学意义(均P>0.05);而P组术后24 h,P组血糖、去甲肾上腺素、肾上腺素及多巴胺水平均低于C组患者,差异均有统计学意义(均P<0.05)。两组患者拔管即刻(T0)时的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏-C反应蛋白(hs-CRP)水平对比,差异无统计学意义(P>0.05);P组患者术后T1~T4时间的IL-6、TNF-α以及hs-CRP指标明显优于对照组患者,差异均有统计学意义(均P<0.05)。两组患者在T0、术后24 h (T4)的VAS评分相比,差异均无统计学意义(均P>0.05);两组患者术后3 h (T1)、6 h (T2)、12 h (T3)的VAS评分比较,差异均有统计学意义(t=8.278、13.875、10.666,均P=0.000)。两组患者的手术时间比较,差异无统计学意义(P>0.05);观察组患者麻醉起效时间以及术中舒芬太尼用量均少于对照组,差异均有统计学意义(均P<0.05)。P组阻滞效果总优良率(95.00%)明显优于C组(80.00%),差异均有统计学意义(均P<0.05)。P组患者的麻醉并发症发生率(11.67%)低于C组(33.33%),差异有统计学意义(P<0.05)。结论超声引导下胸部神经阻滞可以改善乳腺癌根治术患者的应激反应,降低术后疼痛感,调节炎症反应。     

羟考酮注射液对宫颈癌手术全麻苏醒期的影响

目的 观察羟考酮注射液在腹腔镜宫颈癌手术患者全麻苏醒期的临床镇痛效果.方法 选择择期全麻下进行腹腔镜宫颈癌手术的女性患者60例,年龄48~65岁.采用随机数表法将其随机分为两组:羟考酮组(Q组,n=30),芬太尼组(F组,n=30).常规麻醉诱导后,用七氟醚、丙泊酚和瑞芬太尼进行术中维持,手术结束前30 min分别给予羟考酮(Q组)0.1 mg/kg、芬太尼(F组)1.5 μg/kg.术毕送到恢复室(PACU)进行复苏,记录患者的手术时间和麻醉时间,进入复苏室后自主呼吸恢复时间、苏醒时间以及拔管时间,记录患者入复苏室(T0)拔管时(T1)、拔管后5(T2)、15 min(T3)的各时点视觉模拟评分(VAS)和镇静评分(Ramsay),记录患者苏醒期出现的不良反应.结果 两组患者麻醉时间及手术时间比较,差异无统计学意义(P>0.05).Q组患者自主呼吸恢复时间、拔管时间及苏醒时间均较F组短,差异有统计学意义(P<0.05);Q组在T3时VAS评分明显低于F组,差异有统计学意义(P<0.05),Q组在的Ramsay评分在T0、T1、T2时间点均明显低于F组,差异有统计学意义(P<0.05).结论 盐酸羟考酮注射液应用于腹腔镜宫颈癌手术患者全麻苏醒期是有效的,0.1 mg/kg能够提供有效的镇痛,有利于维持患者苏醒期的血流动力学稳定,保护患者全麻苏醒期的安全.