椎旁神经阻滞术治疗急性带状疱疹神经痛

目的：观察CT导向下选择性椎旁神经阻滞术为主治疗急性带状疱疹神经痛的疗效。方法：急性带状疱疹神经痛患者80例随机分为A、B 2组各40例,均给予常规抗病毒治疗,A组同时在CT导向下选择性椎旁神经阻滞术。治疗前后观察2组疼痛视觉模拟评分（VAS）及后遗神经痛（PHN）的发生率。结果：治疗1、7、14及30 d时VAS评分2组均较治疗前逐渐下降,A组各时间段均明显低于B组（均P〈0.05）;PHN发生率A组亦明显低于B组（2.5%与10.0%,P〈0.05）。结论：CT导向下选择性椎旁神经阻滞术配合治疗急性带状疱疹神经痛疗效显著,值得临床推广。     

胸椎旁阻滞联合高能量激光治疗胸背部带状疱疹后神经痛的疗效观察

目的:观察超声引导下胸椎旁神经阻滞联合高能量激光(high intensity laser therapy, HILT)对胸背部带状疱疹后神经痛(postherpetic neuralgia, PHN)的疗效。方法:选择2017年3月至2018年3月于我科住院治疗的100例确诊为胸背部带状疱疹后神经痛的病人为研究对象,随机分A组(对照组)和B组(试验组),每组50例。两组病人均给予营养神经和止痛药物及超声引导下胸椎旁神经阻滞治疗;在此基础上,B组病人每日行高能量激光(high intensity laser therapy, HILT)治疗,A组病人接受假激光治疗。比较两组病人治疗前后视觉模拟疼痛评分(visual analogue scale, VAS)和睡眠质量评分(self-ratingscaleofsleep,SRSS)的差异,治疗总体有效率,治疗期间平均每日盐酸曲马多使用量以及不良反应发生情况。结果:与治疗前比较,两组病人治疗后1周(1 w)、1月(1 m)、2月(2 m)和3月(3 m)的VAS评分和SRSS评分均明显降低(P<0.05);B组病人治疗后各时间段VAS评分和SRSS评分与A组比较,差异具有统计学意义(P <0.05);B组总体有效率明显高于A组(P <0.05);B组治疗期间平均每日盐酸曲马多使用量明显低于A组(P <0.05);两组不良反应无显著差异(P> 0.05)。结论:超声引导下胸椎旁阻滞联合高能量激光治疗胸背部带状疱疹后神经痛疗效显著,值得临床推广应用。     

调神止痛针联合超声引导下胸椎旁神经阻滞在带状疱疹后遗神经痛中的应用

目的:分析调神止痛针法联合超声引导下胸椎旁神经阻滞对带状疱疹后遗神经痛(PHN)患者疼痛(VAS)评分及生活质量的影响。方法:选取2017年2月～2018年5月我院收治70例PHN患者为研究对象,依照治疗方案不同分为对照组和观察组,每组35例。对照组予以超声引导下胸椎旁神经阻滞治疗,观察组予以调神止痛针法联合超声引导下胸椎旁神经阻滞治疗,疗程为4周。比较两组治疗效果、治疗前后生活质量(GQOL-74评分)、负性情绪(HAMD、HAMA评分)及治疗前和治疗1 d、1个月VAS评分情况。结果:观察组总有效率明显高于对照组,P0.05;治疗前,两组VAS评分比较,无显著性差异(P0.05);治疗1 d及1个月两组VAS评分均明显降低,且观察组评分明显低于对照组,P0.05;治疗前,两组GQOL-74评分、HAMD及HAMA评分比较,差异无统计学意义(P0.05);治疗后,观察组GQOL-74评分明显高于对照组,HAMD、HAMA评分明显低于对照组,P0.05。结论:调神止痛针法联合超声引导下胸椎旁神经阻滞应用于PHN患者,可有效强化治疗效果,减轻疼痛,改善生活质量,缓解负性情绪。     

改良椎旁神经阻滞治疗带状疱疹后遗神经痛

带状疱疹后遗神经痛(PHN)是困扰中、老年人群常见的痛症之一.由于长期遭受疼痛折磨,患者苦不堪言,生活质量严重下降,工作和社交能力降低甚至丧失.当前的治疗手段主要有药物治疗、神经阻滞、椎管内治疗等.神经阻滞被认为是目前缓解PHN病人剧烈疼痛最有效的方法~([1～3]).以往临床上多用肋间神经阻滞及硬膜外神经阻滞治疗PHN,但上述方法治疗效果不理想且易复发~([4]).本研究主要采用改良胸椎旁神经阻滞治疗躯体带状疱疹后遗神经痛,效果良好,现报道如下.     

神经阻滞联合口服药物治疗带状疱疹后遗神经痛临床观察

目的 比较单纯口服药物和联合神经阻滞两种方法治疗带状疱疹后遗肋间神经痛(PHN)的效果.方法 40例病程超过6个月的PHN患者,分成两组,每组各20例.A组口服卡马西平、多寨平、双氯芬酸钠、B族维生素,B组在口服上述药物的基础上应用醋酸曲安奈德、弥可保、0.4%利多卡因行肋间神经阻滞.比较两组患者治疗前、治疗后3周和治疗后6个月的视觉模拟评分(VAS).结果 B组患者在治疗后3周和6个月VAS均较治疗前明显降低(P<0.01),A组在治疗后3周VAS低于治疗前,6个月后与治疗前无显著作差异.组间比较:B组治疗后3周和6个月VAS均明显低于A组(P<0.01).结论 神经阻滞联合口服药物治疗顽固PHN止痛作用强,疗效持久.     

椎旁阻滞联合臭氧自体血回输治疗老年带状疱疹疗效观察

目的:观察胸椎旁阻滞联合臭氧自体血回输治疗老年胸段带状疱疹急性期疼痛的疗效、皮损持续时间、带状疱疹后神经痛(postherpetic neuralgia,PHN)发生率。方法:100名大于60岁的急性胸段带状疱疹患者,随机分为试验组(n=50)及对照组(n=50),两组均行超声引导下胸椎旁阻滞,试验组同时接受臭氧自体血回输。记录治疗前、治疗后1、2、3、4、6、8、12周视觉模拟评分(visual analogue scale,VAS)及情绪评分(emotional scale,ES)。记录疼痛缓解、皮损愈合时间及PHN发生率。结果:两组治疗后各时间点VAS及ES均显著降低。试验组前4周VAS及前8周ES显著降低,疼痛和皮损持续时间显著缩短(P=0.011,P<0.001)。在第3个月时试验组PHN发生率显著降低(P=0.012)。结论:老年急性胸段带状疱疹病程中,早期椎旁阻滞联合臭氧自体血回输是一种安全有效的治疗方式。     

威伐光照射联合胸椎旁阻滞治疗带状疱疹后神经痛

目的研究威伐光照射联合胸椎旁阻滞治疗胸背部带状疱疹后神经痛的效果。方法胸背部带状疱疹后神经痛患者60例,随机分为两组:胸椎旁阻滞组(A组,n=30),威伐光照射联合胸椎旁阻滞组(B组,n=30)。两组患者所用消炎镇痛药物均为:复方倍他米松、盐酸利多卡因、盐酸罗哌卡因、甲钴胺每周1次,共3次。分别记录两组患者治疗前后的视觉模拟评分(visual analogue scale,VAS)值,匹兹堡睡眠质量指数(pittsburge sleep quality index,PSQI)值,是否存在痛觉超敏以及治疗过程中和治疗后的不良反应。结果与治疗前比较,两组患者治疗后VAS值和PSQI均显著降低(P0.05);三次治疗后威伐光照射联合胸椎旁阻滞组(B组)的VAS评分及PSQI均较胸椎旁阻滞组(A组)低(P0.05);两组患者痛觉超敏均显著改善(A组85%,B组85.71%),两组患者治疗中和治疗后均未出现明显不良反应。结论威伐光照射联合胸椎旁阻滞治疗胸背部带疱疹后神经痛疗效确切,安全可行,值得疼痛门诊推广。     

认知行为干预在B超引导下神经阻滞治疗带状疱疹后遗神经痛中的应用

[目的]探讨认知行为干预在B超引导下神经阻滞治疗带状疱疹后遗神经痛(PHN)中的应用效果。[方法]根据随机数字表法将2017年1月—2017年12月收治的92例B超引导下神经阻滞治疗PHN病人分为观察组及对照组各46例,对照组治疗期间行常规性护理干预,观察组治疗期间对其实施认知行为干预。采用治疗依从性调查问卷评价两组病人治疗依从性,采用视觉模拟评分法(VAS)评价两组病人疼痛情况,采用自拟的PHN病人疾病知识调查问卷评价病人疾病知识知晓情况,采用病人满意度调查问卷评价病人治疗满意率,比较两组病人并发症发生率,分别于干预前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和简易生活质量量表(SF-36)评价两组病人负性情绪及生活质量。[结果]观察组治疗依从率、疼痛缓解率、疾病知识知晓率、治疗满意率均高于对照组(P0.05),并发症发生率低于对照组(P0.05)。观察组干预后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、视觉模拟评分(VAS)均低于对照组(P0.05),生活质量评分高于对照组(P0.05)。[结论]认知行为干预能有效减轻B超引导下神经阻滞治疗带状疱疹后遗神经痛病人负性情绪,提高病人疾病知识及治疗效果,改善病人生活质量。     

超声引导下胸椎旁神经阻滞对老年带状疱疹后神经痛的疗效分析

目的:观察超声引导下胸椎旁神经阻滞对老年带状疱疹后神经痛的疗效。方法:选择上海市第六人民医院疼痛科收治的60例胸背段带状疱疹后神经痛患者为研究对象,随机分为对照组(C组)和胸椎旁阻滞组(TPVB组),两组各30人。对照组采用口服药物镇痛(加巴喷丁);TPVB组采用超声引导下胸椎旁神经阻滞联合口服药物治疗。比较两组治疗前后数字疼痛分级法(NRS)的差异,4周中加巴喷丁的用量,治疗总有效率,以及不良反应发生情况。结果:TPVB组治疗后4周NRS评分明显低于C组(P<0.05),4周中加巴喷丁的用量均少于C组(P<0.05),随访的第6,8,12周的NRS评分明显低于C组(P<0.05),治疗总有效率TPVB组明显优于C组(P<0.05),两组不良反应无明显差异。结论:采用超声引导下胸椎旁神经阻滞可以有效缓解老年带状疱疹后遗神经痛,同时可以减少口服药物的用量。     

超声引导下椎旁神经阻滞联合针刺拔罐治疗带状疱疹神经痛的疗效研究

目的 探讨超声引导下椎旁神经阻滞联合针刺拔罐治疗带状疱疹神经痛的疗效。方法 将纳入的100例带状疱疹患者,分为两组各50例。对照组采用口服西药治疗,试验组加用椎旁神经阻滞联合针刺拔罐治疗。比较两组患者治疗前后的疼痛程度、皮损愈合情况、睡眠质量、有效率及带状疱疹后遗神经痛发生率。结果 治疗后,试验组较对照组在疼痛程度改善、皮损愈合情况及睡眠改善等方面优于对照组,临床总有效率高于对照组,后遗神经痛发生率低于对照组(P<0.05)。结论 超声引导下椎旁神经阻滞联合针刺拔罐治疗带状疱疹神经痛的疗效确切,可有效降低患者的疼痛程度,改善睡眠质量,促进皮损愈合,降低PHN的发生率,值得临床推广。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.