硬膜外自控镇痛在前列腺切除术后的应用

前列腺增生(BPH)患者常需行耻骨上经膀胱前列腺切除术,且病人多为老年患者,常合并心肺疾患.术后由于切口疼痛、膀胱痉挛影响恢复.传统的口服或肌注镇痛药效果欠佳.硬膜外病人自控镇痛(PCEA)是近年来研究的一种安全、有效的镇痛方法,我们对60例前列腺切除患者行PCEA,取得了良好的效果,现报道如下.     

阿司可咖胶囊用于镇痛随机对照多中心临床试验

目的：考察阿司可咖胶囊临床镇痛效果和不良反应。方法：采用多中心随机对照试验设计。对照药氨酚待因2号片。设单次给药、1周给药组，分别用于治疗中等程度手术后疼痛和癌痛。镇痛效果判定指标为疼痛强度差、总疼痛强度差、疼痛缓解率、有效率。结果：手术后疼痛单次给药对照试验，阿司可咖胶囊和氨酚待因2号片的总有效率分别为66．6％和74．0％，癌痛治疗一周给药对照试验，总有效率分别为87．5％和75．0％，综合疗效比较两组差异均无显性。两药不良反应有头晕、恶心、呕吐、胃不适、便秘等。结论：阿司可咖胶囊片与氨酚待因2号片基本等效，是安全有效的镇痛药。     

A Randomized Controlled Trial of Mindfulness in Recovery from Colorectal Cancer

Objective:This study examined whether a 4-week group-based mindfulness intervention would be superior in reducing psychological distress in colorectal cancer(CRC) patients compared to a psychoeducation and cognitive behavioural skills learning support active control group.Methods:Patients with CRC were randomized via Computerised Permuted Block Randomisation to mindfulness or active control groups(2-h weekly sessions over 4 weeks).Outcomes were measured pre-intervention,and 8 weeks and6 months p...     

Ultrasound-guided Transversus Abdominis Plane Block Improves Postoperative Analgesia and Early Recovery in Patients Undergoing Retroperitoneoscopic Urologic Surgeries：A Randomized Controlled Double-blinded Trial

Objective To evaluate the effects of ultrasound-guided transversus abdominis plane (TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries. Methods This was a randomized, controlled, double-blinded trial. Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups. Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery, and Group C received TAP sham block with normal saline. All patients received retroperitoneoscopic urologic surgeries under general anesthesia. The primary outcome was the severity of pain after surgery. Secondary outcomes included opioids consumption, analgesics, postoperative nausea and vomiting, time to Foley catheter removal and to passage of flatus, length of post-anesthesia care unit stay and hospital stay. Results Eighty patients completed the study, forty cases in each group. Compared to the Group C, the Group TAP had lower visual analogue scale pain scores within two postoperative days (allP<0.05). They also had less consumption of intraoperativefentanyl (2.0±0.5vs. 3.8±0.7μg/kg,P<0.05), reduced incidence of postoperative rescue analgesic usage (12.5%vs. 45.0%,P<0.05), and lower incidence of postoperative nausea and vomiting within postoperative 48 hours (12.5%vs. 25.0%,P<0.05) when compared to the Group C. In addition, Group TAP had a shortened post-anesthesia care unit stay (25±8vs. 49±12 minutes,P<0.05), and a greater proportion of patients discharged within postoperative three days (57.5%vs. 35.0%,P<0.05). Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.     

静脉氯胺酮与硬膜外吗啡超前镇痛对胃切除术病人的作用

目的　探讨静脉氯胺酮与硬膜外吗啡超前镇痛对胃切除术病人的作用。方法　ASAⅠ～Ⅱ级胃切除术病人 6 0例 ,随机分成 4组 ,第 1组 :静脉内注入氯胺酮 ;第 2组 :硬膜外注入吗啡 ;第 3组 :静脉氯胺酮与硬膜外吗啡联合注入 ;第 4组 :静脉与硬膜外分别注入盐水。分别测定术后 6、12、2 4、4 8h的视觉模拟评分、运动后痛觉评分及术后镇痛吗啡消耗量。结果　第 3组术后各时间点的视觉模拟评分、运动后痛觉评分及术后镇痛吗啡消耗量与其他各组相比均明显减少 (P <0 0 5 )。结论　静脉氯胺酮与硬膜外吗啡超前镇痛对胃切除病人镇痛效果非常确切     

舒芬太尼用于前列腺摘除术后硬膜外自控镇痛的临床观察

目的观察舒莽太尼复合甲磺酸罗哌卡因用于硬膜外前列腺摘除术后自控镇痛的效果。方法选择80倒硬膜外麻醉下行前列腺摘除手术的病人,随机分2组,A组舒芬太尼复合甲磺酸罗哌卡因,B组吗啡复合甲磺酸罗哌卡因,采用视觉模拟评分（vAs）测定术后自控镇痛的效果,同时观察不良反应,并发症。结果VAS评分、不良反应,PCEA泵按压次数,舒芬太尼组均低于吗啡组。结论舒芬太尼用于硬膜外前列腺摘除术后自控镇痛较吗啡镇痛作用强,且副作用少。     

针刺联合硬膜外麻醉在胸腔镜肺切除手术中应用的随机对照研究

目的:观察针刺联合硬膜外麻醉在胸腔镜肺切除手术围手术期应用的临床效果。方法:40例择期行胸腔镜肺切除手术患者随机分为硬膜外麻醉组(简称"硬膜外组")和硬膜外麻醉+针刺镇痛组(简称"联合麻醉组"),每组20例。所有患者均行胸腔镜肺切除手术治疗,术中采用常规硬膜外麻醉,联合麻醉组在硬膜外麻醉基础上加用电针针刺镇痛,硬膜外组加用模拟电针。观察两组术后疼痛、恶心程度及追加杜冷丁情况,比较两组患者术中麻醉药物用量及术后住院天数、住院总费用。结果:术后24 h、48 h、72 h,联合麻醉组患者的疼痛、恶心情况均优于硬膜外组,两组比较差异均有统计学意义(P0.05)。术后硬膜外组追加杜冷丁人数为7例,联合麻醉组为1例,联合麻醉组追加杜冷丁人数明显少于硬膜外组(P0.05)。术中两组患者利多卡因、甲磺酸罗哌卡因用量比较,差异无统计学意义(P0.05),硬膜外组右美托咪定用量明显多于联合麻醉组(P0.05)。两组患者的术后住院天数及住院总费用比较,差异均无统计学意义(P0.05)。结论:针刺镇痛能够有效减轻硬膜外麻醉下胸腔镜肺切除手术患者的术后疼痛和恶心程度,改善术后不良应激。     

Effectiveness of Topic-specific Infobuttons: A Randomized Controlled Trial

Objective

Infobuttons are decision support tools that provide links within electronic medical record systems to relevant content in online information resources. The aim of infobuttons is to help clinicians promptly meet their information needs. The objective of this study was to determine whether infobutton links that direct to specific content topics (“topic links”) are more effective than links that point to general overview content (“nonspecific links”).

Design

Randomized controlled trial with a control and an intervention group. Clinicians in the control group had access to nonspecific links, while those in the intervention group had access to topic links.

Measurements

Infobutton session duration, number of infobutton sessions, session success rate, and the self-reported impact that the infobutton session produced on decision making.

Results

The analysis was performed on 90 subjects and 3,729 infobutton sessions. Subjects in the intervention group spent 17.4% less time seeking for information (35.5 seconds vs. 43 seconds, p = 0.008) than those in the control group. Subjects in the intervention group used infobuttons 20.5% (22 sessions vs. 17.5 sessions, p = 0.21) more often than in the control group, but the difference was not significant. The information seeking success rate was equally high in both groups (89.4% control vs. 87.2% intervention, p = 0.99). Subjects reported a high positive clinical impact (i.e., decision enhancement or knowledge update) in 62% of the sessions.

Limitations

The exclusion of users with a low frequency of infobutton use and the focus on medication-related information needs may limit the generalization of the results. The session outcomes measurement was based on clinicians'' self-assessment and therefore prone to bias.

Conclusion

The results support the hypothesis that topic links are more efficient than nonspecific links regarding the time seeking for information. It is unclear whether the statistical difference demonstrated will result in a clinically significant impact. However, the overall results confirm previous evidence that infobuttons are effective at helping clinicians to answer questions at the point of care and demonstrate a modest incremental change in the efficiency of information delivery for routine users of this tool.     

硬膜外自控镇痛术用于分娩镇痛的研究

目的观察硬膜外自控镇痛术用于分娩镇痛的临床效果。方法60例产妇(观察组)在产程中应用硬膜外自控镇痛术;另外60例产妇(对照组)在产程中未采取干预性镇痛措施,观察两组产妇的疼痛程度、产程、分娩方式、胎儿窘迫、新生儿Apgar评分情况。结果观察组疼痛程度明显减轻,与对照组比较差异有显著性意义(P<0·05);观察组第一产程活跃期与对照组间差异有显著性意义(P<0·01),两组分娩方式间差异有显著性意义(P<0·05)。结论硬膜外自控镇痛术能明显地减轻产妇分娩的痛苦,缩短第一产程活跃期,降低剖宫产术率,值得在产科推广使用。但其价格不菲,须视产妇的经济状况而定。     

硬膜外腔注入氯胺酮进行超前镇痛用于子宫切除术术后镇痛的临床观察

目的:观察硬膜外腔注入氯胺酮进行超前镇痛用于子宫切除术术后镇痛效果.方法:30例子宫切除术患者随机分为两组: Ⅰ组15例 ,氯胺酮0.3 mg/kg 生理盐水稀释成6 ml 于手术切皮前硬膜外腔注入; Ⅱ组(对照组)15例 ,生理盐水 6 ml 于手术切皮前硬膜外腔注入.观察两组患者术后镇痛效果、并发症的发生.结果:Ⅰ组13例术后无痛(VAS0～1分)占86.7 %,Ⅱ组5例占33.3 %,两组比较差异非常显著(P＜0.01) ,术后VAS评分Ⅰ组明显低于Ⅱ组(P＜0.01) .呼吸抑制、头痛、恶心呕吐、皮肤瘙痒、幻觉等副反应差异无显著性(P＞0.05).结论:硬膜外腔注入氯胺酮进行超前镇痛可降低创伤导致的疼痛致敏作用 ,镇痛效果优于单独使用罗哌卡因 ,更有利于术后恢复.     

Effect of Thick-Needle Therapy in Patients with Bell''s Palsy at Recovery Stage: A Multi-center Randomized Controlled Trial

Objective: To compare the clinical effects of thick-needle therapy (TNT) and acupuncture therapy(AT) on patients with Bell''s palsy (BP) at the recovery stage. Methods: A total of 146 eligible participants from 3 hospitals in China were randomized into the TNT group (73 cases) and the AT group (73 cases) using a central randomization. Both groups received Western medicine thrice a day for 4 weeks. Moreover, patients in the TNT group received subcutaneous insertion of a thick needle into Shendao (GV 11) acupoint, while patients in the AT group received AT at acupoints of Cuanzhu (BL 2), Yangbai (GB 14), Dicang (ST 4), Xiaguan (ST 7), Jiache (ST 6), Yingxiang (LI 20) and Hegu (LI 4), 4 times a week, for 4 weeks. Both groups received 2 follow-up visits, which were arranged at 1 month and 3 months after treatment, respectively. The primary outcome measure was House-Brackmann Facial Nerve Grading System (HBFNGS) grade. And the clinical recovery rates of both groups were evaluated according to the HBFNGS grades after treatment. The secondary outcome measures included the facial disability index (FDI) and electroneurogram (EnoG). The adverse events were observed and recorded in both groups. Results: Three cases withdrew from the trial, 2 in the TNT group and 1 in the AT group. There was no significant difference in the clinical recovery rates between the TNT and AT groups after 4-week treatment [40.85% (29/71) vs. 34.72% (25/72), P>0.05]. At the 2nd follow-up visit, more patients in the TNT group showed reduced HBFNGS grades than those in the AT group (P<0.01). No significant difference was observed between the two groups in FDI score, EnoG latency and maximum amplitude ratio at all time points (all P>0.05). Conclusion: The clinical effect of TNT was equivalent to that of AT in patients with BP at recovery stage, while the post-treatment effect of TNT was superior to that of AT. (Registration No. ChiCTR-INR-16008409)     

帕瑞昔布钠超前镇痛在腹腔镜直肠癌根治术中的疗效观察

目的:帕瑞昔布钠超前镇痛在腹腔镜直肠癌(保肛)根治术中的疗效。方法 :将60例美国麻醉师协会分级(ASA)Ⅰ或Ⅱ级择期腹腔镜直肠癌(保肛)根治术患者随机分为A、B两组,A组分别于麻醉诱导时静脉注射帕瑞昔布钠40 mg及术后12 h静脉注射帕瑞昔布钠40 mg,而B组在麻醉诱导时给予0.9%氯化钠溶液4 ml及术后12 h静脉注射帕瑞昔布钠40 mg。两组患者术后均采用芬太尼进行患者自控静脉镇痛(PCA)。观察术后12和24 h患者自控静脉镇痛(PCA)的总按压次数和PCA有效按压次数、术后2、4、6、12和24 h的疼痛强度(VAS评分)、满意程度(BCS评分)、镇痛的补救措施以及相关不良反应。结果与B组比较,A组术后12和24 hPCA总按压次数和PCA有效按压次数降低(P<0.05),术后2、4、6和12 h的VAS评分降低而BCS评分提高(P<0.05),而两组24 h疼痛强度和满意度以及有关不良反应发生率差异无统计学意义。结论:腹腔镜直肠癌(保肛)根治术超前应用帕瑞昔布钠,能减少术后芬太尼的用量,提高镇痛质量。     

奥氮平与氟哌啶醇治疗谵妄的对照研究

目的比较非典型抗精神病药物奥氮平与传统抗精神病药物氟哌啶醇治疗谵妄的疗效和安全性。方法符合标准的98例谵妄病人随机分为奥氮平组（n=40）、氟哌啶醇组（n=38）和对照组（n=20）,用简明精神病评定量表（BPRS）、临床总体印象量表严重程度（CGI—SI）评定疗效,用副反应量表（TESS）和实验室检查评定不良反应和安全性。观察时间为期1周。结果奥氮平组、氟哌啶醇组和对照组的显效率分别为82．5％、78．9％o和30％,两治疗组和对照组比较,差异有显著性（P〈0．01）,两治疗组之间比较差异无显著性（P〉0．05）。奥氮平组不良反应总发生率为17．5％,氟哌啶醇组为52．6％,差异有显著性（P〈0.01）。结论奥氮平治疗谵妄病人安全有效,疗效与氟哌啶醇无差异,副反应较轻,可替代传统抗精神病药用于谵妄治疗。     

Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial

Context.— Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy. Objective.— To evaluate the efficacy and safety of moxibustion on acupoint BL 67 to increase fetal activity and correct breech presentation. Design.— Randomized, controlled, open clinical trial. Setting.— Outpatient departments of the Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's and Children's Hospital in the People's Republic of China. Patients.— Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation. Interventions.— The 130 subjects randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks' gestation and delivery. Main Outcome Measures.— Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery. Results.— The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group (P<.001; 95% confidence interval [CI] for difference, 10.56-15.60). During the 35th week of gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (P<.001; relative risk [RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the control group and 1 subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group (P=.02; RR, 1.21; 95% CI, 1.02-1.43). Conclusion.— Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.      

Chelation Therapy for Ischemic Heart Disease: A Randomized Controlled Trial

Context  Chelation therapy using EDTA is an unproven but widely used alternative therapy for ischemic heart disease. Objective  To determine if current EDTA protocols have a favorable impact on exercise ischemia threshold and quality of life measures in patients with stable ischemic heart disease. Design  Double-blind, randomized, placebo-controlled trial conducted between January 1996 and January 2000. Setting  Participants were recruited from a cohort of cardiac catheterization patients and the practices of cardiologists in Calgary, Alberta. Participants  We screened 3140 patients, performed a qualifying treadmill test in 171, and enrolled 84. Entry criteria included age at least 21 years with coronary artery disease proven by angiography or a documented myocardial infarction and stable angina while receiving optimal medical therapy. The required treadmill test used a gradual ramping protocol and patients had to demonstrate at least 1-mm ST depression. Interventions  Patients were randomly assigned to receive infusion with either weight-adjusted (40 mg/kg) EDTA chelation therapy (n = 41) or placebo (n = 43) for 3 hours per treatment, twice weekly for 15 weeks and once per month for an additional 3 months. Patients in both groups took oral multivitamin therapy as well. Main Outcome Measure  Change from baseline to 27-week follow-up in time to ischemia (1-mm ST depression). Results  Thirty-nine patients in each group completed the 27-week protocol. One chelation patient had therapy discontinued for a transient rise in serum creatinine. The mean (SD) baseline exercise time to ischemia was 572 (172) and 589 (176) seconds in the placebo and chelation groups, respectively. The corresponding mean changes in time to ischemia at 27 weeks were 54 seconds (95% confidence interval [CI], 23-84 seconds; P<.001) and 63 seconds (95% CI, 29-95 seconds; P<.001), for a difference of 9 seconds (95% CI, -36 to 53 seconds; P = .69). Exercise capacity and quality of life scores improved by similar degrees in both groups. Conclusion  Based on exercise time to ischemia, exercise capacity, and quality of life measurements, there is no evidence to support a beneficial effect of chelation therapy in patients with ischemic heart disease, stable angina, and a positive treadmill test for ischemia.      

重组人血小板生成素促进异基因造血干细胞移植血小板恢复的随机对照临床试验

目的 评价重组人血小板生成素(rhTPO)在异基因造血干细胞移植中促进血小板恢复的临床有效性和移植安全性.方法 123例接受标准骨髓清除性预处理方案的HLA相合同胞及无血缘造血干细胞移植受者,随机进入试验组(n=61)和对照组(n=62).试验组第7天开始接受rhTPO 1.0 μg/kg·d-皮下注射,至第20天或虽...     

参附注射液对老年患者硬膜外自控镇痛及肠功能恢复的影响

目的探讨参附注射液对老年患者硬膜外自控镇痛效应及肠功能恢复的影响。方法 40例老年患者,随机分为参附注射液组（参附组）和对照组,每组20例。参附组手术结束前静滴参附液1 ml/kg,此后每隔24 h再给两次。对照组则静滴等量的生理盐水。术毕启动硬膜外自控镇痛,观察患者镇痛效果、不良反应发生及术后肠功能恢复情况。结果参附组与对照组镇痛评分一致,镇静评分则低于对照组,不良反应少于对照组,距术毕肛门排气时间短于对照组。结论参附注射液能增强老年患者硬膜外吗啡的镇痛效应,降低不良反应发生率,同时可以促进腹部手术后肠功能的恢复。     

氯诺昔康预先镇痛对妇科术后吗啡硬膜外自控镇痛的影响

目的探讨氯诺昔康静脉预先镇痛对妇科手术病人吗啡硬膜外自控镇痛(PCEA)的影响。方法开腹全子宫切除患者52例,ASAⅠ～Ⅱ级,随机分实验组和对照组,各26例。实验组在开腹前和关腹前分别静脉注射氯诺昔康8mg。两组PCEA均为0.01%吗啡与0.125%布比卡因混合液配方。用法:负荷量5ml,背景量1.5ml/h,PCA量3ml,锁定时间20min。观察指标:镇痛效果使用VAS评分法,记录术后1、2、4、8、12、24、36、48h病人疼痛评分,术后第1、2天的PCA按压次数(PCAC)。副反应:病人镇静、头晕、恶心、呕吐等情况。结果实验组术后12h内的疼痛评分低于对照组(P﹤0.05),24、36、48h两组差别不明显(P>0.05)。术后第1天实验组PCAC明显少于对照组(P﹤0.05)。副作用:实验组恶心、呕吐发生率(15.3%)低于对照组(38.4%)。结论氯诺昔康预先镇痛对妇科手术病人术后吗啡自控镇痛有明显增效作用,减少了PCEA过程的吗啡用药量,以及胃肠道副作用的发生率。     

腰硬联合阻滞下无痛分娩的临床护理

随着人们生活水平的不断提高和围产医学的快速发展,产妇要求无痛分娩逐渐成为社会的一个普遍现象.无痛分娩是指用药物或精神疗法减少产妇在分娩过程中所产生的痛苦,帮助产妇顺利度过分娩期.如何安全、有效地降低分娩时的疼痛成为产妇、家属和医护人员共同关注的问题.我院于2009年6～12月应用腰硬联合阻滞法对住院产妇开展分娩镇痛,取得良好效果.现将临床观察及护理体会报告如下.