舒芬太尼与曲马多用于术后病人静脉自控镇痛的比较

目的观察比较全麻术后舒芬太尼与曲马多病人自控静脉镇痛（PCIA）的临床镇痛效果与不良反应。方法选择全身麻醉手术病人90例。美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，年龄18～50岁，随机分两组：A组（舒芬太尼组）45例，选择舒芬太尼0．1mg＋利多卡因100mg＋地塞米松5mg＋生理盐水稀释至100ml PCIA泵入；B组（曲马多组）45例，选择曲马多800mg＋利多卡因100mg＋地塞松5mg＋生理盐水稀释至100ml PCIA泵入。两组背景剂量2ml／h，单次追加剂量0．5ml，锁定时间15min。观察患者24h内用药量、按键次数、心率、呼吸频率、脉氧饱和度、视觉模拟评分法（VAS）、镇静评分、恶心呕吐。结果A组患者的VAS评分、镇痛药消耗量及按压次数显明显低于B组（P〈0．05）。镇静评分，A组镇静评分达2分者高于B组，两组差异有显著性（P〈0．05）。术后恶心呕吐发生半，B组明显高于A组。心率和呼吸频率，B组普遍略高于A组，术后血氧饱和度两组差异无显著性。结论舒芬太尼是目前用于人体最强效的芬太尼类镇痛药，镇痛作用确切，安全可靠、恶心呕吐等不良反应发生率低；曲马多在单一途径中镇痛作用较弱。     

不同剂量舒芬太尼复合曲马多用于老年髋部手术后患者静脉自控镇痛

[目的]评价不同剂量舒芬太尼复合曲马多用于老年髋部手术后静脉自控镇痛（PCIA）的效果.[方法]选择本院在连续硬膜外麻醉下择期髋部手术老年患者60例,随机分为三组.A组：舒芬太尼 50 μg ＋曲马多300 mg;B组：舒芬太尼100 μg ＋曲马多300 mg;C组：舒芬太尼150 μg ＋曲马多300 mg.三组镇痛药物均加入氟哌啶2.5 mg,用生理盐水稀释至100 mL.手术结束前连接PCA泵,镇痛模式为负荷剂量2 mL,持续剂量 1. 2 mL/h, PCA为 2 mL,锁定时间 20 min,全程观察24 h.分别于术后 2～4 h、8～10 h、12～20 h、22～24 h访视记录患者 VAS评分,镇痛药用量、PCA按压次数、Ramsay镇静评分和生命体征及不良反应.[结果]术后 24 h各时段 B、C两组 VAS评分均低于A组（P〈0.05）;与B组相比较,C组8～10 h、12～20 h VAS评分均降低（P〈0.05）;各时段 B、C两组镇痛药用量明显少于A组（P〈0.05）.在 2～4 h、8～10 h时间段 PCA有效按压次数 B、C两组明显低于 A组（P〈0.05）;三组患者各时段 Ramsay镇静评分未见明显差异.[结论]150 μg舒芬太尼复合300 mg曲马多用于老年髋部手术后患者PCIA,临床效果好,安全可靠.     

Patient-controlled extradural analgesia after caesarean section: a comparison between tramadol,sufentanil and a mixture of both

In a double-blind randomised study into post-operative pain relief by extradural PCA, 66 Caesarean section patients were divided in to three groups to receive either sufentanil (2 μ/ml), tramadol (10 mg/ml) or a mixture of both. After a loading dose of 10 ml, patients were allowed to ask for additional boluses of 2.5 ml, respecting a lock-out time of 10 min and a 1-h limit of 10 ml. Every 6 h, VAS pain scores, consumption of drugs, number of demands and side-effects were registered. At 6 h, pain was significantly less in the combination group compared to patients receiving tramadol alone. The 24-h dose requirements for sufentanil and tramadol when used alone were 123.5±10.3 μg and 652±42 mg, respectively. Combining both drugs decreased the consumption and number of demands for tramadol only (22%, p<0.05 vs 18% for sufentanil, NS). In the tramadol groups, more failures and significantly more side-effects, mainly nausea and vomiting, were noticed. It may be concluded that the extradural use of tramadol is less beneficial than previously reported. Due to disturbing side-effects, relatively high dose requirements (even after the addition of a lipophilic opioid) and somewhat inferior analgesic quality, its extradural administration for postoperative pain relief cannot be recommended.     

产科手术病人术后镇痛不同用药的观察

【目的】比较产科手术病人术后用舒芬太尼、芬太尼和曲马多静脉自控镇痛（PCIA）的效果及不良反应的发生率。【方法】60例妊娠待产病人随机均分为舒芬太尼PCIA组（MS组）和芬太尼PCIA组（MF组）、曲马多PCIA组（MT组）,记录比较术后镇痛、镇静评分及不良反应发生率。【结果】MS组术后镇痛、镇静效果最好,MT组效果最差、不良反应发生率最高。【结论】舒芬太尼PCIA用于产科术后镇痛效果好、安全,不良反应发生率低。     

盐酸羟考酮注射液超前镇痛对乳腺癌改良根治术术后镇痛的影响

[目的] 探讨盐酸羟考酮注射液超前镇痛对乳腺癌改良根治术术后镇痛的影响.[方法] 选择ASAⅠ~Ⅱ级择期于全麻下行乳腺癌改良根治术患者90例,随机分为A、B、C三组,每组30例.于麻醉诱导前10 min,A组静注盐酸羟考酮0.1 mg/kg,B、C两组静注生理盐水10 mL;手术停止时三组患者给予自控静脉镇痛泵(PCIA),A、B两组均为舒芬太尼1.0 μg/(kg·100 mL),C组为舒芬太尼2.0 μg/(kg·100 mL),三组PCIA背景剂量均为2 mL/h,病人自控剂量为3 mL,锁时时间为15 min,三组患者其他用药相同. 采用VAS疼痛评分在术后2 h、8 h、24 h、48 h对患者的镇痛效果进行评价并观察患者有无恶心、呕吐、头晕等不良反应. [结果] 三组患者的苏醒与拔管时间相比较差异无显著性(P>0.05);A、C两组VAS评分显著低于B组(P<0.05);A、C两组VAS评分差异无显著性(P>0.05);A、B两组不良反应发生率低于C组(P<0.05),A、B两组之间差异无显著性(P>0.05).[结论] 盐酸羟考酮能安全有效的用于乳腺癌改良根治术患者的超前镇痛,不影响苏醒和拔管时间,并可以减少PCIA舒芬太尼的用量从而降低术后镇痛不良反应的发生率.     

The Effect of Cold Vapor and Ice Cube Absorption in the Early Postoperative Period on Sore Throat and Hoarseness Induced by Intubation

PurposeThis study aimed to determine the effect of cold vapor and ice cube absorption in the early postoperative period on sore throat and hoarseness induced by intubation.DesignThis is a randomized controlled experimental study.MethodsFour groups (n = 30) were involved in the study: cold vapor application (group 1), ice cube absorption (group 2), ice cube absorption along with cold vapor application (group 3), and a control group (group 4). The sample consisted of 120 participants. The data were collected using the visual analog scale (VAS) and Stout's hoarseness scale postextubation (zeroth hour) and at the second, sixth, and 24th hours.FindingsAfter the interventions, the mean VAS scores for sore throat at the sixth postoperative hour were found to be 1.50 ± 1.71, 1.16 ± 1.08, and 1.30 ± 1.62 in group 1, group 2, and group 3, respectively. The mean VAS score for sore throat of group 4 was found to be 3.70 ± 1.89. The decrease in the VAS score for the sixth postoperative hour was ranked from highest to lowest as follows: ice cube absorption group, ice cube absorption along with cold vapor application group, and cold vapor application group. There was no significant difference between application groups in terms of mean VAS scores; however, it was found that mean VAS scores of all application groups were lower than that of control group, and there was a significant difference between them (P < .05). We found that at the sixth postoperative hour after intervention, 33.3% of group 1, 36.7% of group 2, 30% of group 3, and 46.7% of group 4 had hoarseness. No significant difference was found between groups, in terms of hoarseness scores of patients in the sixth postoperative hour after intervention (P > .05).ConclusionsCold vapor application, ice cube absorption, and ice cube absorption along with cold vapor application were effective in reducing sore throat but were ineffective as treatment for hoarseness.     

Combined lumbar muscle block and perioperative comprehensive patient-controlled intravenous analgesia with butorphanol in gynecological endoscopic surgery

BACKGROUNDLaparoscopic surgery has become a common surgical approach for the clinical treatment of intra-abdominal lesions in recent years. We hypothesized that lumbar block with postoperative patient-controlled intravenous analgesia (PCIA) by butorphanol after gynecological surgery under general anesthesia would be more effective than PCIA by butorphanol alone.AIMTo investigate the effect of lumbar block with PCIA by butorphanol after gynecological surgery under general anesthesia.METHODSThis study assessed 120 women scheduled for laparoscopic surgery at our hospital between May 2017 and May 2020. They were divided using a random number table into a research group (those who received quadratus lumborum block combined with PCIA analgesia by butorphanol) and a control group (those who received only PCIA analgesia by butorphanol), with 60 patients in each group. Demographic factors, visual analog scale scores for pain, serum inflammatory markers, PCIA compressions, Ramsay scores, and adverse events were compared between groups using a t-test, analysis of variance, or χ² test, as appropriate.RESULTSThere were no significant differences in demographic factors between groups (all P > 0.05). The visual analog scale scores of the research group in the resting state 12 h and 24 h postoperatively were significantly lower than those of the control group (P < 0.05). Two hours after surgery, there were no significant differences in the levels of serum tumor necrosis factor-α, interleukin (IL)-6, or IL-8 between groups (P > 0.05). The serum tumor necrosis factor-α levels of the research group 24 h postoperatively were significantly lower than those of the control group (P < 0.05). The levels of serum IL-6 and IL-8 in the study group 24 h and 48 h postoperatively were significantly lower than those in the control group (P < 0.05).CONCLUSIONLumbar block with PCIA with butorphanol after gynecological surgery under general anesthesia significantly improves the analgesic effect and reduces the degree of inflammation, instances of PCIA compression, and adverse reactions.     

Efficacy of Preventive Analgesia with Tramadol or Lornoxicam for Percutaneous Nephrolithotomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Background: Prevention of postoperative pain provides better and more rapid convalescence for patients.Objective: The aim of this study was to compare the preventive analgesic effect of tramadol and lornoxicam in the early postoperative period in patients undergoing percutaneous nephrolithotomy (PCNL).Methods: Patients who were scheduled for elective PCNL at the Cumhuriyet University Hospital, Sivas, Turkey, were enrolled in this prospective, double-blind, placebo-controlled study. The patients were randomly assigned to 1 of 3 groups: tramadol, lornoxicam, and normal saline (NS). Ten minutes before induction of anesthesia, the tramadol group received tramadol 100 mg IV, the lornoxicam group received lornoxicam 8 mg IV, and the NS group received NS 2 mL IV. Anesthesia was induced using fentanyl 1 μg/kg and thiopental sodium 4 to 7 mg/kg. Vecuronium 0.1 mg/kg was used for muscle relaxation. Desflurane 4% to 6% and 50%:50% oxygen/nitrous oxide were used for maintenance. Oxygen saturation, heart rate, and mean blood pressure were recorded before induction and during the postoperative period. During the postoperative period, visual analogue scale O/AS) scores, time to first analgesic (TFA), total analgesic consumption (TAC), and patient satisfaction scores were determined. Data about postoperative nausea and vomiting and other adverse events and complications were also collected.Results: Seventy-three patients were assessed for enrollment and 60 (33 women, 27 men; mean [SD] age, 44.69 [11.27] years; age range, 20-62 years) were included in the study. The baseline demographic characteristics and duration of surgery were similar in all 3 groups. The mean (SD) VAS scores in the tramadol group were significantly lower than in the NS group at 15 and 30 minutes and 1, 2, 4, and 12 hours after surgery (all, P < 0.05). The VAS scores in the lornoxicam group were significantly lower than in the NS group at 15 and 30 minutes and 1 hour (all, P < 0.05). The VAS score at 1 hour after surgery was significantly lower in the tramadol group than in the lornoxicam group (18 [8] vs 32 [16]; P < 0.05); however, there were no other significant differences in VAS scores between the active groups. A significantly shorter TFA was associated with the NS group when compared with the tramadol and lornoxicam groups (46 [27] vs 354 [187] and 180 [118], respectively; both, P < 0.05). TFA was significantly shorter in the lornoxicam group when compared with the tramadol roup (180 [118] vs 354 [187]; P < 0.05). TAC was significantly higher in the NS group than in the tramadol and lornoxicam groups (270 [47] vs 115 [74] and 145 [72], respectively; both, P < 0.05). Patient satisfaction score (range) was significantly lower in the NS group when compared with the tramadol and lornoxicam groups (0 [0-1] vs 3 [0-3] and 2 [0-3], respectively; both, P < 0.05). There were no other significant between-group differences observed.Conclusions: Tramadol and lornoxicam were more effective than NS in preventing early postoperative pain. The preventive analgesic effect of tramadol was comparable with that of lornoxicam, except at 1 hour when tramadol was more effective among these patients undergoing PCNL. Both drugs were well tolerated.     

舒芬太尼静脉自控镇痛对妇科手术患者血浆胃动素及术后恶心呕吐的影响

目的:研究舒芬太尼静脉自控镇痛对妇科手术患者血浆胃动素水平及术后恶心呕吐的影响。方法:选择50例ASAⅠ～Ⅱ级在腰硬联合阻滞麻醉下行妇科手术的患者,分为P组(n=25)和S组(n=25),P组采用肌注哌替啶50 mg镇痛,总剂量不超过100 mg/d。S组采用患者自控静脉镇痛,负荷剂量为舒芬太尼10%g+生理盐水10 mL静脉注射,背景剂量为舒芬太尼100%g+生理盐水稀释至100 mL,输注速度为1.8～2 mL/h,自控剂量为2～3 mL/h,锁定时间30 min。分别于术前、术后当天及术后第1、2和3天晨抽取空腹静脉血2 mL,放免法测定血浆胃动素含量。同时记录各时点恶心呕吐的发生率。结果:S组患者于术后当天、术后第1天及第2天的血浆胃动素水平均显著高于术前(P<0.01),而术后第3天已经恢复到术前水平(P>0.05)。而P组血浆胃动素水平3 d内均无显著性变化(P>0.05),但显著低于S组水平(P<0.01)。S组术后第1天与第2天恶心呕吐发生率高,第3天发生率显著低于前2 d(P<0.01),其变化与血浆胃动素水平的变化时间一致(P<0.01)。P组术后3 d内恶心呕吐发生率差异无显著性,但显著低于S组(P<0.01)。结论:舒芬太尼静脉镇痛可增加妇科手术患者血浆胃动素的分泌,这可能是舒芬太尼静脉镇痛导致术后恶心呕吐的机制。     

帕瑞昔布钠对肝癌切除术患者肝功能及术后镇痛药物舒芬太尼用量的影响

目的探讨帕瑞昔布钠对肝癌切除术患者肝功能及术后镇痛药物舒芬太尼用量的影响。方法 36例原发性肝癌患者随机分为超前镇痛组(A组)、术后镇痛组(B组)和对照组(C组)各12例。A组于麻醉诱导前30min和12h后、B组于手术结束时和12h后分别静脉注射帕瑞昔布钠40mg;C组在手术结束时和12h后分别静脉注射生理盐水2mL。3组均采用舒芬太尼自控镇痛(patient controlled intravenous analgesia,PCIA),观察术后3组患者肝功能指标变化、舒芬太尼用量、PCIA总次数和PCIA有效次数以及术后2,4,6,12,24hVAS评分和患者镇痛满意度。结果与C组比较,给药12,24h后A,B组舒芬太尼用量减少,PCIA总次数和PCIA有效次数降低(P<0.05),术后2,4,6,12,24h VAS评分降低,术后24h镇痛满意度明显提高(P<0.01);术后即刻和术后1d3组总蛋白、白蛋白降低,谷丙转氨酶、谷草转氨酶升高,术后2～3d总蛋白、白蛋白逐渐升高,谷丙转氨酶、谷草转氨酶逐渐降低,A,B组与C组比较差异均无统计学意义(P>0.05);3组各时间点肌酐、尿素氮、血小板、凝血酶原时间、活化部分凝血活酶时间等指标无明显变化(P>0.05);A组与B组间在舒芬太尼用量、镇痛效果及术中出血量方面比较差异无统计学意义(P>0.05)。结论肝癌切除术患者使用帕瑞昔布钠可减少术后舒芬太尼用量,提高镇痛质量,且对肝功能无明显影响。     

微创经椎间孔腰椎间融合术治疗腰椎椎管狭窄症的效果评价

目的 探讨微创经椎间孔腰椎间融合术(Mis-TLIF)治疗腰椎椎管狭窄症的临床效果.方法 回顾性分析2014年1月-2019年1月83例在该院住院的腰椎椎管狭窄症患者的临床资料,按手术方法不同分为Mis-TLIF组(n=40)和腰椎后路椎间融合(PLIF)组(n=43).Mis-TLIF组腰椎椎管狭窄原因:腰椎滑脱15...     

Effectiveness of lidocaine spray on radial arterial puncture pain: A randomized double-blind placebo controlled trial

ObjectiveRadial arterial puncture is a painful procedure. The aim of this study was to evaluate the effect of lidocaine spray (10%) on pain associated with radial artery blood withdrawal for arterial blood gas analysis.MethodsThis randomized, controlled, double-blind study was performed between December 2018 and September 2019. Before radial arterial puncture, 10% lidocaine or placebo spray was applied to each patient by the attending physician, who was blinded with regard to random assignment. The spray was administered six times on the site from a distance of 5 cm. After waiting for 5 min, a radial arterial puncture was performed routinely. The pain levels of patients during radial arterial puncture and 5 min after puncture were evaluated with the visual analog scale (VAS). The Wilcoxon test was used to compare pain scores during puncture.ResultsThe research was performed with 67 patients (34 patients in the lidocaine group, 33 patients in the placebo group) who were admitted to the emergency department and required ABG analysis. Forty-three patients were men, and 24 were women. The ages of the patients ranged between 19 and 86 years, and the mean (± standard deviation) age was 56.3 ± 16.6 years. Pain levels, as measured by VAS, were significantly lower in the lidocaine group (24.00 mm IQR:[14.75–33.75]) compared with the placebo group (33.00 mm IQR:[22.00–61.50]) during radial arterial puncture (p = 0.011).ConclusionsThe level of pain perceived during radial arterial puncture was significantly lower in those who were administered lidocaine spray. Lidocaine spray application can be used in pain management related to radial arterial puncture.     

萘普生复合舒芬太尼用于经尿道前列腺电切术后静脉镇痛的临床观察

目的观察萘普生复合舒芬太尼用于经尿道前列腺电切(TRUP)术后患者自控静脉镇痛的效果和不良反应。方法选择择期TRUP术后行自控静脉镇痛的患者60例,随机分为两组:Ⅰ组为舒芬太尼组,Ⅱ组为萘舒组。Ⅰ组术后镇痛给予舒芬太尼1.5μg/ml+昂丹司琼16 mg;Ⅱ组术后镇痛给予舒芬太尼1.0μg/ml+萘普生0.825 g+昂丹司琼16 mg。两组患者自控静脉镇痛泵的设置:背景剂量为2 ml/h,自控静脉镇痛剂量为每次0.5 ml,锁定时间15 min。观察并记录两组患者术后4、8、12、24、48 h的镇痛、镇静评分及不良反应的发生情况。结果Ⅱ组术后镇痛及镇静评分低于Ⅰ组,两组不良反应发生率比较差异无统计学意义(P>0.05)。结论舒芬太尼复合萘普生用于TRUP术后静脉自控镇痛的效果优于舒芬太尼。     

硬膜外和静脉自控镇痛对剖宫产术后腰背痛的影响

目的比较剖宫产术后硬膜外自控镇痛（PCEA）和静脉自控镇痛（PCIA）对产妇腰背痛的影响。方法选择2012年7月-9月美国麻醉医师协会分级I～Ⅱ级单胎足月择期剖宫产初产妇60例,随机分为3组,每组20例。A组予舒芬太尼1μg／mL＋罗哌卡因1mg／mLPCEA;B组予舒芬太尼1．5μg／mLPCEA;C组予舒芬太尼1．5μg／mL＋昂丹司琼0．16mg／mLPCIA。背景剂量：2mL／h,自控镇痛（PCA）剂量：2mL,锁定时间：20min。采用疼痛视觉模拟评分法评估术后镇痛效果,记录镇痛泵使用情况、不良反应,同时了解产妇发生腰背痛的情况。结果3组产妇术后无明显疼痛,镇痛效果良好,各组比较差异无统计学意义（P〉0．05）。3组产妇均有一定比例发生腰背痛,各组比较差异无统计学意义（P〉0．05）。A组术后有5例腿部麻木不适,B组有1例,C组无此现象发生,A组发生腿麻比例明显高于B、C组（P〈0．05）。B组有1例术后恶心呕吐,A、C组无此现象发生,组间比较差异无统计学意义（P〉0．05）。结论在相同术后镇痛效果情况下,单纯舒芬太尼PCEA与舒芬太尼PCIA是更理想的术后PCA方式。     

超声引导下腹横肌平面阻滞对于妇科腹腔镜手术患者预防性镇痛的效果

目的评价超声引导下腹横肌平面阻滞(TAPB)对于妇科腹腔镜手术患者预防性镇痛的效果。方法选取拟在全麻下行妇科腹腔镜手术患者60例,既往无其他特殊病史,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄30~50岁,体重50~65 kg。采用随机数字表法,将其分为3组(n=20):对照组(Ⅰ组)、术前TAPB组(Ⅱ组)和术后TAPB组(Ⅲ组)。Ⅰ组不实施神经阻滞,Ⅱ组和Ⅲ组分别于麻醉诱导前或手术结束后行超声引导下双侧TAPB术。术后3组患者均采用1μg/ml舒芬太尼静脉自控镇痛(PCIA),背景输注速率2 ml/h,患者自控镇痛(PCA)剂量2 ml,锁定时间15 min,持续至术后第2天,维持疼痛视觉模拟(VAS)评分≤3分,若VAS评分3分时,静脉注射氟比洛芬酯50 mg行镇痛补救。记录术后24 h内舒芬太尼单位时间内用量、镇痛补救情况和不良反应的发生情况,计算舒芬太尼节俭程度。结果与Ⅰ组比较,Ⅱ组和Ⅲ组术后24 h内舒芬太尼单位时间内用量、镇痛补救率和恶心呕吐的发生率降低(P0.05);与Ⅲ组比较,Ⅱ组术后24 h内舒芬太尼单位时间内用量、镇痛补救率及恶心呕吐的发生率降低(P0.05)。Ⅱ组较Ⅰ组舒芬太尼用量节俭35.0%,较Ⅲ组舒芬太尼用量节俭16.0%。结论超声引导下TAPB能为妇科腹腔镜手术患者提供良好的术后镇痛,术前行神经阻滞效果优于术后。     

CYP3A4*1G基因多态性对老年患者全髋置换术后舒芬太尼药效学的影响

目的探讨CYP3A4*1G基因多态性对老年患者全髋置换术后舒芬太尼药效学的影响。 方法选择2016年1月至2017年8月台州市中心医院择期行全髋置换手术的老年患者116例,术后患者静脉自控镇痛（PCIA）。采用焦磷酸测序法检测CYP3A4*1G基因多态性,根据基因型将患者分成野生型纯合子（AA）组69例、突变型杂合子（GA）组39例和突变型纯合子（GG）组8例。记录并比较所有患者术后6、12、24、48 h静息状态下的视觉模拟疼痛评分（VAS）,术后48 h的舒芬太尼总用量、PCIA次数。 结果三组患者术后6、12、24、48 h的VAS的比较差异均无统计学意义（F=0.907、0.192、0.757、0.256,P均>0.05）。而达到相同镇痛效果的GG组患者术后48 h舒芬太尼消耗量[（89.8 ± 0.8）、（95.8 ± 0.5）、（96.0 ± 0.4）μg,F=25.113,P<0.001]及PCIA次数[（10.9 ± 2.0）、（17.4 ± 4.5）、（18.3 ± 3.7）次,F=35.227,P<0.001]均显著少于AA组和GA组患者。而GA组和AA组术后48 h舒芬太尼消耗量及PCIA次数比较差异均无统计学意义（P均>0.05）。 结论结合患者基因型调整舒芬太尼药量可减少老年患者药物使用量。     

氢吗啡酮静脉自控镇痛降低剖宫产术后疼痛及相关焦虑抑郁的发生

目的:观察氢吗啡酮静脉自控镇痛对剖宫产术后患者急性、慢性疼痛及焦虑、抑郁的影响。方法:剖宫产初产妇339例纳入研究,随机分为舒芬太尼组和氢吗啡酮组,分别于术后给予舒芬太尼或氢吗啡酮行静脉内自控镇痛(PCIA)。采用数字评分法(NRS)评估产妇术后疼痛;手术后3个月电话访问患者是否存在慢性疼痛及疼痛评分。术前及术后1周使用医院焦虑和抑郁量表(HADS)评估焦虑和抑郁情况。采用Ramsay量表评估术后24 h镇静情况。记录2组不良反应;记录术后6 h和12 h的血流动力学及血氧饱和度。结果:与舒芬太尼组相比,氢吗啡酮组产妇术后6 h和12 h活动痛评分显著降低(P=0.001和P=0.033),术后48 h内各时间点宫缩痛评分显著低于舒芬太尼组(P0.05);术后HADS焦虑和抑郁评分均显著低于舒芬太尼组(P0.05);慢性疼痛发生率较低(P=0.047);而2组血流动力学、Ramsay镇静评分差异无统计学意义(P0.05)。结论:氢吗啡酮静脉自控镇痛可显著缓解剖宫产术后产妇急性和慢性疼痛,尤其可缓解内脏痛,此外也可改善产妇焦虑、抑郁状况,效果优于舒芬太尼。在稳定血流动力学及不良反应方面,与舒芬太尼相当。     

多模式镇痛对老年人腹腔镜快通道术后应激反应的影响*

目的探讨多模式镇痛对老年人腹腔镜快通道手术后应激反应的影响,比较不同镇痛模式的术后镇痛效果。方法选择2014年3月-2015年8月60岁以上的择期手术患者80例,随机分为A、B两组(n=40):A、B组患者均于术前给予凯纷(氟比洛芬酯注射液)2.00 mg/kg行超前镇痛;A组患者术后行硬膜外自控镇痛(PCEA),B组患者术后行静脉自控镇痛(PCIA)。A组与B组术后镇痛均于术毕拔除气管导管后5 min开始使用。比较两组手术前后平均动脉压(MAP)、心率(HR)、血糖值和皮质醇浓度等指标,以及术后视觉模拟疼痛评分(VAS)与不良反应的发生情况。结果在术后6及24 h,A组VAS疼痛评分明显低于B组(P0.05);与B组比较,A组的血糖、皮质醇、MAP以及HR水平在术后6 h明显较低(P0.05),且在术后24 h,A组的血皮质醇水平仍明显低于B组(P0.05);此外,A组老年病患在术后呕吐、头晕和嗜睡等不良反应发生情况明显低于B组(P0.05)。结论凯纷超前镇痛复合硬膜外术后镇痛模式比复合静脉术后镇痛模式更适用于老年腹腔镜快通道患者术后镇痛,值得临床推广和应用。     

Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study

ObjectiveLittle is known about the therapeutic relationship between coblation discoplasty and cervicogenic dizziness (CGD). CGD can be caused by abnormal proprioceptive inputs from compressed nerve roots, intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc. The aim was to analyze the efficacy of coblation discoplasty in CGD through intradiscal nerve ablation and disc decompression in a 12-month follow-up retrospective study.MethodsFrom 2015 to 2019, 42 CGD patients who received coblation discolplasty were recruited as the surgery group, and 22 CGD patients who rejected surgery were recruited as the conservative group. Using intent-to-treat (ITT) analysis, we retrospectively analyzed the CGD visual analogue scale (VAS), neck pain VAS, CGD frequency score, and the CGD alleviation rating throughout a 12-month follow-up period.ResultsCompared with conservative intervention, coblation discoplasty revealed a better recovery trend with effect sizes of 1.76, 2.15, 0.92, 0.78 and 0.81 in CGD VAS, and effect sizes of 1.32, 1.54, 0.93, 0.86 and 0.76in neck pain VAS at post-operative 1 week, and 1, 3, 6, 12 months, respectively. The lower CGD frequency score indicated fewer attacks of dizziness until postoperative 3 months (p < 0.01). At post-operative 12 months, the coblation procedure showed increased satisfactory outcomes of CGD alleviation rating (p < .001, −1.00 of effect size).ConclusionsCoblation discoplasty significantly improves the severity and frequency of CGD, which is important inbridging unresponsive conservative intervention and open surgery.

Key messages

• There is a correlation between the degenerative cervical disc and cervicogenic dizziness (CGD).
• CGD can be caused by abnormal proprioceptive inputs from a compressed nerve root and intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc.
• Cervical coblation discoplasty can alleviate CGD through ablating intradiscal nerve endings and decompressing the nerve root.

     

老年开胸患者术后不同镇痛方式的比较

目的：比较硬膜外自控镇痛（PCEA）、静脉自控镇痛（PCIA）和间断肌注镇痛三种方式用于老年患者开胸术后镇痛的效果及不良反应。方法：选择90例老年开胸手术病人，随机分为PCEA组（n=30）、PCIA组（n=30）和曲马多肌注组（n=30），分别记录患者VAS镇痛评分、镇静评分、不良反应及HR、MAP、SpO2值。结果：镇痛评分PCEA、PCIA组低于肌注组（P〈0．01），且PCEA组低于PCIA组（P〈0．01）；镇静评分PCEA、PCI-A组高于肌注组（P〈0．01），且PCIA组高于PCEA组（P〈0．01）；不良反应以PCEA组最低（P〈0．01）；HR、MAP、SpO2以PCEA组最平稳（P〈0．01）。结论：老年患者开胸术后3种镇痛方式中，肌注曲马多不能取得完善的镇痛效果，PCIA和PCEA镇痛效果满意，但PCEA优于PCIA。