超声引导髂筋膜阻滞与股神经阻滞治疗全膝关节置换后疼痛的疗效比较

【摘要】 目的 探讨超声引导下股神经阻滞和髂筋膜阻滞治疗全膝关节置换后疼痛的疗效比较。方法 2016年7月至2019年5月,纳入84例年龄在20～80岁且美国麻醉师协会（ASA）分级为Ⅰ～Ⅱ计划进行单侧全膝关节置换患者。使用计算机随机化分组将患者分为2组。一组40例患者接受超声引导髂筋膜阻滞（FIB组）,另一组44例接受超声引导股神经阻滞（FNB组）。记录术后30 min和1、2、6、12和24 h的视觉模拟评分（VAS）和吗啡消耗剂量。填写手术后24 h,患者完成恢复质量（QoR- 40）问卷,同时记录术后恶心、呕吐不良反应。结果 与FNB组相比,FIB组术后24 h的VAS水平显著降低（P＜0.05）,其他1～12 h时间两组VAS评分没有明显差异。FNB组术后0～30 min的吗啡消耗剂量显著低于FIB组;然而,FIB组术后6～24 h的吗啡消耗剂量显著低于FNB组。术后24 h FIB组的QoR- 40评分显著高于FNB组（P＜0.05）。两组患者在术后恶心、呕吐不良反应方面没有显著差别。FNB组有1例患者术后发现手术侧大腿前侧感觉障碍。结论 股神经阻滞在术后最初30 min内提供了更有效的镇痛效果。6 h后,髂筋膜阻滞表现出更好的疼痛控制。且髂筋膜阻滞患者的术后恢复质量较高。     

Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks

Purpose

Postoperative pain in arthroscopic shoulder surgery cannot be easily controlled with analgesics and nerve blocks. This study shows the analgesic effect of interscalene block (ISB) and suprascapular nerve block and axillary nerve block (SSNB + ANB) in patients under patient controlled analgesia (PCA).

Methods

Sixty-one patients (26 men and 35 women) who underwent arthroscopic rotator cuff repair were selected and allocated non-randomly to one of three groups: PCA only-group, PCA with ISB-group and PCA with SSNB + ANB-group. Visual analogue scale (VAS) score, degree of satisfaction, PCA usage and incidence of nausea and vomiting were evaluated at the recovery room, 8, 16 and 24 postoperative hours.

Results

The VAS score of the PCA only-group was highest at the recovery room. The VAS score of the PCA with ISB-group was the lowest, however, with large fluctuations over time. Although the VAS score of the PCA with SSNB + ANB-group was higher than that of the PCA with ISB-group, it was steadily lower than the PCA-only group, without any fluctuations. The degree of satisfaction of the PCA with ISB-group was highest at the recovery room. The number of times the PCA was used at the 8-h postoperative evaluation was largest in the PCA only-group.

Conclusions

The initial 24 h after surgery plays a key role in controlling pain after arthroscopic shoulder surgery. PCA with SSNB + ANB is a better anaesthetic choice than PCA with ISB or PCA only during the initial 24 h of the postoperative period.

Level of evidence

Clinical study, Level II.     

超声引导股神经阻滞与收肌管阻滞用于全膝关节置换术后镇痛的跌倒风险

目的 探讨超声引导股神经阻滞与收肌管阻滞用于全膝关节置换术后镇痛的跌倒风险比较.方法 2016年11月至2019年11月将80例择期行单侧全膝关节置换的患者随机分为股神经阻滞组(39例)和收肌管阻滞组(41例).两组患者在术后即刻接受基于持续收肌管阻滞和股神经阻滞的多模式镇痛.比较两组患者在术后24 h和48 h的Ti...     

CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip

Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block ( = immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1 % mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1–8 weeks in 7 of 15 patients. Excellent pain relief for 3–11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. Received: 2 December 1999 Revised: 17 August 2000 Accepted: 21 August 2000     

Examination of the contamination aetiological agent of legionellosis in the water supply systems of medical treatment facilities

This study considers the features of colonization of water distribution systems by Legionella in large multi-type health-care facilities in Moscow-city, Russia. The investigation of 16 pavilions in 5 multi-type health-care facilities had found the hith level of hot water systems contaminated by Legionella pneumophila (68%), including the risk units. Among the different species of Legionella pneumophila, circulating in hot water systems of health-care facilities, the following strains had prevailed: the serogroup 6 (44%), 5 (26%) and 1 (13%). The findings conclude that certain prevention measures should be taken for microbial control and ensuring water safety in water systems of health-care facilities to prevent the nosocomial cases of legionellosis.     

神经刺激仪引导下锁骨上臂丛神经阻滞罗哌卡因半数有效浓度的研究

目的：测定锁骨上臂丛神经阻滞罗哌卡因的半数有效浓度（half-effective concentration,EC50）。方法：选择ASAⅠ－Ⅱ级上肢手术患者50例,采用神经刺激仪引导定位锁骨上臂丛神经阻滞。30 m in内评定麻醉效果,以VAS评分≤4分作为麻醉阳性（有效）指标。罗哌卡因总量30 m l,初始浓度为0.30%,其后浓度采用双盲根据前一患者的麻醉效果序贯递增或递减,间隔浓度为0.025%。通过SPSS13.0统计软件,prob it回归确定EC50及95%可信区间。结果：在本研究条件下罗哌卡因用于锁骨上臂丛神经阻滞的EC50为0.295%,95%可信区间为0.276%－0.316%。结论：罗哌卡因用于神经刺激仪引导下的锁骨上臂丛阻滞的EC50为0.295%。术中辅助用药可能对其EC50的影响尚需进一步研究。     

Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: A randomized, blinded, controlled study

Objectives

To compare the short-term effects and advantages of ultrasound-guided selective nerve root block with fluoroscopy-guided transforaminal epidural block for radicular pain in the lower cervical spine through assessment of pain relief, functional improvement, and safety.

Methods

A total of 120 patients with radicular pain from cervical spinal stenosis or cervical herniated disc were enrolled. All procedures were performed using a fluoroscopy or ultrasound apparatus. The subjects were randomly assigned to either the fluoroscopy (FL) or ultrasound (US) group. The complication frequencies during the procedures, treatment effects, and functional improvement of the nerve root block were compared at 2 and 12?weeks after the procedures.

Results

Verbal Numeric Pain Scale (VNS) improved 2?weeks and 12?weeks after the injections in both groups. Statistical differences were not observed in VNS, Neck Disability Index (NDI), and effectiveness between the groups. In 21 patients at US, vessels were identified at the anterior aspect of the foramen. Eleven patients had a critical vessel at the posterior aspect of the foramen and five patients had on artery continue medially into the foramen, forming, or joining a segmental feeder artery. In both cases, the vessels might well have been in the pathway of the needle correctly positioned under fluoroscopic guidance. Five cases of intravascular injections were observed only in FL without significant difference between the groups.

Conclusions

The US-guided method may facilitate identifying critical vessels at unexpected locations relative to the intervertebral foramen and avoiding injury to such vessels, which is the leading cause of the reported complications from cervical transforaminal injections. On treatment effect, using either method of epidural injections to deliver steroids for cervical radicular pain, secondary to herniated intervertebral disc or foraminal stenosis, significant improvements in function and pain relief were observed in both groups after the intervention. However, significant difference was not observed between the groups. Therefore, the ultrasound-guided method was shown to be as effective as the fluoroscopy-guided method in pain relief and functional improvement, in addition to the absence of radiation and avoiding vessel injury at real-time imaging.     

Pulse oximetry to detect hypoxemia during apnea: comparison of finger and ear probes

INTRODUCTION: When investigating apnea, for example in diving or altitude studies, hypoxemia is a variable that must be monitored to reduce the risk of hypoxic syncope. Pulse oximetry is a simple technique that measures arterial oxygen saturation (SpO2). As apnea induces a peripheral vasoconstriction, we hypothesized that it would be better to measure hypoxia using more centrally placed ear lobe oximetry probes rather than peripheral finger probes. METHODS: Seven men were studied, ages 18-35. Two pulse oximeters were used, a Satlite Trans (Ox-1) and Ohmeda Biox (Ox-2), both with ear and finger probes. Subjects carried out a sub-maximal breath hold for 60 s while performing dynamic leg exercise on a cycle ergometer at 50 W. Subjects performed the maneuver six times in total, in a crossover design. RESULTS: The Ox-1 finger probe showed 6.0 +/- 3.7% higher values than the ear-lobe probe at their respective nadirs. The Ox-2 probes differed in the same manner by 6.5 +/- 4.2%. The average delay between the nadir shown by the ear and finger probes was 15 s (+/- 3.5). When the ear-probes were at their nadir (SpO2 78 +/- 3.5%), the finger probes had considerably higher SpO2 levels (94.6 +/- 3.5%). DISCUSSION: Apneic induced hypoxemia was monitored poorly by finger probe pulse oximetry. The delay in response may jeopardize safety, for example in breath-hold diving studies. Hypoxemia does not seem to be accurately reflected by finger measurements in situations where peripheral vasoconstriction may occur.     

Evolution of radiation exposure to operator in diagnostic and interventional radiology procedures and reduction of radiation exposure to operator with protective device

A study was performed to evaluate operator dose during diagnostic and interventional radiology procedures (IVR) and to establish methods of operator dose reduction with a radiation protective device. Operator dose was measured by glass dosimeters worn on the neck and on the abdomen outside the lead apron. In addition, the dose of the primary beam at the collimator surface was measured, which made it possible to define the correlation between the entrance air kerma, measured with Skin Dose Monitor, and operator dose exposed during the monitored procedure. IVR protectors were developed to decrease the amount of scatter radiation received by operators performing the procedures, and their effects were evaluated in abdominal and cardiac angiography procedures. The average effective dose and doses of the neck and abdomen outside the lead apron, estimated for individual procedures, were as follows: abdominal angiography procedures: effective dose, 0.07 mSv; neck area, 0.18 mSv; abdominal area, 0.51 mSv; cardiac angiography procedures: effective dose, 0.07 mSv; neck area, 0.13 mSv; abdominal area, 0.68 mSv. Operator doses were well correlated with exposure dose in abdominal angiography procedures (diagnostic procedure r=0.84, IVR r=0.77). It was found that 68.0% of the effective dose in abdominal angiography procedures and 43.0% of the effective dose in cardiac angiography procedures could be reduced by the use of IVR protectors. Operator and patient doses in interventional radiology were interdependent. The minimization of operator doses is particularly important during interventional radiology, and it is necessary to be aware of practical radiation protection procedures. Measures that reduce patient dose will also reduce occupational exposure. Moreover, operator dose could be substantially reduced by the use of IVR protectors in addition to wearing a protective lead apron during IVR. It was suggested that IVR protectors are effective radiation protective devices in interventional radiology procedures.     

以窦神经阻滞防治由颈动脉窦刺激引起的血液动力学紊乱的实验研究

目的　探讨窦神经阻滞对过度刺激颈动脉窦所致血液动力学紊乱的预防和治疗作用。方法　对 2 4只健康日本大耳白兔 ,平均分成 3组 ,分别行窦神经生理盐水 (NS)模拟阻滞 (A1组 )、0 5 %利多卡因单侧 (A2组 )和双侧阻滞 (A3组 ) ,观测血压、心率变化 ;选上述实验用兔 12只 ,平均分成 2组 ,分别行窦神经NS模拟阻滞 (B1组 )和利多卡因阻滞 (B2组 )后 ,反复多次刺激颈动脉窦 ,对比观察血压变化 ;另 12只兔行颈动脉窦持续牵拉刺激 ,3min后再予窦神经NS模拟阻滞 (C1组 )和利多卡因阻滞 (C2组 ) ,观察血压变化。结果　A1、A2组血压、心率无显著性变化 (皆F <1 5 2 ,P >0 0 5 ) ,A3组血压有短暂明显增高 ( 10min内各时点t>2 60 ,P <0 0 1) ;B1组每次刺激皆能引出血压降低(各刺激时点t>2 63 ,P <0 0 1) ,B2组阻滞后 60～ 90min(平均 71 3min)内 ,刺激颈动脉窦血压无显著变化 (各时点t<1 65 ,P >0 0 5 ) ;C1组模拟阻滞后血压降低状态继续维持平均 17min(各时点t>1 98,P <0 0 5 ) ,C2组阻滞后减低的血压立即恢复并维持在刺激前水平 (各时点t <1 65 ,P >0 0 5 )。结论　窦神经单侧阻滞对正常动物血液动力学无明显影响 ,而对过度刺激颈动脉窦压力感受器所致的血液动力学变化有明确有效的预防和治疗作用     

Technical results and effects of operator experience on uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial

PURPOSE: To document the technical results and spectrum of practice of uterine artery embolization (UAE) for fibroids in the health care setting in Canada. The effects of interventional radiologist's (IR's) experience with UAE on procedure and fluoroscopy time were also investigated. MATERIALS AND METHODS: The study involved a multicenter prospective single-arm clinical treatment trial and included the practices of 11 IRs at eight university-affiliated teaching and community hospitals. Vascular access with percutaneous femoral artery approach was followed by transcatheter delivery of polyvinyl alcohol (PVA) particles into uterine arteries with fluoroscopic guidance. Technical success, complications, procedural time, fluoroscopy time, and effects of operator experience were outcomes analyzed. RESULTS: Between November 1998 and November 2000, 570 embolization procedures were performed in 555 patients. UAE was bilaterally successful in 97% (95% CI: 95%-98%). Variant anatomy was the most common reason for failure to embolize bilaterally. The procedural complication rate was 5.3% (95% CI: 3.6%-7.4%). Of the 30 events, three involved major complications (one seizure and two allergic reactions) that resulted in additional care or extended hospital stay. Procedure time and fluoroscopy time averaged 61 minutes (95% CI; 58-63 minutes) and 18.9 minutes (95% CI; 18-19.8) and varied significantly among IRs (P <.001; P <.001). The average 27% reduction in procedure time (20 minutes; P <.001) and 24% reduction in fluoroscopy time (5.1 minutes; P <.001) with increasing UAE experience were significant. CONCLUSIONS: A high level of technical success with few complications was obtained with a variety of operators in diverse practice settings. Increased experience in UAE significantly reduced procedure and fluoroscopy time.     

应用低容量苯酚腹腔神经丛毁损治疗上腹部癌痛

【摘要】 目的 评估单针低容量苯酚毁损腹腔神经丛治疗上腹部癌性疼痛,为晚期上腹部癌痛患者的治疗提供参考。方法 回顾性分析2017年12月到2019年12月147例晚期癌痛患者行CT引导低容量苯酚腹腔神经丛毁损的临床资料。对在CT引导下低容量苯酚行腹腔神经丛毁损前后的疼痛评分、阿片类药物的每日摄入量、肿瘤患者生活质量指数的6个月随访期间的数据进行分析,同时收集手术时间以及与手术相关的并发症发生情况。结果 随访期间患者的疼痛评分、每日阿片类药物摄入量和生活质量较术前均得到显著改善（P＜0.05）。由于疾病进展,在第4至第6个月疼痛评分有所恢复。9例患者术中发现血管摄取对比剂征象,术后27.2%患者出现了低血压,14.9%患者出现了短暂性的腹泻。所有患者均无腹部灼痛和醉酒征象出现。结论 CT引导单针低剂量苯酚用于腹腔神经丛毁损是一种有效、安全且耗时较少缓解上腹部癌痛的方法,可提供长达6个月的疼痛缓解。     

CT引导下经皮穿刺盘内注射臭氧联合神经根阻滞治疗腰椎间盘突出症

目的：探讨CT引导下经皮穿刺椎间盘内注射臭氧联合神经根阻滞治疗腰椎间盘突出症的临床应用。方法：对125例148个椎间盘在CT引导下经皮穿刺达病变的椎间盘,缓慢注射浓度为60μg/ml臭氧气体15~20 ml;退针至神经根附近,缓慢注射浓度为40μg/ml臭氧气体5~10 ml,再注入利多卡因、曲安奈德、注射用腺苷钴胺和维生素B1混合液3~5 ml。结果：对患者进行随访,疗效分为优、良、中和差,本组优良率达91%。结论：CT引导下经皮穿刺盘内注射臭氧联合神经根阻滞治疗腰椎间盘突出症是一种有效、安全的微创方法。     

头皮神经阻滞在颅脑外科术后镇痛中应用

目的探讨头皮神经阻滞(SNB)在颅脑外科术后镇痛应用中的可行性。方法选取2014年7月至2016年6月在中国医科大学附属第一医院行开颅手术的71例患者作为研究对象。其中,行SNB术后镇痛者31例(SNB组),行患者自控静脉镇痛(PCIA)者40例(PCIA组)。观察并比较两组患者术后各时间点视觉模拟量表(VAS)评分,以及阿片类药物使用量、术后镇痛相关并发症发生率。结果 SNB组患者术后镇痛效果与PCIA组相当,但阿片类药物使用量和术后镇痛相关并发症发生率均低于PCIA组(P<0.05)。结论颅脑外科术后SNB镇痛可以提供与传统镇痛方法相当的镇痛效果,同时,也具备传统镇痛方法不具备的优势。     

The effectiveness of protective clothing in the reduction of potential DNA contamination of the scene of crime

The use of ultra-sensitive low copy number (LCN) DNA typing allows the analysis of picogram amounts of DNA. Trace evidence accidentally left at a scene of crime (SOC) by the investigating team may be inadvertently collected and analysed, potentially leading to spurious evidence being introduced into the criminal investigation. A series of experiments were undertaken to determine the extent to which an investigator could contribute to any DNA contamination of a scene of crime under different simulated activities. Further, the degree to which any contamination was reduced by the use of commercially available protective clothing was demonstrated. Precautions that should routinely be taken at a scene of crime to reduce the risk of DNA contamination are recommended.