不同护理干预对缩短硬膜外自控镇痛产妇留置尿管时间的效果研究

目的 探讨新斯的明三阴交穴位注射对剖宫产术后硬膜外白控镇痛（PCEA）产妇尿管留置时间、预防尿潴留的效果。方法 将剖官产术后24h且使用PCEA的患者160例随机分为2组，各80例．实验组采用新斯的明三阴交穴位注射，对照组采用生理盐水三阴交穴位注射，干预后立即拔出尿管，分别观察2组患者的首次自行排尿时间，测定膀胱残余尿量（RUV），评定预防尿潴留效果和不良反应发生情况。结果 实验组首次自行排尿时间明显早于对照组，x^2值=47．427．P〈0．01，实验组预防尿潴留显效率87．5％，明显优于对照组37．5％，x^2值=42．933。P〈0．01；实验组发生寒战4倒占5％．恶心、呕吐3例占3．75％，2组产妇均无心动过缓、呼吸抑制、低血压发生。结论 新斯的明三阴交穴位注射能有效缩短剖宫产术后PC队产妇留置尿管时间，预防尿潴留效果显著。     

不同护理干预对缩短硬膜外自控镇痛产妇留置尿管时间的效果研究

目的探讨新斯的明三阴交穴位注射对剖宫产术后硬膜外自控镇痛(PCEA)产妇尿管留置时间、预防尿潴留的效果.方法将剖宫产术后24 h且使用PCEA的患者160例随机分为2组,各80例,实验组采用新斯的明三阴交穴位注射,对照组采用生理盐水三阴交穴位注射,干预后立即拔出尿管,分别观察2组患者的首次自行排尿时间,测定膀胱残余尿量(RUV),评定预防尿潴留效果和不良反应发生情况.结果实验组首次自行排尿时间明显早于对照组,x2值=47.427,P<0.01,实验组预防尿潴留显效率87.5%,明显优于对照组37.5%,x2值=42.933,P<0.01;实验组发生寒战4例占5%,恶心、呕吐3例占3.75%,2组产妇均无心动过缓、呼吸抑制、低血压发生.结论新斯的明三阴交穴位注射能有效缩短剖宫产术后PCEA产妇留置尿管时间,预防尿潴留效果显著.     

护理干预缩短剖宫产术后留置尿管时效探讨

目的探讨新斯的明三阴交穴位注射对剖宫产术后硬膜外自控镇痛（PCEA）产妇尿管留置时间、预防尿潴留的效果。方法将剖宫产术后24h且使用PCEA的患者160例随机分为2组,每组各80例。观察组采用新斯的明三阴交穴位注射。对照组未用任何特殊处理,干预后即拔出导尿管,分别观察2组患者的首次自行排尿时间、测定膀胱残余尿量、评定预防尿潴留效果和不良反应情况。结果观察组首次自行排尿时间明显早于对照组（P〈0．05）;观察组预防尿潴留显效率87．5％,明显优于对照组（37．5％）（P〈0．05）;2组产妇均未发生心动过缓、呼吸抑制、低血压等不良反应。结论新斯的明三阴交注射能缩短剖宫产术后PCEA产妇留置尿管时间,预防尿潴留效果显著。     

三阴交穴位注射新斯的明对腹式全子宫切除术后患者留置尿管的影响

目的探讨新斯的明三阴交穴位注射配合膀胱区热按摩对腹式全子宫切除术后使用硬膜外自控镇痛（PCEA）患者留置尿管时间及预防尿潴留的效果。方法将200例腹式全子宫切除术后PCEA患者随机分为实验组和对照组各100例。实验组采用新斯的明三阴交穴位注射配合膀胱区热按摩,对照组采用维生素B,三阴交穴位注射配合膀胱区热按摩,干预后拔出尿管,分别观察两组患者首次自行排尿时间,测定膀胱残余量（RUV）,评定预防尿潴留的效果和不良反应的发生情况。结果实验组首次自行排尿时问早于对照组,差异有统计学意义（x^2=43．8,P〈0．01）;实验组预防尿潴留总有效率为98％,明显优于对照组的6l％,差异有统计学意义（X^2=41．7,P〈0．01）;两组患者均无心动过缓、呼吸抑制及低血压发生。结论新斯的明三阴交穴位注射配合膀胱区热按摩能有效缩短腹式全子宫切除术后PCEA患者留置尿管时问,预防尿潴留效果显著。     

同侧双穴位注射治疗肛肠病术后尿潴留的护理研究

[目的]探讨新斯的明同侧足三里、三阴交双穴位注射与新斯的明肌肉注射治疗肛肠病术后尿潴留的临床效果。[方法]筛选肛肠病术后尿潴留住院病人146例,按住院先后顺序随机分为两组,观察组予左侧足三里及三阴交穴位注射新斯的明,对照组予常规肌肉注射新斯的明。[结果]观察组78倒中显效59％,有效35％,总有效率94％;对照组68例中显效22％,有效31％,总有效率53％;两组总有效率差异有统计学意义（χ^2=31.7,P〈0．01）。[结论]新斯的明同侧足三里、三阴交穴位注射治疗肛肠病术后尿潴留疗效明显优于新斯的明肌肉注射法。     

产后尿潴留的两种护理治疗方法临床比较

目的:探讨对产后尿潴留患者联合应用产后康复治疗仪与新斯的明双侧三阴交穴位封闭注射的临床护理治疗效果。方法:选择100例在我科住院分娩发生尿潴留的患者作为研究对象,将其随机分为实验组和对照组,各50例。对照组在传统诱导排尿基础上仅给予新斯的明0.5mg双侧三阴交穴位封闭注射,实验组在对照组基础上给予产后康复治疗仪刺激下腹部及腰骶部。比较两组患者尿潴留的改善情况。结果:实验组患者尿潴留改善情况明显优于对照组(P0.01)。结论:产后康复治疗仪与新斯的明双侧三阴交穴位封闭联合应用对产后尿潴留护理治疗效果明显,能有效缩短患者自解小便的时间,为尿潴留患者解除痛苦的同时,也降低了产后出血的发生率。     

三阴交穴注射新斯的明治疗肛肠术后尿潴留的效果观察

[目的]观察三阴交穴位注射新斯的明注射液治疗肛肠术后尿潴留临床效果.[方法]将80例肛肠术后尿潴留者随机分为对照组和观察组,每组40例,对照组采用肌肉注射新斯的明注射液,观察组采用三阴交穴位注射新斯的明注射液,比较两组治疗肛肠术后尿潴留的效果.[结果]单向有序等级资料的秩和检验显示,对照组和观察组平均秩次分别为33.60和47.40,观察组效果明显大于对照组(P=0.006).[结论]三阴交穴注射新斯的明注射液治疗肛肠术后尿潴留优于传统肌注新斯的明注射液,该法应引起各级医疗工作者的重视.     

三阴交穴注射新斯的明治疗肛肠术后尿潴留的效果观察

[目的]观察三阴交穴位注射新斯的明注射液治疗肛肠术后尿潴留临床效果。[方法]将80例肛肠术后尿潴留者随机分为对照组和观察组,每组40例,对照组采用肌肉注射新斯的明注射液,观察组采用三阴交穴位注射新斯的明注射液,比较两组治疗肛肠术后尿潴留的效果。[结果]单向有序等级资料的秩和检验显示,对照组和观察组平均秩次分别为33.60和47.40,观察组效果明显大于对照组(P=0.006)。[结论]三阴交穴注射新斯的明注射液治疗肛肠术后尿潴留优于传统肌注新斯的明注射液,该法应引起各级医疗工作者的重视。     

新斯的明联合维生素B_1穴位注射治疗肛肠疾病术后尿潴留的观察与护理

目的:探讨新斯的明联用维生素B1穴位注射治疗肛肠疾病术后尿潴留的效果观察与护理。方法:选取2011年4月~2014年4月肛肠疾病术后尿潴留患者300例,随机将其等分为A、B、C 3组,A组采用双侧足三里、三阴交穴位注射治疗,每穴封新斯的明0.25 mg加维生素B120mg;B组采用双侧足三里、三阴交穴位注射,每穴封新斯的明0.15 mg加维生素B110 mg;C组患者抽取新斯的明1 mg肌内注射。治疗后比较3组患者的治疗效果、排尿量及显效时间。结果:3组患者临床疗效比较,A、B组分别与C组比较差异有意义(P0.05);A、B组比较有差异(P0.05);3组患者排尿量和显效时间比较,A组与B、C组比较均有统计学意义(P0.05)。结论:新斯的明联合维生素B1穴位注射治疗肛肠疾病术后尿潴留疗效确定,且每穴注射新斯的明0.25 mg加维生素B120 mg效果更佳。     

新斯的明曲骨穴注射预防产后尿潴留疗效分析

目的探讨新斯的明曲骨穴位注射治疗产后患者尿潴留的效果。方法产后尿潴留妇女90例,分三组,实验组用新斯的明曲骨穴位注射,对照1组用无菌0.9%氯化钠溶液曲骨穴位注射,对照2组用新斯的明肌内注射。观察自主排尿效果。结果实验组自行排尿总有效率93.33%,明显高于对照1组和对照2组,差异有统计学意义。结论新斯的明曲骨穴位注射能有效地治疗产后患者尿潴留。     

胸段硬膜外注射新斯的明用于肝部分切除术后镇痛的效果

目的:研究胸段硬膜外单次注射新斯的明用于肝部分切除术后镇痛的有效性。方法:将75例18~65岁、ASAⅠ~Ⅱ级、限期于硬膜外阻滞复合全麻下行开腹肝部分切除术的患者随机分为3组,每组25例,诱导前分别通过硬膜外导管给予0.9%氯化钠液稀释的新斯的明100μg(终体积5 mL,N组)、0.9%氯化钠液稀释的吗啡2 mg(终体积5 mL,M组)或0.9%氯化钠液5 mL(S组)。手术结束后,3组患者均接受同种模式的患者自控硬膜外镇痛。记录术中芬太尼用量、术后第1次按压镇痛泵的时间、术后24 h和48 h的视觉模拟评分法(visual analogue scale,VAS)评分、术后镇痛用药总量、有效按压次数、总按压次数,恶心呕吐和皮肤瘙痒发生情况以及第1次肛门排气时间。结果:3组术中芬太尼的用量差异无统计学意义(P0.05)。S组第1次按压镇痛泵的时间显著短于N组和M组(P0.05),N组显著短于M组(P0.05)。术后24 h和48 h时3组的VAS评分差异无统计学意义(P0.05),但S组镇痛药的用量显著多于N组和M组(P0.05);在术后24 h,S组有效按压次数与总按压次数比值显著低于N组和M组(P0.05)。3组恶心呕吐和肛门第1次排气时间差异无统计学意义,而M组术后24 h皮肤瘙痒发生率显著高于N组和S组(P0.05)。结论:胸段硬膜外单次给予新斯的明100μg能显著减少肝部分切除术后镇痛药物的用量,但不增加恶心呕吐的发生率,不影响术后第1次肛门排气时间。与硬膜外注射吗啡相比,硬膜外注射新斯的明后患者的皮肤瘙痒的发生率较低。     

吗啡与新斯的明注入硬膜外腔术后镇痛的对照研究

目的 研究吗啡与新斯的明的镇痛作用,同时对其用于硬膜外镇痛的安全性和有效性进行评价。方法采用完全随机设计。随机选择90例拟行腰段硬膜外麻醉的病人随机分为5组,按实验分组予以不同的镇痛配方,用视觉模拟疼痛评分进行疼痛评分,记录相应指标和不良反应。结果镇痛效果从好到差依次为新斯的明1.5mg加吗啡1.5mg加氟哌啶2.5mg组（Ⅰ组）、吗啡2.0mg加氟哌啶2.5mg组（对照组）、新斯的明1.0mg加吗啡1.0mg加氟哌啶2.5mg（Ⅱ组）、新斯的明0.7mg加吗啡0.7mg加氟哌啶2.5mg组（Ⅲ组）、新斯的明0.5mg加吗啡0.5mg加氟哌啶2.5mg组（Ⅳ组）;Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组和对照组另加镇痛药使用率分别为0％、2.0％、30.0％、65.0％和6％;不良反应发生率分别为66.7％、20.0％、20.0％、5.0％和73.4％。结论 吗啡与新斯的明应用于硬膜外腔有镇痛作用,且新斯的明1.0mg、吗啡1.0mg的剂量加氟哌啶能提供相对较好的镇痛作用,不良反应发生率低。     

Effects of neostigmine and glycopyrrolate on pulmonary resistance in spinal cord injury

Preliminary findings in subjects with spinal cord injury (SCI) suggest that neostigmine administered intravenously increases colonic tone, increases colonic contractions, and facilitates bowel evacuation. Of concern are potential pulmonary side effects, including an increase in airway secretions and bronchospasm. The objectives of the study were to determine the effects of intravenously administered neostigmine or neostigmine combined with glycopyrrolate on forced oscillation indices in persons with SCI. Pulmonary resistances at 5 Hz (R5) and 20 Hz (R20) were measured with the use of an impulse oscillation system (IOS) in 11 subjects with SCI. Values were obtained before and after the intravenous administration of 2 mg of neostigmine alone and, on a separate day, before and after the administration of 2 mg of neostigmine combined with 0.4 mg of glycopyrrolate. Baseline R5 and R20 values before neostigmine correlated significantly with baseline values before neostigmine combined with glycopyrrolate. Following neostigmine, mean R5 values increased 25% and mean R20 values increased 18%. Following neostigmine combined with glycopyrrolate, mean R5 values fell 9% and mean R20 values fell 7%. In summary, baseline IOS values obtained on 2 different days were highly reproducible in this population. Neostigmine alone induced significant bronchoconstriction, whereas neostigmine combined with glycopyrrolate caused bronchodilation.     

固本育阴膏联合右佐匹克隆片对阴虚火旺型亚健康失眠的疗效观察

目的:评价固本育阴膏联合右佐匹克隆片干预阴虚火旺型亚健康失眠的临床疗效、安全性和依从性。方法:,研究对象为80例阴虚火旺型亚健康失眠受试者,随机分为对照组和固本育阴膏观察组,每组40例,治疗8周。比较两组有效率及相关量表评分比较、多导睡眠图(PSG)检测指标、两组阴虚体质积分转化指标。结果:两组有效率比较,观察组(95%)高于对照组(75%),差异有统计学意义(P<0.05);对照组和观察组治疗前PSQI(匹兹堡睡眠质量指数表)评分分别为(16.20±2.33)分、(16.27±2.34)分,治疗后PSQI评分分别为(8.92±1.87)分、 (6.97±1.79)分,对照组和观察组治疗前的PSQI评分无明显差别 (P=0.886),但两组治疗后PSQI评分比较差异有统计学意义(P=0.000)。两组治疗后CGI(临床医生总体印象)评分、WHOQOL-BREF(WHO生活质量测定量表简明版)评分也有改善(P<0.05)。观察组治疗后与对照组治疗后相比,觉醒次数、觉醒时间及睡眠潜伏期、RL、睡眠效率均改善得更加明显(P<0.05)。睡眠结构变化来说,观察组治疗后与对照组治疗后相比,NREM (S1、S2、S3+S4)、REM均改善得更加明显(P<0.05)。结论:固本育阴膏联合右佐匹克隆片与单纯右佐匹克隆片比较,固本育阴膏联合右佐匹克隆片对阴虚火旺型亚健康失眠的干预更有显著效果,疗效更好。     

耳穴埋籽对肛肠术后尿潴留的影响

目的探讨耳穴埋籽对肛肠术后尿潴留的影响。方法将96例患者按单双日随机分成实验组与对照组,每组48例,对照组按传统方法进行护理,实验组采用耳穴埋籽。结果对照组术后发生尿潴留的概率高达25%,实验组术后发生尿潴留的概率仅为8.51%,2组比较差异有统计学意义(P<0.05)。结论耳穴埋籽可有效预防肛肠术后尿潴留的发生,从而减轻患者的痛苦。     

New diagnostic and therapeutic approach to thyroid-associated orbitopathy based on applied kinesiology and homeopathic therapy

OBJECTIVES: To investigate pathogenetic mechanisms related to the lacrimal and lymphatic glands in patients with thyroid-associated orbitopathy (TAO), and the potential of applied kinesiology diagnosis and homeopathic therapeutic measures. DESIGN: Prospective. SETTINGS/LOCATION: Thyroid outpatient unit and a specialized center for complementary medicine (WOMED, Innsbruck; R.M. and H.M.). SUBJECTS: Thirty-two (32) patients with TAO, 23 with a long-standing disease, and 9 showing discrete initial changes. All patients were euthyroid at the time of the investigation. INTERVENTIONS: Clinical investigation was done, using applied kinesiology methods. Departing from normal reacting muscles, both target organs as well as therapeutic measures were tested. Affected organs will produce a therapy localization (TL) that turns a normal muscle tone weak. Using the same approach, specific counteracting therapies (i.e., tonsillitis nosode and lymph mobilizing agents) were tested. OUTCOME MEASURES: Change of lid swelling, of ocular movement discomfort, ocular lock, tonsil reactivity and Traditional Chinese Medicine criteria including tenderness of San Yin Jiao (SP6) and tongue diagnosis were recorded in a graded fashion. RESULTS: Positive TL reactions were found in the submandibular tonsillar structures, the pharyngeal tonsils, the San Yin Jiao point, the lacrimal gland, and with the functional ocular lock test. Both Lymphdiaral (Pascoe, Giessen, Germany) and the homeopathic preparation chronic tonsillitis nosode at a C3 potency (Spagyra, Gr?dig, Austria) counteracted these changes. Both agents were used therapeutically over 3-6 months, after which all relevant parameters showed improvement. CONCLUSIONS: Our study demonstrates the involvement of lymphatic structures and flow in the pathogenesis of TAO. The tenderness of the San Yin Jiao point correlates to the above mentioned changes and should be included in the clinical evaluation of these patients.     

伍用不同剂量氟哌啶对曲马多PCEA术后镇痛效应的影响

研究不同剂量量氟哌啶对曲马多病人自控硬膜外镇痛（ＰＣＥＡ）效应及副作用的影响。方法：择期手术３２０例随机分为四组,Ａ组（ｎ＝８０）：１％曲马多＋０．１５％丁哌卡因（对照组）;Ｂ组（ｎ＝８０）：１％曲马多＋０．１５％丁哌卡因＋０．００５％氟哌啶;Ｃ组（ｎ＝８０）：１％曲马多＋０．１５％丁哌卡因＋０．０１％氟哌啶;Ｄ组（ｎ＝８０）：１％曲马多＋０．１５％丁哌卡因＋０．０１５％氟哌啶。上述各组按比例配制     

Half-Dose Sugammadex After Neostigmine Versus Neostigmine as a Routine Reversal Agent: A Pilot Randomized Trial

PurposeThe use of sugammadex at a lower dose after a routine reversal dose of neostigmine may prevent residual neuromuscular blockade (rNMB). Our goal was to investigate the effects of the use of half-dose sugammadex for reversing rNMB after administration of neostigmine, and compare these effects to a routine full-dose of neostigmine.DesignProspective, single-blinded, randomized trial.MethodsNinety-eight patients having lower abdominal tumor resection surgery under general anesthesia were randomized into two groups. Group N (Neostigmine) (n = 48) patients received standard reversal dose of intravenous neostigmine 0.05 mg/kg and atropine 0.02 mg/kg before extubationl Group N + S (Neostigmine + Sugammadex) (n = 50) patients received 1 mg/kg of intravenous sugammadex three minutes after a standard neostigmine reversal dose. The primary end-point was the incidence of a train-of-four (TOF) ratio less than 0.9 at tracheal extubation. Secondary end-points were periods between the start of administration of reversal agents and extubation or operating room discharge in minutes to achieve recovery of TOF ratio < 0.9 to 0.7 and TOF ratio ≥ 0.9.FindingsThe demographic data were not different between the two groups (P > .005). The incidence of rNMB presented as TOF ratio < 0.9 to 0.7 was present in 52% of Group N patients compared to 8% in Group N + S patients (P < .0001). The time to recovery between administering reversal and extubation as well as operating room discharge in Group N were; 18.52 ± 6.34 minutes and 23.27 ± 6.95 minutes, respectively, whereas; in Group N + S, they were; 12.86 ± 5.05 and 17.82 ± 4.99 minutes, respectively. (P < .0001, P < .0001, respectively). Adverse events were similar between groups (P > .05).ConclusionsA half-dose sugammadex (1 mg/kg) after full-dose reversal of neostigmine provides a lower incidence of rNMB and shorter recovery times as compared to full-dose neostigmine reversal agent. This practice is safe and effective in case of rNMB.     

患者自控硬膜外分娩镇痛对母婴影响的临床观察

目的:比较产妇分娩时患者自控硬膜外镇痛(patient controlled epidural analgesia,PCEA)对母婴的影响。方法:自愿接受分娩镇痛足月、单胎、头位初产妇120例,宫口扩张3 cm时随机分为两组:舒芬太尼混合罗哌卡因PCEA组(S组),芬太尼混合罗哌卡因PCEA组(F组)。当产妇宫口开至3 cm时,S组硬膜外注射0.1%罗哌卡因和0.5μg/ml舒芬太尼混合液5 ml,随后以0.1%罗哌卡因和0.5μg/ml舒芬太尼混合液行PCEA。F组混合液中则以2μg/ml芬太尼替代0.5μg/ml舒芬太尼。另外未要求行任何镇痛处理的60例产妇为对照组(C组)。三组胎儿娩出后行血气分析,记录新生儿1和5 min Apgar评分和出生后1~5 d的新生儿神经行为(neonatal behavioral neurological assessments,NBNA)评分。结果:三组间血气分析的各项指标的差异均无统计学意义(P>0.05)。S组与F组间PCEA用量、按压次数、总按压次数/有效按压次数的差异无统计学意义(P>0.05)。S和F组产妇使用催产素的构成比明显高于C组(P<0.01)。三组间器械助产、剖宫产率和新生儿1和5 min Apgar评分的差异无统计学意义(P>0.05)。新生儿出生后第1 d,F组的NBNA1显著低于S组和C组(P<0.05)。三组间NBNA2、NBNA3、NBNA4和NBNA5评分的差异均无统计学意义(P>0.05)。结论:产妇分娩时应用舒芬太尼0.5μg/ml或芬太尼2μg/ml复合0.1%罗哌卡因均能提供满意且安全的分娩镇痛,对母婴无明显不良影响。