舒芬太尼患者自控镇痛用于面神经显微血管减压术后镇痛

目的 比较舒芬太尼和芬太尼患者自控镇痛(PCA)用于面神经显微血管减压术(MVD)后镇痛的疗效、安全性及其副作用.方法 将62例MVD术后患者分为舒芬太尼组(S组,n=32)和芬太尼组(F组,n=30),分别使用舒芬太尼和芬太尼进行术后PCA.记录术后1、6、12、24、48和72 h的疼痛评分、生命体征、副作用以及患者总体满意度.结果 术后12 h时安静痛VAS及48 h时需求按压及有效按压次数S组少于F组(P<0.05);两组效果均较满意,S组非常满意率高于F组(P<0.05).结论 舒芬太尼和芬太尼PCA用于面神经显微血管减压术后镇痛时安全有效;等效剂量舒芬太尼镇痛、镇静效果强于芬太尼.     

小剂量纳洛酮对舒芬太尼术后镇痛及不良反应的影响

目的 观察小剂量纳洛酮对舒芬太尼术后静脉自控镇痛(PICA)效果及不良反应的影响.方法 选择全麻术后行静脉自控镇痛患者100例,随机分为舒芬太尼复合纳洛酮组(A组)和舒芬太尼组(B组),每组50例.术后24 h进行VAS疼痛评分,并记录不良反应.结果 两组镇痛效果差异无统计学意义;但A组恶心、呕吐及瘙痒发生率明显低于B组(P<0.05).结论 小剂量纳洛酮可有效减少舒芬太尼术后镇痛不良反应发生率,但并不影响其镇痛效果.     

开腹手术新生儿不同剂量舒芬太尼术后镇痛的效果

目的 评价不同剂量舒芬太尼用于开腹手术新生儿术后镇痛的效果.方法 选择拟在全麻下行开腹手术的足月新生儿60例,日龄7～28 d,ASA Ⅱ或Ⅲ级,体重2.4～4.2 kg,均于术毕拔除气管导管后连接舒芬太尼术后静脉镇痛泵,随机分为3组(n=20),镇痛泵配方:Ⅰ组舒芬太尼0.6 μg/kg(输注速率0.3 μg·kg~(-1)d~(-1)),Ⅱ组舒芬太尼1.2 μg/kg(输注速率0.6μg·kg~(-1)d~(-1)),Ⅲ组舒芬太尼2.4 μg/kg(输注速率1.2 μg·kg~(-1)d~(-1)),均溶于100 ml生理盐水中,于术后24 h时停用舒芬太尼.于术毕即刻、术后4、8、12、24 h时记录呼吸频率、HR、SpO_2、MAP及疼痛评分.于术毕即刻和术后24 h时抽取桡动脉血样行动脉血气分析,取外周静脉血样测定血浆白细胞介素6(IL-6)浓度.记录术后24 h内镇痛满意情况和不良反应发生情况.结果 与术毕即刻比较,Ⅰ组术后8～24 h时HR、MAP和疼痛评分升高,术后24 h时血浆IL-6浓度升高,Ⅲ组术后8 h时HR降低,术后24 h时动脉血氧分压、血浆IL-6浓度降低;与Ⅰ组比较,Ⅱ组和Ⅲ组术后8～24 h时HR、MAP及疼痛评分降低,术后24 h时血浆IL-6浓度降低,Ⅲ组术后24 h时动脉血氧分压降低(P<0.05);与Ⅱ组比较,Ⅲ组术后8 h时HR降低、术后24 h时血浆IL-6浓度降低(P<0.05).Ⅱ组和Ⅲ组镇痛满意率高于Ⅰ组(P<0.05).三组呼吸频率、恶心、呕吐和呼吸抑制发生率比较差异无统计学意义(P>0.05).结论 新生儿开腹手术后静脉输注舒芬太尼0.6 μg·kg~(-1)d~(-1)行术后镇痛效果好,有利于免疫功能的调节.     

舒芬太尼术后病人自控静脉镇痛的观察

舒芬太尼在国内刚刚开始用于临床,其与阿片受体亲合力高,镇痛效价是芬太尼的5～10倍。舒芬太尼用于术后镇痛,与等效价的芬太尼相比,在镇痛效果、副反应方面有无优越性,本研究进行了对比临床观察。     

舒芬太尼术后镇痛在颅脑手术患者的应用

目的探讨三种不同浓度的舒芬太尼在开颅术后镇痛效果的安全性和可行性。方法开颅术后患者60例,ASA Ⅰ或Ⅱ级,男32例,女28例,年龄21～60岁。随机均分成三组。A 组:舒芬太尼2 μg/kg 昂丹司琼16 mg 生理盐水至100 ml;B 组:舒芬太尼3 μg/kg 昂丹司琼16 mg 生理盐水至100 ml;C 组:舒芬太尼4 μg/kg 昂丹司琼16 mg 生理盐水至100 ml。患者自控静脉镇痛(PCIA),镇痛泵设定持续输注背景流量2 ml/h,PCA 每次0.5 ml,锁定时间15 min,最大用药量4 ml/h。分别在术后1、2、18、24和48 h 观察并比较静态疼痛视觉模拟评分(VASr)、动态疼痛视觉模拟评分(VASm)、警觉/镇静(OAA/s)评分;生命体征:SBP、DBP、HR、RR、SpO_2;并发症:呼吸抑制、恶心、呕吐、皮肤瘙痒的发生率。并计算 PCA 有效按压次数和镇痛药用量。结果 VASr、VASm 在术后48 h C 组显著低于 A 组(P<0.05或 P<0.01)。术后镇痛生命体征平稳,OAA/S 评分、呼吸抑制、恶心、呕吐、皮肤瘙痒发生率三组间比较差异无统计学意义。结论三种浓度的舒芬太尼用于开颅术后镇痛均安全、有效,舒芬太尼4 μg/kg 镇痛效果较好。     

婴幼儿患者静脉输注舒芬太尼术后镇痛的效果

舒芬太尼具有镇痛作用强、作用时间长等特点。其脂溶性高，产生相同的术后镇痛效应，硬膜外途经较静脉途经用药量多，因此推荐静脉输注舒芬太尼进行术后镇痛。有关舒芬太尼静脉输注用于婴幼儿患者术后镇痛有待进一步探讨。本试验拟观察婴幼儿患者静脉输注舒芬太尼术后镇痛的效果。     

曲马多复合不同剂量舒芬太尼在患儿术后静脉镇痛中的应用

目的 探讨舒芬太尼联合曲马多用于患儿术后镇痛的安全性、有效性和最佳剂量.方法 选择气管插管全麻下择期手术患儿60例,行术后静脉镇痛,随机均分为三组:A组,曲马多10mg/kg+舒芬太尼1.6 μ g/kg+托烷司琼0.2 mg/kg;B组,曲马多10 mg/kg+舒芬太尼2.0 μg/kg+托烷司琼0.2 mg/kg;C组,曲马多10 mg/kg+舒芬太尼2.4 μg/kg+托烷司琼0.2mg/kg.术毕清醒拔管后开启镇痛泵,负荷量2 ml,持续量2 ml/h,PCA 1.5 ml,锁定时问15 min.术后镇痛效果不佳时,单次静推曲马多0.5～1.0 mg/kg作为补救措施.分别于术后2、4、8、12、24、48 h采用VAS评分法和Ramsay镇静评分法评估患儿术后疼痛程度和镇静程度;记录术后48 h舒芬太尼和曲马多总用量、PCA总按压次数和有效按压次数;同时观察术后恶心呕吐(PONV)、皮肤瘙痒、呼吸抑制等不良反应发生情况.结果 术后2、4、8、1 2、24、48hB、C组VAS评分均明显低于、Ramsay镇静评分明显高于A组(P＜0.05),C组Ramsay镇静评分明显高于B组(P＜0.05).C组PONV发生率明显高于A、B组(P＜0.05).与A组比较,B组和C组舒芬太尼总用量增加、曲马多总用量减少、PCA总按压次数减少、有效按压率增加(P＜0.05).结论 曲马多复合舒芬太尼用于患儿术后静脉镇痛安全、有效,最佳镇痛方案是曲马多0.2 mg/kg+舒芬太尼2.0μg/kg+托烷司琼0.2 mg/kg,镇痛及镇静效果满意,不良反应发生率低.     

尿道下裂患儿术后静脉输注不同剂量舒芬太尼镇痛的比较

目的观察不同剂量舒芬太尼静脉输注用于尿道下裂修复术患儿术后镇痛的效果。方法纳入行尿道下裂修复术患儿60例,年龄2~4岁,ASAⅠ级,随机分为三组,每组20例。在吸入诱导下行单次骶管阻滞(0.25%罗哌卡因1 ml/kg)后,静脉持续输注丙泊酚50μg.kg-1.min-1维持镇静。手术结束后静脉注射舒芬太尼0.1μg/kg,静脉通路连接全自动注药泵,以2 ml/h速度持续输注舒芬太尼1μg.kg-1.d-1(A组)、1.25μg.kg-1.d-1(B组)和1.5μg.kg-1.d-1(C组)至术后48 h。评估并记录小儿术后2、4、8、12、24、36、48 h镇痛效果、镇静程度和不良反应。结果 A、B和C组术后有效镇痛时间分别为25.3 h(95%CI 16.3~34.3 h)、39.9 h(95%CI 32.8~47.0 h)和43.9h(95%CI 38.5~49.3 h);A组镇痛效果欠佳,B和C组术后镇痛效果满意(P<0.05或P<0.01);但C组镇静程度和恶心、呕吐发生率高于A、B组(P<0.05)。结论 1.25μg.kg-1.d-1舒芬太尼静脉输注,用于2~4岁小儿尿道下裂修复术术后镇痛,镇...     

微血管减压术治疗面肌痉挛术后并发症分析

目的探讨微血管减压术（microvascular decompression,MVD）治疗面肌痉挛术后并发症原因及处理。方法对2000年12月～2007年3月我院207例面肌痉挛行MVD术后进行1年以上的随访,观察相关并发症的发生及恢复情况。结果无一例死亡,15例（7.2%）在术后1周内出现脑脊液漏皮下积液,给予加压包扎（13例）,穿刺抽吸后加压包扎并头高脚低位（2例）处理后出院时积液基本消失,48例（23.2%）出现面瘫,20例（9.7%）出现听力下降,12例（5.8%）出现耳鸣。术后随访1～7.3年,（4.2±2.7）年,无一例发生脑脊液漏及颅内感染,面瘫及耳鸣患者全部恢复,10例（4.8%）仍有听力障碍,其中6例（2.9%）为耳聋。结论脑脊液漏、皮下积液、面瘫、耳鸣、听力下降是MVD的主要并发症,脑脊液漏、皮下积液、面瘫、耳鸣可逆转,听力障碍是远期主要的并发症,术中注重操作技巧可减少并发症的发生。     

开胸手术病人舒芬太尼术后镇痛的有效血药浓度

开胸手术创伤大，术后疼痛严重，可导致过度应激、加重循环负荷、抑制病人有效呼吸及咳嗽等不良反应。术后镇痛可减少术后不良反应，加快康复。舒芬太尼具有镇痛效果良好、血液动力学稳定、安全范围大等特点，适用于术后镇痛，但舒芬太尼达到镇痛、镇静满意时的血药浓度有待进一步探讨。本研究拟探讨开胸手术病人舒芬太尼术后镇痛的有效血药浓度。     

Chronologic analysis of symptomatic change following microvascular decompression for hemifacial spasm: value for predicting midterm outcome

The objectives of this study are to categorize the patterns of symptomatic change and to chronologically analyze them. From January 2004 to February 2006, microvascular decompression was performed on 236 consecutive patients. Follow-up time was at least over 1 year (mean, 17.1 months). We categorized the postoperative courses into five different groups according to the similarity of the temporal changes of the residual symptoms. The symptomatic change during each follow-up interval was chronologically analyzed among five different groups. The five improvement patterns included group A (immediate recovery without relapse), group B (temporary relapse followed by cure), group C (slow but steady improvement that leads to cure after one or more months), group D (recurrence with sustained symptoms), and group E (no improvement or improvement to some extent that does not lead to cure). The symptomatic change in the successful groups (groups A, B, and C) differed from that in the unsatisfactory groups (groups D and E), especially during the follow-up interval between postoperative 3 weeks and 3 months (p = 0.014). This finding was true with (p = 0.029) or without (p = 0.015) the relapse curve. Therefore, we can predict the postoperative result as early as 3 months after the surgery. Overall cure rate in this series (93.2%) was nearly correspondent to the estimated cure rate at the first postoperative year (93.4%). Postoperative 3 months can be the most efficient and earliest time to predict the postoperative result.     

Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review

Over the last decades microvascular decompression (MVD) has been established as the curative treatment of the primary Hemifacial Spasm (HFS), proven to be linked in almost all cases to a neurovascular compression of the facial nerve. Because the disease is not life-threatening and MVD not totally innocuous, efficacy and safety have to be weighted before decision taken of indicating surgery. The authors have been charged by the French Speaking Society of Neurosurgery to conduct a detailed evaluation of the probability of relief of the spasm that MVD is able to obtain, together with its potential complications. For the review, the authors have gone through the reports available from the Pubmed system. Eighty-two publications have been read and analysed, totalizing more than 10,000 operated cases. In most series, the percentage of patients with total relief ranged between 85% and 90%. Relief was obtained after a certain delay in as many as in 33% ± 8% of the patients in many series. For those, delay lasted around one year in 12% of them. When effect of MVD was considered achieved, relief remained permanent in all but 1%–2% of the long-term followed patients. As regards to complications, risk of permanent cranial nerve deficit was evaluated at 1%–2% for facial palsy, 2%–3% for non-functional hearing loss, 0.5%–1% for lower cranial nerve dysfunction. Risk of stroke was at 0.1% and mortality at 0.1%. CSF leakage and related complications could be reduced at less than 2% in most series provided careful closing techniques be applied. Complications were at a higher rate in repeated MVD. MVD is an effective curative method for almost all the patients affected with primary HFS. Because MVD for HFS is functional surgery, scrupulous consideration of its potential risks, together with the ways to avoid complications are of paramount importance. When MVD is estimated to have failed, it is wise to wait one year before considering to repeat surgery, as number of patients may benefit from delayed effect. This is the more so as important as repeated surgery entails a higher rate of complications.     

Varied patterns of postoperative course of disappearance of hemifacial spasm after microvascular decompression

Summary Background. The precise course of resolution of postoperative residual HFS after a single MVD has not been well categorised quantitatively in the literature. Not all patients with HFS were cured immediately after a single MVD; some of them exhibited a gradual disappearance of the HFS over a period of time. The time course of the gradual resolution of HFS is categorised and the situation of re-exploration in a few patients whose HFS persisted or recurred is determined.Methods. The results of 547 MVDs in 545 Chinese patients were reviewed using the database from the authors personal records between January 1992 and December 2002. Different outcomes were observed and divided into four categories according to the variable convalescent period: type 1, spasm cured immediately; type 2, spasm persisted with milder severity and faded away gradually from 7 days to as long as 2 years; type 3, spasm ceased immediately but recurred after 3 days and ran the same course as in type 2; type 4, failed.Findings. Four hundred and seventy-nine patients followed a type 1 course, which constituted an 87.9% immediate success rate. Forty-one patients (7.5%) followed a type 2 course, including three whose spasm persisted for more than 2 years. Twenty-three patients (4.2%), including one with venous compression, followed a type 3 course with their spasm ceased within three months. All of them had typical vascular loop compression. Another patient with a venous contact failed to respond positively to the first MVD underwent re-operation within 2 months. Re-operation was also performed in one patient four days after the first MVD due to persisting and even more severe spasm. These two patients were categorized type 4 as they failed the first MVD (0.4%). Late recurrence was noted in five patients from 1 to 2 years after the first MVD, only one of whom underwent re-exploration and was then cured again.Conclusions. Approximately 80% of the patients with HFS achieved immediate excellent results after a single MVD, the rest of the patients exhibited residual but usually milder spasms, which resolved gradually over a period of time. According to the patterns of the residual or persisting spasms, the situation and timing of re-exploration can be determined without difficulty. The surgeon should be concerned about missing the responsible vessels in patients with typical HFS who completely failed the first MVD.     

不同用药方式对昂丹司琼预防术后镇痛后恶心、呕吐疗效的影响

目的比较不同用药方式对中枢性镇吐药昂丹司琼预防术后镇痛治疗后发生恶心、呕吐的疗效差异。方法择期妇科手术患者120例按昂丹司琼用药方式不同分为四组镇痛泵联合静脉用药组(A组)、镇痛泵用药组(B组)、静脉用药组(C组)和对照组(D组),每组30例。记录手术结束后的不同时间点(0、1、3、6、12和24h)疼痛视觉模拟评分(VAS)以及不同时间段内(0~1h、1~3h、3~6h、6~12h、12~24h)恶心、呕吐发生例数。结果不同时间点组内和组间VAS差异无显著意义。恶心、呕吐发生率在A组和C组间以及B组和D组间差别无显著意义。而A组和B组间以及C组和D组间差异有显著意义(P<0·05)。结论术后静脉注射昂丹司琼较其他用药方式可明显减少术后镇痛后恶心、呕吐的发生率。     

Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm

Summary Background. Microvascular decompression (MVD) for hemifacial spasm (HFS) provides a long-term cure rate. Delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this report is to evaluate the incidence of delayed facial palsy after MVD and its clinical course and final results. Methods. From January, 1998 to April, 2004, 410 patients underwent microvascular decompression for hemifacial spasm at our Institute. During this time, 21 patients (5.4%) developed delayed facial weakness; eighteen of them were given steroid medication and they were followed up in the out-patient clinic. Findings. Twenty-one patients developed DFP after microvascular decompression an incidence of 5.4%. There were seventeen women (81.0%) among the 21 patients with DFP who were included in this study. In twenty of them, the symptoms of HFS improved completely after the operation, but the spasm remained with one of them. The onset of palsy occurred between postoperative day 7 and 23 (average: 12.1 days). The palsy was at least Grade II or worse on the House-Brackmann (HB) scale. The time to recovery averaged 5.7 weeks (range: 25 days–17 weeks); 20 patients improved to complete recovery and 1 patient remained with minimal weakness, as Grade II on the HB scale, at the follow-up examination. Conclusion. Our findings demonstrated that the incidence of DFP was not so low as has been reported the literature, and it did not have any striking predisposing factors. Even though the degree of facial palsy was variable, almost all patients exhibited a complete recovery without any further special treatment. The etiology of DFP and its association with herpes infection should be further clarified.     

帕瑞昔布钠对腰椎手术患者舒芬太尼术后镇痛效果的影响

目的:观察帕瑞昔布钠对腰椎手术患者舒芬太尼术后镇痛效果的影响.方法:择期行腰椎手术的患者40例,随机分为帕瑞昔布钠组和对照组.两组术中采用相同的麻醉方法.帕瑞昔布钠组术前和第1次给药后12 h静注帕瑞昔布钠40 mg,对照组则静注2 ml生理盐水.术后均采用舒芬太尼自控镇痛.观察术后48 h内的视觉模拟评分(VAS评分...     

微血管减压术治疗面肌痉挛的远期效果

目的：探讨微血管减压术治疗面肌痉挛1年以上的远期疗效。方法：对1987年7月至1999年6月间329例患者的临床资料及随访结果进行回顾性分析。结果：本组患者随访1－3年97例,痉挛完全缓解92．7％,明显缓解3．1％,部分缓解2．1％,无改变2．1％;3－5年77例,完全缓解92．2％,明显缓解3．9％,部分缓解1．3％,无改变占2．6％;5－10年121例,完全缓解90．9％,明显缓解4．1％,部分缓解2．5％,无改变2．5％;10年以上34例,痉挛综合缓解91．2％,明显缓解5．9％,无改变2．95。329例中主观满意度≥80％者占82．1％,痉挛复发率5．2％,并发症发生率5．5％,。结论：采用微血管减压术治疗面肌痉挛,尽量减少对脑神经及血管损伤,不遗漏面神经根附近的责任血管,是提高远期疗效养活并发症的重要环节。     

托烷司琼不同给药方式对术后镇痛恶心、呕吐的预防作用

目的 比较托烷司琼的不同给药方式对术后曲马多静脉自控镇痛患者恶心、呕吐的预防作用.方法 选择气管内全麻下择期腹部手术患者240例,ASAI或Ⅱ级,随机均分为四组.Ⅰ组术毕静脉连接患者自控镇痛（PCA）泵;Ⅱ组术毕静注5 mg托烷司琼后连接PCA泵;Ⅲ组术毕静注2 mg托烷司琼后连接PCA泵（PCA泵内加托烷司琼3 mg）;Ⅳ组术毕连接PCA泵（PCA泵内加托烷司琼5 mg）.PCA泵药物配制：900 mg曲马多加生理盐水配至总容量为100 ml.分别于术后2、4、8、20、36和48 h观察患者恶心、呕吐的发生情况.结果 （1）与Ⅰ组比较,Ⅱ组和Ⅲ组在术后2、4 h恶心的发生率明显降低（P＜0.05）;与Ⅳ组比较,Ⅱ组和Ⅲ组术后2、4和8 h恶心的发生率明显降低（P＜0.05或P＜0.01）.（2）与Ⅰ组比较,Ⅱ组在术后2、4、8和36 h呕吐的发生率明显降低（P＜0.05）;Ⅲ组在术后2、4、8、36和48 h呕吐的发生率明显降低（P＜0.05）;与Ⅱ组比较,Ⅲ组在术后48h呕吐的发生率明显降低（P＜0.05）;Ⅳ组在术后2、4、8 h呕吐的发生率明显高于Ⅱ组（P＜0.05）;Ⅲ组在术后2、4和48 h呕吐的发生率明显低于Ⅳ组（P＜0.05）.结论 术毕单次注射2 mg托烷司琼,并通过PCA泵持续输注可在术后48 h内有效预防恶心、呕吐的发生;术毕单次注射5 mg托烷司琼,术后短时间内可预防恶心、呕吐,但术后48 h已无此作用;而通过PCA泵中持续输注5mg托烷司琼不能预防恶心、呕吐.     

Fusiform aneurysm of the vertebral artery presenting with hemifacial spasm treated by microvascular decompression

Summary We report a rare case of symptomatic hemifacial spasm caused by a fusiform vertebral artery aneurysm. A 59-year-old woman presented with left hemifacial spasm of 18 months duration. Magnetic resonance imaging showed an enlarged a fusiform aneurysm of the left vertebral artery which compressed the seventh cranial nerve at its exit from the caudal pons. Microvascular decompression of the facial nerve with moving of the aneurysm resulted in complete relief of the hemifacial spasm. No enlargement of the aneurysm was shown on follow-up for a period of 6 years.