芬太尼复合布比卡因用于硬膜外病人自控镇痛的临床观察

近两年我们采用芬太尼复合布比卡因对术后病人实施硬膜外自控镇痛（PCEA）取得了良好的效益，现报告如下：     

骨科患者术后应用自控镇痛的护理

骨科患者因骨折后疼痛难忍，特别是术后持续疼痛影响骨折的愈合。止痛技术作为手术后的一项特殊治疗，已在各级医院逐渐展开，尤其是患者自探镇痛(PCA)的开展，更使术后止痛技术日趋完善，但同时对护理工作提出了更高的要求，现将我院骨科2000年至今实施术后PCA技术以来的护理体会总结介绍如下。     

硬膜外吗啡镇痛对术后自控镇痛效果的影响

目的 观察硬膜外吗啡预先镇痛对术后硬膜外病人自控镇痛(PCEA)效果的影响。方法 选择ASA Ⅰ～Ⅱ级、择期在硬膜外麻醉下经腹子宫切除术病人40例,随机分为预先镇痛组(A组)和术后镇痛组(B组),每组20例。硬膜外阻滞所用局麻药均为2％利多卡因。采用负荷量+持续量+PCA量(LCP)模式病人自控镇痛:负荷量3 ml(2mg吗啡+1.25ng氟哌啶)+持续输注量100 ml(0.125％布比卡因100ml中含3mg吗啡及2.5mg氟哌啶)+PCA量,镇痛泵流速2ml/h,单次PCA量2ml,锁定时间为15 min。A组在切皮前20min经硬膜外导管注入负荷量作为预痛,B组则在术毕注入负荷量。观察并记录术后4、8、12、24、48 h的视觉模拟疼痛评分(VAS)、Ramesay镇静评分、PCA总需要量、总体满意度及并发症情况。结果 A组在术后8、12、24、48 h的VAS评分均显著小于B组(P<0.05);Ramesay镇静评分及总体满意度则显著高于B组(P<0.05),但A组的PCA总需要量却明显少于B组(P<0.05)。两组均无呼吸抑制发生,且恶心、呕吐及皮肤瘙痒的发生率组间差异不显著。结论 硬膜外吗啡预先镇痛效果优于术后镇痛,且并发症不增加。     

骨科病人术后采用自控静脉镇痛泵的观察和护理

自控静脉镇痛(PCIA)是通过静脉输液管接置有镇痛药物的自控注射泵,已广泛应用于临床,它是一种持续给药的麻醉泵,患者根据自己的疼痛程度,通过按压PCA上的按钮,自行注射一定剂量的药物,且使用剂量在麻醉医师设定的范围内,能安全迅速缓解疼痛,深受患者欢迎.我院自2001年开始引进PCIA,用于骨科病人术后镇痛,取得了良好的效果,现将护理体会总结如下.     

患者自控镇痛法用于骨科术后患者的常见不良反应和处理

术后疼痛是一种伤害性刺激 ,严重损害患者的身心健康。静脉、硬膜外应用麻醉镇痛药已成为目前术后镇痛治疗的主要手段。镇痛泵操作简单 ,能持续稳定镇痛 ,已广泛应用于术后镇痛。现将 2 0 0 1年以来 ,我科 176 0例术后接受自控镇痛法 (PCA)患者的不良反应及处理报道如下。1　临     

骨科老年患者术后自控镇痛的观察护理

随着我国人口的老年化问题日益突出,老年人的骨关节损伤的发病率明显提高.近几年患者自控镇痛（PCA）被广泛应用于骨科手术后患者的疼痛治疗,具有安全,药量小,疗效好,病人能主动的参与到术后镇痛中来的特点.我科2007年3月-2008年12月对68例手术老年患者实施术后自控镇痛,取得了较好的临床效果,现报告如下.     

骨科病人应用自控镇痛泵的观察及护理探讨

骨科病人因四肢骨折,疼痛明显而持久,而术后病人因惧怕疼痛,影响了术后功能锻炼效果,近年来,镇痛泵广泛应用于骨折术后病人,使病人顺利的度过了术后最初的疼痛期,镇痛效果满意,提高了病人的生活质量,但其副反应也给临床护理带来了新的问题,我科采用术前教育及术后各种护理措施。减少了副反应的发生,现将护理措施总结如下：     

腹部术后患者不同镇痛方式的镇痛效果研究

目的通过对腹部术后患者不同镇痛方式镇痛效果的研究,探讨一种安全、有效、经济的镇痛方式。方法将120例腹部手术患者按照手术时间的先后顺序随机分成3组,每组各40例,术后分别采用不同的镇痛方式:A组肌内注射哌替啶,B组患者硬膜外自控镇痛(PCEA),C组采用电子镇痛泵经静脉自控镇痛(PCIA)。分别于术后1,6,24,48 h记录患者的疼痛评分、心率(HR)及呼吸频率(RR)、血氧饱和度(Sp(O2))。结果 B、C组患者术后各时点视觉模拟评分法(VAS)评分明显低于A组(P<0.05);C组术后1,6,48 h的VAS评分低于B组,术后各时点的HR、RR均低于A、B组(P均<0.05),术后1,6,24 h的Sp(O2)高于A、B组(P均<0.05)。结论患者硬膜外自控镇痛及经静脉自控镇痛均能起到较好的镇痛作用,而且后者的镇痛效果更好,对患者呼吸、循环功能的影响较小。     

NEIMADIAN-POINT ACUPUNCTURE AND AURICULAR-POINT PRESSING USED FOR ORTHOPAEDIC POSTOPERATIVE ANALGESIA

The authors have treated 64 cases of orthopaedic postoperative pains by Neimadian-point acupuncture and auricular-ponit pressing with satisfactory results. In this paper, therapeuticmethods, therapeutic-effect observations and typical cases are reported, and the analgetie mechanismis preliminarily explored as well.     

CLINICAL EVALUATION INDEXES FOR ACUPUNCTURE THERAPY USED FOR STROKE PATIENTS IN REHABILITATION STAGE

Objective: To investigate the correlation of different clinical evaluation indexes of acupuncture therapy in stroke patients.Methods: This is a prospective cohort study.We chose international assessment scales to evaluate the treatment effect of acupuncture in patients with ischemic stroke in rehabilitation stage.In this study, 60 cases were chosen, 30 from the combined treat-ment group using XNKQ needling method, Danqi hemiparalysis capsule and massage, and another 30 from the control group using rehabilitation therapy.All the patients were evaluated with Fugl-meyer, NIHSS and MBI on admission, the end of 2 and 4 weeks after the admission and 3 months after the treatment period.The scores of Fugl-meyer and NIHSS were analyzed by correlative analysis at the same periods and different periods with MBI.Results: There is no obvious difference between the two groups in sex, age, course and history of disease(P0.05).Fugl-meyer and NIHSS of the combined treatment group and the control group had correlation with MBI at the same period and different periods(P0.01).The value of correlation coefficient was roughly equal with that in literature.Conclusion: The positive correlation between Fugl-meyer and MBI suggests that the lower score of Fugl-meyer, the more serious degree of injury of motor function and the more difficulty recovery of activities of daily living of patients.The negative correlation between NIHSS and MBI suggests that the higher score of NIHSS, the more serious degree of injury of nerve function and the more difficulty recovery of patients.The result of this study suggests that there may exit some relationship between the degree of injury of motor function and nerve function of reconvalescent and their prognosis.All of the three scales can be used for the evaluation of the patients in the recovery stage of stroke, and the utilization is good.     

EVALUATION OF DIFFERENT MOXIBUSTION DOSES FOR LUMBAR DISC HERNIATION:A RANDOMISED CONTROLLED CLINICAL TRIAL OF MOXIBUSTION THERAPY ON CV4

Objective: Whether moxibustion therapy is effective for patients with lumbar disc herniation(LDH) is still unclear, but previous studies neglected the dose of moxibustion and usually adopted standardized 15-minute dose in the treatment of LDH.Dose of moxibustion plays an important role in obtaining good effects.Therefore, we report the protocol of a randomized controlled trial to confirm the efficacy of moxibustion for LDH and to clarify the relationship between the dose and efficacy of moxibustion for LDH.Methods: Forty participants with LDH were randomized into four groups.The small moxibustion dose group(SM), moderate moxibustion dose group(MM) and large moxibustion dose group(LM) respectively received 15-minute, 30-minute, and 60-minute treatment of suspended moxibustion on Guanyuan(CV4).The acupuncture group(AC) received acupuncture treatment as the control group.Moxibustion and acupuncture were performed a total of five times(once per week), a total of 10 treatments in a 2-week treatment period.Outcome was evaluated by VAS pain intensity and Roland Morris Questionnaire(RMQ).Results: VAS and RMQ scores were improved in the four groups during the treatment.Significant reduction in pain intensity(P0.01) and RMQ(P0.01) was shown in the LM group.After treatment, the group that received large moxibustion dosereported less pain intensity compared to the acupuncture group or the groups that received 15-minute and 30-minute treatments of moxibustion, and the differences were statistically significant(P0.05).Conclusion: The large moxibustion dose treatment may be more effective in the treatment of LDH.The time of treatment was between 15 and 60 min, and efficacy of moxibustion on CV4 gradually improved with increasing of treatment time.     

EFFICACY OF ACUPUNCTURE FOR MOTION SICKNESS:A RANDOMIZED CONTROLLED CLINICAL TRIAL

Objective: In this randomized, controlled study, we observed the efficacy of acupuncture in motion sickness.Methods: We did a randomized and controlled trial of acupuncture in volunteers with motion sickness.A total of 60 patients were randomly assigned to acupuncture or standard care group.The acupuncture group received treatments on acupuncture points including GV20(Baihui), EX-HN1(Sishencong), bilateral PC6(Neiguan) and ST36(Zusanli), twice per week for 5 weeks.The control group received only usual care during the same period.The two experimental groups received tests with motion sickness device in the same environment.Graybiel score and the degrees of discomfort were used to evaluate the degree of motion sickness.Car trials were used for the evaluation of clinical efficacy.Analysis was performed on the last score except patients who were dropped out before completion.Results: The Graybiel scores were 10.12±3.37 and 9.95±2.60 in the acupuncture group and the control group respectively with no significant difference(P0.05) before treatment.The Graybiel scores were 0.92±0.40 and 9.86±2.53 in the acupuncture group and the control group respectively with significant differences(P0.05) after treatment.The motion sickness degree distribution in the acupuncture group was N, 0;I, 0; IIB, 0; IIA, 7; III, 16; and F, 2 before treatment; and N, 3; I, 22; IIB, 0; IIA, 0; III, 0; and F, 0 after treatment.The distribution of the control group was N, 0; I, 0; IIB, 0; IIA, 5; III, 16; and F, 1 before and after treatment.After the experiment, the degrees of discomfort in the acupuncture group significantly decreased(P0.01).Total effective rates of the acupuncture group and the control group were 96% and 0% respectively with significant differences(P0.05).No adverse effects of acupuncture were reported.Conclusion: These data suggest that acupuncture is an effective therapy for patients with motion sickness.The anti-motion sickness capabilities are improved and the sufferings of patients with motion sickness were alleviated after acupuncture treatment.     

应用敞式装置固定大白鼠的针剌镇痛模型

<正> 在针刺镇痛原理和痛觉生理的实验性研究中,大白鼠是被研究和应用得较多的一种动物,有人采取闭式装置,即将动物装入硬质筒内,这样只能使其身体的一部分露于筒外。我们是采用敞式法,将清醒大白鼠比较自然的固定在特制的实验基座上,使其身体的绝大部分敞露于外。这对选择伤害性     

测力式骨科固定器的特征研究

为确定生理应力对骨愈合的影响，提高临床疗效，在动物实验和大量临床观察的基础上，研制完成了新型骨科医疗器械－测力式骨科固定器。该器械除用于骨干骨折、矫形、部分关节内骨折外，还可用于肢体延长和相关骨科疾病的研究。这项研究指出，该器械既能保持固定稳定，又能使骨折端得到有益于愈合的生理应力，且无功能替代，即能较好地满足弹性固定准则。     

家兔黑质内注射海人酸对电针镇痛和吗啡镇痛的影响

<正> 中脑黑质致密部是多巴胺神经元中(Do-paminergic Neuron)比较集中的部位由此发出黑质纹体束主要通往同侧尾核、壳核和中央杏仁核。近年来有报道提示黑质纹体多巴胺系统可能有对抗电针镇痛和吗啡镇痛的作用。本文将海人酸(Kainic Acid KA)直接注入家兔黑质,观察黑质神经元被损毁后,对电针镇痛和吗啡镇痛的影响,并用连续切片、染色和荧光组织化学的方法,观察了神经元被损毁的情况。方法实验对象造体重为2～3公斤的家兔39只,雌雄未限。电针取穴为一侧相当“足三     

刺激方法与针刺镇痛的实验研究

<正> 引言我国独创的针麻已经成为一种麻醉办法在临床中应用。针麻效果确有能达到象科教电影和示范表演那样的优秀的麻醉水平.可是,总的说来现在针麻的镇痛效果,还不够满意,影响着针麻的进一步普及推广. 尽管针麻镇痛不全,但是针麻的诞生促进了人们对疼痛的研究兴趣,促进了人们寻     

异丙嗪对针刺镇痛的影响

<正> 组胺H_1受体拮抗剂异丙嗪(Promethazine),即非那根(phenargan),是临床上常用的药物。在临床针刺麻醉中,普遍用为针麻的辅助药物,主要目的是镇静镇痛。但其确切的作用效果及其作用机制却未见研究报道。通过多年的研究,观察临     

脊髓r-氨基丁酸参与针刺镇痛

<正> r-氨基丁酸(GABA)是广泛分布于中枢神经系统内的抑制性神经递质,其在针刺镇痛中的作用早已为人们注视,但所获结果很不一致。有报道说明电针镇痛时脑内GABA增多,而细胞外 GABA含量的增多与针刺镇痛有关,但范少光等研究结果是脑内GABA能系统具有对抗针刺镇痛作用,可能与给药部位、途径及方法以及测痛方法等不同有关,并说明GABA的作用是复杂的,有待进一步研究。脊髓背角胶状质含有GABA能中间神经元,可与初级传入末梢形成轴-轴突触,也可与伤害感受种经元形成轴-树突触,脊髓水平的GABA可能在痛觉调制与针刺