指压穴位用于结肠镜检查镇痛的效果观察

目的探讨指压穴位对结肠镜检查的镇痛效果。方法将行结肠镜检查的200例患者随机分为观察组和对照组各100例。观察组在结肠镜检查过程中予指压足三里、内关穴配合检查；对照组采用常规检查，不予穴位指压。结果观察组疼痛程度显著低于对照组（P〈O．05）；插镜时间较对照组显著缩短（P〈0．01）。结论指压穴位镇痛效果好、无创、安全，可保证结肠镜检的顺利进行。     

咪唑安定联合芬太尼在结肠镜检查中的应用研究

目的观察咪唑安定联合芬太尼在结肠镜检查中的镇静、镇痛效果。方法将需行结肠镜检查的145例ASAⅠ～Ⅱ级患者随机分为A组（70例）和B组（75例）。A组采用传统结肠镜方法检查并施行常规护理；B组采用无痛检查方法，即静脉推注咪唑安定0．05mg／kg、芬太尼1μg／kg，1～2min后开始进行结肠镜检查；检查前、中、后均施予针对性护理支持。结果两组MAP、HR组间变化差异有显著性意义（均P〈0．01）；B组呼吸抑制发生率为4．00％；B组92．00％患者镇静程度达Ramsay 2～3级水平，效果显著优于A组（P〈0．01）；B组镇静镇痛效果、遗忘及满意程度和再次接受结肠镜意愿显著优于A组（均P〈0．01）。结论咪唑安定联合芬太尼用于结肠镜检查具有良好的镇静、镇痛效果，且安全；护理支持是顺利完成检查的有效保障。     

急性子提取物抗炎镇痛作用的实验研究

目的探讨中药急性子的抗炎镇痛效果，为临床合理应用提供理论依据。方法采用二甲苯致小鼠耳肿胀、冰醋酸致小鼠扭体反应、小鼠热板法、蛋清致大鼠足肿胀和肉芽肿实验观察急性子提取物的抗炎镇痛效果。结果与模型对照组比较，急性子水提物中、大剂量组小鼠扭体次数明显减少（P＜0.05），急性子水提物中、大剂量组大鼠足肿胀减轻。中、大剂量急性子水提物对小鼠耳肿胀无效，其中大剂量可延长60 min（P＜0.01）和90 min（P＜0.05）小鼠疼痛阈值；急性子醇提取物大剂量可显著减少小鼠扭体次数（P＜0.01），减轻小鼠耳肿胀程度（P＜0.05），明显延长30 min疼痛阈值（P＜0.01），减轻大鼠肿胀程度；急性子醇提物大剂量可延长60 min疼痛阈值（P＜0.01）。急性子提取物对大鼠肉芽肿无抑制作用。结论急性子提取物有一定的镇痛效果和抑制急性炎症作用。     

咪唑安定联合芬太尼在结肠镜检查中的应用研究

目的 观察咪唑安定联合芬太尼在结肠镜检查中的镇静、镇痛效果.方法 将需行结肠镜检查的145例ASAⅠ～Ⅱ级患者随机分为A组(70例)和B组(75例).A组采用传统结肠镜方法检查并施行常规护理;B组采用无痛检查方法,即静脉推注咪唑安定0.05 mg/kg、芬太尼1μg/kg,1～2 min后开始进行结肠镜检查;检查前、中、后均施予针对性护理支持.结果 两组MAP、HR组间变化差异有显著性意义(均P＜0.01);B组呼吸抑制发生率为4.00%;B组92.00%患者镇静程度达Ramsay 2～3级水平,效果显著优于A组(P＜0.01);B组镇静镇痛效果、遗忘及满意程度和再次接受结肠镜意愿显著优于A组(均P＜0.01).结论 咪唑安定联合芬太尼用于结肠镜检查具有良好的镇静、镇痛效果,且安全;护理支持是顺利完成检查的有效保障.     

持续硬膜外镇痛对重度子痫前期患者剖宫产术后血儿茶酚胺水平的影响

目的 观察持续硬膜外镇痛对重度子痫前期患者剖宫产术后血儿茶酚胺（CA）水平的影响.方法 40例重度子痫前期剖宫产终止妊娠患者,随机分为观察组（A组,22例）和对照组（B组,18例）.B组术后不作镇痛处理;A组持续术后患者自控硬膜外镇痛（PCEA）,泵内药物为0.75%左旋布比卡因30 ml加芬太尼0.4 mg加昂丹司琼8 mg加生理盐水至200 ml.两组患者在术前、术后24、48、96 h分别采集静脉血.采用竞争性酶免试验法分析血CA浓度.记录术后96 h内产科用药情况.结果 A组术后48 h肾上腺素（E）、三个时段的去甲肾上腺素（NE）、96 h多巴胺（DA）均低于B组（P＜0.05或P＜0.01）.术后96 h内产科用药A组明显减少.结论 重度子痫前期剖宫产患者使用PCEA能有效地降低术后疼痛应激反应.     

指压穴位用于结肠镜检查镇痛的效果观察

目的探讨指压穴位对结肠镜检查的镇痛效果。方法将行结肠镜检查的200例患者随机分为观察组和对照组各100例。观察组在结肠镜检查过程中予指压足三里、内关穴配合检查;对照组采用常规检查,不予穴位指压。结果观察组疼痛程度显著低于对照组(P<0.05);插镜时间较对照组显著缩短(P<0.01)。结论指压穴位镇痛效果好、无创、安全,可保证结肠镜检的顺利进行。     

笑气吸入镇痛在结肠镜检查中的临床应用

目的探讨笑气吸入用于结肠镜检查的镇痛效果。方法将施行结肠镜检查的478例病人随机分为观察组和对照组,观察组病人在结肠镜检查过程中给予吸入笑气与氧气混合气体以镇痛,对照组采用常规的结肠镜检查。观察两组病人的疼痛程度、结肠镜检查的操作时间、检查成功率以及检查结束后病人的腹胀情况。结果观察组镇痛效果、结肠镜检查的操作时间、检查成功率等方面明显优于对照组(P0.01),检查结束后病人的腹胀情况与对照组比较无明显的统计学意义(P0.05)。结论笑气吸入用于结肠镜检查的镇痛效果好,操作简便、无创,而且安全有效,明显提高了结肠镜检查的成功率。     

胃肠起搏缓解电子结肠镜检查术后腹胀的效果探讨

目的探讨胃肠起搏对缓解电子结肠镜检查术后腹胀的效果。方法将电子结肠镜检查的80例患者随机分为治疗组及对照组各10例。对照组采用常规按摩腹部处理；治疗组在此基础上采用胃肠起搏缓解术后腹胀。结果治疗组患者腹胀程度显著低于对照组．腹胀缓解时间显著短于对照组，胃肠电图主频（FP）显著高于对照组（均P〈0．01）；两组均无并发症发生。结论胃肠起搏对缓解电子结肠镜检查术后腹胀有明显疗效。     

上腹部手术后镇痛对儿茶酚胺的影响

选择３０例上腹部手术患者，随机分为三组，每组１０例，采用Ｎ２一Ｏ２一安氟醚（ＧＯＥ）吸入麻醉，其中镇痛两组术终采用０．２５％丁哌卡因２０ｍｌ行腹腔神经丛阻滞，术后硬膜外分别持续滴入０．１２５％丁哌卡因及０．０００２５％芬太尼生理盐水溶液，在术终及术后２、５、８小时分别采静脉血分离血浆，并同时用线性视觉模拟评分法作疼痛程度评定，标本采用反相离子对色谱一电化学检测法分析血中儿茶酚胺浓度。结果镇痛两组疼痛评分较低，与对照组相比差异显著（Ｐ＜０．０１）。多巴胺血浆浓度在组间及组内比较均无差异（Ｐ＞０．０５），而肾上腺素和去甲肾上腺素的血浆浓度术后２、５、８小时与术终相比差异非常显著（Ｐ＜０．０１），三组间比较术终无差异，而术后２、５、８小时镇痛两组与对照组比较差异显著（Ｐ＜０．０１），但镇痛两组间相比无差异（Ｐ＞０．０５）。结论：上腹部手术后在腹腔神经丛阻滞下，行硬膜外术后镇痛既能明显减轻患者的痛苦，又能有效地阻止术后疼痛应激引起儿茶酚胺的明显变化。//     

虚拟现实技术对结肠镜检查患者疼痛和焦虑的影响

目的 探讨减轻结肠镜检查患者疼痛和焦虑的有效方法。 方法 将接受结肠镜检查的60例患者随机分为对照组、虚拟现实组和清醒镇静组各20例。对照组接受常规结肠镜检查；虚拟现实组患者在检查过程中佩戴虚拟现实一体机无线头盔眼镜，视听自选视频；清醒镇静组在检查时接受镇静药物处理。评价患者检查各阶段生命体征，疼痛及焦虑评分。 结果 检查中清醒镇静组、虚拟现实组疼痛评分显著低于对照组，检查后患者焦虑评分显著低于对照组（均P＜0.05）。 结论 虚拟现实技术可减轻患者结肠镜检查过程中的疼痛，并改善患者的焦虑状态。     

腰麻-硬膜外联合阻滞术行分娩镇痛的临床体会

Objective To study the clinical efficacy and safety of combined subarachnoid-epidural analgesia (CSEA) in labor.Methods CSEA was conducted in 100 primiparas,with another 100 cases as control group.The pain relief was assessed using WHO pain stage criterion.Labor progress,neonatal Apgar score and blood loss were compared.Results Compared with control group pain relief with CSEA was very distinct during labor (P＜0.01),with little side effects,obviously shortened labor progress (P＜0.01),reduced blood loss (P＜0.01) and incidence of cesarean (P＜0.05);section,and with no increased incidence of neonatal asphyxia.Conclusion CSEA is an ideal method for labor pain relief,which is rapid,effective and safe analgesia.     

三棱针穴位针刺结合挤压手法在北方蝮蛇咬伤救治中的应用

目的：探讨三棱针穴位针刺结合挤压手法在北方蝮蛇咬伤救治中的应用价值。方法：2010年6月-2011年9月就诊的60例四肢蝮蛇咬伤患者,随机分为两组,对照组使用抗蝮蛇毒血清及季德胜蛇药片等常规治疗,治疗组在此基础上早期进行患肢穴位三棱针针刺并从近心端自近及远挤压肿胀部位以利毒液排出。比较患者伤后第0（就诊时）～3天的患肢肿胀评分和疼痛评分的变化,皮肤软组织坏死情况、脏器功能损害发生率、凝血功能损害发生率及住院时间。结果：治疗组伤后第1、2、3天患肢肿胀评分和疼痛评分均小于对照组（P〈0．05）;治疗组并发症发生率少于对照组（P〈0．05）;组织坏死面积小于对照组（P〈0．05）。结论：用三棱针穴位针刺结合挤压手法辅助治疗北方蝮蛇咬伤患者,可显著减少并发症,减轻肿胀、疼痛症状及局部组织坏死,值得推广应用。     

Blood rheology in PCA and PCEA after total knee arthroplasty

The rheological events in 2 groups of patients undergoing total knee arthroplasty were compared--15 patients were given general anesthesia and controlled their postoperative pain applying intravenous patient-controlled analgesia; 17 individuals received combined spinal-epidural anesthesia and controlled their postoperative pain by patient-controlled epidural analgesia (PCEA). Twenty-four and 48 hours after surgery, the patient-controlled analgesia group showed a significant increase in whole-blood viscosity at the 3 shear rates (P < .01), as well as in relative viscosity at both periods (P < .001 and .01, respectively). Similar findings were observed for red blood cell aggregation (P < .001) and fibrinogen level (P < .001). These values were less expressed in the PCEA group, particularly 48 hours after surgery (P < .01), and the patients showed lower scores on the visual analog pain scale. The better results observed in the PCEA group favor the application of epidural anesthesia and PCEA analgesia in patients undergoing total knee arthroplasty.     

曲马多复合小剂量氯胺酮用于腹部手术患者的手术后镇痛：一项双盲、安慰剂对照的随机研究

背景鉴于氯胺酮联合曲马多用于患者手术后镇痛的研究较少，本文旨在验证曲马多复合氯胺酮能否改善腹部大手术的术后镇痛效果。方法在此项双盲、随机、对照研究中，行择期开腹手术的成年患者（n=120）随机分入氯胺酮组（氯胺酮手术中用量为0．3mg／kg，手术后以0．1mg·kg^-1·h^-1速度输注）或对照组（相同剂量和速度的生理盐水）。所有患者在手术中均使用曲马多3mg／kg，手术后48小时持续输注曲马多0．2mg·kg^-1·h^-1另以患者自控吗啡镇痛用于补救性镇痛。结果在整个48小时研究期间，氯胺酮组在静息（P=0．01）和活动（P=0．02）时的疼痛评分较低，吗啡的需求量较少（P=0．003）。在0～24小时期间，氯胺酮改善了患者主观的镇痛效果（P=0．008），镇静作用较小（P=0．03），需要医师干预的严重疼痛较少（P=0．01）。氯胺酮组中产生幻觉的患者较多，但两组的其他副作用均相似。结论腹部大手术后，小剂量氯胺酮是辅助吗啡和曲马多镇痛的有效药物。     

氧化亚氮吸入用于产妇分娩镇痛及其对新生儿的影响

目的 寻求一种简便易行、安全、有铲的分娩镇高痛方法。方法 将60例产程进入活跃期的产妇随机分为观察组和对照组各30例。观察组在第一产程宫口开大3cm以上、产痛剧烈时吸入氧化亚氮，对照组剧痛时予注意力分散的心理安慰，结果 观察组镇痛优良率76.67%，有效率达93.33%。两组疼痛程并比较，差异有极显著性意义（P＜0.01）。两组新生儿脐静脉、脉动脉血气分析各项指标比较，差异无显著性意义（均P＞0.05）。结论 氧化亚氮吸入用于产妇分娩镇痛效果满意，对于宫胎盘的血流无明显影响，不干扰胎儿的生理代谢及中枢神经系统功能。     

Improvement in postoperative pain relief by the addition of midazolam to an intrathecal injection of buprenorphine and bupivacaine

BACKGROUND AND OBJECTIVE: Intrathecal injections of the benzodiazepine midazolam have been reported to cause antinociception in animals and pain relief in human beings, including the potentiation of opioid analgesia. This study compared the efficacy of the addition of midazolam to a mixture of buprenorphine and bupivacaine used for spinal anaesthesia. METHODS: The study was prospective, randomized, and observer blinded. It involved 60 patients (30 per group), ASA I and II, age 20-40 yr, undergoing minor and intermediate lower abdominal surgery under spinal anaesthesia. Patients were randomized into two groups: the control group received a spinal injection of hyperbaric bupivacaine (15 mg) plus buprenorphine (0.15 mg) and the experimental group received a spinal injection of the same two drugs and doses but supplemented with intrathecal midazolam (2 mg). RESULTS: The duration of postoperative analgesia in the control group was 9.24 +/- 2.57 h (mean +/- SEM), and 21.33 +/- 12.69 h in the midazolam treated group (P < 0.001). Patients treated with intrathecal midazolam had better pain relief judged by visual analogue score on coughing (P = 0.0013) and a nursing mobility score (P < 0.0001). Adverse effects were minor and their incidence was similar in both groups. CONCLUSIONS: We conclude that intrathecal midazolam 2 mg improves the quality and duration of postoperative pain relief afforded by intrathecal buprenorphine and bupivacaine.     

Randomized sham‐controlled trial of acupuncture for postoperative pain control after stapled haemorrhoidopexy

Aim Haemorrhoidectomy usually causes moderate to strong postoperative pain. Chinese studies have found that acupuncture may have an analgesic effect in posthaemorrhoidectomy patients. This is the first Western study aiming assess the efficacy of acupuncture as an adjunct analgesic therapy after stapled haemorrhoidopexy. Method In a randomized controlled trial, 50 patients were allocated to three groups. Conventional drug therapy (oral diclofenac and metamizol, local lidocaine) served as baseline analgesia. In the control group (n = 17) only this regimen was used. In addition to baseline analgesia, 17 patients received verum acupuncture. Sham acupuncture was performed on 16 patients. Being the primary outcome measure, pain was measured twice daily using the numerical rating scale (NRS) and compared statistically by repeated‐measures analysis of variance. The study was registered (DRKS00003116). Results After verum acupuncture, pain intensity was not significantly lower when compared with conventional analgesia (primary hypothesis, P = 0.057), but was when compared to sham acupuncture (P = 0.007). In the afternoon of postoperative day 1, for example, NRS was 2.7 (SD 1.5) in the verum group, but 4.0 (1.0) in the sham group and 4.1 (1.9) under conventional analgesia. Furthermore, significantly fewer rescue analgesics were necessary if verum acupuncture was applied. Cardiovascular parameters were stable in all three groups, and no complications were recorded. Conclusions In posthaemorrhoidectomy patients, acupuncture appears to be an effective adjunct to conventional analgesia. Further studies are necessary to confirm these observations and to refine the acupuncture technique.     

Patient-controlled epidural analgesia in labor: the addition of clonidine to bupivacaine-fentanyl

BACKGROUND AND OBJECTIVES: Epidural clonidine has not been evaluated as a component of patient-controlled epidural analgesia (PCEA) solutions during labor. A randomized, double-blind trial was conducted to investigate the efficacy and side effects of PCEA using bupivacaine and fentanyl, with or without clonidine. METHODS: Seventy-five healthy parturients in active labor were assigned to a PCEA solution of 0.0625% bupivacaine and fentanyl 2 microg/mL (4 mL demand bolus, 15 min lockout), with or without clonidine 4.5 microg/mL. The primary outcome measure was parturient rating of analgesia; others assessments included pain scores, drug utilization, supplementation and side effects. RESULTS: Thirty-one parturients received clonidine (group BFC) and 38 received control solution (group BF). Eight (6 group BF, 2 group BFC, P = .28) failed to achieve satisfactory epidural analgesia. There was a trend for parturient ratings of pain relief to be higher in group BFC, with significantly more reporting excellent first-stage analgesia (81% v. 57%, P<.05). Pain scores were similar. Clonidine (median dose, 28 microg/h) reduced total bupivacaine and fentanyl use (P<.01), and reduced supplementation (P<.01). Maternal blood pressure (BP) and recordings of systolic BP below 100 mm Hg did not differ. Group BFC had higher sedation scores (P<.01), but no one appeared oversedated. Shivering was reduced in group BFC (P<.01). CONCLUSIONS: The addition of clonidine to epidural bupivacaine and fentanyl for PCEA in labor improved analgesia, reduced the supplementation rate, and reduced shivering. Increased sedation and lower BP were not clinically important.     

Efficacy of low-dose intrathecal morphine for postoperative analgesia after abdominal aortic surgery: a double-blind randomized study

BACKGROUND AND OBJECTIVES: Several studies suggest that intrathecal morphine (ITM) improves analgesia after aortic surgery. We tested the hypothesis that in combination with multimodal postoperative pain management, low-dose ITM associated with general anesthesia would decrease postoperative analgesic requirements in patients undergoing abdominal aortic surgery. METHODS: Thirty patients were randomized to receive either general anesthesia alone or preceded by low-dose ITM (0.2 mg) administration. Patients and providers were blinded to treatment. Postsurgical multimodal pain management was similar in both groups, including parenteral paracetamol, followed by intravenous nefopam and then morphine if not sufficient. Intravenous analgesic requirements, visual analog scale (VAS) scores, and the incidence and severity of side effects were recorded for 48 hours after surgery. RESULTS: Intraoperative data were comparable between the 2 groups, except sufentanil consumption, which was significantly lower in the ITM group when compared with the control group (P = .023). ITM decreased postoperative total-morphine requirements with respect to both the number of patients who received morphine (4 v 12 patients, P = .003) and the cumulative dose of morphine administered (0 [0-12.4] v 23 [13.9-45.6] mg, P = .006). VAS scores at rest were higher in the control group than in the ITM group at awakening (P < .01), at 4 hours (P < .01) after surgery, and at 8 hours (P < .05) after surgery but did not differ between groups after this period. Whereas VAS scores on coughing were higher in the control group at awakening (P < .01) and 4 hours after surgery (P < .05), no differences were found between groups from 8 hours after surgery. CONCLUSION: In patients undergoing abdominal aortic surgery, intrathecal morphine (0.2 mg) improves postoperative analgesia and decreases the need in intraoperative and postoperative analgesics. Further studies are indicated to evaluate the role of ITM in postoperative recovery.     

The influence of timing of systemic ketamine administration on postoperative morphine consumption

STUDY OBJECTIVE: To determine the influence of timing of systemic ketamine administration on postoperative morphine consumption. DESIGN: Prospective randomized study. SETTING: Operating rooms, postanesthesia care unit, and gynecology service of a university hospital. PATIENTS: Forty-five patients undergoing laparotomy for benign gynecologic pathologies were randomized into 3 groups. INTERVENTIONS: In Group 1, before surgical incision, patients received 0.5 mg/kg ketamine IV, followed by normal saline infusion and normal saline IV at wound closure in group 1 (n = 15). In group 2 (n = 15), patients received 0.5 mg/kg ketamine IV before surgery, followed by ketamine infusion 600 mug . kg(-1) . h(-1), until wound closure and normal saline IV at that time. In the other group (group 3, n = 15), patients received normal saline IV before surgery, followed by saline infusion and then 0.5 mg/kg ketamine IV at wound closure. In the postoperative period, patient-controlled analgesia IV morphine was used for postoperative pain relief. First requested analgesic medication time was recorded. Postoperative pain was assessed by measuring morphine consumption at 0 to 2, 0 to 4, and 0 to 24 hours and visual analog scale (VAS) pain scores in response to cough at 2nd, 4th, and 24th hours and during rest at 0 to 2, 0 to 4, and 0 to 24 hours after surgery. MEASUREMENT AND MAIN RESULTS: First requested analgesia was shorter in group 1 than the others (P < .01). Mean VAS pain scores in response to cough at 24th hour in groups 2 and 3 were significantly lower than in group 1 (P < .001 and P < .01, respectively). Mean VAS pain scores during rest at 0 to 24 hours in groups 2 and 3 were significantly lower than in group 1 (P < .01 and P < .05, respectively). Morphine consumption was lower in groups 2 and 3 at 0 to 2 hours (P < .001 and P < .01). Moreover, morphine consumption at 0 to 4 hours in group 2 was significantly lower (P < .01). CONCLUSIONS: Lower pain scores and morphine consumption in groups 2 and 3 may be related to higher plasma ketamine concentrations caused by the higher doses and later administration. Our findings suggest that a single preoperative dose of ketamine provided less analgesia compared with other dosing regimens that included intraoperative infusions or postoperative administration.