曲马多自控镇痛在前列腺切除术后的应用

目的观察前列腺术后静脉和硬膜外曲马多患者自控镇痛(PCA)效果.方法90例前列腺切除患者随机分为静脉注射曲马多患者自控镇痛(PCIA)组、经硬膜外曲马多患者自控镇痛(PCEA)组和未使用术后镇痛(对照)组,每组30例.曲马多负荷量为1 mg/kg.术后定时进行镇静、镇痛评分、24 h曲马多用量、患者满意度、膀胱痉挛次数、膀胱痉挛时间、膀胱冲洗液转清时间及不良反应观察.结果PCIA和PCEA组患者术后视觉模拟评分低于对照组(P＜0.05),镇痛满意度好于对照组(P＜0.05);PCIA组24 h用药量、按键次数及VAS评分均明显低于PCEA组(P＜0.05),镇静评分、不良反应发生率与PCEA组无显著性差异.结论曲马多用于前列腺切除术后镇痛安全有效,且静脉注射镇痛效果优于硬膜外给药.     

冬眠合剂对前列腺术后膀胱痉挛的疗效观察及护理

目的 观察冬眠合剂应用于前列腺摘除术后治疗膀胱痉挛收缩痛的疗效。方法 将接受前列腺摘除术患者68例随机分为两组，观察组30例应用冬眠合剂缓慢静滴，对照组38例应用硬膜外止痛泵（PCA）。结果 观察组镇痛效果明显优于对照组（P〈0．01），膀胱痉挛发生率低于对照组（P〈0．01）。结论 冬眠合剂缓慢静滴治疗前列腺摘除术后膀胱痉挛疗效显著。     

自控硬膜外镇痛缓解膀胱痉挛性疼痛的作用

观察自控硬膜外镇痛( PCEA)在前列腺摘除术后缓解膀胱痉挛性疼痛的作用. 116例患者分为两组对照组 51例,术后未做 PCEA,根据需要口服或肌注镇痛、解痉药. PCEA组 65例,手术结束前经硬膜外导管给予 2.5 g/L布比卡因 5 mL+吗啡 1 mg作为负荷量,接美国光达 2000型电子镇痛泵.结果表明对照组膀胱痉挛较为频繁, PCEA术后镇痛满意, VAS评分明现低于 A组,膀胱痉挛基本消失.前列腺摘除术后应用 PCEA,解除患者的疼痛,减弱术后应激反应,减少膀胱痉挛的发生,有利于术后恢复.     

经尿道前列腺汽化电切术后膀胱痉挛性疼痛防治方法探讨

目的:探讨经尿道前列腺汽化电切术(TUVP)后膀胱痉挛性疼痛防治方法.方法:TUVP患者60例,术后病人按不同的解痉镇痛方法随机分成三组,Ⅰ组(对照组),当膀胱痉挛疼痛时肌注哌替啶1 mg/kg,阿托品0.01 mg/kg;Ⅱ组术后保留硬膜外导管,间隔硬膜外腔注药镇痛,Ⅲ组术后行硬膜外自控镇痛(PCEA),所有病人治疗时间为3 d,术后以疼痛视觉模拟评分法(VAS)间接评估镇痛效果,定时记录膀胱内压、膀胱痉挛次数及病人术后恢复情况.结果:术后膀胱痉挛性疼痛发生率Ⅲ组、Ⅱ组、Ⅰ组分别为20%、45%、75%(P＜0.05);术后36 h三组病人膀胱痉挛性疼痛发生次数为Ⅲ组＜Ⅱ组＜Ⅰ组(P＜0.05),术后镇痛效果Ⅲ组＞Ⅱ组＞Ⅰ组(P＜0.05);Ⅰ组病人术后3 d膀胱内压明显高于Ⅱ组和Ⅲ组病人,术后2 dⅡ组明显高于Ⅲ组(P＜0.05);Ⅱ组和Ⅲ组病人术后尿液转清、拔尿管时间均明显早于Ⅰ组(P＜0.05),Ⅰ组有2例病人因术后出血再手术.结论:TUVP后膀胱痉挛性疼痛临床防治方法中,硬膜外注药的效果明显优于传统的肌注用药,应用PCEA模式效果更佳.     

硬膜外注药治疗前列腺摘除术后膀胱痉挛的观察与护理

目的 :观察留置硬膜外导管注药治疗前列腺摘除术后膀胱痉挛的疗效。方法 :将接受前列腺摘除术的 4 4例随机分为 2组 ,治疗组 2 5例术后留置硬膜外导管注射吗啡和布比卡因 ,对照组 19例术后拔除硬膜外导管。结果 :治疗组和对照组每天膀胱痉挛次数分别为 4 6± 1 6 ,18 2± 8 9(P <0 0 1) ,每次膀胱痉挛的持续时间分别为 0 5± 0 2min ,1 8± 1 0min (P <0 0 1) ,持续天数分别为 2 0± 1 0d ,5 0± 2 0d ,差异有显著性 (P <0 0 1)。结论 :留置硬膜外导管注药治疗前列腺摘除术后膀胱痉挛疗效显著     

浓度递减法硬膜外腔注药防治前列腺切除术后膀胱痉挛痛的临床观察

目的:观察经腹前列腺切除术后不同时段硬膜外腔持续注射不同浓度的罗哌卡因缓解膀胱痉挛的效果.方法:经腹前列腺切除术患者36例,随机分为三组:A组术后0.12%的罗哌卡因含芬太尼硬膜外腔持续注射;B组术后0.2%的罗哌卡因含芬太尼硬膜外腔持续注射;C组术毕至术后10 h(T1)用0.25%的罗哌卡因含芬太尼硬膜外腔持续注射、术后10～24 h(T2)用0.2%的罗哌卡因含芬太尼硬膜外腔持续注射、术后24～72 h(T3)用0.12%的罗哌卡因含芬太尼硬膜外腔持续注射.观察术后患者平均动脉压、心率血氧饱和度;记录术后T1,T2,T3时段膀胱痉挛次数和改良Bromage评分;采用VAS评分记录膀胱痉挛与非痉挛时的VAS评分;观察术后不良反应以及术后3 d膀胱冲洗液红细胞总数.结果:三组患者术后平均动脉压、心率及血氧饱和度平稳,差异无统计学意义(P>0.05);T1时段膀胱痉挛次数A>B>C,Bromage评分C>B>A(P<0.05);T2时段膀胱痉挛次数B≈CA,T3时段三组痉挛次数差异无统计学意义(P>0.05),但Bromage评分B>A,B>C(P<0.05);膀胱痉挛时VAS评分A组>B、C两组,非痉挛时三组VAS评分差异无统计学意义;三组不良反应差异无统计学意义;24 h膀胱冲洗液红细胞总数A组>B、C两组,B、C两组相近.结论:经腹前列腺切除术术后0.12%的罗哌卡因混合芬太尼能有效缓解切口痛,但不能完全缓解膀胱痉挛,采用浓度递减法硬膜外腔持续注射能有效缓解膀胱痉挛且有利于患者早期活动,不良反应少,效果好.     

自控镇痛泵与硬膜外注射吗啡对膀胱痉挛镇痛的效果观察

目的 探讨静脉自控镇痛泵与硬膜外注射吗啡对膀胱痉挛的镇痛效果.方法 将132例行前列腺及膀胱手术后并发膀胱痉挛患者,分为硬膜外注射吗啡组(实验组)和镇痛泵组(对照组).采用国际通用的视觉模拟评分法(VAS),评估镇痛效果,分别于术后定时进行随访,根据5个时间点计分,计算出每小时患者术后镇痛的平均计分.经统计分析比较实验组和对照组的镇痛效果.结果 实验组VAS评分明显低于对照组,持续镇痛时间高于对照组,2组对膀胱痉挛的镇痛效果有显著性差异(P＜0.01).结论 硬膜外注射吗啡对膀胱痉挛的镇痛效果确实、可靠、安全.     

硬膜外自控镇痛泵防止术后膀胱痉挛的观察

目的：为了解前列腺摘除术后应用硬膜外自控镇痛泵与传统肌肉注射止痛药物对术后膀胱痉挛的防治。方法：将36例病人随机分为实验组和对照组，实验组采用硬膜外自控镇痛泵，对照组采用间断肌肉注射止痛药物镇痛。观察两组病人术后3d膀胱痉挛次数。结果：实验组膀胱痉挛次数明显减少。结论：前列腺摘除术后应用硬膜外自控镇痛泵可以使膀胱痉挛次数明显减少。     

心理干预对前列腺摘除术后焦虑及膀胱痉挛的影响

目的:探讨心理干预对减轻前列腺摘除术后焦虑及膀胱痉挛的影响.方法:将49例前列腺摘除术患者随机分为观察组24例和对照组25例,观察组在常规护理的基础上行系统的心理干预,对照组行常规护理.应用Zung焦虑自评量表(SAS)、膀胱痉挛评定标准分析各项指标.结果:观察组术后72 h SAS得分为35～50分例数、术后72 h内不同时段膀胱痉挛发生例数均低于对照组,两组比较差异有统计学意义(P＜0.05).结论:对前列腺摘除术后患者进行心理干预,可减轻焦虑及膀胱痉挛发生频率.     

不同方式解除经尿道前列腺电切术后膀胱痉挛的疗效比较

【目的】观察采用静脉镇痛泵、琥珀酸索利那新片、酒石酸托特罗定缓释片联合静脉镇痛泵治疗经尿道前列腺电切术（TURP）后膀胱痉挛的疗效。【方法】将本院80例行TURP术后患者随机均分为四组。对照组于膀胱痉挛出现后给予哌替啶50 mg联合山莨菪碱10 mg 肌肉注射。静脉镇痛泵组手术后患者保留静脉镇痛泵导管,连接静脉输液（镇痛液配方为舒芬太尼100μg＋格拉司琼6 mg ,用生理盐水稀释至100 mL ）,调节药量为恒速注药2mL,维持72h。索利那新组手术前1d口服琥珀酸索利那新片每次5mg,1次/日;联合用药组手术前1d口服酒石酸托特罗定缓释片每次2mg ,1次/日,同时联合静脉镇痛泵治疗。比较各组临床疗效。【结果】试验三组术后d1,d2,d3膀胱痉挛次数、膀胱痉挛平均持续时间、膀胱冲洗液转清时间均短于对照组,联合用药组的膀胱痉挛次数及膀胱痉挛平均持续时间均短于静脉镇痛泵组及索利那新组,且各组之间比较差异均有显著性（均 P ＜0．05）,静脉镇痛泵组及索利那新组各项指标相比较差异无显著性（ P ＞0．05）。【结论】静脉镇痛泵、琥珀酸索利那新片、酒石酸托特罗定缓释片联合静脉镇痛泵三种方式对于预防和治疗术T U RP后早期膀胱痉挛均有较好的效果,且联合用药组效果更加显著,可在临床推广。     

Observation Medicine in Emergency Medicine Residency Programs

OBJECTIVE: To evaluate observation unit (OU) prevalence, emergency medicine (EM) resident exposure in observation medicine (OM), EM faculty/residency director (RD) OM training, and RD attitudes toward OM. METHODS: Information was obtained from residency programs by telephone during a four-month period. RESULTS: Survey respondents indicated that 36.1% have OUs and 44.9% plan to have an OU. Observation medicine resources include textbooks 32.0%, articles 45.9%, lectures 36.9%, fellowships 2.5%, and research 26.2%. Observation medicine patient care occurs: 1) during residency: 25.4% of RDs, 11.3% of entire faculty; 2) as an attending: 45.1% of RDs. CONCLUSIONS: Nearly two-thirds of EM programs have or are planning an OU. Resources are lagging behind. This survey describes current OM education strategies to teach OM.     

Pediatric Emergency Medicine Education in Emergency Medicine Training Programs

BACKGROUND: The educational goal of emergency medicine (EM) programs has been to prepare its graduates to provide care for a diverse range of patients and presentations, including pediatric patients. OBJECTIVE: To evaluate the methods used to teach pediatric emergency medicine (PEM) to EM residents. METHODS: A written questionnaire was distributed to 118 EM programs. Demographic data were requested concerning the type of residency program, number of residents, required pediatric rotations, elective pediatric rotations, type of hospital and settings in which pediatric patients are seen, and procedures performed. Information was also requested on the educational methods used, proctoring EM received, and any formal curriculum used. RESULTS: Ninety-four percent (111/118) of the programs responded, with 80% of surveys completed by the residency director. Proctoring was primarily performed by PEM attendings and general EM attendings. Formal means of PEM education most often included the EM core curriculum (94%), journal club (95%), EM grand rounds (94%), and EM morbidity and mortality (M&M) conference (91%). Rotations and electives most often included the pediatric intensive care unit (PICU) and the emergency department (ED) (general and pediatric). CONCLUSIONS: Emergency medicine residents are exposed to PEM primarily by rotating through a general ED, the PED, and the PICU, being proctored by PEM and EM attendings and attending EM lectures and EM M&M conferences. Areas that may merit further attention for pediatric emergency training include experience in areas of neonatal resuscitation, pediatric M&M, and specific pediatric electives. This survey highlights the need to describe current educational strategies as a first step to assess perceived effectiveness.     

日本汉方医学领域循证医学研究现状及其启示

目的 对日本汉方医学的循证医学研究现状进行总结。 方法 系统评价日本东洋医学会（JSOM）循证医学工作组对日本汉方医学的循证医学评价和总结报告。 结果 JSOM 的循证医学特别委员会成立较早,并在全日本范围内进行了三次汉方治疗的系统总结与评价,其制剂质量规范可靠。2009 版汉方诊疗指南对日本汉方临床的诊疗可望有较好的推动作用。 结论 为促进我国中医药循证医学的发展,我们需要借鉴JSOM 的循证医学研究计划,重视研究数据的真实性、重视非随机试验的科学分析和报告;根据中医学的特点,由简到繁、系统地开展循证医学研究。     

International Emergency Medicine and the Role for Academic Emergency Medicine

International emergency medicine continues to grow and expand. There are now more than 30 countries that recognize emergency medicine as a specialty. As the field continues to develop, many physicians are reaching across borders and working with their colleagues to improve patient care, education, and research. The future growth and success of the specialty are based on several key components. These include faculty development (because this is the key driver of education), research, and curriculum development. Each country knows what resources it has and how best to utilize them. Countries that are developing the specialty can seek consultation from successful countries and develop their academic and community practice of emergency medicine. There are many resources available to these countries, including distance learning and access to medical journals via the Internet; international exchanges by faculty, residents, and medical students; and physicians who are in fellowship training programs. International research efforts require more support and effort to be successful. This report discusses some of the advantages and hurdles to such research efforts. Physicians have a responsibility to help one another succeed. It is the hope of the authors that many more emergency physicians will lend their skills to further global development of the specialty.     

循证医学理念在长学制临床医学教学质量管理中的应用

目的 探讨循证医学理念在长学制临床医学教学质量管理中的应用效果.方法引入循证临床教学质量管理体系的概念,初步构建以<基于网络环境的教学质量实时监控系统>为核心的临床教学质量管理体系.采用专门的评估量表由学生对教师的教学效果进行评估,并用SPSS 10.0软件和u检验的方法对评估结果进行统计分析.结果 2001～2003年该系统获得数据共853 280条.在被评估的285个课题中,有96.4%(275/285)的课题的评估成绩在85分以上;有无出国经历和年龄是否＞45岁对教师授课质量无影响(P＞0.05);有无博士学历对教师授课质量的影响有统计学差异(P＜0.05).结论在长学制临床医学教学质量管理工作中,只有本着循证的思想,采取科学的手段寻求最客观的依据,实施有效的措施,才能保证长学制临床医学教学质量的稳步提高.