不同麻醉和镇痛方式对胃癌根治术患者术后镇痛效果及细胞免疫功能、应激水平的影响

探讨不同麻醉和镇痛方式对胃癌根治术患者术后镇痛效果及细胞免疫功能、应激水平的影响.选取我院201 7年2月至201 9年2月实施胃癌根治术患者68例,采用随机数字表法分为研究组和对照组,每组各34例.研究组手术采用静脉全麻复合硬膜外麻醉,术后行硬膜外镇痛;对照组手术采用静脉全麻,术后行静脉自控镇痛.对比两组患者术后48...     

不同麻醉镇痛方式对胃癌根治术患者快速康复的影响

目的 比较不同麻醉镇痛方式对开放胃癌根治术患者快速康复的影响.方法 全身麻醉下行开放胃癌根治术患者67例,采用随机数字表法分为3组:全身麻醉联合硬膜外镇痛组(EA组,20例)、全身麻醉联合患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)组(PCIA组,24例)、全身麻醉联合肋缘下腹横肌平面(subcostal transverseabdominis plane,STAP)阻滞组(STAP组,23例).3组全身麻醉诱导、维持用药相同,EA组行硬膜外阻滞和硬膜外镇痛,PCIA组行静脉镇痛,STAP组行双侧STAP阻滞和静脉镇痛.记录七氟醚、舒芬太尼及血管活性药物用量,记录术后1 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)VAS评分及哌替啶用量,记录肠道功能恢复时间、首次进食时间、首次下床时间、住院时间,观察不良事件的发生情况.结果 与PCIA组VAS评分[(3.8±2.0)、(4.7±1.8)、(6.5±1.7)分]比较,EA组和STAP组在T1[(2.3±1.2)、(3.1±2.3)分]、T2[(2.3±1.1)、(3.4±2.0)分]、L[(2.8±1.1)、(3.6±2.0)分]时点VAS评分显著降低(P＜0.05),发生恶心呕吐、疲倦嗜睡和头晕的例数显著减少(P＜0.05).与EA组比较,PCIA组、STAP组舒芬太尼和哌替啶用量显著增多,麻黄碱用量和低血压例数显著减少(P＜0.05).STAP组、EA组、PCIA组两两比较,肠道功能恢复时间[(37±12)、(50±16)、(74±13) h]、首次进食时间[(47±10)、(61±15)、(89±11) h]、首次下床时间[(41±15)、(54±18)、(56±22)h]依次延长(P＜0.05).3组住院时间差异无统计学意义(P＞0.05).结论 全身麻醉联合硬膜外阻滞或多点STAP阻滞对开放胃癌根治术患者术后快速康复有利,而全身麻醉联合PCIA效果较差、副作用较多、恢复时间较长.     

不同剂量布托啡诺对胃癌根治术后患者静脉自控镇痛效能的比较

目的观察不同剂量的布托啡诺对胃癌根治术后患者静脉自控镇痛效能的比较。方法选择行胃癌根治的患者232例,ASA为Ⅰ～Ⅱ级。将232例患者随机分为布托啡诺静脉自控镇痛组和对照组,每组均为29例。其中布托啡诺组分为6个小组,分别是布托啡诺浓度为0.004%、0.005%、0.006%、0.007%、0.008%和0.009%的A1、A2、A3、A4、A5和A6组。对照组分为2个小组,分别是吗啡浓度为0.025%的B1组以及传统方法治疗B2组。在胃癌根治术后1d观察患者情况,详细记录患者的舒适度评分、镇静度评分、视觉模拟评分以及患者的不良反应与PCIA的总按压频率次数和实际用药情况。结果①A3～A6组以及B1组的VAS评分明显低于B2和A1、A2组,而BCS的评分要高于B2和A1、A2组（P〈0.05）。②A3～A6组的PCIA总压次数明显低于A1、A2组,然而用药量远远高于A1、A2两组（P〈0.05）。③B1组患者腹胀、恶心、呕吐等不良症状发生频率远远高于A1～A6以及B2组患者（P〈0.05）。A6组患者的嗜睡程度最高。A1、A2组需要其他镇痛药物辅助,镇痛效果才能达到A3～A6组。结论布托啡诺的浓度为0.006%、0.007%时,以0.0022～0.0026mg/（kg.h）的速率给药,负荷剂量为0.005mg/（kg.h）的静脉PCIA会获得最佳的镇痛疗效,并且不良反应的发生率极低,可以应用于相关临床疾病的治疗中。     

超前镇痛对胃癌根治术患者术后镇痛作用和血浆IL-6的影响

超前镇疼是在伤害性刺激作用于肌体之前采取一定的措施．防止中枢敏感化．减少或消除伤害引起的疼痛。动物实验和临床研究均显示手术损伤以及术后疼痛会产生免疫抑制．如果处理不当，即可以产生一系列负面效应．发生炎性反应综合征．甚至发展成为多器官功能衰竭。术前持续硬膜外镇痛或静脉镇痛是目前常用的超前镇疼方法。本研究观察超前镇痛对胃癌根治术患者术后的镇痛效果．以明确超前镇痛的作用，同时观察不同镇痛方式对患者血浆IL-6的影响。     

不同镇痛方法对开胸手术围术期应激反应的影响

开胸手术可以产生严重的术后疼痛,并使呼吸运动、咳嗽、排痰功能受到影响,增加术后并发症,可能延长卧床时间及住院时间。因此开胸手术的术后镇痛在减轻上述不利影响方面具有重要作用。目前在临床上存在多种不同的开胸术后镇痛方法,硬膜外镇痛及冷冻镇痛术由于其镇痛效果好、副作用少而在临床较广泛应用。本研究选择开胸行食管癌根治术及肺叶切除术的患者探讨上述两种镇痛方法对术中及术后应激反应的影响。     

胃癌根治术后肝功能异常的影响因素分析

目的 分析胃癌根治术后肝功能异常(LA)的相关影响因素.方法 回顾性收集2018年6月至2020年12月择期行胃癌根治术的1013例患者临床资料,男699例,女314例,年龄24～92岁,ASAⅡ或Ⅲ级.根据术后第1天是否发生LA将患者分为两组:肝功能正常组(NLA组)和肝功能异常组(LA组).LA定义为血清中以下任一...     

腹腔镜与开腹胃癌根治术后深静脉血栓形成影响因素的研究进展

胃癌是一种常见的恶性肿瘤,腹腔镜和开腹胃癌根治手术是目前最主要的手术治疗方法,术后均存在发生深静脉血栓形成(DVT)风险.胃癌术后DVT发生有着复杂的发病机制和较多高危因素,而且不同的手术类型和方式导致下肢DVT发生率也存在差异,对治疗和预后会产生较大影响.腹腔镜与开腹胃癌根治术都存在着DVT的诱因,但目前关于开腹和腹...     

不同腹腔镜胃癌根治术对原发性胃癌病人胃肠动力、炎性应激及预后的影响分析

目的探讨不同腹腔镜胃癌根治术对原发性胃癌病人胃肠动力、炎性应激及预后的影响分析。方法行腹腔镜远端胃癌根治术病人89例,根据手术治疗方式不同将其分为研究组及对照组。研究组44例,采用全腹腔镜远端胃癌根治术(TLDG)治疗,对照组45例,采用腹腔镜辅助远端胃癌根治术(LADG)治疗,比较两组病人的临床效果的差异。结果研究组病人的手术时间较对照组长,而术中出血量、切口长度、住院时间与对照组比较,差异有统计学意义(P0.05)。两组淋巴结清扫数目及术后不良反应发生率(如术后切口感染、出血等)比较差异无统计学意义(P0.05);术前两组病人胃肠动力指标比较,差异无统计学意义(P0.05)。术后研究组病人胃肠动力指标与对照组比较改善明显(P0.05);术前两组病人的炎性应激反应指标比较,差异无统计学意义(P0.05),术后两组病人炎性应激指标比较,差异有统计学意义(P0.05);两组病人术后1年总生存率及复发率比较差异无统计学意义(P0.05)。结论 TLDG对原发性胃癌病人的疗效较LADG更佳,不仅有利于胃肠功能的恢复,同时对机体的炎性应激反应较小且不影响病人预后。     

加速术后康复对腹腔镜胃癌根治术病人应激反应及营养状况的Meta分析

目的系统评价加速术后康复(enhanced recovery after surgery,ERAS)对腹腔镜辅助胃癌根治术病人应激反应及营养状况。方法检索近10年(2008年1月至2019年5月)发表在数据库(CNKI、万方、维普、PubMed、Web of Science、The Cochrane Library、Embase)的随机对照试验(RCTs),严格按纳入和排除标准,最终纳入15篇RCTs文献(855例),并行质量评价和提取数据,采用RevMan(5.3版)软件进行Meta分析。结果 ERAS组(425例)较对照组(430例)术后血清白蛋白水平更高[术后第1天:MD=0.73, 95%CI(0.09,1.37),P<0.05;第4天:MD=2.43,95%CI(1.92,2.94),P<0.05;第7天:MD=3.85,95%CI(2.74,4.96),P<0.05]。ERAS组术后血清前白蛋白较对照组更高[术后第1天:MD=0.7,95%CI(-3.08,4.47),P<0.05;术后第4天:MD=15.11,95%CI(9.16,21.06),P...     

胃癌根治术后远期腹痛原因分析

胃癌根治术后远期出现腹痛较多见，原因复杂，有时很难明确病因。1998年1月～2008年1月，我院共58例患者于胃癌根治术后1年以上出现反复腹痛，现进行分析报告如下。     

术后不同镇痛方法对神经内分泌和细胞因子的影响

目的 观察术后不同镇痛方法对血糖、应激激素和细胞因子的影响。方法 ３０例胆囊切除术患者,按术后不同镇痛方法,随机分成四组,Ｃ组：硬膜外腔注射生理盐水;ＥＭ组：硬膜外腔注射吗啡２ｍｇ;ＰＣＥＦＡ组：硬膜外腔应用芬太尼病人自控镇痛;ＰＣＩＦＡ组：静脉应用芬太尼病人自控镇痛。检测围术期病人血糖、皮质醇、胰岛素和白细胞介素２（ＩＬ－２）、白细胞介素６（ＩＬ－６）及肿瘤坏死因子α（ＴＮＦα）的水平。结果 Ｃ     

不同镇痛方法对膝关节置换术后疼痛和早期康复的影响

[目的]对比不同镇痛方法对膝关节置换术后疼痛和早期康复的影响。[方法]2016年9月~2017年9月,择期行单侧全膝关节置换术(TKA)的患者75例列入本研究,依据术后镇痛方式,随机均分为3组:连续收肌管阻滞联合关节周围浸润组(CA+P组)、连续股神经阻滞联合关节周围浸润组(CF+P组)、连续硬膜外镇痛组(E组),所有患者均采用腰硬联合麻醉。记录术前、术后静息及活动状态下的疼痛视觉模拟评分(VAS)和股四头肌肌力,记录术后膝关节最大主动屈曲角度(°)和不良反应。[结果]术后24、48、72 h活动状态下,E组患者VAS评分明显高于CA+P组和CF+P组,差异有统计学意义(P0.05)。CF+P组和E组患者术后6、12、24 h股四头肌肌力下降,差异有统计学意义(P0.05)。CF+P组和E组术后1、2、3 d膝关节主动屈曲角度明显降低,差异有统计学意义(P0.05)。E组加用镇痛药物用量及术后并发症的发生率明显高于其他两组,差异有统计学意义(P0.05)。[结论]连续收肌管阻滞联合关节周围浸润可有效缓解全膝关节置换术患者疼痛,且对股四头肌肌力影响更小,不良反应发生率更低。     

Comparison of analgesic methods by using ropivacaine after arthroscopic shoulder surgery

Background

There is no clinical study which has evaluated real effectiveness of ropivacaine when it is used in a subacromial pump in addition to its bolus injection in a mixture of agents. The aim of the study is to evaluate pain relieving effect of ropivacaine infusion by a pain pump after arthroscopic shoulder surgery.

Method

Thirty-six patients were randomly divided into three groups. Arthroscopic subacromial surgery was performed under general anesthesia. A subacromial catheter was placed in groups 1 and 2 patients. At the end of the operation, 15 ml of 0.5 % ropivacaine, 15 mg of ketolorac, and 4 mg morphine sulfate mixture was applied to all patients into the subacromial space. In addition to that, group 1 patients were applied with 0.5 % ropivacaine running through a pain pump at 4 cm³/h. Group 2 patients only received 100 cm³ saline (placebo) through the same pain pump, which was also running at 4 cm³/h. No additional intervention except subacromial mixture application was performed in group 3. Pain levels were evaluated by using the visual analogue scale.

Results

Twelve male and 19 female patients were included in this study. During the first postoperative hour, there was no difference between the groups in terms of pain scores. During the ongoing 24-h period, group 2 patients suffered less pain and had less analgesic need compared with the other two groups (p?<?0.05). However, in the same day, there was no significant difference in pain scores and analgesic consumption between groups 1 and 3 (p?>?0.05).

Conclusion

In terms of pain relief, the mixture of morphine, ropivacaine, and ketolorac was found to be as effective as the 24-h pump infusion of ropivacaine following arthroscopic rotator cuff repair. It was observed that placebo-given patients suffered less pain because saline increased the long-term effect of ropivacaine. So if an appropriate analgesic agent is applied to the subacromial space, there is no need for a pump infusion postoperatively.     

Clinical observations of cancer in the stomach after surgery

Among 1,286 patients with gastric carcinoma we observed 75 carcinomas in operated stomach. There are differences in the pathogenesis of cancer in the stomach operated for ulcera duodeni and ventriculi. The average interval between operation for ulcus and tumor development is 24.4 years, the sex ratio 6.5:1 men:women. Curative therapy was possible in 47% with a mortality of 20%. The 5-year-survival rate was 40%. The adequate operative procedure in the therapy of carcinoma in the operated stomach is the total gastrectomy.     

The effects of different analgesic regimens on transcutaneous CO2 after major surgery

Ventilatory impairment may be detected by a rise in transcutaneous carbon dioxide levels (PtcCO₂). This observational study assessed the clinical utility of PtcCO₂ monitoring in the postoperative period, and quantified the effect of different peri-operative analgesic regimens on postoperative respiratory function. Following pre-operative baseline PtcCO₂ recording, continuous PtcCO₂ monitoring was performed in 30 patients after major colorectal surgery for up to 24 h. Mean postoperative values of PtcCO₂ were 1.3 kPa (95% CI 1.0–1.5) higher than pre-operative values (p < 0.001). Patients receiving intravenous opioid patient controlled analgesia had a significantly higher elevation in postoperative PtcCO₂ compared to patients receiving epidural infusion analgesia, 1.8 kPa (CI 1.5–2.1) vs 0.7 kPa (CI 0.5–0.9) respectively (p < 0.001). The mean rise in PtcCO₂ following a single intravenous bolus of morphine delivered via PCA was 0.05 kPa (SEm 0.01), peaking at 12 min post-dose. The transcutaneous capnometer successfully recorded data for 98% of the total time it was applied to patients.     

乳腺癌术后不同乳房再造方法并发症的Meta分析

目的:评估乳房重建术式与术后并发症的关系。方法:计算机检索Pubmed、Embase、Medline、Cochrance、WangFang、CNKI、万方及维普数据库,检索1990年1月至2017年11月已发表的应用横行腹直肌肌皮瓣、腹壁下动脉穿支皮瓣、背阔肌肌皮瓣、背阔肌肌皮瓣联合假体、单纯假体置入5种常用的乳房重建...     

帕瑞昔布钠对脊柱侧凸矫形术后芬太尼镇痛效果的影响

目的 观察帕瑞昔布纳对脊柱侧凸矫形术后芬太尼镇痛效果的影响.方法 择期行脊柱侧凸矫形术患者40例,随机均分为P、C两组.脊柱矫形内固定完成后,P组静注帕瑞昔布钠40mg或0.8 mg/kg,C组静注生理盐水2 ml.术毕均采用芬太尼自控静脉镇痛.记录术后2、6、12、24和48 h的VAS评分和PCA按压总次数、有效次数,术后12、24和48 h芬太尼用量和不良反应.结果 P组术后2、6、12和24 hVAS评分、PCA按压总次数和有效次数及术后12、24和48 h芬太尼用量均少于C组(P<0.05或P<0.01).两组不良反应的差异无统计学意义.结论 脊柱侧凸矫形术后应用帕瑞昔布钠可增强芬太尼镇痛效果,减少芬太尼用量.     

The analgesic effect of gabapentin and mexiletine after breast surgery for cancer

We investigated the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients. They were randomized to receive, in a double-blinded manner, mexiletine 600 mg/d, gabapentin 1200 mg/d, or placebo for 10 days. Anesthesia was standardized, and all patients had access to routine postoperative analgesics on demand. The visual analog scale score assessed pain at rest and after movement. Three months later, all patients were interviewed to identify intensity of chronic pain and analgesic requirements. Mexiletine and gabapentin reduced codeine consumed from the second to tenth day by 50% (P = 0.029; P = 0.018 and P = 0.035 for mexiletine versus control and gabapentin versus control comparisons, respectively). Total paracetamol consumption was also reduced during the same time (P = 0.0085; P = 0.007 and P = 0.011 for the mexiletine and gabapentin groups when compared with the control, respectively). Pain at rest and after movement was reduced by both drugs on the third postoperative day. Pain after movement also was reduced by gabapentin between the second and fifth postoperative day. Three months later, the incidence of chronic pain, its intensity, and need for analgesics were not affected by either treatment. However, burning pain was more frequent in the control group (P = 0.033). IMPLICATIONS: Patients undergoing breast surgery for cancer may develop chronic pain. We evaluated the effect of mexiletine and gabapentin on the acute and chronic pain after breast surgery for cancer. Both drugs reduced the postoperative analgesic requirements, and particularly, gabapentin reduced pain after movement. The overall incidence of chronic pain was unaffected except for burning pain.     

乳腺癌术后皮下积液的预防及两种不同引流方法的疗效分析

目的 探讨乳腺癌术后皮下积液的原因、预防方法及两种不同引流方法的疗效.方法 回顾性分析第三军医大学大坪医院野战外科研究所乳腺甲状腺外科2010年1月-2016年9月行乳腺癌改良根治术的2 100例发生皮下积液68例患者的临床资料.其中1 032例采用维斯第负压封闭引流技术,1 068例采用迪诺保伤口高负压引流系统,均未采用弹力绷带加压包扎.结果 2100例中,发生皮下积液68例,占3.2％,其中纵切口48例,横切口20例.1 068例伤口高负压引流系统引流中,发生皮下积液36例,其中切口感染28例,皮瓣坏死8例;术后拔管时间8～36 d,平均12 d:1 032例维斯第负压封闭引流技术引流中发生皮下积液32例,其中切口感染22例,皮瓣坏死10例;术后拔管时间6～12d,平均8d.全部病例随访3个月后,均无皮下积液及腋窝积液发生.结论 充分的引流是预防皮下积液的关键,维斯第负压封闭引流和伤口高负压引流均能有效减少皮下积液的发生.但维斯第负压封闭引流更适用于渗出较多,潜行腔隙较大、较深,尤其是感染、脓肿的伤口.