对剖宫产术后产妇留置镇痛泵方式的研究

目的：对剖宫产术后产妇留置镇痛泵方式的研究。方法：两组均在腰硬联合麻醉下完成手术,术后一组采取PCEA方法,另一组采取静脉留置针镇痛泵方法。结果：PCIA和PCEA用于剖宫产术后均可得到理想的镇痛效果,PCIA尿潴留及导管脱出率较PCEA明显低,且可避免PCEA潜在的一些严重的并发症的发生,总体镇痛质量较PCEA好。结论：静脉留置针镇痛泵方法舒适、安全、效果好、满意度高。     

妇科术后镇痛引起恶心呕吐的舒适护理

硬膜外自控镇痛（PCEA）是目前常用的术后镇痛方法，镇痛效果好，非常受患者欢迎，但易出现恶心、呕吐症状，给患者带来不适和痛苦。因此，如何防治术后镇痛引起的恶心呕吐已成为临床护理研究的课题。本院妇产科将舒适护理运用于临床，取得一定的效果，现报道如下。     

中西医治疗吗啡硬膜外镇痛并发症的体会

术后疼痛是人体受到手术创伤刺激后的一种反应。因此 ,如何减轻患者术后疼痛一直是研究的课题。现在患者自控镇痛技术 (PCEA)已广泛使用。吗啡属阿片受体激动药 ,有较好镇痛效果 ,在 PCEA中是首选药物 ,但在使用过程中时有副作用发生 ,如呼吸抑制、尿潴留、皮肤瘙痒、恶心呕吐等。现就中西医结合处理吗啡术后镇痛并发症的体会如下。1　临床资料选取单纯使用硬膜膜外麻醉行腹部手术患者 10 0例 ,均使用吗啡硬膜外自控镇痛 (PCEA的药物配方为 :吗啡 1.0 mg + 0 .75 %布比卡因 2 0 m L +生理盐水共10 0 m L)。其中 15例有不同程度副作用…     

剖宫产术后自控镇痛方法的疗效观察

目的:比较剖宫产术后硬膜外自控镇痛(PCEA)和静脉自控镇痛(PCIA)的镇痛疗效.方法:选择剖宫产术后患者400例,随机分为A(观察组)、B(对照组)两组,分别采用PCEA和PCIA进行术后镇痛.结果:PCEA组镇痛效果明显高于PCIA组(P<0.01).结论:PCEA用药量少,镇痛效果好,剖宫产后宜选用.     

开胸术后不同镇痛方法镇痛效果的临床观察与护理

目的:探讨开胸手术后硬膜外镇痛的临床效果及护理。方法:选择择期开胸手术病例120例,随机分为两组,观察组为硬膜外自控镇痛(PCEA)和对照组为术后静脉芬太尼患者自控镇痛(PCIA),每组60例,术后随访并加强护理干预,观察并记录术后4、8、12、24、48h疼痛、舒适评分及生命体征和胸管拔除时间。结果:观察组术后除48h镇痛效果无明显差异,其他各时间点对照组VAS评分明显高于PCEA组(P<0.05),BCS评分对照组明显低于PCEA组(P<0.05),术后胸管拔除时间、咳痰效果均有显著差异(P<0.05)。结论:开胸术后硬膜外镇痛效果优于静脉自控镇痛,通过护理干预,可明显提高开胸手术患者术后的生活质量。     

活血镇痛汤配合硬膜外患者自控镇痛预防下肢骨科术后深静脉血栓形成的临床研究

目的:探讨活血镇痛汤配合硬膜外患者自控镇痛(PCEA)预防下肢骨科术后深静脉血栓(DVT)形成的临床疗效。方法:中药组59例以活血镇痛汤口服,术后行PCEA镇痛;对照组58例口服肠溶阿司匹林并配合低分子右旋糖酐静脉滴注,术后行PCEA镇痛。比较两组患者DVT发生率及治疗前后血液流变学及凝血指标变化的差异。结果:①DVT的发生率中药组为6.78%,对照组为18.97%,两者比较(P&lt;0.05)。②中药组血液流变学及凝血指标术后2d分别与术前相比较(P&lt;0.01),与对照组术后2d比较(P&lt;0.05)。结论:活血镇痛汤配合PCEA在预防下肢骨科术后DVT发生方面有可靠的效果及良好的安全性。     

舒芬太尼复合罗哌卡因在剖宫产术后硬膜外自控镇痛中的应用

目的：观察舒芬太尼复合罗哌卡因用于剖宫产术后病人硬膜外自控镇痛（PCEA）的临床镇痛效果和不良反应。方法：选择ASAⅠ-Ⅱ级,在连续硬膜外阻滞下行剖宫产手术的病人60例,术后行硬膜外自控镇痛（PCEA）。随机分为两组,使用0．5u酬舒芬太尼或4ug／ml芬太尼复合0．24％罗哌卡因。背景剂量4ml／h,自控药量2ml／次,锁定时间30min。观察病人术后镇痛效果,记录镇痛泵使用情况、不良反应以及是否使用其它镇痛药物。结果：舒芬太尼组在术后8小时、24小时和48小时的prince—henry评分、镇静效果、镇痛药消耗量、镇痛泵有效按压次数侯际按压次数比值,静息、咳嗽和活动时镇痛效果优于芬太尼（P〈0．05）。恶心呕吐发生率无显著差异,但舒芬太尼组程度较轻,两组镇痛泵使用情况以及其他不良反应,如下肢麻木、呼吸抑制等无明显差异。结论：舒芬太尼复合罗哌卡因可安全有效地用于剖宫产术后PCEA,镇痛效果优于芬太尼组,不良反应少,程度较轻。     

腕踝针用于术后镇痛的研究进展

腕踝针用于镇痛具有良好疗效。从作用机制、术后镇痛和术后并发症的治疗等方面综述近年来腕踝针在术后镇痛中的临床研究。腕踝针用于术后镇痛能有效降低术后不良反应发生率、减少镇痛药物的应用、提高镇痛有效率和患者满意度,但仍需要在治疗方法的规范性和镇痛药物合用的协同性等方面进一步研究和探讨。     

硬外镇痛泵在皮瓣移植术病人中的应用与护理

对于术后切口疼痛 ,传统通常采用间断肌肉注射止痛药物进行镇痛。其效果不确切 ,且有并发症发生。由于惟恐镇痛药物过量或成瘾 ,75 %的病人存在程度不同的镇痛不全〔1〕。特别是下肢皮瓣移植术的病人 ,术后疼痛刺激可使凝血功能异常 ,导致血栓形成 ,影响皮瓣的成活。为观察硬膜外镇痛泵(PCEA)的术后镇痛效果 ,我们将 1998～ 2 0 0 2年 10月收治的4 6例下肢皮瓣移植病人随机分为两组 ,以传统的术后间断肌肉注射法 (IMD)为对照 ,进行了对照观察。现将观察结果总结报告如下。1　临床资料4 6例患者中男 32例 ,女 14例。年龄 13～ 6 5岁。小腿…     

病人自控硬膜外镇痛的临床应用

目的：讨论病人自控硬膜外镇痛（PCEA）在腹部手术后的临床应用。方法：对我院2004年6月至2005年3月的42例腹部术后应用PCEA的临床资料进行总结。结果：经术后分别观察6h、12h、24h和48h各时间段的镇痛效果，根据视觉模拟评定法（VAS）评分＋BCS（Bruggrmann comfort scale）舒适评分评定镇痛效果，优35例、良6例、欠佳1例、无效0例，优良率97．62％。结论：PCEA应用于腹部部手术后的疼痛能有效抑制手术后疼痛刺激的传入，调控内分泌功能状态，还可以显著减轻患者的精神负担，提前功能活动，有利于病人的康复。     

Scientific bases of acupuncture analgesia

The present paper was to review the physiological bases of acupuncture analgesia (AA) on normal subjects, patients, and animals. Effect of acupuncture on pain perception in normal subjects was studied and compared with sham acupuncture. It was shown that the analgesic effect of acupuncture has its physiological basis. Using neurophysiological, neuropharmacological, neurobiochemical and neuromorphological methods, the neurohumoral mechanism of AA was studied from the peripheral neural pathway of acupuncture sensation (De-Qi sensation in Chinese traditional medicine) to the central neuromodulatory effect of AA. It was indicated that needling of acupuncture point could activate the afferent fibers of peripheral nerves to elicit De-Qi sensation, then ascended mainly through the ventro-lateral funiculi, which conducted pain and temperature sensation upward to the brain, activated the antinociceptive system including certain brain nuclei. modulators (opioid peptides), neurotransmitters, through the descending inhibitory pathway resulting in analgesia. Especially the clinical and laboratory results indicated that the endogenous opiate peptides (EOP) participated in AA from the presynaptic level to the receptor sites, which provided a scientific basis for understanding the mechanism of AA. Substantial evidences have been accumulated that acupuncture has prominent analgesic effect; but it fails to give sufficient analgesia during operation. Some effective measures to improve the therapeutic effect of acupuncture, such as the combination of acupuncture with drugs, the selection of suitable EA parameters and optimal time spacing should be adopted.     

Central neurotransmitters and acupuncture analgesia

The role played by central neurotransmitters in acupuncture analgesia was evaluated by correlating neurochemical changes in central nervous system with the acupuncture effect, as well as modification of the acupuncture effects by pharmacological manipulations of central neurotransmitters. The results of experimental studies which were performed mainly on rats and rabbits indicated that central serotonin and endogenous opiate-like substances (OLS) seem to be the most important substrates for mediation of acupuncture analgesia while central catecholamines, especially norepinephrine through alpha receptors, may exert an antagonistic effect. It was also found that prolonged and repeated acupuncture resulted in a gradual decrease of the acupuncture effects. The development of some endogenous anti-opiate substrates (AOS) in central nervous system was tentatively implicated.     

针刺镇痛机制的多样性及问题分析

从针刺镇痛神经机制(神经生理学、神经化学、神经解剖学)及非神经机制(结缔组织、局部生化改变)等方面,对复杂、多样的针刺镇痛机制进行总结,对多样性机制个体的不足之处、多样性机制间的矛盾之处及其原因进行初步分析,并提出了相应的建议.     

针刺镇痛在肠镜检查中的应用

目的:评估针刺镇痛在减轻患者肠镜检查中不适的效果。方法:将80例门诊结肠镜检查患者随机分为电针组和对照组各40例。电针组在镜检前30min于右侧足三里、上巨虚,左侧阴陵泉、三阴交以电针刺激持续至镜检结束,同时针刺合谷;对照组不予任何防治措施。连续监测患者血压、心率的变化;分别观察两组患者结肠镜插镜时,过乙状结肠、脾区、肝区时的疼痛级别;记录插镜至回盲部时间、术后不良反应以及检查后患者满意度。结果:80例患者全部完成了肠镜检查,电针组患者在结肠镜插镜时、过乙状结肠以及脾区时其疼痛评分显著低于对照组(P<0.01);同时电针组患者插镜至回盲部的时间为(9.58±3.86)min,亦显著快于对照组的(12.96±6.4)min(P<0.05);电针组患者术后满意度亦显著高于对照组(P<0.05)。2组患者血压、心率并无显著差异。结论:针刺镇痛能够有效地缓解患者结肠镜检查的不适感,同时缩短肠镜检查时间,患者满意度高。     

Electroacupuncture analgesia for surgery in cattle

To establish the proper analgesic method by electroacupuncture (EA) for bovine surgery, the analgesic effect of dorsal and lumbar acupoints, in addition to the combination with dorsal and lumbar acupoints, were investigated in the present study. Four Korean native cattle (two males and two females) and 24 Holstein-Friesian cattle (all females) were used. The experimental animals were divided into four groups according to used acupoints: dorsal acupoint group (Tian Ping [GV-20] and Bai Hui [GV-5]: 7 heads), lumbar acupoint group (Yap Pang 1 [BL-21], Yao Pang 2 [BL-23], Yao Pang 3 [BL-24] and Yao Pang 4 [BL-25]; 5 heads), dorsal-lumbar acupoint group (Yao Pang 1 [BL-21], Yao Pang 2 [BL-23], Yao Pang 3 [BL-24] and Bai Hui [GV-5]; 8 heads) and control group (non-acupoints, the last intercostals space and the femoral area; 3 heads). The acupoints were stimulated with currents of 2-6 V (30 Hz) in dorsal acupoint group, 0.5-2.0 V (30 Hz) in lumbar acupoint group and 0.3-2.5 V (30 Hz) in dorsal-lumbar acupoint group. Recumbency time was 10 seconds to 1 minute (except one case) and induction time of analgesia was approximately 1 to 6 minutes in dorsal acupoint group. Analgesic effect was systemic, including the extremities in dorsal acupoint group. During the EA, the consciousness was evident and blepharo-reaction was still present under EA in dorsal acupoint group. During the surgery, grades of analgesic effect were 6 excellent (6/7, 87.5%) and 1 good (1/7, 14.3%). In addition, induction time for analgesia was about 10 minutes in both lumbar and dorsal-lumbar acupoint groups. Analgesic areas were found in abdominal areas from the last intercostal spaces to the femoral areas, except lower abdomen in lumbar and lumbar-dorsal acupoint groups. The consciousness was evident and standing position was maintained during EA stimulation in contrast to that of dorsal excellent (1/5, 20.0%), 3 good (3/5, 60.0%) and 1 poor (1/5, 20.0%) in the lumbar acupoint group. Additionally, grades of analgesic effect were 4 excellent (4/8, 50.0%), 3 good (3/8, 37.5%) and 1 poor (1/8, 12.5%). On the other hand, pain was present and analgesia was not accomplished under EA stimulation in control group. In conclusion, analgesia by EA was effective with decreasing order of dorsal acupoint > dorsal-lumbar acupoint > lumbar acupoint among groups. It was considered that dorsal acupoint group might be useful for operation with recumbent position, and lumbar and dorsal-lumbar acupoint groups might be proper for operation with standing position.     

Effects of promethazine on acupuncture analgesia

Promethazine, one of histaminergic H1-receptor antagonist, was often used as an adjuvant drug prior to and during acupuncture anesthesia in clinics, However, its effects was not known clearly. By using potassium iontophoretic dolorimetry and stimulating unilateral "Hegu" and "Waiguan" points with electroacupuncture (EA) in 42 rabbits, we found that Promethazine could drop the pain threshold in small dosages (0.5 mg/kg, 1 mg/kg) and raise the pain threshold in relatively large dosages (2 mg/kg, 4 mg/kg). In different dosages (1 mg/kg, 2 mg/kg), promethazine could attenuate the analgesic effect of EA. It was suggested that promethazine should be used carefully in acupuncture anaesthesia.     

针刺镇痛机制的探讨

针刺镇痛涉及整个神经系统各部的功能,脊髓是初步对针刺镇痛处理、译释的第一站;脑干是针刺镇痛信息整理、辨析、激发、综合、承上启下的中继站,对针刺镇痛起到重要作用;丘脑部分对各种信息的复杂分析,综合调整,有多种神经体液参与,是加强针刺镇痛和控制镇痛的协调中枢;边缘系统及其核团和多种神经介质参与,对针刺镇痛起到协调作用;大脑皮层是最高中枢,对针刺镇痛不单是兴奋和抑制过程,而且是一个复杂的调整、指挥中枢,既能加强镇痛,又能抑制其太过,起到保持动态平衡的作用。