右美托咪定腰硬联合麻醉在新式剖宫产术患者中的效果观察及对产后出血及泌乳的影响

目的:研究和探讨右美托咪定腰硬联合麻醉在新式刮宫产术患者中的应用效果。方法:以我院2014年8月至2016年8月收治的142例新式剖宫产患者为研究对象,对其进行随机分组,研究者71例采用右美托咪定腰硬联合麻醉,对照组71例采用罗哌卡因麻醉。对两组患者VAS等级评定镇痛有效率、产后出血情况及产妇泌乳情况进行比较分析。结果:采用右美托咪定腰硬联合麻醉的研究组麻醉镇痛有效率为100%,高于对照组的90.14%。对照组患者出现7例产后出血,研究组患者未见产后出血。研究组患者产后24 h内泌乳27例,高于对照组的7例,组间差异具有统计学意义(P0.05)。结论:右美托咪定腰硬联合麻醉用于新式剖宫产效果优于罗哌卡因麻醉,且母乳喂养的成功率较高,无明显不利反应,可在临床推广使用。     

罗哌卡因复合舒芬太尼用于产妇自控硬膜外分娩镇痛的效果及对血浆催乳素的影响

目的:探讨罗哌卡因复合舒芬太尼用于产妇自控硬膜外分娩镇痛的效果及对血浆泌乳素的影响。方法:选择在我院分娩的产妇80例,随机分为观察组和对照组。两组产妇均为足月初产妇,观察组产妇接受罗哌卡因复合舒芬太尼自控硬膜外分娩镇痛,对照组产妇拒绝接受分娩镇痛。观察并比较两组产妇第一产程(T_1),第二产程(T_2)、第三产程(T_3)时的疼痛情况,同时观察产妇的最终分娩方式及不良反应,并在产前及产后48h检测血浆催乳素浓度,探讨自控镇痛对血浆泌乳素分泌的影响。结果:观察组各产程VAS评分均低于对照组(P0.05);产后48h,两组产妇血浆催乳素浓度均较产前升高(P0.05),且观察组升高幅度大于对照组(P0.05);观察组阴道分娩例数多于对照组(P0.05);两组不良反应发生率比较无统计学差异(P0.05)。结论:罗哌卡因复合舒芬太尼硬膜外自控镇痛能有效缓解产妇各产程的疼痛,减少分娩疼痛对于血浆催乳素的影响,减少阴道助产及剖宫产的发生,不良反应少,是一种安全有效的分娩镇痛方式。     

不同浓度罗哌卡因程序化间断硬膜外给药在分娩镇痛中的应用观察

目的观察不同浓度罗哌卡因程序化间断硬膜外给药(PIEB)在分娩镇痛中的应用效果及安全性。方法选取2018年1月至2019年1月廊坊市第四人民医院接收的240例硬膜外分娩镇痛初产妇作为研究对象。随机分为A组、B组、C组,每组80例。两组均实施PIEB+硬膜外自控镇痛(PCEA)模式。A组药物配方为0.075%罗哌卡因+0.5μg·mL~(-1)舒芬太尼;B组药物配方为0.1%罗哌卡因+0.5μg·mL~(-1)舒芬太尼。C组药物配方为0.05%罗哌卡因+0.5μg·mL~(-1)舒芬太尼。观察三组产妇硬膜外分娩镇痛前即刻(T_0)、镇痛后1h(T_1)、镇痛后2h(T_2)、镇痛后3h(T_3)、镇痛后4h(T_4)、镇痛后5h(T_5)、分娩即刻(T_6)和分娩后1h(T_7)时视觉模拟疼痛评分法(VAS)评分、硬膜外胸椎阻滞平面及体温。比较2组下肢运动阻滞程度、单侧阻滞例数、产间发热例数、胎心率、出血量、新生儿Apgar评分、镇痛时间、产程时间、罗哌卡因和舒芬太尼用量、PCEA按压次数、催产素使用例数、分娩方式、新生儿体重、产妇满意度。结果三组T_1～T_7时VAS评分均低于T_(0 ),差异具有统计学意义(P0.05),T_4～T_7时体温高于T_0,差异具有统计学意义(P0.05),A组、C组T_4、T_5时体温低于B组,差异具有统计学意义(P0.05)。A组产间发热率低于B组,差异具有统计学意义(P0.05)。三组改良Bromage评分、单侧阻滞、胎心率、出血量、新生儿Apgar评分等指标差异无统计学意义(P0.05)。A组、C组PCEA按压次数多于B组,差异具有统计学意义(P0.05),C组舒芬太尼用量多于A组、B组,差异具有统计学意义(P0.05)。3组镇痛时间、产程时间、罗哌卡因用量差异无统计学意义(P0.05)。A组产妇满意度高于B组及C组,差异具有统计学意义(P0.05)。3组催产素使用例数、分娩方式、新生儿体重差异无统计学意义(P0.05)。结论与0.1%、0.05%罗哌卡因复合0.5μg·mL~(-1)舒芬太尼相比,0.075%罗哌卡因复合0.5μg·mL~(-1)舒芬太尼行PIEB+PCEA模式分娩镇痛,效果确切,安全性和产妇满意度更高,是一种更合理的给药方式。     

舒芬太尼复合不同浓度罗哌卡因硬膜外阻滞在产程潜伏期阶梯式分娩镇痛中的效果观察

目的探讨舒芬太尼复合不同浓度罗哌卡因硬膜外阻滞在产程潜伏期阶梯式分娩镇痛中的效果观察。方法选取2015年4月5日至2016年4月5日在成都市金牛区人民医(成都市脑外伤抢救中心)分娩的92例初产妇作为研究对象。采用随机数表法将患者分为两个组,每组各46例。对照组给予0.125%罗哌卡因加上0.45μg/ml舒芬太尼进行镇痛;观察组根据产妇宫口扩张情况进行相应镇痛:≥3cm时用药方案同对照组,3cm时给予0.075%罗哌卡因+0.45μg/ml舒芬太尼。观察对比两组产妇镇痛前后视觉模拟评分(VAS)、下肢运动阻滞评分(Bromage评分)以及新生儿评分(Apgar评分);比较两组产妇潜伏期、活跃期时间以及产后出血量;比较两组产妇不良反应发生率情况。结果痛前,两组患者的VAS比较,差异无统计学意义(P0.05);镇痛后,两组患者的VAS与镇痛前相比均有显著下降,差异具有统计学意义(P0.05),两组镇痛后比较差异无统计学意义(P0.05)。观察组潜伏期(368.8±79.3)min明显少于对照组(409.3±80.9)min,两组差异比较具有统计学意义(P0.05);两组活跃期、第一产程、第二产程时间比较,差异均无统计学意义(P0.05);观察组出血量(146.5±38.3)ml明显低于对照组(178.5±45.3)ml,两组差异比较具有统计学意义(P0.05)。观察组Bromage评分0分占(21.7%)高于对照组(6.5%),观察组Bromage评分2分占(8.7%)低于对照组(32.6%),两组比较差异具有统计学意义(P0.05);两组Bromage评分中1分的比例差异无统计学意义(P0.05)。两组新生儿的Apgar评分比较,差异无统计学意义(P0.05)。两组产妇不良反应发生率比较,差异无统计学意义(P0.05)。结论产程潜伏期应用0.075%+0.45μg/ml舒芬太尼,活跃期应用0.125%罗哌卡因+0.45μg/ml舒芬太尼,镇痛效果良好,产程影响小,产后的出血量相对较少,对产妇运动阻滞以及新生儿影响都很小,是比较理想的分娩镇痛方式,值得临床推广应用。     

舒芬太尼复合罗哌卡因椎管内分娩镇痛对减少产后性功能障碍作用

目的:探讨舒芬太尼复合罗哌卡因用于连续硬膜外阻滞(CEA)与腰硬联合阻滞(CSEA)分娩镇痛对减少产后性功能障碍的作用。方法:选取本院正常足月妊娠、头胎、要求阴道分娩的产妇86例,随机分为A组、B组、C组,A组为CEA组,B组为CSEA组,C组为未进行无痛分娩的产妇,分别记录并分析所有产妇产后3个月、6个月、9个月的性功能评分(FSFI)。结果:产后3个月A组、B组、C组FSFI总分分别为(24.82±3.21)分、(26.95±2.87)分、(28.65±3.92)分,产后6个月A组、B组、C组FSFI总分分别为(27.85±3.80)分、(31.19±3.69)分、(31.70±4.12)分,三组产妇的性交疼痛、性高潮、性满意度及总分具有统计学差异(P0.05)。产后9个月A组、B组、C组FSFI总分分别为(36.15±2.97)分、(36.19±2.96)分、(36.37±3.35)分,总分及各项评分差异不具有统计学意义(P0.05)。结论:三组方式相比,顺产对产妇产后性功能水平恢复影响最小,其次为腰硬联合阻滞(CSEA)麻醉的无痛分娩,相对于连续硬膜外阻滞(CEA)能显著减少产后性功能障碍。     

TAPB联合剖宫产术后应用舒芬太尼静脉自控镇痛对产妇应激反应和舒适度的影响

目的超声引导下腹横肌平面阻滞(TAPB)联合剖宫产术后应用舒芬太尼静脉自控镇痛(PCIA)对产妇镇痛镇静以及舒适度的影响。方法选取2019年1月至6月唐山市妇幼保健院拟行择期剖宫产手术的78例足月初产妇作为研究对象。依据双盲随机原则分成观察组(n=39)和对照组两组(n=39)。观察组产妇术后使用TAPB(0.375%罗哌卡因20mL)联合PCIA[舒芬太尼0.05μg/(kg·h)]镇痛,对照组产妇术后只采用PCIA。分别使用舒适度评分量表(BCS)、视觉模拟评分(VAS)以及Ramsay镇静量表评估两组产妇术后4h、12h、24h和48h的舒适度、镇静镇痛效果;比较两组产妇舒芬太尼用量和不良反应情况。结果观察组产妇术后各时间点VAS评分、Ramsay评分均显著低于对照组产妇,BCS评分高于对照组产妇,组间差异具有统计学意义(P0.05);观察组产妇舒芬太尼用量少于对照组产妇,差异具有统计学意义(P0.05);两组产妇不良反应发生率差异无统计学意义(P0.05)。结论超声引导下腹横肌平面阻滞联合剖宫产术后静脉自控镇痛能够减少阿片类药物使用剂量,缓解手术创伤造成的生理应激反应,提升产妇舒适度。     

罗哌卡因单用或联合舒芬太尼硬膜外给药用于分娩镇痛对比观察

目的观察罗哌卡因单独或联合舒芬太尼硬膜外给药用于分娩镇痛的临床效果。方法选取2016年1月至2018年3月廊坊市第四人民医院诊治的192例单胎、头位、要求分娩镇痛初产妇作为研究对象。将其随机分为观察组和对照组,每组96例产妇。观察组孕妇以0.125%罗哌卡因,对照组孕妇以0.09%罗哌卡因配伍0.3μg/ml舒芬太尼的配方,行硬膜外分娩镇痛。采用数字评分法(NRS)和视觉模拟评分法(VAS)进行第一产程和第二产程分娩疼痛强度评定。采用Bromage评分评定运动神经阻滞程度。记录镇痛相关不良反应发生情况以及胎儿脐带血血气分析指标和Apgar评分。结果两组孕妇镇痛前即刻NRS评分[9.1(8.6～10.0)vs9.0(8.3～10.0)]、第二产程NRS评分[4.3(3.9～5.6) vs 4.4(4.0～6.2)]及第一产程[9(8～10) vs 10(9～10)]、第二产程[8(7～10) vs 9(8～10)]VAS镇痛满意度评分差异不显著(P0.05)。组内比较,两组第二产程NRS评分均高于第一产程[4.3(3.9～5.6)vs 2.1(1.7～3.1),4.4(4.0～6.2)vs2.5(1.9～3.9)],差异具有统计学意义(P0.01)。观察组第一产程NRS评分高于对照组[2.5(1.9～3.9)vs2.1(1.7～3.1)],差异具有统计学意义(P0.05)。观察组Bromage评分0分所占比例高于对照组[9(9.38)vs 2(2.08)],1分所占比例低于对照组[87(90.62)vs 94(97.92)],组间比较差异具有统计学意义P0.05)。观察组孕妇各种不良反应发生率均低于对照组孕妇,其差异无统计学意义(P0.05)。两组胎儿脐带血PaO_2、PaCO_2、HCO~(3-)、碱剩余、pH值、血乳酸等血气指标比较差异无统计学意义(P0.05)。观察组胎儿1 min Apgar评分≤7分所占比例明显低于对照组[1(1.04) vs 8(8.33)],组间比较差异具有统计学意义(P0.05)。结论与罗哌卡因复合舒芬太尼比较,罗哌卡因单独应用于硬膜外分娩镇痛的效果更为显著,且对母胎的影响更小。     

针刺合谷穴、腕踝穴配合连续硬膜外药物镇痛在剖宫产镇痛中的应用研究

目的 探讨针刺合谷穴、腕踝穴配合连续硬膜外药物镇痛在剖宫产镇痛中的作用。方法 选取南京市浦口区中医院2019年5月至2022年5月收治的240例剖宫产初产妇作为研究对象。采用随机数字表法分为A组、B组、C组和对照组,各60例。在剖宫产手术麻醉中,对照组采用常规0.15%罗哌卡因,A组予以针刺合谷穴、腕踝穴配合0.08%罗哌卡因,B组予以针刺合谷穴、腕踝穴配合0.12%罗哌卡因,C组予以针刺合谷穴、腕踝穴配合0.15%罗哌卡因。比较四组麻醉效果及不良反应。结果 B组、C组手术10 min、手术结束时、术后2 h疼痛评分均低于A组、对照组(P<0.05);B组、C组麻醉满意率均高于A组、对照组(P<0.05);A组、B组不良反应发生率均低于C组、对照组(P<0.05)。结论 针刺合谷穴、腕踝穴配合连续硬膜外麻醉可减轻剖宫产疼痛,在降低罗哌卡因浓度的同时还可增强麻醉效果,且安全。     

高龄前列腺增生患者经尿道电切汽化术的麻醉效果分析

目的：探讨舒芬太尼复合罗哌卡因硬膜外麻醉用于前列腺经尿道电切汽化术的临床效果。方法：选择62～88岁经尿道前列腺汽化电切术患者150例,随机均分为不同的三组,给与不同剂量的舒芬太尼复合罗哌卡因进行麻醉,监测麻醉期间60min内的血流变化,评价麻醉效果,统计不良反应的发生情况。结果：小剂量舒芬太尼复合罗哌卡因的起效时间和维持时间均明显高于单独给与罗哌卡因组,三组之间不良反应数量和血流动力学变化均没有差异。结论：经尿道前列腺汽化电切术硬膜外麻醉小剂量舒芬太尼复合罗哌卡因的麻醉效果比单纯应用局麻药罗哌卡因效果较好。     

剖宫产相关并发症对产妇生殖健康及性功能影响的临床研究

目的:探讨剖宫产相关并发症对产妇生殖健康及性功能影响性。方法:选取2011年6月至2015年5月共149例剖宫产产妇为研究对象,按是否出现相关并发症分成两组,对照组无并发症,76例,研究组出现相关并发症,73例,均采用问卷调查方式,观察不同时间两组在性功能指标和生殖健康指标变化情况。结果:研究组生产3个月、6个月性功能指数为(20.97±2.11)分、(22.11±2.65)分,显著低于对照组(23.56±2.35)分、(25.97±3.12)分,两组比较差异显著(P0.05);研究组3个月、6个月性生活频率远少于孕前为63.01%、49.32%,对照组为50%、38.16%,性生活恢复上研究组3个月、6个月比率为58.9%、78.08%,远低于对照组77.63%、89.47%,两组比较差异显著(P0.05),而以上指标产后9个月后比较差异不显著(P0.05);生产半年后研究组在社会功能、物质生活、心理功能、躯体功能总分上显著低于对照组,两组比较差异显著(P0.05)。结论:剖宫产相关并发症在9个月内产妇生殖健康及性功能影响性大,9个月后则无明显影响性。     

Comparison of topical anesthesia and subcutaneous infiltration anesthesia with regard to effect of plasma skin regeneration system

The plasma skin regeneration (PSR) system is a safe device for skin regeneration, which is usually carried out under local anesthetic to control the pain. Topical anesthesia and subcutaneous infiltration anesthesia are the common and safe anesthetizations. This study was undertaken to evaluate the effects of PSR after using topical anesthetization as compared with subcutaneous infiltration anesthesia, thereby inquiring into the effect of subcutaneous infiltration anesthesia in PSR and increasing electivity for clinical work. 14 Sprague Dawley rats were randomly utilized in this experiment. After adequate sedation and depilation, the rat's back was randomly divided into three experimental regions marked as A, B, and C. A and B were treated with lidocaine cream and lidocaine hydrochloride, respectively, before PSR. C was treated solely with PSR without any anesthesia. Biopsies were taken from all treatment sites at 4 and 30 days after treatment to observe the skin necrosis and thickness of new collagen fiber. Histopathologic examination was performed by observers blinded to the treatment conditions. In this analysis, there was a statistically significant reduction (P < 0.01) in the skin necrosis and thickness of new collagen fiber in the topical anesthesia group compared with that in the other two groups, while a statistically significant increase (P < 0.01) in the subcutaneous infiltration anesthesia group. The results suggest that subcutaneous infiltration anesthesia group showed a deeper range of tissue effects via the treatment of PSR as compared with the topical anesthesia and the control groups. Meanwhile, the effect of the topical anesthesia was the lowest. So we conclude that subcutaneous infiltration anesthesia for PSR treatment was superior to that of the topical anesthesia.     

Local anesthesia in dermatology

Local and regional anesthetic procedures are an integral part of daily dermatological practice. Safe and effective analgesia in skin and soft tissues is crucial for otherwise painful diagnostic or therapeutic interventions. Tumescent local anesthesia allows for pain‐free interventions that previously had to be done by using general anesthesia. Older patients with multiple co‐morbidities are especially suited for local anesthetic procedures, because they may significantly reduce surgical risks. For dermatologists, the knowledge of mode of action and toxicity of local anesthetics, as well as the emergency management of their potential complications, is essential.     

Buzzing away the pain: Using an electric toothbrush for vibration anesthesia during painful procedures

Many dermatologic procedures are painful and traumatic, for both pediatric patients and providers alike. Vibration anesthesia has recently been discussed as an effective method for reducing pain associated with injections, but some vibration machines can be cost prohibitive for providers. We describe how to employ an electric toothbrush as an inexpensive and effective option to provide vibration anesthesia during painful pediatric procedures.     

Estimated beginning time of local anesthesia effectiveness in forced cold air application: A preliminary study

Background: The literature has reported that forced cold air anesthesia decreases the discomfort effect of various laser therapies. The aim of this preliminary study was to determine the average beginning time of the local anesthetic effect of the forced cold air application when it is applied to all body surfaces except the face. Materials and methods: A total of 52 participants (26 females and 26 males) were included in this study. During application of the forced cold air, the beginning time of local anesthesia effectiveness for each volunteer was determined by giving painful stimuli. The results were then analyzed statistically. Results: The mean beginning time value of the local anesthesia was 52.88 (ranging between 30 and 60) seconds in the female group and 56.34 (ranging between 30 and 60) seconds in the male group. The mean beginning time value of the local anesthesia was 54.61 (ranging between 30 and 60) seconds in both genders. There was no statistical difference between the two groups (Z = ? 0.834, p = 0.404). Conclusion: Forced cold air anesthesia—which is a quick, safe, cost-effective, and practical local anesthesia method—seems to be useful and effective when used alone in laser treatment.     

有针麻醉与无针麻醉在小儿包皮环切术中的对比研究

目的:探讨无针麻醉与有针麻醉运用盐酸利多卡因在小儿包皮环切术中的对比分析。方法:选择2012年11月至2013年8月在本院择期行包皮环切术的患儿60例,随机分成两组,每组各30例,对照组给予有针麻醉应用1%盐酸利多卡因后行包皮环切术,治疗组给予无针麻醉运用1%盐酸利多卡因后行包皮环切术,两组均采用传统包皮环切手术方法,采用视觉模拟疼痛评分方法(VAS)对疼痛进行评分,比较两组患儿的麻醉起效时间、麻醉维持时间、VAS、手术时间、术后水肿情况及术后1周切口愈合程度。结果:两组患儿VAS评分、麻醉起效时间、麻醉剂量差异有统计学意义(P0.05);两组手术时间、麻醉维持时间差异无统计学意义(P0.05);治疗组术后水肿情况及1周切口愈合程度显著优于对照组,两组差异有统计学意义(P0.05)。结论:无针麻醉运用盐酸利多卡因应用于小儿包皮环切术麻醉效果好,患儿耐受性好,有效缩短了手术时间,且术后恢复快,值得在基层医院推广使用。     

Comparison of flow rate accuracy and consistency between the on-Q,baxter, and ambu pain infusion devices

AIM: Providing analgesia via peripheral nerve catheters attached to an infusion pump is an effective pain management option in children.METHODS: Portable infusion pumps are being used with increased frequency in pediatric patients. Because these pumps are infusing potentially toxic doses of medications, the accuracy and consistency of these devices becomes very important in this patient population. This study is a comparison of the actual delivery volume of local anesthetic of three elastomeric infusion devices approved for patient use in the ambulatory setting. Three brands of disposable elastomeric infusion devices were used(Five On-Q, Five Baxter, and Five Ambu pumps). Each was filled with 200 m L of Ropivicaine 0.1% and connected to a single, end hole infusion catheter and set to infuse at 12 m L/h. The devices were run simultaneously. The fluid delivered was measured every hour with a graduated column over a tenhour period. The ambient temperature was also recorded.RESULTS: There were statistically significant differences in the output from each elastomeric device over the 10 h infusion period when compared to the nominal rate of 12 m L/h. The output from the Ambu and Baxter pumps was less than that set on the regulator, while the output from the On-Q pump was greater than that set on the regulator. The results remained statistically significant after adjusting the nominal rate to correct for differences in temperature. The Ambu infusion device was the most consistent, while the Baxter infusion device was the most accurate. This emphasizes the importance of health care providers understanding the infusion profile of the pump being used for continuous peripheral nerve block, as these alterations in flow could result in inadequate analgesia, early reservoir exhaustion, excessive muscle weakness or potential toxicity, especially when used in pediatric patients.CONCLUSION: This investigation demonstrates that three modern elastomeric infusion pumps have significantly different output than the nominal rate set on the regulator.     

The evidence for reducing the pain of administration of local anesthesia and cosmetic injectables

Administration of injections, whether local anesthetic or cosmetic injectable, can result in significant distress and discomfort to patients. This review explores factors that can alleviate anxiety and pain associated with injections including cosmetic injectables. We highlight that many techniques used to reduce pain have only been reported based on anecdotal evidence and small series. The techniques that have been reported to reduce pain, by randomized controlled trials, include pretreatment with topical local anesthetic agents and combined cosmetic injectables with local anesthetics.     

Anaesthesia and pancreatic surgery:Techniques,clinical practice and pain management

Pancreatic cancer continues to pose a major public health concern. The incidence of the disease is nearly equivalent to the death rate associated with the diagnosis of pancreatic cancer. Thus, there exists a need for continued improvement in the diagnostic, therapeutic and palliative care of these patients. There have been significant advances made over the years in the areas of critical care, anesthesia, and surgical technique, which have led to improved mortality rates and survival after resection for pancreatic cancer. Resections are performed with the goals of negative margins and minimal blood loss and referral to high-volume centers and surgeons is encouraged. However, 5-year survival rate after curative resection still remains at less than 20%. Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist and the intensive care team. Major morbidity is often secondary to pancreatic anastomotic leakage and fistula or infection. The anesthesiologist plays a crucial role in the perioperative management of such patients and in the pain control. Pancreatic ductal adenocarcinoma has a high rate of neural invasion(80%-100%) and can be associated with moderate to severe pain. In the recent past, new information has emerged on many issues including preoperative biliary drainage, nutritional support, cardiovascular assessment, perioperative fluid therapy and hemodynamic optimization. Careful patient selection and appropriate preoperative evaluation can greatly contribute to a favorable outcome after major pancreatic resections.