腰麻-硬膜外联合阻滞与单纯硬膜外麻醉效果的比较

本研究观察了腰麻硬膜外阻滞麻醉的效果及安全性,并与单纯硬膜外麻醉进行了对比。资料和方法　择期行下腹及下肢手术患者４０例,随机分成腰麻硬膜外联合阻滞组（联合组）和单纯硬膜外阻滞组（单纯组）,每组２０例。穿刺间隙选择Ｌ２～３或Ｌ３～４,硬膜外穿刺成功后联合组用腰麻针刺破硬膜,回吸有脑脊液流出后注入重比重的卡因溶液１．５～２．５ｍｌ,退出腰麻针,向头侧置硬膜外导管２．５ｃｍ备用,如腰麻平面不够或麻醉效果减退及时硬膜外注入２％利多卡因５ｍｌ。单纯组用药为利多卡因和的卡因合剂。观察麻醉起效时间、阻滞完…     

硬膜外注射氯丙嗪和利多卡因用于术后镇痛

硬膜外注射氯丙嗪和利多卡因用于术后镇痛杨华，宋言珠（菏泽地区人民医院，２７４０３１）本文观察了１００例硬膜外阻滞的手术病人，于手术结束前５～１０ｍｉｎ，经硬外导管一次注入氯丙嗪２５ｍｇ和利多卡因２０ｍｇ混合液２ｍｌ术后镇痛的临床作用。注药后病人出现安...     

硬脊膜外麻醉后严重头痛1例报告

１　病历报告患者，女，４６岁，因子宫肌瘤并发失血性贫血行子宫全切＋右侧附件切除术。既往、术前均无头痛史。术前常规苯巴比妥钠０．２ｇ、阿托品０．５ｍｇ肌注。选择Ｔ１２～Ｌ１椎间隙直入法行硬膜外穿刺，成功后针尖斜面向头端，注入２％利多卡因５ｍｌ（含１∶２０００００肾上腺素），随即向尾侧顺利置入硬膜外导管３ｃｍ，改平卧位。５ｍｉｎ后无腰麻现象，注入上述药液８ｍｌ，麻醉平面Ｔ８～Ｓ５。术中追加用药２次，总量２５ｍｌ，术中血压、脉搏平稳，麻醉效果满意。术毕拔出硬膜外导管时有阻力，取屈曲弓背位后拔出，术后第…     

氯胺酮对吧啡术后硬膜外镇痛效应的影响

目的：研究氯胺酮对术后吧啡硬膜外镇痛效应的影响。方法：４０例硬膜外麻醉下行妇产科手术病人,按双盲法分为两组,Ｍ组（ｎ＝２０）：吗啡０．２５ｍｇ／ｍｌ＋肾上腺素４μｇ／ｍｌ＋布比卡因１．５ｍｇ／μｇ＋胃复安０．５ｍｇ／ｍｌ共６０ｍｌ,ＭＫ组（ｎ＝２０）：氯胺酮０．４μｇ／ｍｌ＋吗啡０．２５ｍｇ／ｍｌ＋肾上腺素４μｇ／ｍｌ＋布比卡因１．５ｍｇ／ｍｌ＋胃复安０．５ｍｇ／ｍｌ共６０ｍｌ。于镇痛治疗３、６、     

子宫颈癌根治术异丙酚辅助硬膜外麻醉临床观察

本组２０例子宫颈癌根治术病人（ＡＳＡ１～２）手术时间（１６０±２０５）ｍｉｎ，硬膜外麻醉选择Ｔ１２Ｌ１椎间隙穿刺，局麻药用１３３％利多卡因加０１６％地卡因混合液，试验量５ｍｌ，切皮前将麻醉平面调节为Ｔ４～Ｔ６至Ｌ５～Ｓ５（１２～１８ｍｌ），每间隔４５ｍｉｎ追加５ｍｌ。切皮前１ｍｉｎ静注异丙酚１ｍｇ／ｋｇ，静脉滴注每小时１０～３７ｍｇ／ｋｇ。结果表明，在注药后１～３ｍｉｎ，潮气量、血氧饱和度、血压和心率明显降低（Ｐ＜００５），其后逐渐恢复注药前水平。停药后唤醒时间和语言能力恢复时间较快。我们认为，静脉异丙酚辅助硬膜外麻醉能消除硬膜外阻滞不全所致的不适感和疼痛，对呼吸和循环抑制较小，尤其在面罩吸氧情况下更为安全可靠     

硬膜外试验量产生广泛阻滞4例

硬膜外试验量产生广泛阻滞４例王建（青岛市第三人民医院麻醉科山东青岛２６６０４１）１９８８年～１９９７年间，我们在硬膜外麻醉中，常规试验剂量注入１．５％～２％利多卡因４～５ｍｌ产生广泛神经阻滞４例，报告如下。１临床资料４例患者均常规硬膜外穿刺，置管顺利...     

碱化利多卡因硬膜外麻醉的临床研究

５０例ＡＳＡ－Ⅰ，Ⅱ级行腰段硬膜外麻醉病人按先后顺序随机分为碱化组和非碱化组，每组２５例，分别注射ｐＨ７．１９和ＰＨ４．９７的１．７％利多卡因２０ｍｌ，动态测记阻滞情况；其中每组随机取６例病人桡动脉穿刺置管，分利于硬膜外注药５．６７ｍｇ·ｋｇ－１后５，１０，１５、２０和４０ｍｉｎ各取血２ｍｌ，测定血中利多卡因浓度。结果：碱化组阻滞显效时间和平面固定时间显著缩短（Ｐ＜０．００１），镇痛完善率和下肢肌松显著提高（Ｐ＜０．００１．Ｐ＜０．０５），加药时间延长（Ｐ＜０．００１）；血中药物峰值时间（９．１７ｍｉｎ）较非碱化组（１４．１７ｍｉｎ）显著提前（Ｐ＜０．０１），但各时间之血药浓度组间均无明显差异（Ｐ＞０．０５）。结果表明碱化能明显缩短利多卡因硬膜外麻醉诱导时间，增强效果，延长作用时间，且安全可靠。     

HPLC法同时测定人血浆中四种氟喹诺酮药物的血药浓度

研究了用ＨＰＬＣ同时测定人血浆中氧氟沙星、诺氟沙星、洛美沙星和环丙沙星血药浓度的方法。采用ＳｐｈｅｒｉｓｏｒｂＣ（１８）色谱柱（２５０ｍｍ×４．６ｍｍ，５μｍ），以甲醇－０．００８ｍｏｌ／Ｌ磷酸盐缓冲液－０．５ｍｏｌ／Ｌ四丁基溴化铵（１６：７５：１．４，ｐＨ２．６）为流动相，检测波长２８０ｎｍ，血浆样品用乙腈沉淀蛋白后进样，简便快速，回收率稳定，对氧氟沙星，诺氟沙星，洛美沙星，环丙沙星四种氟喹诺酮药物检测的线性范围分别为：０．１０～５．００μｇ／ｍｌ；０．１１～５．４０μｇ／ｍｌ；０．１３～５．００μｇ／ｍｌ；０．１０～１０．００μｇ／ｍｌ。其方法检测限为：２０ｎｇ／ｍｌ；２０ｎｇ／ｍｌ；２５ｎｇ／ｍｌ及４０ｎｇ／ｍｌ，回收率均高于８６％。应用本法观察了健康人口服氧氟沙星和环丙沙星后的血药浓度变化。     

综合治疗顽固性肱骨外上髁炎15例

我院疼痛门诊自１９９４年３月～１９９７年５月对局部阻滞疗法难以根治的１５例顽固性肱骨外上髁炎,采用局部阻滞、针刀剥离［１］、手法松解［２］三种方法综合治疗,取得了满意效果,现报告如下。１　临床资料１．１　一般资料　共１５例,男１０例,女５例。年龄３５～５５岁。病史１～３年。既往均接受过局部阻滞治疗,最少者５次,最多者１１次。均因效果不佳而行局部阻滞、针刀剥离、手法松解综合治疗。１．２　治疗方法　按以下三步进行：１．２．１　局部阻滞　药液配方为２％利多卡因４ｍｌ,利美达松１ｍｌ（含４ｍｇ）。屈肘９…     

参数与偏差范围的表示

１　数值范围：５至１０写为５～１０;３×１０３～８×１０３不能写成３～８×１０３。２　百分数范围：２０％～３０％不能写成２０～３０％。３　具有相同单位的量值范围：１．５～３．６ｍｇ不必写成１．５ｇ～３．６ｇ。４　偏差范围：（２５±１）℃不能写成２５±１℃;（８５±２）％不能写成８５±１％。参数与偏差范围的表示@吴淑芬     

Walking Epidural : An Effective Method of Labour Pain Relief

Background

Labour pain can be deleterious for mother and baby. Epidural analgesia relieves labour pains effectively with minimal maternal and foetal side effects. A prospective open label study was undertaken to ascertain effective dosing regime for walking epidural in labour.

Methods

Fifty women with singleton foetus in vertex position were included. Epidural catheter was inserted in L2-3 / L3-4 interspinous space. Initial bolus of 10 ml (0.1% bupivacaine and 0.0002% fentanyl) solution was injected and after the efficacy of block was established, an epidural infusion of the same drug solution was started at the rate of 5 ml/hour.

Results

In first stage of labour 80% of the parturient had excellent to good pain relief (visual analogue scale 1 to 3) with standard protocol while 20% parturient required one or more additional boluses. For the second stage, pain relief was good to fair (VAS 4-6) for most of the parturient. The incidence of caesarian section was 4% and 6% needed assisted delivery. No major side effects were observed.

Conclusion

0.1% bupivacaine with 0.0002% fentanyl maximizes labour pain relief and minimizes side effects.Key Words: Labour analgesia, Walking epidural     

腰麻-硬膜外联合麻醉在小儿外科手术及术后镇痛的应用

目的:观察罗哌卡因与布比卡因在小儿腰麻-硬膜外联合麻醉(combined spinal-epidural anesthesia,CSEA)麻醉的效果、术后镇痛效果和不良反应.方法:选择50例行下腹部及以下手术的患儿,年龄为6～14岁,随机分为两组:罗哌卡因Ropivacaine(R)组25例和布比卡因Bupivacaine(B)组25例,全部采用CSEA麻醉.R组注入腰麻药为:10 g*L-1罗哌卡因1.5 ml+注射用水0.5 ml+100 g*L-1葡萄糖1 ml.B组注入腰麻药物为:7.5 g*L-1布比卡因2 ml+100 g*L-1葡萄糖1 ml.两药的终末浓度皆为5 g*L-1.给药剂量按以下公式计算:药量(ml)=年龄(岁)×0. 2+体重(kg)×0.05/2.当手术超过1.5 h,开始向硬膜外腔输注局麻药物:R组为2.5 g*L-1罗哌卡因1 mg*kg-1*h-1,B组为2.5 g*L-1布比卡因1 mg*kg-1*h-1.研究中观察血压、心率、氧饱和度,麻醉平面,VAS评分,下肢运动阻滞的变化.术后两组均进行硬膜外镇痛,各为0.75 g*L-1罗哌卡因100 ml或布比卡因加入曲马朵200 mg和氟哌利多5 mg.硬膜外持续输注3 ml*h-1(6～9岁)或4 ml*h-1(10～14岁),必要时由患儿或其父母自控镇痛每次2 ml,间隔时间为15 min.观察镇痛效果、下肢运动恢复情况及术后24 h患儿恶心、呕吐、下肢麻木、头痛、尿潴留等不良反应.结果:两组麻醉平面无明显差异.术中下肢运动阻滞,R组明显弱于B组,差异有显著性.术后下肢运动阻滞消退明显快于B组,差异有显著性.在观察中两组各有1例发生恶心,术后B组有1例发生尿潴留,两组间差异无显著性.结论:CSEA用于小儿外科手术能达到满意的麻醉和术后镇痛效果.但罗哌卡因的运动阻滞明显弱于布比卡因,这有利于患儿术后早期下地活动及肠功能的恢复.     

蛛网膜下腔与硬膜外间隙联合注射乙醇治疗癌痛30例报告

目的探讨蛛网膜下腔与硬膜外间隙联合注射乙醇治疗癌痛的效果。方法30例癌痛患者在蛛网膜下腔穿刺成功后，注入乙醇达一定平面，拔出腰穿针置入硬膜外导管，再于硬膜外间隙注入同一药物，保留硬膜外导管7～10日，以便必要时重复注药，直到无痛为止。结果本组患者疼痛均有不同程度的减轻，用药后25例(83．3％)患者疼痛完全消失，4例(13．3％)疼痛明显减轻；1例(占3．4％)效果较差。结论乙醇注入蛛网膜下腔与硬膜外间隙有良好的镇痛效果，两者联合用药能升高阻滞平面，可用最小的剂量达到最大的阻滞效果，呼吸循环可保持稳定，不良反应少。     

L-4F对oxLDL刺激下脂肪细胞表达单核细胞趋化蛋白-1的影响

目的观察载脂蛋白A-I模拟肽L-4F对氧化型低密度脂蛋白(oxLDL)刺激下3T3-L1脂肪细胞分泌表达单核细胞趋化蛋白-1(MCP-1)的影响,并探讨其可能的作用机制。方法 3T3-L1脂肪细胞促分化成熟后,oxLDL(50μg/ml)刺激脂肪细胞,给予L-4F(1-50μg/ml),H-89(10μmol/L)及H-89+L-4F(50μg/ml)干预,收集细胞,测定脂肪细胞MCP-1上清液中的浓度和mRNA表达水平,以及脂肪细胞核因子C/EBPα、β的蛋白质水平;改良Boyden小室法检测不同干预组上清液对人外周血单核细胞趋化活性的影响。结果 OxLDL(50μg/ml)刺激使分化成熟的3T3-L1脂肪细胞表达及分泌MCP-1明显增加,并使得诱导的单核细胞移动距离明显增加。L-4F以浓度依赖的方式减少脂肪细胞MCP-1的表达和分泌,降低单核细胞趋化活性;50μg/ml L-4F使MCP-1 mRNA的表达降低(91±6)%(P<0.01)。PKA抑制剂H-89(10μmol/L)干预oxLDL刺激的脂肪细胞后MCP-1 m RNA的表达也显著减少(P<0.01),但是,在50μg/ml L-4F作用的基础上,H-89(10μmol/L)的孵育并未使得MCP-1 mRNA的表达进一步降低(P>0.05)。50μg/ml oxLDL刺激对脂肪细胞C/EBPα的含量无明显影响,但增加C/EBPβ蛋白量,且该作用呈时间依赖性;L-4F和H-89干预均降低C/EBPβ的蛋白质含量。结论 OxLDL时间依赖性地诱导脂肪细胞C/EBPβ的蛋白合成,并增强脂肪细胞MCP-1的表达分泌,L-4F以浓度依赖的方式对抗oxLDL的致炎作用,cAMP/PKA-C/EBPβ信号通道可能是L-4F的作用途径之一。     

经椎间孔腰椎椎体间融合术治疗单节段退变性腰椎滑脱的疗效分析

目的 比较微创经椎间孔腰椎椎体间融合术(MIS-TLIF)Wiltse入路与正中入路治疗单节段退变性腰椎滑脱的疗效。方法 单节段退变性腰椎滑脱症患者70例,随机分为Wiltse入路组(n=32)和正中入路组(n=38)。Wiltse入路组随访12~24个月,平均18.6个月;正中入路组随访12~22个月,平均16.1个月。术后3、6、12个月随访,评估JOA腰痛评分、腰痛及下肢痛VAS,行影像学检查评估椎间融合及多裂肌萎缩程度。结果 两组性别、年龄、滑脱部位、滑脱程度、JOA腰痛评分、腰痛及下肢痛视觉模拟评分(VAS)差异无统计学意义(P>0.05)。两组平均手术时间差异无统计学意义(P>0.05)。与正中入路组相比,Wiltse入路组手术切口长度小、显露时间短、显露出血量及总出血量少,差异有统计学意义(P<0.05)。术后12个月随访,两组JOA腰痛评分及各项VAS评分均较术前改善,差异有统计学意义(P<0.05);两组间JOA腰痛评分、改善率和下肢痛VAS差异无统计学意义(P>0.05)。术后12个月随访时,Wiltse入路组腰痛VAS低于正中入路组,MRI肌萎缩评分高于正中入路组,差异有统计学意义(P<0.05)。结论 两种入路TLIF治疗单节段退变性腰椎滑脱手术疗效相近,但Wiltse入路对多裂肌的损伤比后正中入路小,术后腰背痛等并发症的发生率低。     

LONG-TERM OUTCOMES OF FENESTRATED DISCECTOMY FOR LUMBAR DISC

Objective To evaluate the long-term outcomes of fenestrated discectomy for lumbar disc herniation and analyze the correlative influence factors. Methods Eighty-two cases of lumbar disc herniation, from February 1996 to May 1999, were retrospectively studied. All patients were treated with simple fenestrated discectomy. The average follow-up time was 8 years and 7 months （from 7 years tolO years and 3months）. There were 13, 38 and 31 cases at 13 - L4, L4 - L5 and L5 - S1 level, respectively. Results The average scales before operation were as following ： Japanes Orthopaedics Association （ JOA ） scale 6. 5 （ 5 - 9 ） , visual analysis scale （ VAS） of low back pain4.8 （0-8）. and VAS of sciatica 7.2 （4-10）. At the final follow-up, the above parameters were 13.2 （ 10 - 14 ）, 1.8 （0 - 10） and 1.2 （0 - 7）, respectively. The average increase ratio of JOA scale was 78. 8%. The average disc-vertebra height ratio （ Mochida method） was 80.2%. At the final follow-up, 7 cases reoccurred disc herniation. The final clinical satisfaction rate was 80% （ modified Macnab method ）. Conclusion With appropriate surgical indications, the successfid long-term outcomes could be expected with fenestrated discectomy. Discectomy improves sciatica to a greater extent than low back pain. The occurrence of low back pain is related to intervertebral disc height, segment stability, disc degeneration, and lumbar muscle disability.     

Effect of preemptive intravenous oxycodone on low-dose bupivacaine spinal anesthesia with intrathecal sufentanil

Objectives:

To evaluate the efficacy of preemptive intravenous oxycodone on low-dose bupivacaine spinal anesthesia with intrathecal sufentanil in patients undergoing transurethral resection of the prostate (TURP).

Methods:

In this randomized, double-blinded, placebo-controlled trial, 60 patients undergoing TURP were allocated into 2 groups: oxycodone group (group O, n=30) and a normal saline group (group N, n=30). Oxycodone 0.1 mg/kg, or normal saline 0.1 ml/kg was administered intravenously 10 minutes before surgical procedures in group O, or in group N. All patients received sufentanil 5 µg + bupivacaine 0.5% (0.8 ml) + normal saline 0.7 ml - in total, bupivacaine 0.25% (1.6 ml) intrathecally. Spinal block characteristics, hemodynamic values, the perioperative analgesic requirements, visual analogue scale (VAS) scores, Ramsay sedation scale, and side effects were assessed. The study was carried out at the First Hospital of Jilin University, Jilin, China between March and September 2014.

Results:

The time to 2-segment regression of sensory block, full recovery of sensory block, and first analgesic request was longer in group O. Fewer patients required postoperative analgesics, and the VAS pain scores at 4, 8, 16, and 24 hour after operation were significantly lower in group O.

Conclusion:

Preemptive intravenous oxycodone was an efficient and safe method to decrease postoperative pain and reduce tramadol analgesia in patients under low-dose dilute bupivacaine spinal anesthesia combined with intrathecal sufentanil.Intrathecal anaesthesia is preferred for transurethral resection of the prostate (TURP) for early recognition of transurethral resection syndrome. Low-dose bupivacaine with intrathecal 5 µg sufentanil can yield adequate anaesthesia with minimal hemodynamic instability for TURP.1 Most patients undergoing TURP are elderly and frequently present with cardiac or pulmonary conditions. Therefore, it is important to decrease and delay postoperative pain to reduce stress reactions, and furthermore to prevent the occurrence of severe adverse effects.2,3 Preemptive analgesia has been shown to be effective in control of postoperative pain by protecting the CNS from deleterious effects of noxious stimuli, which can result in allodynia and increased pain. Oxycodone, a type of opioid, was previously reported to have a preemptive analgesic effect on general anesthesia.4 However, there is a scarcity of information on an association with preemptive analgesic efficacy of intravenous oxycodone on spinal anesthesia. In this prospective, randomized, placebo-controlled, double-blinded clinical trial, the hypothesis was tested that preemptive intravenous oxycodone would enhance this method of spinal anesthesia, reduce postoperative pain, and decrease and delay postoperative analgesic requirement.     

选择性脊神经根阻滞治疗盘源性坐骨神经痛

目的观察选择性神经根阻滞治疗盘源性坐骨神经痛的临床效果和安全性。方法选择伴有明显腿部放射痛或腿痛重于腰痛的腰椎间盘突出症患者41例,在斜位透视影像监测下,选用22G腰穿针,经椎弓根的外下方行腰脊神经根穿刺术,当患者出现与平时相似的腿部放射痛,造影剂试验显影充盈的神经根袖时,每1神经根注入1～2．5 ml阻滞液(2％利多卡因2 ml 复方倍他米松1 ml 0．9％生理盐水1 ml)。结果治疗后3日、3个月VSA评分均较治疗前明显降低(P<0．05),直腿抬高试验较治疗前明显提高(P<0．05),治疗后3日和3个月时的治疗优良率分别是80．49％(33例)和73．17％(30例)。治疗后未发现明显的并发症。结论选择性腰骶脊神经根阻滞能迅速缓解腰椎间盘突出症引起的根性坐骨神经痛,具有穿刺准确、靶位注射、药物集中、疗效确切和并发症少等优点。     

Percutaneous Nucleoplasty Using Coblation Technique for the Treatment of Chronic Nonspecific Low Back Pain: 5-year Follow-up Results

Background:This study evaluated the efficacy of percutaneous nucleoplasty using coblation technique for the treatment of chronic nonspecific low back pain (LBP),after 5 years of follow-up.Methods:From ...     

Effects of Intrathecally Administerd NaV1.8 Antisense Oligonucleotide on the Expression of Sodium Channel mRNA in Dorsal Root Ganglion

Neuropathicpainisoftenresistanttothether apeuticintervention.Acommonclinicalfindingisthatbroad spectrumsodiumchannelblockers,re presentedbylocalanestheticssuchaslidocainecanacutelysuppressneuropathicpain,oftenwithse verecomplicationsofcentralnervousorcardiovas cularsystemanddonotdistinguishbetweensodi umchannelsubtypes.Importantly,theexpressionofNaV1.8isrestrictedtotheperipheryinsensoryneuronsofthedorsalrootganglia(DRG),sugges tingthatablockadeofthischannelmightallowre lieffromneuropathicpai…