复杂性区域疼痛综合征1例分析

下肢复杂性区域疼痛综合征(CRPS)临床较为罕见,发病机制复杂,治疗困难。某医院收治T12椎体骨折1例,先后经过静脉镇痛泵、局部神经阻滞、镇痛镇静药物、激素、非甾体类抗炎药物、电针等治疗,局部疼痛有一定缓解,但疗效短暂且未达到医患预期目的。该文报告了该患者术后出现下肢异常疼痛的临床特点及诊治经过,系统回顾分析了相关文献,总结CRPS的救治要点,以期提高对CRPS的认识及诊治水平。     

肌苷和维生素C预防肢体缺血再灌注损伤的观察

四肢手术常需扎止血带 ,当松解止血带恢复血流灌注后 ,可引起缺血肢体急剧损害或使缺血期间的损害进一步加重 ,其原因可能与心肌缺血后再灌注损伤一致[1] 。因此 ,我们观察了用肌苷、维生素Ｃ对肢体缺血再灌注损伤的预防效果。1　对象和方法1 1　对象　下肢骨科择期手术且上止血带时间相近的患者 2 9例。随机分为Ａ组 (肌苷组 ) 9例 ,其中男 6例 ,女 3例 ,平均年龄 3 9 50岁 ,止血带时间 68 3 3±1 4 1 4ｍｉｎ ;Ｂ组 (肌苷 维生素Ｃ组 ) 9例 ,男 5例 ,女4例 ,平均年龄 3 5 55岁 ,止血带时间 68 89± 1 1 93ｍｉｎ ;Ｃ组 (对照组 ) 1 1…     

抗生素在妇产科围手术期的预防应用分析

目的研究抗生素在妇产科围手术期使用中的预防医疗效果。方法随机抽取2012年8月～2013年3月接诊的384例妇产科手术患者为研究对象,将其随机分为观察组和对照组,每组各192例。对两组患者术后药物不良反应、术后切口感染率、最高体温以及恢复正常所需的时间、药物费用、平均的住院天数分别进行统计,进而比较分析。结果术后观察组药物不良反应率0明显低于对照组8．6％、平均住院天数、术后感染率以及总药物费用均明显小于对照组,有显著性差异（P〈0．05）;两组的术后体温恢复时间无显著性差异（P〉0．05）。结论应用抗生素能达到妇产科围手术期预防感染的目的,可以减少患者的药物不良反应等症状,有助于患者恢复健康。     

儿童维生素D水平与龋齿发生风险相关性的Meta分析

目的系统评价儿童维生素D水平与龋齿发生风险的关系。方法计算机检索中国期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库、PubMed、Web of Science、Cochrane Library、Embase数据库,收集有关儿童维生素D水平与龋齿发生风险关系的流行病学观察性研究,检索时限从建库到2019年3月。由两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用Stata 15.1软件对纳入研究进行Meta分析。结果最终纳入10篇文献共14项观察性研究,其方法学质量均较高,其中6项横断面研究为A级,3项队列研究为A级,4项病例对照研究为B级,1项孟德尔随机化研究为A级。共纳入12 596例研究对象,患龋者5338例,患龋率为42.38%。其中维生素D缺乏者1075例,患龋者512例,患龋率为47.63%;维生素D不足者3676例,患龋者1580例,患龋率为42.98%;维生素D水平正常者7845例,患龋者3246例,患龋率为41.38%。Meta分析结果显示,维生素D缺乏或不足者龋齿的发生风险较维生素D水平正常者升高11%(RR=1.11,95%CI 1.01...     

早期应用阿替洛尔注射液治疗急性冠脉综合征的Meta分析

目的评价β受体阻滞剂阿替洛尔注射液在急性冠脉综合征(ACS)早期治疗中的作用效果。方法计算机检索Cochrane图书馆、Pubmed、Embase、Highwire、Medline、CBM、CNKI、CSJD等中外生物医学数据库,收集关于阿替洛尔注射液在ACS治疗中早期应用的随机对照试验。按Cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据,采用RevMan 5.0软件进行Meta分析。结果共纳入6项研究,共计26 658例患者。Meta分析结果显示,阿替洛尔注射液治疗组与对照组相比,ACS患者的死亡率明显降低(RR=0.84,95%CI 0.73～0.96,P=0.01);室性快速性心律失常发生明显减少(RR=0.62,95%CI 0.42～0.91,P=0.01);患者再次心肌梗死的发生率明显减少(RR=0.54,95%CI0.32～0.92,P=0.02);心源性休克发生率差异无统计学意义(RR=0.16,95%CI 0.22～1.28,P=0.16),表明阿替洛尔注射液并不增加心源性休克的风险,且可显著降低卒中发生风险(RR=0.70,95%CI 0.58～0.84,P=0.0001)。结论 ACS治疗中应用阿替洛尔注射液治疗可明显减少室性快速性心律失常的发生,从而降低患者死亡率,改善患者预后。     

264例剖宫产围手术期抗菌药物预防应用分析

剖宫产术作为临床常见手术,由于其技术水平的提高以及各种社会因素的影响,近10年来呈逐渐上升趋势[1],有报道个别地区可高达90%以上,我院也基本达到50%左右。但剖宫产术切口为Ⅱ级刀口即清洁一污染切口,可能受到污染,特别是有些产妇本身具有潜在感染因素,术后感染的可能性明显增加,所以目前剖宫产术后应用抗菌药物已成为     

MRI诊断梨状肌综合征与坐骨神经变异相关性的Meta分析

目的:采用Meta分析评价MRI观察梨状肌综合征(PMS)患者与健康人之间坐骨神经变异情况的差异.方法:检索在PubMed、Ebase、Web of science、CBM、中国知网、维普、万方数据库收录的关于MRI诊断PMS的文献.数据分析采用Stata 15.1软件.结果:共纳入文献9篇,共1897例患者.PMS组...     

某三甲医院Ⅰ类切口手术围术期预防用药情况分析

目的 调查研究成都医学院第一附属医院Ⅰ类切口手术围术期抗菌药物预防用药情况在专项整治前后的变化,为进一步规范抗菌药物在围术期预防性使用提供科学依据及改进方向.方法 抽取该院2011年5月—2015年12月期间Ⅰ类切口手术病历,将2011年5月—2012年7月归为干预前期,2012年8月—2013年12月归为干预期,2014年1月—2015年12月归为持续干预期,比较3个时期抗菌药物在围术期预防性应用的合理性,并对经干预后围术期抗菌药物使用合理性仍不理想的几种手术进行单独分析.结果 该院Ⅰ类切口手术围术期预防使用抗菌药物有了明显的持续改进,但仍有一定的进步空间;3类重点监管手术总体控制可,但在预防用药品种选择和预防用药时机选择上仍存在一些问题.结论 为了改善Ⅰ类切口手术围术期预防使用抗菌药物的合理性,可以进一步加强信息化管理手段、改进人员培训模式、借鉴ISO 9000标准体系来提高管理水平.     

Cerebral glucose metabolism change in patients with complex regional pain syndrome: a PET study

Purpose The aim of this study was to examine abnormalities of the central nervous system in patients with chronic pain who were diagnosed with complex regional pain syndrome (CRPS). Materials and methods Brain activity was assessed using ¹⁸F-fluorodeoxyglucose positron emission tomography. The data collected from 18 patients were compared with data obtained from 13 normal age-matched controls. Results Our results showed that glucose metabolism was bilaterally increased in the secondary somatosensory cortex, mid-anterior cingulated cortex (ACC) or posterior cingulated cortex (PCC) (or both), parietal cortex, posterior parietal cortex (PPC), and cerebellum as well as in the right posterior insula and right thalamus in our patients. In contrast, glucose metabolism was reduced contralaterally in the dorsal prefrontal cortex and primary motor cortex. Glucose metabolism was bilaterally elevated in the mid-ACC/PCC and the PPC, which correlated with pain duration. Conclusion These data suggested that glucose metabolism in the brains of patients with CRPS changes dramatically at each location. In particular, glucose metabolism was increased in the areas concerned with somatosensory perception, possibly due to continuous painful stimulation.     

Complex regional pain syndrome of the right wrist – Type I (CRPS-I)

Complex regional pain syndrome (CRPS) is an intractable neuropathic painful disorder affecting one or less commonly more than one limb, disproportionate to or even without clear noxious event. It may occur without or with peripheral nerve injury, thus classifying such syndrome into type I or II, respectively. It was previously referred to as reflex sympathetic dystrophy (RSD) or Sudek's atrophy. We had reported this case as right wrist CRPS-I in 62 year old male patient, presented with severe unexplained acute right wrist pain and periarticular distal forearm soft tissue swelling, preliminary clinically diagnosed as septic arthritis. After full radiological examinations, CRPS type I was reported after exclusion of all other similar clinico-radiological presentations. The patient was treated conservatively with successful response.     

影响创伤骨科患者术后疼痛的相关因素研究

目的探讨创伤骨科患者术后疼痛的影响因素。方法回顾性分析2011年9月—2015年9月武汉市东西湖区人民医院收治的224例创伤骨科患者行外科手术治疗的临床资料,根据患者术后主诉情况分为疼痛组(n=89)与非疼痛组(n=135)。采用多元Logistic回归模式对创伤骨科患者术后疼痛的相关影响因素进行观察、分析。结果疼痛组患者平均年龄较低、女性、性格外向、高学历、心理状态不佳、体位不当,治疗过程中牵引、外固定等,医护人员对疼痛评估知识缺乏比例均显著高于非疼痛组(P0.05),但两组患者骨折部位及骨折原因方面的差异均无统计学意义(P0.05);经多元Logistic回归模型分析,最终得出影响创伤骨科患者术后疼痛相关因素包括:年龄、性别、性格、文化程度、心理状态、体位、治疗中的因素以及医护人员自身因素(P0.05)。结论影响创伤骨科患者术后疼痛相关因素较多,应注意对这些因素的密切观察,并采取相关处理措施,以改善患预后状况。     

Internal and external focus show similar effect on the gait kinematics in patients with patellofemoral pain: A randomised controlled trial

PurposeThe purpose of this study was to examine how attentional focus during training influences the effects of a 6-week hip-knee strength training program on pain, function, strength, and kinematics in males and females with Patellofemoral pain (PFP).MethodsSeventy-five males and females with PFP were randomly allocated to a group that trained with an internal focus (n = 25), a group that trained with an external focus (n = 25), or a control group (n = 25). All patients completed testing before (baseline) and after (posttest) the 6-week period. The primary outcome was pain, assessed by Visual Analog Scale (VAS). The secondary outcomes were function, hip muscles strength and lower extremity kinematics, assessed by Kujala Questionnaire, handheld dynamometer and a 2-D motion capture, respectively. All outcomes were measured at the baseline and after the 6-week intervention. Analysis of covariance was used to compare posttest outcomes among the groups while accounting for group differences in baseline performance.ResultsThe hip-knee strengthening exercises resulted in improved knee valgus (ES(95 % CI) = 0.43(0.26 to 0.75), p = 0.03), and external rotator strength (ES(95 % CI) = 0.51(0.12 to 0.78), p = 0.03) for males and females who trained with an external compared to internal focus.ConclusionsOur findings indicate that males and females with PFP may benefit from completing a hip-knee strengthening training program with an external focus vs. an internal focus. Physical therapists and clinicians should consider using instructions that promote an external focus when implementing hip-knee strengthening training programs with PFP patients. This result could be strengthened or re-enforced by larger studies with longer follow up.     

血清氧化应激/抗氧化产物水平与脑梗死患者I型复杂性局部疼痛综合征严重程度的相关性研究

目的 自由基清除可以改善Ⅰ型复杂性局部疼痛综合征(type I complex local pain syndrome, CRPSI)患者的症状体征,间接表明自由基和氧化应激增加参与了CRPSI的发病机制。本研究通过测定脑卒中后CRPSI患者血清氧化应激产物脂质过氧化产物丙二醛（malondialdehyde ,MDA）和抗氧化产物超氧化物歧化酶（superoxide dismutase ,SOD）的水平以判定其与CRPSI严重程度的相关性。方法 选择南方医科大学第三附属医院诊断为脑梗死后CRPSI的患者75例以及非CRPSI患者80例,同时选择同期常规健康体检者78例,分为三组,即脑梗死后CRPSI患者组(n=75),脑梗死后非CRPSI患者组(n=80)以及健康对照组(n=78)。血清MDA和SOD测量采用酶联免疫吸附实验进行测定(enzyme-linked immunosorbent assay ,ELISA)。采用视觉模拟评分法(visual analogue scale,VAS)评分量表对24 h内患者所感受到的最大疼痛强度进行测量,VAS评分≥7分为重度疼痛组,＜7分为轻中度疼痛组。采用 Constant - Murley肩关节功能评分、Cooney 腕关节评分和Carroll 手功能评分分别评估患者肩关节、腕关节、手功能情况。采用受试者工作特征曲线 (receiver operating characteristic curve, ROC曲线)分析血清MDA和SOD对于疼痛分级评定的诊断价值。采用Logistic回归分析预测CRPSI患者疼痛的风险因素。结果 血清MDA水平在脑卒中伴有CRPSI患者显著高于无CRPSI患者以及健康志愿者,而血清SOD水平在脑卒中伴有CRPSI患者中水平则显著低于无CRPSI患者以及健康志愿者。CRPSI患者血清MDA水平在重度疼痛组显著大于轻度疼痛组,血清SOD水平在重度疼痛组显著低于轻度疼痛组。血清MDA和SOD水平与VAS评分分别成显著正相关性和显著负相关性。ROC曲线分析表明高水平血清MDA和低水平SOD对于脑卒中伴有CRPSI患者疼痛分级评定具有较好的诊断价值。CRPSI患者血清MDA水平与Constant -Murley评分、Cooney 评分和Carroll评分分别显著负相关性,而血清SOD水平与Constant - Murley评分和Carroll评分显著正相关性。CRPSI患者Brunnstrom 4级患者血清MDA显著低于3级患者,Brunnstrom 3级患者血清MDA水平显著低于1/2级患者。而血清SOD水平在Brunnstrom 4级患者显著高于3级,在Brunnstrom 3级患者血清显著高于1/2级患者。 Logistic回归分析表明血清MDA和SOD水平均可以作为预测CRPSI患者疼痛的独立因子。 结论 血清氧化应激/抗氧化产物可能参与了CRPSI的病理生理进程,这在血清中可以得到反映,对CRPSI患者的诊断和治疗可能具有重要意义。     

Currarino syndrome as an incidental radiologic finding in a patient with acute flank pain: A case report

Currarino syndrome is an autosomal dominant hereditary disease defined as a triad of anorectal abnormality, sacral dysgenesis, and a presacral mass, primarily an anterior sacral meningocele. It is often seen in children and considered rare in adults. It is mostly found as an incidental finding. We present a 21-year-old man who presented with acute flank pain. He had a history of Hirschsprung''s disease and therefore had undergone surgery in his infancy. He also had a history of prolonged constipation and had an episode of admission due to suspected obstruction. On physical examination, he had a severe costovertebral angle tenderness. urine exam revealed microscopic hematuria. Laboratory tests were otherwise unremarkable. Computed tomography scan revealed renal stones as well as a horseshoe kidney. Incidental findings included a large simple cystic structure in the presacral area suggestive of an anterior meningocele and sacral dysgenesis associated with scimitar sacral appearance. These findings suggested a diagnosis of Currarino syndrome. Urinary complications of this disease are reported in few articles. An important takeaway note for physicians is to have a high level of suspicion when encountering patients with gastrointestinal, neurologic, or urologic signs and symptoms and consider a thorough history taking and physical examination alongside proper imaging evaluation.     

Early use of regional and local anesthesia in a combat environment may prevent the development of complex regional pain syndrome in wounded combatants

Complex regional pain syndrome (CRPS) is a relatively common disabling disorder of unknown pathophysiology. CRPS is a variable symptom complex that probably results from multiple causes through different pathophysiological mechanisms. Changes in peripheral, central, somatosensory, autonomic, and motor processing, accompanied by pathological interactions of sympathetic and afferent systems, are observed as underlying mechanisms. Standardized early interventions for patients with extremity wounds may prevent the onset of CRPS or at least reduce the severity or duration of the condition.     

The effect of gender on intramuscular pressure in patients with chronic exertional compartment syndrome of the lower leg

This study aimed to compare intramuscular pressure (IMP) in all four compartments of the lower leg between men and women in patients with suspected chronic exertional compartment syndrome (CECS), and to assess possible effects of gender in relation to covariation factors. A consecutive series of patients with exertional leg pain (n = 962, median age 27 years, 56.2% women) underwent IMP measurements between 2009 and 2019. The CECS diagnosis was confirmed (n = 491, 48% women) or ruled out (n = 471, 65% women) based on the patient's history, clinical examination, and IMP measurements. IMP values of the compartments were compared between genders. A multiple linear regression analysis was performed for IMP in the anterior and lateral compartments, where the number of patients was large enough to investigate the possible impact of other factors such as height, age, and duration of pain. Among those with a confirmed CECS diagnosis, one-minute post-exercise IMP was significantly lower in women than in men for all four muscle compartments: anterior (median [range] mmHg 44 [24–120] vs. 50 [24–130]), lateral (35 [20–89] vs. 40 [26–106]), deep posterior (31 [25–36] vs. 34 [24–53]), and superficial posterior (32 [27–39] vs. 37 [22–54]). In the multiple regression analysis, gender differences remained significant in the anterior compartment but not the lateral compartment, where only height remained a significant predictor of IMP. Gender should be considered when using cut-off values for IMP in diagnosing CECS, especially for the anterior compartment.