手背部深度烧伤切削痂植皮术术后常见的几种并发症

手背部深度烧伤，创面采用早期切除或削除焦痂植皮覆盖，可使绝大部分病人的手部功能和外形恢复，但是仍有些病人的术后出现不同程度的并发症，影响手部的功能。现将并发症的原因分析和处理方式总结如下。     

溶痂期行削痂加植皮术治疗深度烧伤24例

目的探讨深度烧伤患者在溶痂期的治疗。方法对24例深度烧伤患者在溶痂期行削痂术,其中23例行植皮术。结果22例患者创面一期愈合,1例患者行2次植皮术愈合,1例未植皮患者行换药术愈合。结论削痂加植皮是治疗溶痂期深度烧伤患者的有效方法。     

地佐辛应用于剖宫产术后静脉镇痛临床效果观察

目的:观察地佐辛和芬太尼应用于剖腹产术后静脉镇痛的临床效果.方法:随机将60例剖腹产产妇分为两组,每组30例.Ⅰ组使用芬太尼静脉泵镇痛,Ⅱ组使用地佐辛静脉泵镇痛,比较两组的镇痛效果和不良反应.结果:两组镇痛效果无明显差异(P＞0.05),不良反应Ⅰ组与Ⅱ组有明显差异(P＜0.05).结论:地佐辛复应用于剖腹产术后镇痛可取得良好效果,可安全用于剖宫产的术后镇痛.     

地佐辛用于剖宫产术后静脉镇痛的效果观察

目的探讨地佐辛用于剖宫产术后静脉镇痛的临床效果。方法 128例行剖宫产术的产妇,随机分为地佐辛组（D组）和芬太尼组（F组）,每组64例。记录两组产妇VAS疼痛、Ramsay镇静评分和不良反应发生情况。结果两组术后各时间点VAS评分和Ramsay镇静评分比较,差异无统计学意义（P〉0.05）,D组不良反应的发生率低于F组,差异有统计学意义（P〈0.05）。结论地佐辛用于剖宫产术后静脉镇痛效果确切,不良反应发生率低,值得临床推广。     

小剂量地佐辛复合曲马多用于胆囊切除术后镇痛效果观察

目的比较小剂量地佐辛复合曲马多与单独用地佐辛、曲马多的术后镇痛效果。方法 60例胆囊切除术患者随机分为地佐辛组、复合组及曲马多组,观察VAS评分、不良反应及治疗费用等。结果与曲马多组相比,地佐辛组和复合组在2、6、12、24、48 h各时间点的心率、血压、VAS分值差异具有统计学意义;地佐辛组和复合组两组之间差异无统计学意义。相对于单纯应用曲马多组,复合组治疗费明显降低。结论小剂量地佐辛复合曲马多在胆囊切除术后镇痛效果、不良反应方面与单用地佐辛相当,费用节省。     

地佐辛与曲马多术后早期镇痛效果的比较

目的 比较地佐辛与曲马多单次静脉给药用于腹腔镜胆囊切除术后患者患者早期镇痛的效果及不良反应.方法 选择择期行腹腔镜胆囊切除术患者40例,美国麻醉师协会Ⅰ～Ⅱ,年龄18～65岁,完全随机分为地佐辛组和曲马多组,各20例,均采用气管插管全身静脉麻醉.术中靶控输注异丙酚、瑞芬太尼,间断给予顺式阿曲库铵维持麻醉.地佐辛组关腹前30 min分别静脉注射地佐辛0.1 mg/kg、曲马多组给予曲马多2 mg/kg.记录2组术前(T0)、给药时(T1)、拔管时(T2)、拔管后5 min(T3)、拔管后10 min(T4)、拔管后30 min(T5)、拔管后1 h(T6)患者的HR、SBP、DBP和动脉血氧分压(SpO2),并观测苏醒时间、拔管时间以及T3、T4、T5、T6的视觉模拟评分(VAS),观察拔管后患者的不良反应情况.用警觉/镇静评分评估患者全麻后意识恢复程度.结果 地佐辛组T2、T3时间点心率分别为(105±11)、(96±10)次/min,明显低于曲马多组[分别为(93±6)、(87±6)次/min,P<0.05],SpO2在T2、T3、T4时间点差异无统计学意义,T4时间点地佐辛组VAS评分明显高于曲马多组[(2.06±0.85)分比(2.69±0.93)分,P<0.05].曲马多组呼吸抑制1例,恶心呕吐3例,躁动2例;地佐辛组呼吸抑制1例,躁动1例,头晕1例.2组不良反应发生情况差异无统计学意义.结论 地佐辛在拔管早期对抑制拔管反应的作用和镇痛比曲马多好,不良反应较少.

Abstract：

Objective To study the effect of dezocine versus tramadol for postoperative analgesia and side effects after laparoscopic cholecystectomy. Methods Forty patients with postoperative analgesia, American Society of Anesthesiologists I - II class, were randomly divided into two groups. Target controlled infusion of propofol and remifentanly was used to both groups. Both groups were given intermittent cisatracurium. The single intravenous injections of dezocine(0.1 mg/kg)and tramdol(2 mg/kg) were given before 30 min of operation closure. The analgesic efficacy and side effects was assessed by verbal and visual scales at regular intervals after administration. Hemo-dynamic parameters and SpO2 were recorded, before operation, after administration, extubation time, 5, 10, 30, 60 min after extubation. The visual analogue scale(VAS) pain score and OAA/S score of 5, 10, 30, 60 min after extubation were conducted. Adverse reactions with nausea and vomiting and dysthesia after extubation were obtained. Results There was statistical significance of hemodynamic parameters of extubation(P<0.05). Tramadol group (Group T) has the highest incidence of nausea and vomiting. Dezocine group (Group D)has the highest VAS score after recovery (P<0.05). There were no significant changes in respiratory parameters. Conclusion A single 0. 1 mg intravenous injection of dezocine is safe and effective for postoperative pain after laparoscopic cholecystectomy.     

不同剂量地佐辛在术后静脉镇痛中应用效果的比较分析

目的比较不同剂量地佐辛在患者术后静脉自控镇痛(PCIA)中的应用效果,寻找最佳剂量。方法选择全身麻醉下手术患者120例,随机分成地佐辛1组(D1组)、地佐辛2组(D2组)、地佐辛3组(D3组)和芬太尼组(C组),每组30例。D1组给地佐辛0.5mg/kg,D2组给地佐辛0.7mg/kg,D3组给地佐辛0.9mg/kg,C组给芬太尼15μg/kg。镇痛泵药物配方:D1组:地佐辛0.5mg/kg加托烷司琼5mg加0.9%氯化钠注射液至100ml;D2组:地佐辛0.7mg/kg加托烷司琼5mg加0.9%氯化钠注射液至100ml;D3组:地佐辛0.9mg/kg加托烷司琼5mg加0.9%氯化钠注射液至100ml;芬太尼组:芬太尼15μg/kg加托烷司琼5mg加0.9%氯化钠注射液至100ml。术毕前15min静脉注射首次剂量:地佐辛组静脉注射地佐辛0.1 mg/kg加托烷司琼5mg;芬太尼组静脉注射芬太尼lμg/kg加托烷司琼5mg。观察并记录术后1 h(T1)、2 h(T2)、4 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)患者的生命体征(BP、HR、Sp02)及疼痛评分(VAS)、镇静评分(Ramsay)、舒适度评分(BCS)和不良反应发情况。结果所有患者的生命体征均平稳,D1组T2和T3时点HR略高于其他3组但差异无统计学意义;四组患者Ramsay、BCS评分在各时间点间差异均无统计学意义(P>0.05);VAS评分D2组、D3组和C组间差异无统计学意义,D1组在T1、T2时点高于其它3组且差异有统计学意义(P<0.05);D3组和C组间不良反应发生率高于D1组和D2组,差异有统计学意义(P<0.05)。结论地佐辛用于术后静脉镇痛效果优于芬太尼,且其最佳剂量为0.7mg/kg。     

腹腔镜胆囊切除术后地佐辛镇痛效果观察

目的：观察地佐辛在腹腔镜胆囊切除术后的镇痛效果。方法：80例行腹腔镜胆囊切除术患者随机分为观察组和对照组各40例。对照组术后给予曲马多0.2 mg·kg-1镇痛,观察组术后给予地佐辛0.01 mg·kg-1镇痛。根据患者疼痛状况进行单次药物追加。比较两组患者的手术各项时间,VAS、BCS疼痛状况评分,以及两组患者药品不良反应发生情况。结果：两组患者的手术时间、睁眼时间、清醒时间及拔管时间比较,差异均无统计学意义（P〉0.05）。观察组患者在术后30 min、1 h、2 h及6 h的VAS评分明显低于对照组（P〈0.05）,BCS评分明显高于对照组（P〈0.05）。观察组药品不良反应发生率明显低于对照组（P〈0.05）。结论：地佐辛在腹腔镜胆囊切除术后麻醉的镇痛效果良好,可显著改善患者的术后疼痛状况,值得临床广泛应用。     

地佐辛与苏芬太尼用于术后静脉镇痛的临床效果比较

目的比较术后应用地佐辛与苏芬太尼进行患者静脉自控镇痛（PCIA）的临床效果和安全性。方法60例择期全麻下胸腹部及盆腔手术患者,ASAⅠ-Ⅲ级,随机分为地佐辛组（A组）和苏芬太尼组（B组）,每组30例。镇痛泵药物配方：A组为地佐辛0．6mg／kg＋恩丹西酮8mg＋0．9％氯化钠注射液至100ml;B组为苏芬太尼2．5μg／kg＋恩丹西酮8mg＋0．9％氯化钠注射液至100ml;首次剂量A组为地佐辛0．1mg／kg＋恩丹西酮4mg,B组为苏芬太尼0．1μg/kg＋恩丹西酮4mg;镇痛泵注射速度为2ml／h,自控剂量为1ml,锁定时间为15min。观察并记录患者的生命体征（BP、HR、SPO2）及1h、2h、4h、12h、24h、48h疼痛评分（VAS）、镇静评分（Ramsay）、舒适度评分（BCS）及不良反应。结果所有患者的生命体征均平稳;A、B两组的Ramsay、VAS、BCS评分在各时间点间差异均无统计学意义（均P〉0．05）。两组不良反应发生率差异无统计学意义（P〉0．05）。结论地佐辛用于术后静脉镇痛可以取得和舒芬太尼一样的满意效果。     

右美托咪定联合舒芬太尼用于小儿大面积烧伤削痂植术后镇痛的临床研究

目的 探讨右美托咪定联合舒芬太尼用于小儿大面积烧伤削痂植皮术后的镇痛效果.方法 选取本院2015年2月至2016年5月收治的拟行削痂植皮术的患儿48例,按照随机数字法分为对照组与观察组,每组24例.观察组术后应用右美托咪定联合舒芬太尼镇痛,对照组仅用舒芬太尼镇痛,观察并比较48 h后两组镇痛效果和不良反应.结果 经过48 h观察与评估,观察组Ramsay评分静态(3.8±0.5)、动态(3.1±0.2),明显高于对照组的(1.6±0.2)和(1.3±0.3)μg;观察组动静态镇静率均为100.0％,明显高于对照组的58.3％和41.7％;观察组的舒芬太尼用量(41.47±3.26)μg,明显低于对照组的(58.32±3.79);观察组补救镇痛率为0.0％,明显低于对照组的37.5％;观察组术后不良反应发生率为0.0％,明显低于对照组的12.5％;以上差异具有统计学意义(均P＜ 0.05).结论 右美托咪定联合舒芬太尼可显著改善大面积烧伤患儿削痂植皮术后的镇痛效果,减少不良反应.     

帕瑞昔布钠、曲马多和芬太尼用于多模式镇痛的效果比较

目的比较帕瑞昔布钠、曲马多和芬太尼在多模式镇痛中的应用效果。方法选取医院胸外科开胸手术患者90例,随机分为A,B,C 3组。在手术缝合皮肤时分别静脉给予患者自控镇痛负荷剂量,A组给予曲马多1 mg/kg,B组给予芬太尼1μg/kg,C组给予帕瑞昔布钠40 mg,启动镇痛泵。评估给药后1,2,3,4,5,6 h时患者疼痛状况,疼痛评估采用视觉模拟评分(VAS);记录患者全身麻醉苏醒期发生不良反应的例数,统计其发生率。结果C组明显比A组和B组的镇痛时间长,镇痛效果好,B组略优于A组(P<0.05);不良反应发生率C组明显比A组和B组低,拔管平稳。结论帕瑞昔布钠可作为术后患者自控镇痛负荷剂量的理想用药。     

芬太尼透皮贴剂治疗37例中重度晚期癌痛疗效观察

目的观察合并中重度疼痛癌症患者使用芬太尼透皮贴剂(多瑞吉)的镇痛效果及不良反应。方法采用多中心开放式研究，37例中重度癌痛患者使用芬太尼透皮贴剂治疗，观察并记录疼痛变化，生活质量改善情况，不良反应等。结果使用芬太尼透皮贴剂后疼痛完全缓解率37．84％，明显缓解率51．35％，轻度缓解率8．11%，未缓解率3．23％，不良反应主要为：头晕、恶心及呕吐、便秘、嗜睡、排尿困难、局部皮肤瘙痒等。结论芬太尼透皮贴剂治疗癌痛效果良好，毒副作用轻微，使用方便。     

Efficacy of intranasal fentanyl spray versus other opioids for breakthrough pain in cancer

Abstract

Objective:

To compare the efficacy of intranasal fentanyl spray (INFS), oral transmucosal fentanyl citrate (OTFC), fentanyl buccal tablet (FBT) and oral morphine (OM) for the treatment of breakthrough cancer pain (BTCP).     

氨酚曲马多治疗骨科急慢性疼痛的疗效

目的探讨氨酚曲马多治疗骨科急慢性疼痛的疗效。方法对骨科门诊124例疼痛患者（111例急性疼痛,13例慢性疼痛）其疼痛的程度用视觉模拟评分法（VAS）进行评分后,给予氨酚曲马多治疗5d,然后再次对疼痛进行评分并对疗效进行评价,并记录不良反应。结果急性疼痛患者治疗前平均疼痛的VAS评分为（5.38±1.43）,治疗后平均疼痛的VAS评分为（3.50±1.69）,二者有统计学意义;慢性疼痛患者治疗前平均疼痛的VAS评分为（4.83±1.30）,治疗后平均疼痛的VAS评分为（4.00±1.47）,二者有统计学意义。急性疼痛患者的不良反应主要为头晕14%、恶心4.5%、呕吐8.1%;慢性疼痛患者没有不良反应的发生。结论氨酚曲马多对于治疗骨科急慢性疼痛安全性较好,总体效果满意。     

芬太尼透皮贴剂联合吗啡皮下注射治疗晚期肝癌介入治疗后疼痛的护理观察

目的 观察芬太尼透皮贴剂联合吗啡皮下注射在晚期肝癌介入术后疼痛护理应用中的优势。方法 回顾性分析166例晚期肝癌介入治疗后疼痛治疗护理的临床资料,对89例芬太尼联合吗啡治疗组和77例吗啡治疗组在疼痛评分、缓解率两方面数据进行比较,并进行统计学分析;同时记录各组治疗中的副反应。结果 与吗啡治疗组比较,芬太尼联合组疼痛评分,在12 h（1.97±0.56 vs 3.23±1.49,P<0.05）以及24 h（1.63±0.44 vs 4.19±1.68,P<0.01）均有显著降低。与吗啡治疗组比较,芬太尼联合组介入治疗后疼痛总缓解率,在介入后12 h（92.1% vs 76.6%,P<0.05）以及24 h（97.8% vs 70.1%,P<0.05）均有显著缓解。结论 晚期肝癌介入治疗后联合使用吗啡皮下注射+芬太尼透皮贴剂外贴治疗,可以显著提高患者介入术后72 h内的疼痛缓解率。     

Low doses of transdermal fentanyl in opioid-naive patients with cancer pain

Abstract

Objective:

The aim of this study was to evaluate the effect and tolerability of low doses of transdermal (TD) fentanyl patches in opioid-naive patients with cancer pain.     

Benefits of transdermal fentanyl in patients with rheumatoid arthritis or with osteoarthritis of the knee or hip: an open-label study to assess pain control

SUMMARY

Objectives: To evaluate the effectiveness and safety of transdermal fentanyl (TDF) for the treatment of pain associated with rheumatoid arthritis (RA) or osteoarthritis of the knee or hip (OA), which was not adequately controlled by non-opioid analgesics and/or weak opioids.

Methods: The study design incorporated a 1-week run-in period when current analgesic medications were optimised, a 28-day treatment period and a 1-week taper-off period. Patients with RA (n = 104) and OA (n = 159) started treatment with TDF 25?µg/h. Patches were replaced every 72?h, with the option to up-titrate until adequate pain control was achieved. Metoclopramide was taken during the first treatment week and as needed thereafter.

Results: 203 patients completed the treatment phase, 90 entered the taper-off phase. 25?µg/h was the most frequently used maximum dose (51%). Pain control was increased from 4% to 29% of patients during run-in. The number of patients reaching adequate pain control in the first treatment week was increased to 75%, and increased further to 88% on day 28 and to 80% at endpoint. From baseline (screening) to endpoint, there were significant reductions in pain (?p < 0.001) on the Wisconsin Brief Pain Inventory, and significant improvements in quality of life (Short-Form-36: physical p < 0.001; mental health p < 0.05). Eighty per cent of the patients (n = 134) assessed the treatment favourably; nausea and vomiting were the most common adverse events, mainly occurring at treatment initiation. Efficacy of metoclopramide appeared limited. TDF could be initiated in patients pre-treated with non-opioid analgesics or weak opioids and tapered off without major complications.

Conclusions: TDF significantly improved pain control and quality of life, and was well tolerated in patients with RA or knee/hip OA who continued to experience pain on their current analgesic treatment. Treatment could be discontinued without issues. Nausea and vomiting was usually mild during treatment initiation. Patients’ well being could be further accommodated by optimising prophylactic treatment.     

吲哚美辛直肠给药治疗腹部手术后疼痛120例

目的：观察吲哚美辛直肠给药与曲马多肌内注射对腹部手术后疼痛的疗效比较。方法：１２０例腹部术后病人，男性８６例，女性３４例；年龄４１±ｓ８ａ，给予吲哚美辛混悬液５ｍＬ（７５ｍｇ）直肠给药。另有腹部手术后病人６０例，男性４１例，女性１９例；年龄４３±９ａ，用曲马多１００ｍｇ肌内注射。２组作随机单盲对照试验。结果：吲哚美辛组止痛作用优于曲马多组，总有效率分别为９２．５％和８２％（Ｐ＜０．０５）。吲哚美辛组平均镇痛有效持续时间９±５ｈ，优于曲马多组７±３ｈ（Ｐ＜０．０１）。结论：吲哚美辛直肠给药治疗腹部手术后疼痛疗效满意。     

Bioavailability of tramadol hydrochloride after administration via different routes in rats

Tramadol is a synthetic non‐opiate analgesic drug and effective for many kinds of chronic and acute pain. This study compared the bioavailability of tramadol after different administration routes in rats (oral, buccal and nasal). A simple HPLC analytical approach was used to determine the concentration of tramadol in plasma. The pharmacokinetic behavior and bioavailability of tramadol after administration via different routes in rats were investigated. Nasal and buccal administration of tramadol resulted in a fast increase followed by a rapid decrease in the plasma tramadol concentration. The C_max values following buccal and nasal administration were 6 times and 20 times higher than that of oral administration, respectively, (6827.85 ± 7970.87 ng/ml, 22191.84 ± 5364.86 ng/ml, vs 1127.03 ± 778.34 ng/ml). The relative bioavailabilities of the nasal‐ and buccal‐administered drug when compared with the oral route were 504.8% and 183.4%, respectively, which is much higher than that of oral administration. Nasal and buccal administration increased the bioavailability of tramadol, which may allow for a reduction in the dose of tramadol and a subsequent decrease in both side effects and toxicity. Therefore, this approach provides an effective choice for the delivery of tramadol, an analgesic drug. Copyright © 2014 John Wiley & Sons, Ltd.