PDCA循环管理在鞘内药物输注术护理中的应用

目的探讨PDCA循环模式管理在鞘内药物输注术护理中的应用。方法观察25例患者PDCA循环管理前、后的疼痛缓解度、并发症及健康教育方面的变化。结果利用PDCA循环管理模式护理晚期顽固性癌痛较管理前具有明显优势。结论PDCA循环管理能明显提高患者的生活质量,减少并发症。     

舒适护理在急性白血病患者腰穿鞘内注射术中的应用简

目的 探讨舒适护理在急性白血病患者腰穿鞘内注射术中的应用,提高患者手术舒适度及减少手术并发症.方法 选择绍兴市人民医院2010年10月～2012年10月初次行腰穿鞘内注射的急性白血病住院患者72例为研究对象,将其随机分为实验组及对照组,每组各36例,对实验组患者进行舒适护理,对照组患者进行常规护理.观察舒适护理措施对患者情绪、疼痛程度、并发症发生情况的影响.结果 实验组患者术中紧张恐惧、疼痛程度均低于对照组,而术后并发症发生率[88.9％（32/36）]也明显少于对照组[22.2％（8/36）],差异均有统计学意义（P＜0.05）.结论 对行腰穿鞘内注射术急性白血病患者围术期进行舒适护理,能减轻其紧张恐惧情绪,降低疼痛程度,减少并发症的发生,从而顺利完成穿刺术,有助于提高疗效.     

Central nervous system multiple myeloma – potential roles for intrathecal therapy and measurement of cerebrospinal fluid light chains

Central nervous system (CNS) multiple myeloma (MM) is exceedingly rare and portends a dismal prognosis. While immunomodulators have contributed to the improvement in survival in MM, they appear to have limited activity against CNS MM and, paradoxically, may contribute to the evolution of resistant MM clones capable of surviving within the CNS. We undertook a retrospective analysis to characterize the features of CNS MM and outcome in 17 patients from four institutions identified between 2000 and 2011. The median age was 58 years. Patients had received a median of three prior therapies and all had been exposed to at least one of the so‐called novel anti‐MM agents before the diagnosis of CNS MM. The median time to CNS disease from initial diagnosis was 36 months. Cerebrospinal fluid (CSF) light chain measurements produced discrepant results to serum light chain measurements in some patients. Treatments included systemic pharmacotherapy, intrathecal (IT) chemotherapy and/or radiotherapy (RT). The median overall survival (OS) from diagnosis of CNS MM was only 4 months. OS was significantly better in patients who received IT chemotherapy (20 months vs. 2 months, respectively; P < 0·02). We conclude that the systematic evaluation of IT therapy and diagnostic utility of CSF light chain measurements in CNS MM are warranted.     

Comparative effects of intrathecal bupivacaine and tetracaine on analgesia, cardiovascular function and plasma catecholamines

Forty otherwise healthy male patients, scheduled for elective inguinal herniotomy, were randomly allocated to spinal anaesthesia with 3 ml 0.5% hyperbaric tetracaine or bupivacaine under double-blind conditions. The extent of blockade (pin-prick and cold sensation), blood pressure and heart rate and plasma catecholamines were measured before and 5, 10, 15, 20 and 30 min after injection, before skin incision. Cephalad spread of sensory and temperature analgesia was insignificantly higher after tetracaine. The mean time taken to reach maximal spread of analgesia was 22 min in both groups. Mean arterial pressure showed a more pronounced decrease in the tetracaine group (22 vs 12%, P less than 0.009). Heart rate fell slightly and similarly in both groups, while rate-pressure product was significantly lower in the tetracaine group. The correlation between the decrease in mean arterial pressure and the cephalad spread of sensory analgesia was similar in the two groups, suggesting that at identical levels of sensory analgesia changes in blood pressure were similar after tetracaine and bupivacaine. Plasma norepinephrine and epinephrine measurements before spinal puncture and at maximal decrease in mean arterial pressure showed a depressed response to fall in blood pressure in the tetracaine group. It is concluded that spinal anaesthesia with 3 ml hyperbaric 0.5% tetracaine is followed by a more pronounced fall in blood pressure compared to an identical dose of bupivacaine. The more pronounced sympathetic blockade, confirmed by plasma catecholamine measurements, following tetracaine is probably due to a higher cephalad spread of neurogenic blockade, rather than a differential effect on sympathetic nerve fibres.     

Epidural and intrathecal opioids for postoperative pain management in Europe — a 17-nation questionnaire study of selected hospitals

Background : A questionnaire study conducted with the help of selected contact persons in 17 countries in Europe attempted to create a picture of the practice of acute pain management with the use of spinal opioid analgesia (SOA). Methods : A questionnaire was mailed to anaesthesiologists in 105 European hospitals. Depending on the population, 5–10 hospitals from each country were selected by a country co-ordinator. Results : A total of 101 (96.2%) completed questionnaires were returned. During 1 year SOA was used in 55117 patients (6.6% of all in-patient surgical procedures); of these, 89.2% received epidural opioids and 10.8% intrathecal opioids (ratio 8 : 1). The most common opioid for SOA was morphine; fentanyl was also used quite frequently; 12 different opioids and 8 non-opioids had been used. ASA 1–2 patients receiving epidural morphine were nursed on surgical wards in 58.4% of the hospitals; in 25.7% of hospitals even ASA 3–4 were nursed on surgical wards. Respiratory depression (requiring naloxone treatment) was noted in 45 of the 49 183 patients who received epidural opioids (0.09%); 33 of these patients had received morphine. In more than 75% of hospitals the monitoring variables were respiratory rate, sedation level and pulse oximetry. There was a great difference between hospitals and countries regarding duration of monitoring. Conclusions : This questionnaire study showed that SOA was used in about 7% of 836 000 in-patients undergoing surgery at the 105 selected hospitals. Epidural opioids were used eight times more often than intrathecal opioids. Morphine was the commonest opioid for SOA. The duration of monitoring differed greatly between hospitals and countries; the need for official guidelines is emphasized.     

Perceived Success and Failure of Intrathecal Infusion Pump Implantation in Chronic Pain Patients

Objectives. Over the past few years, there has been an increased reliance on the intrathecal delivery of drugs for patients suffering from intractable pain. We sought to demonstrate the effectiveness of the intrathecal pain pump by examining self‐reported pre‐ and postimplantation pain levels. Methods. Eighty‐four patients who had elected to implant a Medtronic SynchroMed 1 or 2 system in order to control their pain were asked to complete a survey. The survey consisted of pain ratings before implantation, pain ratings postimplantation, medications used before and after implantation, and patient satisfaction with the procedure. Results. Perceived success rate for implantation is 68%, when measured by the ability to reduce reliance on oral medication. When measured by willingness to undergo the procedure again, the success rate is 86%. Conclusions. Overall, the implantation of an intrathecal pain pump is an effective way for most people to manage their intractable pain and reduce reliance on oral medications.