普鲁泊福、瑞芬太尼全凭静脉麻醉用于颈椎手术的效果评估

目的:评价普鲁泊福和瑞芬太尼全凭静脉麻醉在颈椎手术中的应用效果.方法:择期颈椎手术患者100例随机分为4组:地氟烷/瑞芬太尼(DR)组:地氟烷1～2 MAC 瑞芬太尼0.15～0.40μg·kg-1·min-1;地氟烷/芬太尼(DF)组:地氟烷1～2 MAC 芬太尼0.05 mg间断静推;普鲁泊福/瑞芬太尼(PR)组:普鲁泊福50～100μg·kg-1·min-1 瑞芬太尼0.15～0.40 μg·kg-1·min-1;普鲁泊福/芬太尼(PF)组:普鲁泊福50～100 μg·kg-1·min-1 芬太尼0.05 mg间断静推.记录术中不良心血管事件发生率、血管活性药物使用情况、拔管时间、指令性活动恢复时间.术后90 min、24 h由专人应用简化的状态-特质焦虑问卷(state-trait anxietyinventory,STAI)和视觉模拟评分法(visual analogue scale,VAS)分别评估患者的精神状态和疼痛程度,并记录恶心呕吐的发生率.结果:应用瑞芬太尼的两组(DR组和PR组)不良心血管事件、拔管时间、指令性活动恢复时间明显早于应用芬太尼的两组(DF组和PF组)(P＜0.05);术后90 min,全凭静脉麻醉的两组(PR组和PF组)STAI评分显著低于吸入麻醉的两组(DR组和DF组)(P＜0.05),但24 h后差异不显著;术后90 min、24 h,全凭静脉麻醉的两组恶心呕吐率显著低于吸入麻醉的两组(P＜0.05),且VAS评分较低,但无显著性差异.结论:普鲁泊福和瑞芬太尼全凭静脉麻醉用于颈椎手术具有血流动力学稳定、苏醒快速完全、术后精神状态好、恶心呕吐率低等优点,可广泛用于临床.     

The benefit of bilateral inferior alveolar nerve block in managing postoperative nausea and vomiting (PONV) after mandibular osteotomy

IntroductionThe purpose of our study was to evaluate the benefit of bilateral inferior alveolar nerve block (BIANB) in managing postoperative pain, nausea and vomiting and opioid and antiemetic consumption in mandibular osteotomy.Material and methods51 patients operated for bilateral sagittal split osteotomy (BSSO) were included in this prospective randomized controlled, double-blind, superiority trial.In the first group (n = 25), standard protocol was applied (general anesthesia and postoperative multimodal analgesia). The second group (n = 26) received bilateral inferior alveolar nerve block anesthesia at the start of surgery in addition to routine protocol. Postoperative monitoring was conducted every 4 h over the first 24 h and targeted the following criteria: postoperative nausea and vomiting (PONV), the visual analog scale (VAS) for pain, consumption of morphine (cumulative dose) and antiemetic agents, need for removal of guiding elastics.ResultsPONV was significantly lower in the BIANB group (15.4 % VS 40 %, p = 0.049), as were mean VAS scores for pain (1 VS 1.57, p = 0.045) and medians of morphine bolus (8 [6–16] VS 5.5 [1–8], p = 0.033). We found no significant difference in incidence of guiding elastic removal, and antiemetic consumption.DiscussionThe use of BIANB in BSSO improved postoperative patient comfort in terms of PONV and pain. Furthermore, it led to a decrease in opioid consumption. In conclusion, it is an additional therapeutic means of improving patients' postoperative comfort.     

Women's responses to nausea and vomiting in pregnancy

OBJECTIVE: To explore women's experiences of nausea and vomiting in pregnancy. DESIGN: secondary (thematic) analysis of data collected by narrative interviews for two wider studies about antenatal screening and about pregnancy for the DIPEx website (www.dipex.org). PARTICIPANTS AND SETTING: A maximum variation sample was recruited throughout the UK. Data from the 73 women interviewed have been analysed. Interviews took place between October 2003 and December 2004, mostly in the home. FINDINGS: sickness is considered a typical and almost inevitable feature of pregnancy. Against this backdrop, a new framework for understanding women's responses to nausea and vomiting in pregnancy, and the meanings they attach to it, is suggested: nausea and vomiting as something to be expected, survived, resisted, resented, and acknowledged by others. KEY CONCLUSIONS: The concepts of loss of self and biographical disruption from the field of chronic illness seem to resonate with the women's experiences, and may perhaps be extended to transient as well as chronic health conditions. People's experiences of their bodies in health as well as illness need to be more widely studied. IMPLICATIONS FOR PRACTICE: Many women would appreciate greater acknowledgement of the distress nausea and vomiting in pregnancy causes them, information about remedies and strategies other women have found helpful, and reassurance. Expressions of empathy by health-care professionals are frequently lacking and particularly desired.     

A comparison of different severities of nausea and vomiting during pregnancy relative to stress, social support, and maternal adaptation

A cross-sectional and comparative research design with convenience sampling was used to recruit pregnant women from prenatal clinics in southern Taiwan between 2002 and 2003 to examine the differences in perceived stress, social support, and maternal psychosocial adaptation among women with different severities (mild or less than mild, moderate, and severe) of nausea and vomiting during pregnancy. A total of 150 pregnant women participated in this study. One-way analysis of variance indicated that perceived stress was significantly different among the 3 groups. The least significant difference post-hoc test revealed that pregnant women with mild nausea and vomiting had significantly lower stress than did pregnant women with severe nausea and vomiting. The severity of nausea and vomiting was significantly associated with the Prenatal Self Evaluation Questionnaire subscales for "acceptance of pregnancy" and "fear of helplessness and loss of control in labor." Social support and maternal psychosocial adaptation were not significantly different among these three groups. The degree of perceived stress and maternal psychosocial adaptation may be related to the severity of nausea and vomiting during pregnancy.     

术后恶心呕吐相关因素的临床调查

目的调查分析术后恶心呕吐（PONV）的相关因素。方法选择2879例手术患者，按手术类型、性别、手术时间、麻醉方式、既往PONV或晕动病史、吸烟史、术后镇痛与否进行调查并统计分析。结果妇产科、骨科、普外科手术患者术后恶心呕吐的发生率较高，与其他各科比较差异有统计学意双P〈0．05）；女性患者的发生率明显高于男性患者（P〈0．01）；手术时间越长恶心呕吐的发生率越高；全麻组术后恶心呕吐的发生率明显高于非全麻组（P〈0．01）；术前有PONV或晕动病史者，PONV发生率高；有吸烟史者，PONV发生率高于不吸烟者；术后镇痛并没有明显增加术后恶心呕吐的发生率。镇痛组与非镇痛组比较差异无统计学意义（P〉0．05）。结论术后恶心呕吐的发生与多方面的因素有关，其中手术种类、性别、手术时间、麻醉方式、术后镇痛、既往PONV或晕动病史、吸烟史为主要影响因素。     

林胜友主任中医师治疗化疗相关性呕吐经验

[目的]分析讨论林胜友主任中医师治疗化疗相关性呕吐的临证经验。[方法]通过跟师学习,归纳整理病案,结合林师平日指导,分析化疗相关性呕吐的病因病机,总结林师治疗该疾病的临床经验,并附验案加以佐证。[结果]林师认为化疗相关性呕吐的病因病机为中焦土虚,胃气失和;腑实不通,浊气犯胃;肝胆不利,气机失转,治疗上主要从健脾土、通肠腑、畅气机着手。所举验案,患者辨证为脾虚腑实,兼有肝郁,采取健脾通腑,辅以疏肝解郁治疗化疗相关性呕吐,疗效明显,顺利帮助患者度过化疗阶段。[结论]林师治疗化疗相关性呕吐采用健脾、通腑、疏肝治法,通补并用,可以取得较好的疗效。     

肝癌患者肝动脉化疗栓塞术后恶心呕吐的非化疗影响因素分析

目的 分析影响肝癌患者肝动脉化疗栓塞术（TACE）后发生恶心呕吐的非化疗因素。方法 采用整群抽样法,选取2012年10月-2013年10月在中国医科大学附属第一医院介入病房住院的符合纳入与排除标准的肝癌患者272例。记录患者年龄、性别、肿瘤是否转移、肿瘤大小、碘化油注射液剂量、疼痛程度、疼痛时间、介入手术次数、发热程度、发热天数、有无腹胀等,分析上述指标与TACE后恶心呕吐的关系。结果 272例患者中恶心程度语言描述分级（NVSD）为0级169例（占62.1%）,1级59例（占21.7%）,2级44例（占16.2%）。年龄与恶心呕吐呈负相关性（r=-0.217,P＜0.05）,疼痛程度、疼痛时间、腹胀与恶心呕吐呈正相关（r=0.333、0.538、0.188,P＜0.05）。多因素Logistic回归分析显示,年龄高为患者TACE后恶心呕吐的保护因素〔OR=0.916,95%CI（0.841,0.998）,P=0.044〕,疼痛时间长、有腹胀为患者TACE后恶心呕吐的独立危险因素〔OR=373.019,95%CI（8.197,16 974.798）,P=0.002|OR=3.677,95%CI（1.064,12.702）,P=0.040〕。疼痛因素对恶心呕吐有直接正向效应（β=0.42,P＜0.01）,恶心呕吐对腹胀有直接正向效应（β=0.77,P＜0.01）;年龄对疼痛有负向效应（β=-0.01,P=0.072）,对腹胀有正向效应（β=0.01,P=0.069）;年龄及腹胀对恶心呕吐的效应均不显著（P＞0.05）。结论 年龄、疼痛时间、腹胀均对TACE后肝癌患者发生恶心呕吐有影响,患者恶心呕吐的发生是多因素共同作用的结果。