Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac

A randomised, controlled study was undertaken to assess the postoperative pain and side effects experienced by patients undergoing day case diagnostic laparoscopy and laparoscopic sterilisation, and to evaluate the effectiveness in these patients of peroperative diclofenac. Patients undergoing laparoscopic sterilisation had significantly higher pain scores at one hour postoperatively, and at discharge, than patients undergoing diagnostic laparoscopy (p less than 0.01) but there were no significant differences in pain scores 24 hours after discharge. The incidence of postoperative side effects following discharge from hospital was high, but there were no significant differences between the groups. Diclofenac had no significant effect in either group on the severity of postoperative pain, or the incidence of postoperative side effects.     

小剂量氯胺酮复合芬太尼术后静脉镇痛

目的　比较小剂量氯胺酮联合芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法选择行上腹部手术后患者 12 0例 ,随机均分为三组 ,每组 4 0例 ,以一次性静脉镇痛泵 (2ml/h)分别行静脉术后镇痛。F组 :单纯芬太尼镇痛 ,0 4 μg·kg-1·h-1芬太尼 +5mg氟哌利多。KF1组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +40 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。KF2组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +80 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。各组镇痛泵中药物均用医用盐水稀释至 10 0ml。观察各组患者镇痛 4 8小时内的静息镇痛评分 (VAS方法 )、恶心呕吐、皮肤瘙痒、尿潴留和幻觉的发生情况。结果　三组患者的静息镇痛评分在 12小时内KF1组和KF2组明显低于F组 (P <0 0 5 ) ,而在 12小时后没有明显差别 (P >0 0 5 ) ;恶心呕吐、皮肤瘙痒和尿潴留发生率KF1组和KF2组显著低于F组 (P <0 0 1)。KF1组和KF2组之间在静息镇痛评分和并发症发生方面没有明显差别。三组中均无幻觉发生。结论　小剂量氯胺酮用于术后静脉镇痛可明显减少芬太尼的剂量 ,使恶心呕吐、皮肤瘙痒和尿潴留发生率降低 ,镇痛效果明显优于单纯芬太尼术后静脉镇痛     

曲马多给药方式对鼾症术后镇痛效果及血药浓度的影响

目的　观察不同曲马多给药模式对鼾症 (OSAS)术后镇痛效果的影响及其与血药浓度的相关性。方法　选择重度OSAS患者 30例 ,ASAⅡ级 ,随机分为三组。Ⅰ组 (术前镇痛组 ) ,于麻醉诱导时静注曲马多 1mg/kg ;Ⅱ组 (术中镇痛组 ) ,在手术过程中以 0 5mg·kg- 1 ·h- 1 持续静注曲马多 ;Ⅲ组 (术后镇痛组 ) ,于术毕静注曲马多 1mg/kg。记录术后VAS评分 ,达到有效镇痛时的曲马多血药浓度以及不良反应。结果　Ⅰ组的VAS评分为 (3 6 7± 1 95 )分 ,镇痛优良率为 6 3 4% ;Ⅱ组的VAS评分为 (2 75± 1 5 8)分 ,镇痛优良率为 77 8% ;Ⅲ组的VAS评分为 (4 43± 1 5 5 )分 ,镇痛优良率为40 %。血清浓度分别为 (2 18± 1 89)、(2 0 1± 0 6 9)和 (3 89± 2 43) μg/ml。三组不良反应发生率分别为 0 %、9 1%和 5 0 %。结论　提前镇痛可改善镇痛效果 ,减少用药量及不良反应。镇痛效果与曲马多的血药浓度之间无线性相关 ,故不宜作为评价镇痛效果的客观指标     

Control del embarazo y manejo intraparto en la enfermedad de McArdle

We describe the pregnancy course and labor in a woman with myophosphorylase deficiency (McArdle’s disease or glycogen storage disease type V). McArdle’s disease is an uncommon hereditary disorder characterized by symptoms of muscular fatigue and pain, as well as by muscle cramps during heavy and continuos exercise. We feared that the increase in muscular effort during labor might complicate delivery, necessitating cesarean section.     

不同镇痛方式对胸外科术后病人舒适状况的临床研究

[目的]观察静脉自控镇痛(PCIA)和硬膜外自控镇痛(PCEA)对胸外科术后病人舒适状况的影响。[方法]选取2009年1月～2010年1月行开胸手术并术后48h内采取PCIA或PCEA病人60例,按随机数字表法分为PCI-A组和PCEA组各30例。[结果]两组48h时各领域舒适度和整体舒适度均明显优于24h(均P﹤0.05);PCEA组在24h、48h时整体舒适度均明显优于PCIA组(均P﹤0.05);从各领域来看,PCEA组生理领域舒适度明显优于PCIA组(P﹤0.05),而在心理、社会和环境领域差异均无统计学意义(均P﹥0.05);PCEA组术后各时点VAS评分均明显低于PCIA组(均P﹤0.05);PCIA组不良反应明显多于PCEA组(P﹤0.05)。[结论]相比PCIA,PCEA不良反应少,镇痛效果好,在术后能从生理上获得更高的舒适度,可作为胸外科病人术后首选的镇痛方式。     

对超期妊娠实施产科干预的临床总结

目的:探讨对超期妊娠实施产科干预对分娩方式等方面的影响。方法:选择无任何合并症及并发症的超期妊娠294例,就其宫颈评分、对静滴缩宫素引产的依从性、最终分娩方式、新生儿体重进行回顾性总结分析。结果:294例超期妊娠中,愿意实施缩宫素引产者仅占30.6%,引产成功127例,其余均实施了剖宫产,新生儿体重在3500g以上者177例。结论:超期妊娠者胎儿巨大儿发生较多,对静滴缩宫素引产的依从性较差,如进行适当的产科干预,可降低剖宫产率。     

Obstetric Complications and Asthma in Childhood

Studies have shown that perinatal factors are associated with childhood asthma. The current analyses examined the association between obstetric complications and risk of asthma at the age of 7 years using a prospectively population-based birth cohort in northern Finland. Results indicated that obstetric complications were associated with a higher risk of asthma among children. Those children who were administered special procedures at birth, i.e., cesarean section, vacuum extraction, and other procedures, including use of forceps, manual auxiliary, and extraction breech, had an adjusted odds ratio (OR) for asthma of 1.38 (95% confidence interval [CI] 1.00-1.92), 1.32 (95% CI 0.80-2.19), and 2.14 (95% CI 1.06-4.33), respectively, as compared to children who were delivered normally. Children who had a lower Apgar score at the first and the fifth minute after birth also had a higher risk as compared to those who had an Apgar score of 9-10. The results encourage further evaluation of the association between obstetric complications and risk of asthma among children in other populations, and further exploration of possible mechanisms underlying the association.     

碳酸利多卡因用于硬膜外阻滞下急症剖宫产术临床效果的评价

目的 比较1．73％碳酸利多卡因和2％盐酸利多卡因用于硬膜外阻滞下急症剖宫产术的临床效果，为其临床应用提供客观依据。方法 30例急症剖宫产术产妇（ASA1－2级），随机分为两组，每组各15例。均采用硬膜外阻滞，所用局麻药I 为1．73％碳酸利多卡因，Ⅱ组为2％盐酸利多卡因。结果 两组产妇局麻药总容积、阻滞平面无明显差异，对血压、心率、SpO2影响均较小，新生儿出生后2分钟Apgar评分均在9分以上。但I组起效快，阻滞完善时间明显缩短，止痛和肌松效果好。结论 用于硬膜外阻滞急症剖宫产手术，碳酸利多卡因优于盐酸利多卡因。