小剂量芬太尼复合氟比洛芬酯在骨科手术患者术后自控静脉镇痛中的应用

2008年1月-2009年3月,我们采用小剂量芬太尼复合氟比洛芬酯用于60例骨科手术患者术后静脉自控镇痛,效果满意。现报告如下。     

氯诺昔康联合小剂量芬太尼用于骨科术后自控镇痛效果观察

2006年1月～2006年3月,我们将不同剂量的氯诺昔康与小剂量芬太尼联合应用于骨科术后镇痛,并与单用芬太尼者进行比较。现报告如下。     

PCEA与PCIA的临床效果比较

手术后患者自控镇痛(PCA)选择何种途径给镇痛药才能达到最佳镇痛效果，是疼痛治疗的重要问题。本文选择了自控静脉镇痛(PCIA)和自控硬膜外镇痛(PCEA)两种给药途径进行观察比较，以探索其镇痛效果与副作用。     

氟比洛芬酯复合芬太尼用于妇科术后静脉镇痛效果观察

将60例择期妇科手术患者随机分为A、B、C三组各20例,均采用静吸复合麻醉,其中B组诱导前15min静注氟比洛芬酯100mg。术毕三组均静注负荷量芬太尼0.05mg后连接自控镇痛泵,所用药物A组为芬太尼0.25μg/（kg·h）＋生理盐水至100ml,B组为芬太尼0.1μg/（kg·h）＋生理盐水至100ml,C组为氟比洛芬酯100mg＋芬太尼0.1μg/（kg·h）＋生理盐水至100ml。观察术后2～48h三组镇痛效果[视觉模拟评分（VAS）]、镇静情况（Ramsay镇静评分）及不良反应。结果三组各时点VAS评分无显著差异（P〉0.05）;A组术后2、6、12h镇静评分及恶心、呕吐发生率均显著高于B、C组（P〈0.05）。认为氟比洛芬酯复合芬太尼用于妇科手术术后镇痛效果确切,可显著减少芬太尼用量和不良反应发生率,安全性高,并发症少;氟比洛芬酯超前镇痛与术后镇痛效果相似。     

高乌甲素复合芬太尼用于老年患者术后镇痛的临床观察

目的观察氢溴酸高乌甲素复合芬太尼用于老年患者术后静脉自控镇痛的临床效果与不良反应。方法选择100例手术的老年患者,随机分为两组。Ⅰ组（50例）采用氢溴酸高钾素复合芬太尼术后镇痛,镇痛液配方为：芬太尼0.5mg＋高乌甲素24mg＋氟哌利多5mg＋0.9%氯化钠注射液共100ml;Ⅱ组（50例）采用芬太尼作术后镇痛,镇痛液配方为：芬太尼1.0mg＋氟哌利多5mg＋0.9%氯化钠注射液共100ml。两组镇痛泵设置：持续输注2ml/h,追加量2ml/次,锁定15min。分别于6、12、24、48h观察镇痛效果及不良反应。结果两组患者VAS评分无明显差异（P〉0.05）;镇静评分Ⅱ组明显高于Ⅰ组（P〈0.05）;术后恶心、呕吐发生率Ⅱ组明显高于Ⅰ组（P〈0.05）。结论高乌甲素复合芬太尼用于老年患者术后镇痛,临床镇痛效果确切,不良反应较少。     

小剂量芬太尼与氯胺酮用于术后镇痛的临床观察

芬太尼用于术后镇痛已广泛用于临床，但常因恶心、呕吐、皮肤瘙痒、尿潴留、剂量较大而引起呼吸抑制等不良反应而限制其临床应用^[1]。氯胺酮作为一种非特异性NMDA受体拮抗药，属苯环已哌啶类，是目前发现的唯一非巴比妥类具有镇痛作用的静脉麻醉药^[2]。氯胺酮单独应用易引起呼吸抑制，感觉和认识的异常以及幻觉、恶梦的发生^[3]。文献报道^[4]氯胺酮与鸦片类药物具有很好的协同作用，联合用于临床效果良好。我们用小剂量芬太尼与氯胺酮联合应用于术后静脉镇痛，取得良好效果，现报告如下。     

氯诺昔康联合芬太尼用于老年患者术后镇痛的临床观察

本研究观察氯诺昔康和芬太尼联合用于老年患者术后镇痛效果及安全性.     

多瑞吉用于骨科术后镇痛27例效果观察

多瑞吉是一种经皮给药的芬太尼贴剂，可通过控释膜的作用，以较稳定的速度经皮持续给药，产生镇痛效果。2000年以来，我们对27例骨科术后患者应用多瑞吉进行镇痛，现将镇痛效果报告如下。     

不同剂量芬太尼静脉自控镇痛在小儿胸外科术后中的应用

目的比较不同剂量芬太尼用于小儿胸外科术后静脉自控镇痛（PCIA）的效果和安全性。方法将90例胸外科手术患儿（ASAⅠ-Ⅱ级）于术后随机分为F1、F2、F3三组各30例,均采用芬太尼行PCIA,芬太尼持续剂量分别为0．1、0．15、0．2μg/（kg·h）,单次追加剂量0．25μg/kg,锁定时间20min,1h最大量1μg／kg。观察两组不同时间点镇痛、镇静评分,芬太尼用量、按压次数（D1）、有效按压次数（D2）,D1／D2,总体满意度及不良反应。结果疼痛及镇静评分：F1组在0．5、2、8、12h高于F3组（P〈0．05）;F2组在0．5、2h高于F3组（P〈0．05）;芬太尼总用量、D1、D1／D2、总体满意度及不良反应发生率F1组〈F2组〈F3组（P〈0．05）。结论认为芬太尼行PCIA用于儿童术后镇痛安全、有效,持续输注剂量以0．2μg/（kg·h）为宜。     

芬太尼病人自控镇痛与常规吗啡镇痛用于心外科术后的对照研究

目的：对比研究心外科术后静脉芬太尼病人自控镇痛（ＰＣＡ）与传统间断肌肉注射镇痛（ＣＡＴ）的临床效果及安全性。 方法：将１８４例心外科术后病人分为 ＰＣＡ组和 ＣＡＴ组,其中 ＰＣＡ组 ９８例,ＣＡＴ组 ８６例。ＰＣＡ组用药为５０μｇ／ｍｌ的芬太尼,单次剂量２５μｇ,锁定时间 ６分,不给病人负荷剂量。拔除气管导管后病人感到疼痛时开始ＰＣＡ,直到拔管后７２小时。 ＣＡＴ组在病人需要镇痛时酌情肌肉注射吗啡１０ ｍｇ。分别在拔除气管导管后 ４、１２、２４、４８、７２、９６及 １２０小时,对病人进行随访并记录有关疼痛及副作用等各项指标。 结果：ＰＣＡ组疼痛总体满意度显著高于ＣＡＴ组,但恶心、呕吐、头晕发生率显著高于ＣＡＴ组。 结论：芬太尼ＰＣＡ用于心脏术后镇痛的疗效,优于常规间断肌肉注射吗啡。     

3种药物治疗大骨节病的临床疗效观察

目的 观察3种药物治疗成人大骨节病患者的临床疗效,为大骨节病病区患者筛选价格低廉、疗效好和副作用小的药物。方法 选择成人大骨节病患者117例,随机分为3组,分别给予口服小活络丸、抗骨增生片和布洛芬缓释胶囊。结果 经2个月治疗,3种药物对减轻患者症状、改善关节功能有效率分别为80.49％、84.85％和95.35％。3种药物治疗大骨节病临床疗效差异无统计学意义(X2=4.35,P>0.05)。结论 小活络丸、抗骨增生片和布络芬缓释胶囊治疗成人大骨节病对改善患者自觉症状、减轻疼痛、恢复关节功能具有肯定疗效。3种药物比较可选用价格低廉、效果肯定的抗骨增生片在病区推广应用。     

Independent risk factor for surgical site infection after orthopedic surgery

No significant progress has been made in the study of orthopedic surgical site infection (SSI) after different orthopedic surgery, and the analysis and prevention of risk factors for orthopedic SSI urgently need to be solved. A total of 154 patients underwent orthopedic surgery from April 2018 to December 2020. General information such as gender, age, marriage, diagnosis, surgical site, and anesthesia method was recorded. Statistical methods included Pearson chi-square test, univariate and multivariate logistic regression analyses, and receiver operating characteristic (ROC) curves. Based on Pearson’s chi-square test, sex (P = .005), age (P = .027), marriage (P = .000), diagnosis (P = .034), and surgical site (P = .000) were significantly associated with SSI after orthopedic surgery. However, in the multiple linear regression analysis, only the surgical site (P = .035) was significantly associated with SSI after orthopedic surgery. In terms of multivariate logistic regression level, surgical site (odds ratio [OR] = 1.568, P = .039) was significantly associated with SSI. ROC curves were constructed to determine the effect of the surgical site on SSI after different orthopedic surgery (area under the curve [AUC] = 0.577, 95% CI = 0.487–0.0.666). In summary, the surgical site is an independent risk factor for SSI after orthopedic surgery, and “trauma” is more likely to develop SSI than spine, arthrosis, and others.     

Quality of life after three kinds of esophagectomy for cancer

AIM:To evaluate quality of life(QOL) following Ivor Lewis,left transthoracic,and combined thoracoscopic/laparoscopic esophagectomy in patients with esophageal cancer.METHODS:Ninety patients with esophageal cancer were assigned to Ivor Lewis(n = 30),combined thoracoscopic/laparoscopic(n = 30),and left transthoracic(n = 30) esophagectomy groups.The QOL-core 30 questionnaire and the supplemental QOL-esophageal module 18 questionnaire for patients with esophageal cancer,both developed by the European Organization for Research and Treatment of Cancer,were used to evaluate patients' QOL from 1 wk before to 24 wk after surgery.RESULTS:A total of 324 questionnaires were collected from 90 patients;36 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits.QOL declined markedly in all patients at 1 wk postoperatively:preoperative and 1-wk postoperative global QOL scores in the Ivor Lewis,combined thoracoscopic/laparoscopic,and left transthoracic groups were 80.8 ± 9.3 vs 32.0 ± 16.1(P 0.001),81.1 ± 9.0 vs 53.3 ± 11.5(P 0.001),and 83.6 ± 11.2 vs 46.4 ± 11.3(P 0.001),respectively.Thereafter,QOL recovered gradually in all patients.Patients who underwent Ivor Lewis esophagectomy showed the most pronounced decline in QOL;global scores were lower in this group than in the combined thoracoscopic/laparoscopic(P 0.001) and left transthoracic(P 0.001) groups at 1 wk postoperatively and was not restored to the preoperative level at 24 wk postoperatively.QOL declined least in patients undergoing combined thoracoscopic/laparoscopic esophagectomy,and most indices had recovered to preoperative levels at 24 wk postoperatively.In the Ivor Lewis and combined thoracoscopic/laparoscopic groups,pain and physical function scores were 78.9 ± 18.5 vs 57.8 ± 19.9(P 0.001) and 59.3 ± 16.1 vs 70.2 ± 19.2(P = 0.02),respectively,at 1 wk postoperatively and 26.1 ± 28.6 vs 9.5 ± 15.6(P = 0.007) and 88.4 ± 10.5 vs 95.8 ± 7.3(P = 0.003),respectively,at 24 wk postoperatively.Scores in the left transthoracic esophagectomy group fell between those of the other two groups.CONCLUSION:Compared with Ivor Lewis and left transthoracic esophagectomies,combined thoracoscopic/laparoscopic esophagectomy enables higher postoperative QOL,making it a preferable surgical approach for esophageal cancer.     

止血散治疗上消化道出血疗效观察

本文用止血散对５０例上消化道出血患者进行治疗观察，并设５０例云南白药组做对照。结果表明：止血散组总有效率（９６％）优于对照组（８０％）。止血散对轻、中、重程度的上消化道出血的止血速度疗效均明显高于对照组。经统计学处理有非常显著性差异（ Ｐ＜０． ０１）。观察结果表明止血散止血速度快，使用方便，便于推广。     

典必殊对翼状胬肉老年患者手术后疗效的观察

目的观察典必殊对翼状胬肉老年患者术后治疗的效果。方法对90例翼状胬肉老年患者采用改良单纯翼状胬肉切除术＋带蒂结膜瓣转位术，手术后患者随机采用典必殊眼膏点眼或金霉素眼膏点眼。裂隙灯下观察角膜上皮完全愈合后，均改为局部点用典必殊眼液，前3d为6次／d，拆线后改为4次／d，渐减。观察2组患者的临床症状和体征。结果术后应用典必殊眼膏的舒适度及局部反应均明显好于金霉素眼膏组。结论及时足量应用皮质类固醇激素可以有效降低翼状胬肉复发率。因此典必殊可作为翼状胬肉术后的常规用药。     

Acute vascular occlusion of the upper extremity after blunt trauma

Intimal ruptures after blunt trauma without joint dislocation are rare. We report the case of a 62 year old male patient presenting with paraesthesia in the fingers I to III and a cool left hand after a blunt trauma of the upper arm. Non-invasive examination documented the thrombotic occlusion of the axillary artery. Due to a circular rupture of the intima surgical revascularization was performed with a vein graft.     

Venous haemodynamics of the upper extremity after subclavian vein thrombosis

Late post-thrombotic complaints after subclavian vein thrombosis are reported with highly varying frequencies (8-80% severe disability). The therapeutic approach depends partly on this frequency. With the aim to evaluate late sequelae a questionnaire was answered by 26 patients with arm-shoulder symptoms leading to arm phlebography, but where the examination did not reveal any thrombi. 65% had remaining symptoms 2-9 years after the examination. 3 had to change profession. 36 patients with phlebographically shown subclavian vein thrombosis answered the same questionnaire. Only 9 (25%) had remaining symptoms and in 4 it was classified as mild, in 4 as moderate and only in 1 patient as severe leading to change of profession. Venous haemodynamics in the upper extremity were also studied in 3 groups of patients; I) healthy volunteers (n = 16 arms), II) patients with arm-shoulder disabilities with negative arm phlebography (n = 7 disabled arms, n = 7 non-disabled arms), III) patients with phlebographically verified subclavian vein thrombi (n = 10 arms with DVT, n = 8 arms without DVT). Strain gauge plethysmography was used measuring venous capacity and maximal venous outflow. Venous pressure measurements were made both with the arms in a resting position and in a military position with and without work-load. Repeat phlebography of arms with symptoms were made. Maximal venous outflow was significantly lower in arms with previous subclavian vein thrombi (p less than 0.05) and venous pressure measurements with the arm in military position was significantly higher in those arms. However, no correlation between these measurements and the degree of arm disability was noted.(ABSTRACT TRUNCATED AT 250 WORDS)     

新型鼻咽通气道联合超声引导下神经阻滞在骨科下肢手术中的应用

目的 评估新型鼻咽通气道联合超声引导下神经阻滞麻醉在骨科手术中供氧的有效性及呼气末二氧化碳分压(PetCO2)监测的准确性.方法 选取择期行骨科下肢手术的40例患者为研究对象,行腰丛+坐骨神经阻滞麻醉,轻度镇静下置入新型鼻咽通气道,连接供氧管,监测PetCO2,行桡动脉穿刺,监测血气分析结果,术中持续小剂量丙泊酚泵入进...     

三种微创方式治疗门静脉高压上消化道出血73例临床分析

目的比较三种微创方式治疗门静脉高压急性上消化道出血的止血效果及并发症情况,为临床选择合适治疗方式提供参考。方法收集浙江大学金华医院2013-02~2017-12因门静脉高压导致急性上消化道出血入院的患者共73例,依据治疗方式不同分为腹腔镜组(16例)、内镜组(31例)、经颈静脉肝内门体分流术(TIPS)组(26例),比较三组患者的一般情况、术后住院时间、术后并发症、围术期死亡情况及术后再出血情况。结果内镜组平均住院时间最短(P0.05),住院费用最少(P0.05),腹腔镜组术后腹腔感染发生率最高(P0.05),TIPS组术后肝性脑病发生率最高(P0.05),腹腔镜组再出血率最低(P0.05)。结论三种微创方式治疗门静脉高压急性上消化道出血各有优势,应综合考虑患者情况、医师的经验以及医院的技术条件,选择合适的治疗方法。