Evaluation of lung function and clinical features of interlaminar cervical epidural steroid injections: a randomized controlled trial

ObjectiveInterlaminar cervical epidural steroid injections (ICESIs) are commonly used to treat axial neck pain and cervical radicular pain. However, local anesthetics can spread to and block the phrenic nerve and upper segments of the thoracic spinal cord where the sympathetic innervation of the lungs emerges. Therefore, changes in lung function may occur following ICESIs.MethodsThe primary outcome measure was the pulmonary function test (PFT) result 30 minutes before and after ICESI with ropivacaine (0.1875% or 0.25%). The secondary outcome measure was the comparison of the pain scores and functional disability between the two concentrations of ropivacaine 4 weeks after the ICESIs.ResultsFifty patients were randomly assigned to either the R1 (0.1875% ropivacaine) or R2 (0.25% ropivacaine) group. No significant difference was observed between the pre-ICESI and 30-minute post-ICESI PFT results within each group, and no difference was observed between the two groups. After 4 weeks of treatment, both groups showed a significant decrease in pain scores and functional disability; however, no significant differences were observed between the two groups.ConclusionsThis study showed no significant change in lung function after ICESIs in either group and no local anesthetic concentration-based difference in the clinical efficacy of the ICESIs.     

中药治疗带状疱疹15例临床疗效观察

目的:探讨由中药治疗带状疱疹的临床疗效。方法:对15例带状疱疹患者采用中药外敷兼内服治疗,并与西医常规治疗对照观察。结果:中药治疗组临床治愈率(40.0%)总有效率(93.3%)均明显高于西医常规治疗组(P0.05)。结论:中药治疗带状疱疹具有实用推广价值。     

敦煌消肿镇痛膏对下肢骨折致膝关节功能障碍患者功能恢复的影响

目的:观察敦煌消肿镇痛膏对下肢骨折致膝关节功能障碍患者功能恢复的影响.方法:将符合入选标准80例下肢骨折致膝关节功能障碍患者随机分为观察组、对照组各40例.两组患者均给予外科手术治疗,并于术后第2天即逐渐给予复康锻炼,观察组于下肢骨折固定术后即以消肿镇痛膏贴患处,每日更换1次.两组疗程均为2个月.结果:痊愈率观察组75.00％,对照组62.50％,两组差异显著(P＜0.05);总有效率观察组95.00％,对照组85.00％,两组差异显著(P＜0.05).膝关节功能评分两组治疗后均明显改善(P＜0.05),治疗后组间相比差异显著(P＜0.05).结论:早期康复锻炼加敦煌消肿镇痛膏外用有助于下肢骨折致膝关节功能障碍患者膝关节功能的恢复.     

针刺麻醉在鼻部手术中的运用及探讨

从鼻腔手术的不同麻醉方式的运用特点、针刺麻醉选穴原则、电针频率及术中评价等方面论述。针刺复合局部麻醉既可以防止局麻的镇痛不全,又可以避免全麻的不良反应,同时可减少麻醉药用量,体现了针刺麻醉自身的独特优势。目前初步认为取迎香及印堂,频率为30Hz,波型为连续波,用于鼻部手术可取得较满意效果。但目前针刺麻醉运用于鼻内镜手术的临床报道不多,且缺乏操作规范,希望优化针刺麻醉鼻腔手术的操作流程,促进针刺麻醉鼻腔手术的临床推广与应用。     

不同麻醉方法在妇科腹腔镜手术中的应用

目的:探讨腰-硬联合阻滞复合浅全麻与插管全麻在妇科腹腔镜手术中的麻醉效果。方法:80例患者随机分为腰-硬联合阻滞(A组)40和插管全麻(B组)40例,观察两组气腹前、气腹后、术毕的BP、HR、RR、SPO2及术后苏醒情况。结果:气腹后A组HR(93.6±15.4)分/次高于气腹前(80.8±14.5)分/次(t=2.123,P<0.05),SBP(104.8±8.8)mmHg低于气腹前(115.8±9.4)mmHg(t=2.233,P<0.05);气腹后B组DBP(85.6±12.5)mmHg高于气腹前(73.6±7.4)mmHg(t=2.343,P<0.05);气腹后A组HR(93.6±15.4)分/次高于B组(82.7±15.8)分/次(t=2.283,P<0.05),A组SBP(104.8±8.8)mmHg低于B组(123.5±12.8)mmHg(t=2.311,P<0.05);A组停药-苏醒时间(4.80±1.40)min明显低于B组(10.99±1.89)min(t=2.321,P<0.05)。结论:腰-硬联合阻滞复合浅全麻比插管全麻能更好地控制机体的应激反应,术后苏醒快,是一种实用的麻醉方法。     

痛风丸治疗痛风的实验研究

目的：观察痛风丸对痛风性关节炎、高尿酸血症的影响及镇痛作用。方法：用尿酸钠致大鼠踝关节肿胀、酵母膏致小鼠高尿酸血症及小鼠冰醋酸所致的扭体反应，观察其抗痛风的作用。结果：痛风丸可明显减轻痛风模型大鼠的关节肿胀程度、降低高尿酸血症模型小鼠的血尿酸、减少扭体次数。结论：痛风丸对痛风的急性发作有一定的治疗作用。     

习见蓼提取物利尿止血及镇痛作用与急性毒性研究

目的:观察黔产习见蓼水提物(AE-P)的利尿、止血、镇痛药理作用及急性毒性。方法:测定NS负荷大鼠的排尿量及尿中Na+,K+,Cl-的含量;小鼠断尾出血时间(BT)及血浆复钙时间(RT);ip醋酸致小鼠扭体反应及热板致痛的潜伏期;LD50等指标。结果:AE-P能明显增加大鼠尿量和尿中Na+,K+,Cl-含量,且ig2次/d,连续给药7d,利尿作用无耐受性产生;AE-P能明显缩短小鼠BT和RT;能明显抑制小鼠扭体反应及延长热致痛潜伏期。AE-P以5g/kg(相当于干燥原生药80.64g/kg)给小鼠24hig3次,观察10d,小鼠全部存活;ip给药,其小鼠LD50为(3.13±0.39)g/kg(相当于干燥原生药50.48g/kg)。结论:AE-P具有利尿、止血及镇痛药理作用,其利尿作用不易产生耐受性,而止血作用与影响内凝系统有关,且毒性较低。     

多模式联合镇痛在人工关节置换围手术期的疗效观察

目的探讨多模式联合镇痛应用于人工关节置换术后的效果。方法选取2011年1月~2013年12月行单侧全髋(THA)、全膝关节置换(TKA)病例138例,年龄53~79岁,平均68.4岁。手术及麻醉均由同一组医生完成。根据镇痛方式分为3组:术后自控静脉镇痛泵组(PCIA,对照组);术后自控静脉镇痛泵+塞来昔布口服组(塞来昔布组);术后自控静脉镇痛泵+塞来昔布口服+罗哌卡因局麻组(罗哌卡因组)。比较术后各组6小时(T1)、12小时(T2)、24小时(T3)、48小时(T4)疼痛视觉模拟评分(VSA)、药物不良反应、病人满意程度、自控追加剂量(Bolus)次数、自控静脉镇痛药用量。结果术后各组T1、T2、T3、T4时间节段点的疼痛VSA评分均无统计学意义。与对照组比较,塞来昔布组和罗哌卡因组药物不良反应减少,镇痛满意度显著升高见(值均<0.05),Bolus次数、舒芬太尼用量显著减少(值均<0.05)。与塞来昔布组比较,罗哌卡因组恶心呕吐、尿潴留的发生率显著降低,镇痛满意度显著升高(值均<0.05),不同时间节段点Bolus次数、舒芬太尼用量显著减少(值均<0.05)。结论自控静脉镇痛泵+塞来昔布口服+罗哌卡因局麻组成的多模式联合镇痛方法有助于降低阿片类镇痛药物用量,减少副作用,提高患者满意度,在人工关节置换术后镇痛疗效确切。     

Application of Lidocaine Jelly on Chest Tubes to Reduce Pain Caused by Drainage Catheter after Coronary Artery Bypass Surgery

The objective of this study was to assess the effect of lidocaine jelly application to chest tubes on the intensity and duration of overall pain, chest tube site pain and the required analgesics for postoperative pain relief in coronary artery bypass graft (CABG) patients. For patients in group L, we applied sterile 2% lidocaine jelly on the chest tubes just before insertion, and for patients in group C, we applied normal saline. Overall visual analogue scale (VAS), maximal pain area with their VAS were documented postoperatively, and the frequency that button of patient-controlled analgesia was pressed (FPB) and total fentanyl consumption were assessed. The number of patients who complained that tube site was the most painful site was significantly higher in group C than in group L (85% vs. 30% at extubation, P<0.001). The overall VAS score was significantly higher in group C than in group L (39.14±12.49 vs. 27.74±13.76 at extubation, P=0.006). After all of the tubes were removed, the VAS score decreased more in group C (5.74±4.77, P<0.001) than in group L (3.05±2.48, P<0.001). FPB and total fentanyl consumption were significantly higher in group C than in group L (73.00, 59.00-78.00 vs. 34.00, 31.00-39.25, P<0.001; 2,214.65±37.01 vs. 1,720.19±361.63, P<0.001, respectively). Lidocaine jelly application is a very simple way to reduce postoperative pain by reducing chest tube site pain after CABG. (Clinical Trials Registry No. ACTRN 12611001215910)