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自控静脉镇痛泵对腹部外科手术后胃肠功能的影响
术后镇痛是围手术期处理的重要环节之一.自控静脉镇痛(patient controlled intravenous analgesia,PCIA)已较广泛应用于临床,基本满足了不同患者、不同时刻或不同疼痛强度下对镇痛的需求.本研究对腹部外科手术应用PCIA术后肠道功能恢复的情况进行了系统观察,总结报道如下.
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PCA术后镇痛存在问题及对策
疼痛是大程度的不舒适,术后急性疼痛已成为术后并发症和病死率增多的重要因素.1968年Sechzer[1]提出"按需镇痛"的理念.1976年第一台病人自控镇痛泵(patient-controlled analgesia,PCA)问世[2].术后病人常采用PCIA(静脉PCA)和PCEA(硬膜外PCA)给药.
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舒芬太尼腰-硬联合分娩镇痛的临床应用研究
随着医学模式的转变,人们生活质量的提高,镇痛分娩越来越受到大众人群的重视,更多产妇要求在无痛苦状态分娩;目前公认对产痛有效的缓解方法是椎管内阻滞镇痛,而腰麻-硬膜外联合阻滞(combined spinal-epidural analgesia,CSEA)被认为是较理想的分娩镇痛方法,CSEA时常用的药物是舒芬太尼与罗哌卡因,多数常用两药的混合液,这对大部分活跃期短的产妇会造成硬膜外自控(patient con-trolled analgesia,PCA)泵的浪费,增加了不必要的经济负担;也有报道单用舒芬太尼行腰麻,但这一方法又不能完全满足活跃期较长的产妇的镇痛需要.
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The use of iodine-125 (125I) in cancer treatment has been shown to relieve patients’ pain. Consid-ering dorsal root ganglia are critical for neural transmission between the peripheral and central nervous systems, we assumed that125I could be implanted into rat dorsal root ganglia to provide relief for neuropathic pain.125I seeds with different radioactivity (0, 14.8, 29.6 MBq) were im-planted separately through L4-5 and L5-6 intervertebral foramen into the vicinity of the L5 dorsal root ganglion. von Frey hair results demonstrated the mechanical pain threshold was elevated after implanting125I seeds from the high radioactivity group. Transmission electron microscopy revealed that nuclear membrane shrinkage, nucleolar margination, widespread mitochondrial swelling, partial vacuolization, lysosome increase, and partial endoplasmic reticulum dilation were visible at 1,440 hours in the low radioactivity group and at 336 hours in the high radio-activity group. Abundant nuclear membrane shrinkage, partial fuzzy nuclear membrane and endoplasmic reticulum necrosis were observed at 1,440 hours in the high radioactivity group. No signiifcant difference in combined behavioral scores was detected between preoperation and postoperation in the low and high radioactivity groups. These results suggested that the mechan-ical pain threshold was elevated after implanting125I seeds without inlfuencing motor functions of the hind limb, although cell injury was present.
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Shaoyang acupoints are the most frequently used in migraine treatment. However, the central anal-gesic mechanism remains poorly understood. Studies have demonstrated that single stimulus of the verum acupuncture in healthy subjects can induce significant connectivity or activity changes in pain-related central networks compared with sham acupuncture. However, these findings are not indicative of the central analgesic mechanism of acupuncture at Shaoyang acupoints. Thus, we recruited 100 migraine sufferers and randomly assigned them into five groups: Shaoyang uncommon acupoint, Shaoyang common acupoint, Yangming uncommon acupoint, non-acupoint control, and blank control groups. Subjects were subjected to evaluation of curative effects and functional MRI prior to and after 10 and 20 acupuncture treatments. Al subjects were diagnosed by physicians and enrol ed fol owing clinical physical examination. Subjects were observed during 1-4 weeks after inclusion. At the fifth week, the first clinical evaluation and resting functional MRI were conducted. The Shaoyang uncom-mon acupoint, Shaoyang common acupoint, Yangming uncommon acupoint, and non-acupoint control grousp then were treated with acupuncture, five times per week, 20 times in total over 4 weeks. The second and third clinical evaluations and resting functional MRI screenings were conducted fol owing 10 and 20 acupuncture treatments. The blank control group was observed during the 5 to 8 week pe-riod, fol owed by clinical evaluation and resting functional MRI. The aim of this study was to examine changes in brain functional activity and central networks in subjects with migraine undergoing acu-puncture at Shaoyang uncommon acupoints. This study provides a further explanation of the central analgesic mechanism by which acupuncture at Shaoyang acupoints treats migraine.
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如何做好患者使用自控镇痛泵的宣教工作
患者自控镇痛(Patient controlled analgesia,PCA)是应用于临床疼痛治疗的新技术,并发挥出独特而优越的作用.由于PCA泵是患者自己控制的止痛泵,它与传统肌肉注射麻醉性镇痛药相比,PCA具有镇痛效果好,用药量少,血药浓度维持恒定,可根据个体对止痛药的不同需求而投放用药等优点.
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术后自控镇痛泵的临床应用与护理
术后镇痛的目的在于减轻病人手术后痛苦和提高病人自身预防围手术期并发症的能力.自控镇痛(patient controlled analgesia,PCA)即PCA泵,是近年来应用于临床镇痛治疗的新技术,尤其对术后病人镇痛疗效可靠. PCA的优点在于能提供病人独立的止痛药管理和取得较好疗效,它排除了病人提出止痛要求的延误,也排除了护理预测准备和给予止痛药的延迟[1].PCA按使用方式不同分为硬膜外自控镇痛(PCEA)和静脉自控镇痛(PCIA).2008年9月~2009年3月,我院有选择性地对麻醉手术后病人采用自控镇痛,取得满意效果.现报道如下.
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融合超前镇痛护理理念的急性疼痛服务体系对开胸术后慢性疼痛的影响研究
开胸术后慢性疼痛是指术后持续至少2个月的切口疼痛,以自发痛、牵涉痛、痛觉过敏和痛觉超敏为特征.国外文献报道开胸术后慢性疼痛发生率高达50%~80%,但国内开胸术后慢性疼痛未受到重视.手术和创伤是慢性疼痛的主要病因.研究发现开胸术后慢性疼痛与急性疼痛的程度、性质和处理方式有关.
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术后自控镇痛泵的临床应用效果与评价
病人自控镇痛 (patiant controlldanalgesia,PCA) 是通过静脉输液管或硬膜外导管接置有镇痛药物的自控注射泵.病人根据自己的疼痛程度, 通过按压 PCA上的按钮, 自行注射一定剂量的药物, 以达到镇痛目的.此法能安全迅速缓解疼痛,
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氯诺昔康超前镇痛用于腹腔镜胆囊切除术的临床观察
超前镇痛(preemptive analgesia),是在伤害性应激作用于机体之前采取措施,防止外周和中枢神经的敏感化,达到减少或消除伤害性刺激引起的疼痛[1].本文旨在观察单次静注氯诺昔康对腹腔镜胆囊切除术病人切口痛的防治效果,为腹部小切口手术寻找简便、有效的术后镇痛手段.现报告如下.
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Relationship Between and Laser Acupuncture Analgesia and the Function of Mast Cells in Adjuvant Arthritis Rats Treated by Acupuncture
Objective:To observe the analgesia effect and of low-level combined- and single-laser irradiation on Zusanli (ST 36) in rats and the relationship between mast cell degranulation and laser acupuncture analgesia.Methods: A total of 66 Sprague Dawley (SD) rats were randomly assigned into normal control,model control,sham irradiation,10.6 μm laser (220 mW,40 Hz) 650nm laser(36mW,continuous),combined laser (10.6 μm+ 650 nm) groups.Arthritis mode 1 was established by injection of Complete Freund's Adjuvant (0.05 mL) into the left ankle joint.The paw withdrawal latency (PWL) was detected with a radiant heat algesimeter.Zusanli (ST 36) was irradiated with sham,single or combined laser for 30 min.After sacrifice under anesthesia (1% embutal),tissues of Zusanli (ST 36) area were sampled,sliced (5 μm) and stained with Toluidine Blue for skin for observing the mast cell degranulation.Results:Compared with model control and sham group,the pain threshold increased significantly in 650nm and combined laser groups (P<0.01),while remained no significant difference in 10.6 μm group.Compared with model and sham group,the degranulation ratios of mast cells in 650nm and combined laser group were significantly higher (P<0.001),while remained no significant difference in 10.6 μm group.The linear correlation coefficient between degranulation ratios of mast cells and PWL after laser acupuncture is 0.737 (P<0.001).Conclusion:Both 650 nm and combined laser stimulation of Zusanli (ST 36) can effectively raise pain threshold,and enhance degranulation ratio of mast cells at the stimulated acupoint.The result also suggested a linear correlation between degranulation ratio of mast cell and analgesia effect.
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Relationship Between and Laser Acupuncture Analgesia and the Function of Mast Cells in Adjuvant Arthritis Rats Treated by Acupuncture
Objective:To observe the analgesia effect and of low-level combined- and single-laser irradiation on Zusanli (ST 36) in rats and the relationship between mast cell degranulation and laser acupuncture analgesia.Methods: A total of 66 Sprague Dawley (SD) rats were randomly assigned into normal control,model control,sham irradiation,10.6 μm laser (220 mW,40 Hz) 650nm laser(36mW,continuous),combined laser (10.6 μm+ 650 nm) groups.Arthritis mode 1 was established by injection of Complete Freund's Adjuvant (0.05 mL) into the left ankle joint.The paw withdrawal latency (PWL) was detected with a radiant heat algesimeter.Zusanli (ST 36) was irradiated with sham,single or combined laser for 30 min.After sacrifice under anesthesia (1% embutal),tissues of Zusanli (ST 36) area were sampled,sliced (5 μm) and stained with Toluidine Blue for skin for observing the mast cell degranulation.Results:Compared with model control and sham group,the pain threshold increased significantly in 650nm and combined laser groups (P<0.01),while remained no significant difference in 10.6 μm group.Compared with model and sham group,the degranulation ratios of mast cells in 650nm and combined laser group were significantly higher (P<0.001),while remained no significant difference in 10.6 μm group.The linear correlation coefficient between degranulation ratios of mast cells and PWL after laser acupuncture is 0.737 (P<0.001).Conclusion:Both 650 nm and combined laser stimulation of Zusanli (ST 36) can effectively raise pain threshold,and enhance degranulation ratio of mast cells at the stimulated acupoint.The result also suggested a linear correlation between degranulation ratio of mast cell and analgesia effect.
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不同麻醉方式应用于老年患者结肠镜检查术的观察
老年人肠道肿瘤发生率高,早行内镜检查非常必要,但由于老年人病理生理的改变,加上内镜操作时引起的应激反应,易造成各种并发症.在检查中辅助麻醉减轻痛苦以提高老年患者对内镜检查耐受性及安全性的措施受到重视.本文对比观察丙泊酚靶控输注(target controlled infusion,TCI)技术和患者自控镇痛(patient controlled analgesia,PCA)技术应用于老年患者结肠镜检查术的镇痛效果和不良反应,报道如下.
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超前镇痛的研究进展
疼痛是一种与组织损伤或潜在的损伤相关的不愉快的主观感觉和情感体验,已被确认为继脉搏、血压、呼吸和体温4个生命体征之后的第五生命指征.Crile[1]先提出了超前镇痛(preemptive analgesia)的概念,即在疼痛发作之前进行镇痛.近20年来,随着人们对疼痛认识的不断加深,超前镇痛再次受到重视,围绕此项技术用于减轻术后疼痛进行了大量的研究,但临床上实施超前镇痛尚缺乏规范,国内外研究结果尚存争议,此篇综述总结了目前关于疼痛的传导途径、超前镇痛的临床应用、超前镇痛有效性的争议及超前镇痛临床研究中的注意事项.
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盐酸氯普鲁卡因蛛网膜下腔阻滞用于剖宫产的低有效剂量探讨
近年来,国内、外已有诸多盐酸氯普鲁卡因成功用于蛛网膜下腔阻滞的报道,但对其低局麻药剂量(minimum local analgesia dose,MLAD)的研究较少.本次研究旨在用序贯法测定剖宫产时蛛网膜下腔盐酸氯普鲁卡因的MLAD.现报道如下.
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臂丛神经自控镇痛对断指再植的效果影响
断指再植术是治疗手指离断的佳手段,除了病情程度和血管吻合技术影响断指成活外,再植指的血液供应也很重要.术后早期常因疼痛而诱发动脉痉挛,术后3 d常规使用镇痛药是十分必要的[1].臂丛神经连续自控镇痛(patient controlled analgesia,PCA)有效地解决了术后疼痛引发的动脉痉挛,扩张再植指的血管,增加局部血流,有利于提高再植指的成活率.
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奥施康定联合硬膜外PCA用于胃癌根治术后镇痛的临床研究
胃癌患者手术后镇痛是术后处理中的一个重要问题,因为相当一部分的术后并发症常与疼痛有关,如肺不张、肺部感染、肠粘连等.持续有效的术后镇痛一方面能使患者在无痛或轻微痛的情况下配合翻身咳嗽、下地站立等术后早期活动,减少胃癌根治术后的并发症;另一方面能改善睡眠,加快患者康复.本次研究进行对比分析奥施康定塞肛+硬膜外患者自控镇痛(patient-controlled analgesia,PCA)镇痛与单用硬膜外PCA镇痛的镇痛效果及副作用.现报道如下.
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产科病人术后静脉自控镇痛效应与妇科手术病人的比较
围产期产妇雌激素产生、血浆浓度及排泄量显著增加 [1].这是否会影响产妇对疼痛的感受及对镇痛需求?目前对此鲜见报道.本次研究采用病人静脉自控镇痛方法(patient contmlled intravenous analgesia,PCIA),比较剖宫产产妇与妇科手术病人术后镇痛效果,初步探讨产妇与非妊娠病人是否存在术后疼痛程度及对术后镇痛需求的差异.
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小儿KDP全凭静脉全麻1,000例临床应用
本文采用氯胺酮200mg,安定20mg,普鲁卡因4 g加10%葡萄糖液200ml的复合液,用于3天~14岁小儿手术1,000例.静滴速率10~25滴/分,麻醉过浅可追加少量的硫喷妥钠或安定静注.术毕5~15分钟清醒.作者认为该麻醉能充分发挥三者的协同作用;减轻副反应;具有速效、短效、强镇静、容易调节、保持自主呼吸的优点,且大多数勿需常规气管内插管.是较好的小儿全麻方法之一.
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先天性无痛症(附1例报告及文献复习)
天性无痛症是一种罕见的先天性感觉神经病综合征,表现为痛觉丧失或迟钝,可伴有无发及智力障碍.其先由Dearborn(1931年)报告,是一种罕见的常染色体隐性遗传性疾病,国内自1994年至今文献报告26例,国外美国30多个案例,日本超过30个家族(约60个病人),瑞典则有将近40个案例.笔者报告1例并结合国内文献报告的26例进行综合分析.