A floating-slab track (FST) increases the interior noise and reduces the passenger’s acoustic comfort. A study combining experimental measurement and numerical simulation was conducted to reveal the characteristics of internal structure-borne noise on different tracks and improve riding comfort. A field measurement was taken to analyze the essential interior noise characteristics on different tracks with different speeds. A noise prediction model was built by combining a vehicle-track coupling model, the structural finite element method and the acoustic boundary element method to predict the interior noise and study the panel contribution for noise control. The results show that the sound pressure level (SPL) of FST is 5 – 10 dB higher than the ordinary monolithic track (OMT). The curve section is 1 – 4 dB larger than the straight section. In the range of 90 – 110 Hz and 135 – 150 Hz, the SPL of FST condition is higher than that of OMT condition, with a maximum difference of 12 dB. And the SPLs at five ISO positions all have peaks at 30 Hz and 90 Hz frequencies, and the sound pressure fluctuates wildly at 100 Hz. The vibration at 90 Hz is relatively violent, which leads to more significant noise, but at 110 Hz, that is small. At different frequencies, the contribution of the panels to the sound pressure in the carriage is different, and the acoustic contribution of these panels may be the opposite.

国际疼痛学会(International Association for the Study of Pain, IASP)将慢性癌症相关性疼痛(chronic cancer-related pain, CCRP)定义为由癌症原发或转移,或癌症治疗所引起的疼痛(以下简称癌痛).不同癌症病人、癌症的不同阶段,其疼痛的病因、病理机制和临床表现均有所不同.疼痛评估是治疗癌痛的首要环节,准确全面的疼痛评估对制订个体化治疗方案和获得满意的治疗效果至关重要.目前因规范化癌痛评估体系的缺乏,影响了癌痛病人的治疗效果.为进一步完善癌痛的规范化管理,为临床医师提供规范的评估标准,中国医师协会疼痛科医师分会、中华医学会疼痛学分会、国家疼痛专业医疗质量控制中心、北京市疼痛治疗质量控制和改进中心组织相关领域专家,借鉴国内外相关指南,并结合临床实践经验,撰写本共识.本共识采用推荐意见分级的评估、制订和评价(grade of recommendations assessment, development and evaluation, GRADE) 分级体系,将证据质量等级分为高 (A)、中 (B)、低 (C)、极低 (D) 4 级;推荐级别分为强推荐和弱推荐(见附录).

Objective:This retrospective study compared the clinical efficacy and safety of knee nerve multi-mode radiofrequency vs knee joint injection medical chitosan in the treatment of refractory knee osteoarthritis(KOA).Methods:From February 2020 to March 2021 66 patients with refractory KOA who received treatment at the Pain Department of China-Japan Friendship Hospital were divided into the surgery group(n = 35)and the injection group(n = 31).The patients'numerical rating scale(NRS)scores,the Western Ontario and McMaster Universities(WOMAC)osteoarthritis index scores,the proportion of nonsteroidal antiinflammatory drugs(NSAIDs)and/or opioid drugs used,surgical related complications and patient satisfaction were evaluated and analyzed at the time of before surgery and 2 weeks,1,3,6 and 12 months after surgery.Results:Compared with pre-operation,the patients in surgical group had better efficacy than the injection group.The NRS scores and WOMAC scores,as well as the postoperative drug use rate,decreased significantly at the times of 2 weeks,1,3,6 and 12 months follow-up after surgery.No serious adverse reactions,such as lower limb numbness,lower limb weakness,hypoesthesia,paresthesia,and neuralgia,were observed after surgery.82.9%of the patients in surgery group,38.7%of the patients in injection group were satisfied with the post-operative results at the time of 12 months follow-up after surgery.Conclusion:The combination of knee nerve radiofrequency and low-temperature plasma radiofrequency ablation can effectively alleviate knee joint pain,improve joint function,and have no serious adverse reactions,which can be used as an alternative treatment mode for refractory KOA other than total knee arthroplasty.

目的:探讨血药浓度监测在普瑞巴林治疗带状疱疹后神经痛(postherpetic neuralgia,PHN)中的作用.方法:选择2018年12月至2020年12月就诊于中日友好医院疼痛科的PHN病人149例.所有病人进行疼痛量化评分后,进入第一阶段治疗.给予口服普瑞巴林150 mg,每日2次.治疗14天后,进行疼痛量化评估,记录药物不良反应,同时测定普瑞巴林的血药浓度.并根据疼痛数字评分法(numerical rating scale,NRS)评分情况将病人分为三组进行第二阶段治疗:将NRS评分≤3的病人归入常规药物组(R组,66例);NRS评分＞3的病人(83例)再按照病人意愿分为两组:增强药物组(P组,37例)和射频治疗组(F组,46例).R组病人继续原治疗方案.P组将普瑞巴林治疗量增加100％(每日2次,每次300mg);F组在原治疗方案的基础上,行选择性神经根脉冲射频.治疗14天后,再次进行疼痛量化评估,同时测定普瑞巴林的血药浓度.结果:治疗前的NRS评分为6.81±1.12,经过第一阶段治疗后,NRS评分降至3.85±1.27(P＜0.01).其中,NRS评分＞3病人的普瑞巴林血药浓度为(2252.33±1308.91)μg/L,明显低于NRS≤3病人的血药浓度(P＜0.01).第二阶段治疗后,P组病人NRS评分降至2.81±0.52,F组降至2.68±0.74.F组NRS评分3分以下的病人占入组病人的87.0％,明显高于P组(P＜0.05).P组总体的普瑞巴林血药浓度上升至(2759.55±1810.88)μg/L,明显高于治疗前(P＜0.05),R组和P组普瑞巴林血药浓度高于F组病人(P＜0.05).不良反应主要为恶心、头晕和嗜睡.其中,F组的不良反应发生率最低.结论:普瑞巴林的血药浓度与PHN的治疗效果呈现一定的相关性.在血药浓度偏低的状态下,与脉冲射频联用可提高PHN的治疗效果,改善就医体验.

目的:观察选择性神经根脉冲射频术联合普瑞巴林治疗不宁腿综合征(restless legs syndrome,RLS)的临床疗效及安全性.方法:收集中日友好医院2019年1月1日至2021年6月30日间RLS病人51例,按照治疗方式不同分为三组:普拉克索(PRA)组19例,普瑞巴林(PRE)组17例及联合治疗(COM)组15例.PRA组给予口服普拉克索每日0.125 mg,PRE组给予口服普瑞巴林每日300 mg;COM组给予普瑞巴林每日150 mg,并对责任神经根行脉冲射频治疗.收集治疗前及治疗后7天国际RLS研究小组严重程度评分(International RLS Study Group rating scale,IRLS)、不适程度数字评分法(numerical rating scale,NRS)评分、入睡质量评分、助眠药物使用情况的变化及各组病人并发症和不良反应的发生率.结果:治疗后三组病人IRLS和NRS评分及助眠药物使用率均较治疗前显著降低,入睡质量评分升高.COM组的IRLS和NRS评分下降最为明显(P<0.01)、助眠药物使用率最低(P<0.01).PRA组主要的不良反应为头痛和恶心,PRE组和COM组主要的不良反应为头晕和恶心,未出现围术期并发症.PRE组恶心与嗜睡最为明显(P<0.05),COM组的头晕和恶心的发生率最低(P<0.05).结论:选择性神经根脉冲射频术联合普瑞巴林治疗RLS的临床疗效良好,可明显改善病人不适症状,从而改善入睡质量且安全性良好.

The lateral femoral cutaneous nerve originates from the anterior branch of the second and third lumbar spinal nerves and innervates the skin sensation of the lateral thigh, and is prone to anatomic variation. Compared with the traditional blind method, nerve block methods assisted by electrical nerve stimulator and guided by ultrasound have higher success rate. There are two approaches to block the femoral cutaneous nerve. The first approach is medial to the anterior superior iliac spine, the second one is below the anterior superior iliac spine which is now recommended. The nerve can be found between the sartorius and tensor fascia latae, where the lateral femoral cutaneous nerve is relatively fixed.

吗啡鞘内给药可直接作用于脊髓阿片受体,发挥镇痛作用,其镇痛效价是口服吗啡的 300 倍 [1].研究表明,持续鞘内镇痛可降低病人疼痛评分,同时减轻全身用药引起的诸多不良反应 [2].美国食品药品监督管理局 (The Food and Drug Administration, FDA) 批准鞘内镇痛用于各种保守治疗均无效的中至重度的躯干和四肢的难治性疼痛 [3,4].从治疗维持费用考虑,若病人预期治疗时间大于 3 ～ 6 个月,通常可以选择鞘内药物输注系统 (Intrathecal drug delivery systems, IDDS) [5].目前鞘内镇痛药物输注越来越多用于控制非癌性疼痛,由于病人生存周期长,故植入式鞘内泵电池寿命问题越来越值得大家关注,然而国内外因电池耗竭而需更换新泵的报道很少.本文报道 1 例带状疱疹后神经痛病人因泵电池耗竭而需更换新的植入式鞘内泵的病例,并结合相关文献进行分析,给临床医师换新泵提供相关数据和参考.

说到老年人的晚年生活,我们就会想起那首脍炙人口的歌曲《夕阳红》,温馨的画面立刻浮现在眼前.可是,老年人常见的疼痛性疾病就像夕阳下的乌云,霎时间打破这如诗的意境.今天,我们就一起来看看老年人常见的疼痛性疾病. 随着人口老龄化的进展,老年人群疾病的发生率逐年提高,而疼痛性疾病尤为常见.在常见的老年人疼痛性疾病中,疼痛不是单独作为一种疾病存在,而是作为一个症状或者一组综合征出现在许多疾病中,涉及内科、外科、妇科、疼痛科等诸多学科,其覆盖面之广发病因素之多、患病率之高,都足以引起广大医务工作者的高度重视.

1998年,在我国著名疼痛生理学家韩济生院士的主持下,中华疼痛学会在广西北海召开了晚期癌痛治疗专题研讨会,与会许多专家正式提出了“三阶梯外疗法或第四阶梯疗法”的概念.虽然目前癌痛“三阶梯治疗”在临床上已经能够使80％以上的患者有效缓解疼痛,从而提高了生存质量,但是仍然有一部分晚期癌痛患者不能有效缓解疼痛、无法耐受药物副作用或因为疼痛复发疗效不佳.为了满足这部分患者缓解疼痛的需要,实施应用“第四阶梯疗法”非常必要,也是中国疼痛诊疗专家对WHO三阶梯疗法的补充、发展和完善.

Objective:To analyze the efficacy and safety of intrathecal morphine infusion by subcutaneous port for the management of severe cancer pain retrospectively.Methods:Thirty patients undergone intrathecal morphine infusion by subcutaneous port for the management of severe cancer pain during October 2013 to March 2016 were included. Patient demographic data, duration of intrathecal administration of opioid, preoperative visual analogue scale (VAS) scores, doses of systemic opioids, VAS scores on the 1st, 3rd, 7th, 14th, 30th days post operation, dose of systemic opioids after procedure, doses of intrathecal morphine, side effects and complications. The relationship between the interval of initial pain to procedure and the time required to increase doses to a satisfactory level and doses of postoperative intrathecal morphine infusion were also evaluated.Results: The average survival time of patients was 10.8±21.6 months and the follow-up time was 5.7±8.1 months. The preoperative VAS score was 7.9±2.8 and the VAS scores on the postoperative 1st, 3rd, 7th, 14th, and 30th days were 5.6±2.5, 4.3±2.1, 3.3±2.0, 3.2±2.3, and 3.3±2.7, respectively, which were significantly lower than preoperative value. The systemic opioid consumption decreased significantly, while the intrathecal morphine consumption increased gradually. Nausea and vomiting were observed in 5 patients. Urinary retention appeared in 3 patients. Cerebrospinal fluid leakage was observed in 5 patients. The time required for increasing the intrathecal morphine to a satisfactory level in the patients whose interval of initial pain to procedure being beyond 1 month was 17.1±5.8 days and the morphine consumption of 24 hours was 4.4±2.1 mg. Both of them were significantly longer or higher than those with the interval of initial pain to procedure being less than 1 month.Conclusion: Intrathecal morphine infusion by subcutaneous port is an effective and safe method for the management of cancer pain.

目的:观察超声药物透入治疗联合口服加巴喷丁治疗胸背部带状疱疹后神经痛的疗效.方法:56例确诊为胸背部带状疱疹后神经痛的患者,采用数字表法随机均分为两组,对照组(n=28):单纯口服加巴喷丁;观察组(n=28):在口服药物的基础上联合疼痛区域的超声药物透入治疗.观察治疗后1天、7天、14天及28天时的视觉模拟评分(visual analogue scale,VAS)和情绪评分(emotional scale,ES)的变化,并记录并发症和不良反应的发生率.结果:两组治疗后各个时间段VAS均较治疗前明显降低(P＜0.05),ES均较治疗前明显降低(P＜0.05);观察组较对照组的VAS降低和ES降低更明显(P＜ 0.05).结论:超声药物透入治疗联合口服加巴喷丁治疗胸背部带状疱疹后神经痛效果确切,可以用于治疗带状疱疹后神经痛.

对于恶性肿瘤患者,疼痛是最常见的症状之一。世界卫生组织（WHO）根据32篇发表资料的综合分析指出:70%的晚期癌症患者可出现明显的疼痛,也就是说,每年至少有350万癌症患者伴随有疼痛的症状,其中只有部分人可能得到合理疼痛治疗。因此,癌性疼痛是怎么引起的,以及医生在癌痛控制中有什么是可能

目的:回顾性研究低温等离子消融术与颈前路椎间盘摘除融合术治疗颈椎间盘突出症的效价比.方法:选择我院行颈前路椎间盘摘除融合术或低温等离子消融术的患者25例,按手术方式分为低温等离子消融组(D组,n=13例)和颈前路椎间盘摘除融合组(S组,n=12例).分析术前椎间盘突出程度、手术时间、术后平均住院日、住院费用及术后1天、术后1个月、术后3个月的NRS (Numerical rating scale,NRS)和JOA (Japanese orthopaedic association,JOA)评分变化.结果:两组患者术后1天、术后1个月、术后3个月的NRS评分较术前均出现明显下降(P＜0.01),JOA评分明显改善(P＜0.05),但两组之间没有明显差异(P＞0.05).D组的手术时间、术后平均住院日、住院费用明显低于S组(P＜0.05).结论:低温等离子消融术和颈前路椎间盘摘除融合术均可有效治疗颈椎间盘突出症,与颈前路椎间盘摘除融合术相比,低温等离子消融术效价比更高,创伤更小,恢复更快.

Objective: To observe the effect of radiofrequency ablation of medial branch of posterior lumbar ramus in the treatment of lumbar pain resulting from failed back surgery syndrome(FBSS). Methods: Bilateral radiofrequency ablation of medial branch of posterior lumbar ramus under X-ray was performed in 40 patients with clinical diagnosis of FBSS. The effect of the treatment was assessed by visual analogue scale(VAS) and back movementss at 5 min, 1, 4 and 12 weeks after procedure. The complications, if any, were recorded. Results: The difference of pre-procedure VAS score and back movements between both groups was not significant(P 0.05). The VAS score was lower and back movements was greater significantly in both groups at 5 min and 1 week after procedure than pre-procedure baseline value(P 0.05). The VAS score and back movements in group B at 4 and 12 weeks after procedure were similar with pre-block baseline value(P 0.05), but VAS score was lower and back movements was greater significantly compared with pre-procedure baseline value in group R(P 0.05). Although there was no significant difference in VAS score and back movements at 5 min and 1 week after procedure between both groups(P 0.05), the VAS score was lower and back movements was significantly greater at 4 and 12 weeks in group R than that in group B(P 0.05). No complication occurred in both groups. Conclusion: Radiofrequency ablation of medial branch of posterior lumbar ramus is an effective procedure for treatment of lumbar pain resulting from FBSS.

目的:本研究旨在通过对神经病理性癌痛(NCP)的发病率和诊疗现状的调查,以寻求更好地控制NCP.方法:运用描述性研究方法,对658例癌痛患者临床特点进行横断面调查,对治疗进行前瞻性随访.NCP诊断标准依照NeuPSIG神经病理性疼痛的最新定义和ID-Pain量表.治疗方案依据NCCN成人癌痛治疗指南,包括镇痛辅助药物、姑息性放化疗和手术,研究周期为3周.结果:符合NP诊断者147例,纳入ITT统计118例.侵犯神经常见于腰骶丛、颈丛、臂丛.临床症状以麻木感、针刺痛和烧灼痛多见.疼痛NRS基础评分5.0±1.4,第3天降至3.7±1.5(P＜0.001).感觉超敏第3天改善(P=0.020).烧灼痛、电击痛第7天改善(P=0.003,0.018).生活质量第3天改善(P=0.002).结论:NCP发病率为22.3％.采用阿片药物为主的综合治疗,多数神经病理性癌痛明显减轻.针刺样痛和麻木感较烧灼痛、电击痛和感觉过敏更加难以控制.

目的:观察颈椎MRI图像测量引导行颈段硬膜外穿刺的有效性.方法:60例拟行颈段硬膜外穿刺置管治疗的慢性疼痛患者,随机均分为MRI图像引导组(M组)和盲探组(B组),分别实施颈段硬膜外穿刺操作.M组先通过PACS工作站在颈椎MRI图像上测量颈段硬膜外穿刺所需的各项参数,然后实施硬膜外穿刺操作.B组直接凭经验实施颈段硬膜外穿刺操作.记录两组患者的穿刺次数和穿刺操作时间、操作中和操作后的并发症.结果:M组的穿刺次数和穿刺时间显著少于B组(P＜0.05),穿刺中神经根刺激症状和术后颈背部痛的发生率明显低于B组(P＜0.05).两组患者均未发生注入蛛网膜下腔、硬膜外血肿、硬膜外腔感染等严重并发症.结论:与盲探法相比较,MRI图像测量引导可明显减少穿刺次数和时间,减少穿刺损伤,避免穿刺的盲目性,提高穿刺成功率.

目的:评价硬膜外注射利多卡因和倍他米松对腰椎术后神经病理性疼痛的治疗效果.方法:选择以下肢酸胀痛为主要症状的腰椎术后患者24例,行硬膜外置管并造影,术后持续泵入利多卡因;于术后第2、10天硬膜外推注倍他米松各1 ml;观察硬膜外造影与“责任”神经根的关系,记录手术前、术后第3天及1个月患者的NRS评分、ES评分、汉密尔顿焦虑评分(HAMA),1月后对治疗效果进行评价.结果:既往手术区域呈造影剂缺失影, “责任”神经根均位于此部位附近1～2个节段.与术前相比,术后第3天及1个月时的NRS评分、ES评分及HAMA评分明显下降(P＜0.05),1个月后治疗效果优良率为54.1％.结论:硬膜外应用利多卡因和倍他米松可有效缓解腰椎术后酸胀样疼痛.

目的:观察玻璃酸钠关节内注射联合隐神经阻滞治疗膝关节骨性关节炎(osteoarthritis,OA)的有效性.方法:膝关节OA患者84例,随机分为联合治疗组(C组,n=42)和单纯注射组(H组,n=42).C组行玻璃酸钠关节内注射联合隐神经阻滞,H组单纯玻璃酸钠关节内注射.评价治疗前、治疗后4周和12周时的西安大略和麦克马斯特大学关节炎指数(Western Ontario and McMaster Universities Arthritis Index,WOMAC)评分和SF-36生活质量评分,记录治疗中和治疗后的并发症.结果:两组患者阻滞前WOMAC和SF-36评分无显著差异,治疗后4周和12周时的WOMAC评分明显低于、SF-36评分明显高于治疗前基础值(P＜0.05),但C组更为显著(P＜0.05).结论:玻璃酸钠关节内注射联合隐神经阻滞可改善膝关节OA的疼痛和功能障碍,是治疗膝关节OA的有效方法.

<正>患者男性,45岁,体重75kg。门诊以"(1)左侧股骨头坏死;(2)心脏移植术后"收入中日友好医院。患者于2005年因"扩张性心肌病"行心脏移植术,术后口服强的松1年,服用环孢素至今;既往否认高血压、糖尿病、脑血管病

>患者男性,44岁,因扩张性心肌病于2005年8月在外院行心脏移植术。术后应用泼尼松龙及环孢素抗免疫排斥治疗,泼尼松龙在最初3个月为25 mg/d,以后每3个月递减5 mg/d,服用1年,总用量约2100 mg;环孢素自术后一直服用,剂量为6片/d。移植心脏功能较好,已恢复正常生活。但自2007年11月开始出现双髋关节疼痛,负重时加重,下蹲及穿鞋袜困难,需持双拐行走,右髋重,左髋轻。在当地医