目的:评价侧卧位斜轴面超声引导颈内静脉穿刺置管的可行性及临床效果.方法:选择需要颈内静脉穿刺置管的手术患者100例,将患者随机分入平卧位斜轴面组,侧卧位斜轴面组,每组50例.记录并比较两组穿刺次数、一次穿刺成功例数、穿刺成功例数、穿刺失败例数、穿刺时间,以及穿刺并发症的发生情况,记录操作者穿刺过程的舒适度.结果:两组穿刺时间、穿刺次数、一次穿刺成功例数、穿刺成功例数和穿刺失败例数、穿刺并发症发生率比较,差异均无统计学意义(P>0.05);操作舒适度方面,侧卧位操作者舒适度更好.结论:超声引导下侧卧位斜轴面颈内静脉穿刺置管方法简单易操作,相比平卧位操作舒适度上更具有优势,临床操作可行性好,值得临床推广.

目的 评价超声引导下外周神经阻滞在血管外科老年危重患者下肢截肢手术的麻醉效果.方法 选择2016年6月—2018年12月本院收治的择期行截肢手术老年危重患者30例,ASAⅢ或Ⅳ级,采用超声引导下髂筋膜阻滞、闭孔神经总支阻滞、骶丛阻滞,分别给予0.3％罗哌卡因30 ml、10 ml、20 ml.记录患者麻醉前(T0)、麻醉后15分钟(T1)、30分钟(T2)、手术开始时(T3)和手术结束时(T4)SBP、DBP和HR的变化.观察患者感觉和运动阻滞的起效时间、持续时间,评价神经阻滞效果.结果 与T0相比,T1～4各时点SBP、DBP和HR差异无统计学意义(P>0.05),所有患者均获得满意的外周神经超声成像,并顺利完成神经阻滞,感觉起效时间(7.5±2.2)min,维持时间(640±60)min;运动起效时间(15.0±3.2)min,维持时间(450±56)min.25例(83.3％)神经阻滞效果为Ⅰ级,5例(16.7％)效果为Ⅱ级.所有患者未出现明显的麻醉并发症.结论 超声引导外周神经阻滞,具有血流动力学稳定、镇痛完善持久和并发症少等优点,用于血管外科老年危重患者的下肢截肢手术是安全可行的,能够满足外科手术要求.

目的:探讨超声引导下前锯肌平面阻滞(serratus anterior plane block,SAPB)复合腹直肌切口局部浸润在胆管结石开腹手术中的临床应用效果.方法:40例择期行胆管结石开腹切除手术患者,随机分为观察组(R组)和对照组(C组),每组20例.R组手术结束关腹前给予腹直肌切口局部浸润,给予0.25％罗哌卡因20 ml,关腹后给予超声引导下前锯肌平面阻滞,给予0.25％罗哌卡因30 ml,接静脉镇痛泵.C组仅给予静脉镇痛泵.记录两组患者术后2、6、12、24、36、48 h视觉模拟评分(VAS)、术后48 h止痛泵按压次数及镇痛满意度;记录两组患者术后不良反应发生情况.结果:与C组相比,R组患者术后2、6、12、24 h VAS评分均低于C组,差异均有统计学意义(P<0.05),镇痛满意度更高(P<0.05);在术后0～2、2～6、6～12、12～24 h R组患者单次使用PCIA次数显著低于C组(P<0.05);两组术后恶心、呕吐、头晕、呼吸抑制发生率比较差异无统计学意义(P>0.05).结论:超声引导下前锯肌平面复合腹直肌切口局部浸润联合静脉镇痛泵与单纯静脉镇痛泵相比,术后24 h镇痛效果好,患者满意度高,是一种值得推荐的麻醉镇痛方式.

目的 观察膝关节内注射生长抑素(SST)治疗膝关节骨关节炎(OA)的有效性以及它的耐受性和依从性.方法 OA患者233例(267膝),随机分成两组,观察组117例133膝,膝关节腔内注射SST 750 μg,每周1次,连续5周;对照组116例134膝,膝关节腔内注射玻璃酸钠2 mL,每周1次,连续5周.记录治疗前后疼痛缓解程度以及关节功能改善情况,并采用VAS疼痛评分和Legusne膝骨关节炎严重程度指数制定评定标准和评价治疗效果.结果 两组患者治疗后疼痛均有明显减轻,VAS评分与治疗前相比,差异有统计学意义(P<0.05).关节综合评分有效率显著提高.一个疗程后治疗组有效率为85.71%,1个月后效果最为明显,有效率为89.47%.停药后6个月时有效率仍为73.68%.结论 应用SST关节腔内注射治疗OA,能有效缓解关节疼痛,改善关节功能.与玻璃酸钠疗效相当,而且SST的作用时间更持久.患者对SST耐受性及依从性均较好.远期疗效尚需继续追踪.

暴发痛是Portenoy 1990年开始报道,在癌痛病人按时接受阿片类药物治疗过程中,可突然暴发短暂剧烈疼痛.很多病人描述这种疼痛发作时非常剧烈和痛苦.氨酚曲马多(Paracetamol and Tramadol Hydrochloride Tablets),商品名及通安,是曲马多(17ramadol)和对乙酰氨基酚(APAP)组成的复方制剂,是一种起效迅速的新型镇痛药物.我们使用及通安治疗癌性暴发痛,观察及通安抑制暴发痛的效果,并与曲马多进行初步临床比较.

Objective To evaluate the analgesia and sedation during double-balloon push enterosco- py (DBE) in the diagnosis of small bowel disease.Methods 126 patients which suspected small bowel dis- eases were examined by DBE.All patients had prior normal results on gastroscopy,colonoscopy,small bowel barium radiography and/or angiograpy.15l procedures were performed in 126 patients,among them 60 pa- tients were performed through mouth,41 patients through anus and 25 patients through both mouth and anus. The patients were recruited and randomized to analgesia and sedation group (group A) in which a mixture of propofol and fentanil was delivered by means of a pump (n=79),or control group (group B) (n = 72). Arterial blood pressure (BP) was monitored at intervals and heart rate and oxygen saturation (SpO_2) were recorded continuously by pulse oximetry.Results All patients in group A did not report any pain and had complete amnesia for the procedure.Patient satisfaction was 100%.None of the patients in group A had any complication.Heart rate and blood pressure was significantly difference between group A and group B during the procedure(P0.05).In group B,before the procedure and during the procedure,heart rate and blood pressure were significantly different (P0.05).All the patients in group B reported nausea,abdominal pain,etc.DBE disclosed abnormal small bowel findings in 96 out of 126 patients (76.2%).55 patients of them suffered from GI bleeding,pathological changes were found in 46 patients by DBE.30 patients suffered from abnominal pain,pathological changes were found in 22 patients by DBE.20 patients of them suffered from chronic diarrhea,pathological changes were found in 11 patients by DBE.21 patients of them suffered from partial small intestine obstruction,pathological changes were found in 17 patients by DBE.Conclusion Analgesia with propofol in DBE is a new safe effective endoscopic procedure in the diagnosis of small intes- tinal disease,which is superior to conventional methods.

Objective To investigate the effect of infecting betamethasone dipropionate 5mg/betamethasone disodium hydrogen phosphate 2mg in articular genu cavity on osteoarthritis.Methods 100 patients were randomly divided into two groups, the treatment group and the control group. The treatment group was treated with diprospan,injected into the inside of knuckle. The control group was treated with oral administration NSAIDs. Results In treatment group the rate of amelioration was 84% after one injection,the rate of amelioration was 90% after one course of treatment. Conclusion Injected diprospan into the inside of knuckle could relieve pain of arthritides, improve the function of arthrosis.