Objective: To identify efficacy and safety of pudendal nerve block in tubing through the third posterior sacral foramen for the treatment of pudendal neuralgia (PN). Methods: A retrospective study with 222 PN patients was conducted in the Department of Pain Management of Beijing Tsinghua Changgung Hospital from January 2020 to April 2023. These patients were divided into two groups based on their treatment methods: pudendal nerve block in tubing through the third posterior sacral foramen (observation group, n=101) and ultrasound-guided pudendal nerve block (control group, n=121). Primary outcome measure was the 90-day postoperative pain relief rate. Secondary outcome measures included visual analog scale (VAS) at 1, 7, 14, 30 and 90 d after surgery, the incidence of tramadol uses after surgery, postoperative self-rating anxiety scale (SAS) scores and the incidence of adverse events. Factors that influenced pain relief within 90 days after surgery were analyzed by using binary logistic regression analysis. Results: Observation group included 34 males and 67 females, aged (49.8±16.0) years old. Control group included 38 males and 83 females, aged (43.7±14.0) years old. The 90-day postoperative pain relief rate of the observation group patients was 38.6% (39/101), which was higher than the 24.0% (29/121) of the control group patients (P=0.018). Both the observation group and the control group showed an interaction effect of time and group after treatment for VAS scores (both P<0.05). In intra-group comparison, the VAS scores at 1, 7, 14, 30 and 90 d after treatment in both groups were lower than those before treatment (all P<0.05). In inter-group comparison, the differences of the VAS scores were not statistically significant in the observation group compared with those in the control group at 1, 7, 14, 30 and 90 d after surgery (all P>0.05). The SAS score of the observation group at 90 d after surgery was 51.5±6.2, which was lower than the 53.4±5.8 of the control group (P=0.022). There was no statistically significant difference in the incidence of postoperative tramadol uses and adverse events between the two groups (both P>0.05). Pudendal nerve block in tubing through the third posterior sacral foramen was a protective factor for pain postoperative relief in PN patients at 90 d after surgery (OR=1.92, 95%CI: 1.05-3.48, P=0.033). Conclusion: Pudendal nerve block in tubing through the third posterior sacral foramen is a safe and effective minimally invasive treatment. It has a higher postoperative pain relief rate within 90 d after surgery, without increasing the uses of postoperative rescue analgesics and the incidence of adverse events.

复杂区域疼痛综合征(complex regional pain syndrome,CRPS)是一种具有复杂病理生理学机制的慢性神经病理性疾病[1].CRPS的全球发病率尚不清楚,据报道[2],荷兰每年的发病率约为26.2/10万,女性患病的风险是男性的3倍.CRPS通常有两种临床类型:CRPS Ⅰ型,早期被称为反射性交感性肌萎缩(reflex sympathetic dystrophy,RSD),通常没有神经损伤的证据;CRPS Ⅱ型,早期被称为灼性神经痛,通常存在神经损伤的证据[2].这两种类型都有相似的症状,包括持续性疼痛,感觉、血管舒缩、发汗、运动和肌肉骨骼营养代谢功能异常,这些构成了CRPS的布达佩斯诊断标准[3].合并症在CRPS中很常见,有研究[4-5]表明,CRPS会显著降低生活质量.

BACKGROUND:Extracorporeal membrane oxygenation (ECMO) has salvaged many people's life during global pandemics. However, ECMO is associated with a high incidence of hemostatic complications. This study aims to explore the effects of the ECMO system on the coagulation system in the healthy ovine ECMO model.METHODS:Ten healthy male sheep were included. Five received the veno-arterial ECMO and five received the veno-venous ECMO. Heparin was infused for systemic anticoagulation and was adjusted according to the activated clotting time. Blood routine tests, coagulation factors, anticoagulation proteins, and fibrinolysis markers were tested at the baseline and every 24 h. After weaning, the pump heads were dissected to explore thrombosis.RESULTS:Platelets decreased in the first 72 h and returned to the baseline at the 120th hour. The neutrophils increased in the first 24 h and returned to the baseline at the 48th hour. Factors II, VII, and X decreased in the first 24 h and gradually increased, while factors VIII, IX, XI, and XII decreased in the first 24 h and remained at a low level. The baseline antithrombin was 73.2 ± 14.4% and reduced to 42.6 ± 9.9% at the 168th hour. Pathology showed seven sheep developed thrombus, but no clinically relevant bleeding or thrombosis events occurred.CONCLUSIONS:The study explored hemostatic alterations during ECMO in healthy animal models, which eliminated the confounding under critically ill conditions. The study may provide insights into ECMO hemostatic disorders and aid the design of optimal therapeutic strategies.

目的 初步探索双腔静脉插管下清醒绵羊长时间静脉-静脉体外膜肺氧合(veno-venous extracorporeal membrane oxygenation,V-V ECMO)模型的建立方法及管理策略的安全性及可行性.方法 选择3只成年雄性绵羊,Avalon Elite双腔插管经右颈静脉插入上腔静脉、右心房和下腔静脉,与离心泵和氧合器相连,组成体外膜肺氧合回路.3只实验羊术后均被转移到监护笼内,麻醉恢复后可在笼内自由活动及自主进食水.每天监测血流动力学指标和体外膜肺氧合设备性能.结果 3只实验羊术后均存活至实验终点(7 d).在整个实验进程中,实验羊的基本生命体征平稳,未出现严重的出凝血事件.实验进程中血红蛋白浓度及血小板计数相对稳定,游离血红蛋白维持在较低水平,体外膜肺氧合流量稳定,氧合器氧合性能良好.结论 双腔静脉插管下清醒绵羊长时间V-V ECMO模型的可行性及稳定性较高.

目的 探索猪的外周型静脉-动脉体外膜氧合及羊的左心室辅助的中短期大动物心肺辅助模型建立的可行性和稳定性.方法 选取家猪3只(体重74 kg、82 kg、110 kg;均为雌性,月龄5～6个月),实验用小型猪1只(体重43 kg,雄性,月龄5～6个月);山羊1只(体重78 kg,雌性,月龄5～6个月).所有实验动物均为健康动物,术前禁食12 h,禁水4 h.实验猪常规术前准备后完成颈动、静脉置管的外周型静脉-动脉体外膜氧合并转流24～72 h.实验羊完成心尖部和降主动脉置管的清醒左心室辅助,转流时间为24 h.实验过程中监测血气、凝血相关指标及游离血红蛋白浓度并及时调整管理策略,实验结束后动物于麻醉状态下处死.结果 所有动物均顺利完成实验,术中生命体征平稳,检测指标结果满意,未出现不良事件.结论 猪的外周型静脉-动脉体外膜氧合及羊的左心室辅助的中短期大动物心肺辅助模型可行性及稳定性高、易于管理.

体外膜氧合(ECMO)是心肺功能衰竭患者通过机械循环辅助装置获得短时间体外生命支持(ECLS)的一种辅助治疗手段.动物模型是ECLS领域研究的基础,基于动物模型可以进行相关生理学研究及分子机制研究,并为相关临床试验提供重要参考.本文旨在对现有的不同ECMO大动物模型的特点和建立方法进行了系统的综述,目的是优化在未来研究设计中模型建立的相关策略.