目的 探讨收肌管阻滞和股神经阻滞在全膝关节置换术后患者中的镇痛应用效果,并观察其对患者膝关节活动度的影响.方法 选取青岛大学附属医院骨科2018年12月至2019年5月收治的行单侧全膝关节置换术的90例膝关节退行性病变患者为研究对象,依据双盲法,将入选患者分成收肌组与参照组,每组45例,参照组在超声下行股神经阻滞,收肌组在超声下行收肌管阻滞.观察两组患者术后12 h、24 h、48 h的膝关节HSS评分及12 h、24 h、48 h后的镇痛效果.结果 收肌组患者12 h、24 h、48 hVAS评分低于参照组,差异有统计学意义(P<0.05);收肌组患者术后12 h、24 h、48 h膝关节HSS评分高于参照组,差异有统计学意义(P<0.05);与参照组(24.44％,11/45)相比,收肌组的总不良反应率(20.00％,9/45)较低,两组差异未见统计学意义(χ2=0.257,P>0.05).结论 收肌管阻滞与股神经阻滞应用于膝关节置换术后镇痛效果同等,但收肌管阻滞更对患者恢复膝关节活动度的影响更小,且不增加不良反应,安全可靠.

全膝关节置换术是解决膝关节炎患者慢性疼痛、改善关节功能和患者生活质量的有效方法,但术后疼痛管理是骨科医师、麻醉医师、患者面临的一大挑战,缓解患者疼痛对增加术后舒适度、减轻患者心理应激、加快术后康复、促进功能锻炼进程、减少并发症发生、缩短患者住院时间等均具有重要意义.但全膝关节置换术后的镇痛不仅要求充分的镇痛,又要求对关节运动功能的影响最小,这对疼痛管理提出了较高的要求.文章对股神经阻滞在膝关节手术后镇痛中的应用进行综述.

Objective:To evaluate the optimized effect of infiltration between the popliteal artery and the capsule of the knee (IPACK)-adductor canal block (ACB) combined with general anesthesia when used for the total knee arthroplasty.Methods:Sixty patients of both sexes, aged 18-64 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective unilateral total knee arthroplasty, were divided into 2 groups ( n=30 each) using a random number table method: IPACK-ACB combined with general anesthesia group (group IA) and conventional anesthesia femoral nerve block-popliteal superior sciatic nerve block combined with general anesthesia group (group C). Before induction of general anaesthesia, 0.375% ropivacaine 15 ml was injected for IPACK and 0.375% ropivacaine 25 ml for ACB under the ultrasound guidance in group IA, femoral nerve block and popliteal superior sciatic nerve block was performed under the guidance of ultrasound combined with a nerve stimulator and 0.375% ropivacaine 20 ml was injected in group C. After confirming the efficacy of nerve block, total intravenous anesthesia was carried out to maintain bispectral index values at 40-60.Patient-controlled intravenous analgesia was performed with sufentanil after operation, and the visual analog scale score was maintained ≤ 3.The quadriceps muscle strength score was recorded when discharge from postanesthesia care unit and at 24, 48 and 72 h after surgery.The first postoperative off-bed time and development of foot drop in awake patients after surgery, requirement for rescue analgesia and adverse reactions were recorded.The postoperative length of hospital stay and score for patients′ satisfaction with postoperative recovery were also recorded. Results:Compared with group C, the postoperative quadriceps muscle strength scores and score for patients′ satisfaction with postoperative recovery were significantly increased, the incidence of postoperative foot drop was decreased, and the length of hospital stay and first postoperative off-bed time were shortened in group IA ( P<0.05). Conclusion:IPACK-ACB combined with general anesthesia may be an optimized strategy which is helpful for outcomes after total knee arthroplasty.

目的 探讨不同剂量右美托咪定复合罗哌卡因超声引导下收肌管阻滞在膝关节置换术后镇痛中的应用价值.方法 2018年3—9月,选择在青岛大学附属医院手术室行单侧膝关节置换术的病人120例,随机分为4组,每组30例.4组均于全身麻醉诱导前30 min行超声引导下收肌管阻滞:A组给予3.75 g/L罗哌卡因20 mL;B组给予0.50μg/kg右美托咪定+3.75 g/L罗哌卡因20 mL;C组给予0.75μg/kg右美托咪定+3.75 g/L罗哌卡因20 mL;D组给予1.00μg/kg右美托咪定+3.75 g/L罗哌卡因20 mL.术毕使用静脉镇痛泵镇痛.观察各组手术后6、12、24、48 h的视觉模拟评分法(VAS)疼痛评分和Ramsay镇静评分;记录各组术后48 h内曲马多用量和镇痛泵有效按压次数;比较各组病人术后满意度和不良事件发生率.结果 术后6、12 h,B、C、D组病人VAS疼痛评分显著低于A组,C、D组病人VAS疼痛评分显著低于B组(F=2.98、3.45,P<0.05).术后不同时间点各组Ram-say镇静评分比较,差异均无统计学意义(P>0.05).B、C、D组病人术后48 h内曲马多用量、镇痛泵有效按压次数均明显低于A组(F=10.26、62.84,P<0.05).B、C、D组病人术后满意度均显著高于A组(Z=2.09～3.04,P<0.05).各组病人术后低血压、呼吸抑制和心动过缓发生率比较,差异无统计学意义(P>0.05).结论 0.75μg/kg右美托咪定复合3.75 g/L罗哌卡因20 mL收肌管阻滞能有效缓解膝关节置换术后疼痛,提高病人术后满意度,减少术后镇痛药物的用量.

目的 观察超声引导不同浓度罗哌卡因坐骨神经复合股神经阻滞对全膝关节置换术后的镇痛效果.方法 选择行择期单侧膝关节置换手术病人90例,随机分为Q组 、W组和E组,每组30例.术前各组用不同浓度(Q组3.50 g/L,W组3.75 g/L,E组4.00 g/L)的罗哌卡因20 mL行坐骨神经阻滞,4.00 g/L罗哌卡因20 mL行股神经阻滞.术中观察病人平均动脉压及心率,术后用视觉模拟评分法(VAS)评估病人疼痛状况,用HSS评分评估病人下肢肌力恢复情况,记录肌力恢复时间(T).结果 3组病人术中平均动脉压 、心率比较差异无显著性(P>0.05),术后运动功能恢复时间和VAS评分差异有显著性(F=19.65~601.20,P<0.05).Q组病人术后疼痛评分较高(VAS评分 ≥4分),肌力恢复较快(T≤24 h);W组术后镇痛效果可(VAS评分 ≤4分),肌力阻滞时间较适中(T≤24 h);E组镇痛效果可(VAS评分 ≤4分),但是肌力阻滞时间较Q组和W组长(T≥24 h).结论 3.75 g/L罗哌卡因坐骨神经复合股神经阻滞用于膝关节置换手术,镇痛效果满意,且术后对运动神经阻滞影响较小.

目的 探讨不同剂量右美托咪定复合4 g/L罗哌卡因股神经阻滞对膝关节置换术后病人的睡眠以及肌力影响.方法 选取90例择期行膝关节置换术的病人,随机分成G1、G2、G3组,每组30例.G1组给予4 g/L的罗哌卡因25 mL;G2组给予右美托咪定0.5μg/kg+4 g/L罗哌卡因25 mL;G3组给予右美托咪定1.0μg/kg+4 g/L罗哌卡因25 mL.观察并比较3组病人术前以及术后1、2 d的阿森斯失眠量表(AIS)失眠评分,术后12、24、48 h的疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分、恶心呕吐(PONV)评分以及肌力恢复情况.结果与G1组和G2组比较,G3组术后第1天的AIS失眠评分和术后12 h肌力显著改善(F=3.871,H=7.660,P<0.05);与G1组相比,G2组和G3组术后12、24、48 h的VAS评分显著降低(F=4.575～5.567,P<0.05).G1、G2、G3组各时间点的Ramsay镇静评分、PONV评分比较差异无显著性(P>0.05).结论 右美托咪定 1.0 μg/kg+4 g/L 的罗哌卡因用于膝关节置换术能减轻病人术后疼痛,改善病人术后睡眠,缩短术后制动时间.

>患者,男,58岁。2009年3月12日因尿频、尿急1年余入院。夜尿8～10次,无腰痛、肉眼血尿,无午后低热、盗汗;否认结核病史。查体无阳性体征。尿找抗酸杆菌连续3次阳性。红细胞沉降率64 mm/1 h。尿常规示白细胞(+++),红细胞(+),蛋白(+)。B超检查:右肾上极高回声结节1.9 cm×1.5cm,考虑血管平滑肌脂肪瘤;右肾下极等回声结节2.5 cm×2.7 cm,考虑肾癌;左侧上尿路轻度积水,左输尿管全程扩张,左输尿管末端狭窄,原因不明。CT检查:左肾上极肾窦区、左肾盂及左输尿管慢性炎症改变并左肾、输尿

<正>病人,女,35岁。因腹痛4d入院。既往无高血压史,入院4d前出现左下腹部疼痛,为阵发性隐痛,持续10 min。入院时测血压20/12kPa,心率70min-1,体质量65kg;CT检查提示左下腹部占位性病变,直径约6cm,左肾囊肿。拟全身麻醉下行腹膜后囊肿切除术。麻醉经过:麻醉前30 min给予苯巴比妥钠0.1g,东莨菪碱0.3mg;入室血压17/10kPa,心率70min-1,给予舒芬太尼15μg,顺式苯阿曲库铵12mg,丙泊酚100mg行麻醉诱导,气管内插管,呼吸

Objective:To investigate the inhibitory effects of octreotide (somatostatin analogs) on androgen independent prostate cancer PC-3 cell line and the expression of vascular endothelial growth factor( VEGF). Methods: After PC-3 cells were induced by 0. 1、0. 3、1. 0、3. 0 mg/L octreotide respectively, the cell acitvity was assayed by MTT at 24,48 and 72 hours, the morphology of apoptosis was observed by Hoechst 33258 staining under fluorescence microscope. The level of caspase-3 and VEGF were detected by reverse transcription-polymerase chain reaction (RT-PCR). Results:Octreotide could suppress the growth and promote the apoptosis of PC-3 cells in dosedependent and time-dependent manners, and the morphology of apoptosis could be examined in the study. When cells were treated with different concentrations of octreotide (0. 1,0. 3,1.0 and 3. 0 mg/L). the cell surviving rate was (0.971±0. 016 ) %、( 0. 853±0. 015 ) %、( 0. 717±0. 031 ) %、( 0. 743±0.029)% respectively at 24hours,(0.918±0. 015)%、(0. 835±0. 015)%、(0. 682±0. 018)%、(0. 727±0.014)% respectively at 48 hours and (0.922±0. 017) %、(0. 841±0. 013) %、(0. 717±0. 017) %、(0. 739±0.003)% respectively at 72 hours, the difference was obviously significant among them. The expression of Caspase-3 was upregulated while VEGF downregulated. Conclusions:Octreotide can suppress the growth and promote the apoptosis of PC-3 cells, and VEGF may involve in it.