Combined lumbar muscle block and perioperative comprehensive patient-controlled intravenous analgesia with butorphanol in gynecological endoscopic surgery

BACKGROUND Laparoscopic surgery has become a common surgical approach for the clinical treatment of intra-abdominal lesions in recent years.We hypothesized that lumbar block with postoperative patient-controlled intravenous analgesia(PCIA)by butorphanol after gynecological surgery under general anesthesia would be more effective than PCIA by butorphanol alone.AIM To investigate the effect of lumbar block with PCIA by butorphanol after gynecological surgery under general anesthesia.METHODS This study assessed 120 women scheduled for laparoscopic surgery at our hospital between May 2017 and May 2020.They were divided using a random number table into a research group(those who received quadratus lumborum block combined with PCIA analgesia by butorphanol)and a control group(those who received only PCIA analgesia by butorphanol),with 60 patients in each group.Demographic factors,visual analog scale scores for pain,serum inflammatory markers,PCIA compressions,Ramsay scores,and adverse events were compared between groups using a t-test,analysis of variance,orχ2 test,as appropriate.RESULTS There were no significant differences in demographic factors between groups(all P>0.05).The visual analog scale scores of the research group in the resting state 12 h and 24 h postoperatively were significantly lower than those of the control group(P<0.05).Two hours after surgery,there were no significant differences in the levels of serum tumor necrosis factor-α,interleukin(IL)-6,or IL-8 between groups(P>0.05).The serum tumor necrosis factor-αlevels of the research group 24 h postoperatively were significantly lower than those of the control group(P<0.05).The levels of serum IL-6 and IL-8 in the study group 24 h and 48 h postoperatively were significantly lower than those in the control group(P<0.05).CONCLUSION Lumbar block with PCIA with butorphanol after gynecological surgery under general anesthesia significantly improves the analgesic effect and reduces the degree of inflammation,instances of PCIA compression,and adverse reactions.

Effects of oxycodone and fentanyl patient-controlled intravenous analgesia on pain, immune response and stress response after laparoscopic surgery

Objective:To study the effects of oxycodone and fentanyl patient-controlled intravenous analgesia on pain, immune response and stress response after laparoscopic surgery.Methods:Patients undergoing laparoscopic surgery in Xianning Central Hospital between June 2015 and February 2017 were selected and randomly divided into oxycodone group and fentanyl group who received postoperative oxycodone and fentanyl patient-controlled intravenous analgesia respectively. 3 d after surgery and 5 d after surgery, the serum contents of pain-related transmitters, immune indexes, stress-related molecules as well as peripheral blood contents of immune cells were measured.Results: 3 d after surgery and 5 d after surgery, CRP, TNF-α, IL-8, sICAM-1, YKL-40, Cor, C-P, FT3, FT4 and HO-1 contents in serum of oxycodone group were significantly lower than those of fentanyl group whereas CD3+CD4+T cell and CD3+CD8+T cell contents in peripheral blood as well as C3 and C4 contents in serum were significantly higher than those of fentanyl group.Conclusion:oxycodone patient-controlled intravenous analgesia after laparoscopic surgery is better than fentanyl and can reduce the pain degree, inhibit the stress response and improve the immune response.

Effect of buprenorphine transdermal patch combined with patient-controlled intravenous analgesia on the serum pain-related biochemical indexes in elderly patients with intertrochanteric fracture

Objective:To study the effect of buprenorphine transdermal patch combined with patient-controlled intravenous analgesia on the serum pain-related biochemical indexes in elderly patients with intertrochanteric fracture.Methods: A total of 92 elderly patients with intertrochanteric fracture who received surgical treatment in the hospital between August 2014 and January 2017 were collected and divided into control group (n=46) and observation group (n=46) according to the random number table method. The control group received patient-controlled intravenous analgesia, and the observation group received buprenorphine transdermal patch combined with patient-controlled intravenous analgesia. Differences in serum levels of inflammatory factors, oxidative stress indexes and pain mediators of two groups of patients were measured before and 24h after surgery.Results: Differences in serum levels of inflammatory factors, oxidative stress indexes and pain mediators were not statistically significant between the two groups before surgery;24 h after surgery, serum IL-1β, IL-6, IL-8, TNF-α, MDA, SP, PGE2, 5-HT, HA and NPY levels of both groups of patients increased significantly while SOD, TAC and CAT levels decreased significantly, and serum IL-1β, IL-6, IL-8, TNF-α, MDA, SP, PGE2, 5-HT, HA and NPY levels of observation group were lower than those of control group while SOD, TAC and CAT levels were higher than those of control group.Conclusion: Buprenorphine transdermal patch combined with patient-controlled intravenous analgesia can effectively inhibit the expression of pain-related indexes and relieve early postoperative pain intensity in elderly patients with intertrochanteric fracture.

Patient-controlled intravenous fentanyl for cystospasm after transurethral resection of the prostate

Objective： To evaluate the clinical efficacy and safety of patient-controlled intravenous analgesia （PCIA） with fentanyl for cystospasm after transurethral resection of the prostate. Methods： Sixty benign prostatic hyperplasia （BPH） patients scheduled for transurethral resection of the prostate （TURP） under general anesthesia with laryngeal mask airway （LMA） were randomly divided into groups F and S. Group F （n=30） received PCIA device with fentanyl 10 ug/kg＋8 mg ondansetron, and Group S （n=30） received placebo （PCIA device with 8 mg ondansetron）. The visual analog scale （VAS） scores for pain were evaluated at 0, 2, 4, 8, 16, 24, and 48 h by the same staff. And recorded were incidence of cystospasm, side effects, application of hemostatic, duration of drawing Foley catheter and continuous bladder irrigation, time of exhaust after operation, time of post-operative stay and cost of hospitalization. Results： The incidence of cystospasm in Group F was significantly lower than that in Group S in the 48 h after operation （P〈0.05）, the VAS scores for pain in Group F was significantly lower than that in Group S within the 48 h after operation （P〈0.01）. The time of exhaust after operation in Group F was significantly later than in Group S （P〈0.05）. No significant difference was observed in applications of hemostatic, duration of drawing Foley catheter, duration of continuous bladder irrigation, time of post-operative stay and cost of hospitalization between the 2 groups. Conclusion： PCIA with fentanyl （10 ug/kg） relieves pain with little side effect and reduces cystospasm satisfactorily.

Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients:a meta-analysis of randomized controlled trials

Background:Managing acute postoperative pain is challenging for anesthesiologists,surgeons,and patients,leading to adverse events despite making significant progress.Patient-controlled intravenous analgesia(PCIA)is a recommended solution,where oxycodone has depicted unique advantages in recent years.However,controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.Methods:We performed a literature search in PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,Chinese National Knowledge Infrastructure,Wanfang,and VIP databases up to December 2020 to select specific randomized controlled trials(RCTs)comparing the efficacy of oxycodone with sufentanil in PCIA.The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption,the Ramsay sedation scale,patients’satisfaction and side effects.Results:Fifteen RCTs were included in the meta-analysis.Compared with sufentanil,oxycodone showed lower Numerical Rating Scale scores(mean difference[MD]=-0.71,95%confidence interval[CI]:-1.01 to-0.41;P<0.001;I^(2)=93%),demonstrated better relief from visceral pain(MD=-1.22,95%CI:-1.58 to-0.85;P<0.001;I^(2)=90%),promoted a deeper sedative level as confirmed by the Ramsay Score(MD=0.77,95%CI:0.35-1.19;P<0.001;I^(2)=97%),and resulted in fewer side effects(odds ratio[OR]=0.46,95%CI:0.35-0.60;P<0.001;I^(2)=11%).There was no statistical difference in the degree of patients'satisfaction(OR=1.13,95%CI:0.88-1.44;P=0.33;I^(2)=72%)and drug consumption(MD=-5.55,95%CI:-14.18 to 3.08;P=0.21;I^(2)=93%).Conclusion:Oxycodone improves postoperative analgesia and causes fewer adverse effects,and could be recommended for PCIA,especially after abdominal surgeries.Registration:PROSPERO;https://www.crd.york.ac.uk/PROSPERO/;CRD42021229973.

Transcranial direct current stimulation efficacy in trigeminal neuralgia

Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.

Trigeminal extracranial thermocoagulation along with patientcontrolled analgesia with esketamine for refractory postherpetic neuralgia after herpes zoster ophthalmicus:A case report

BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.

A comparative study of three concentrations of intravenous nalbuphine combined with hydromorphone for post-cesarean delivery analgesia

Background:Nalbuphine has been suggested to be used for post-cesarean section(CS)intravenous analgesia.However,ideal concentration of nalbuphine for such analgesia remains unclear.The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients.Methods:One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups(38 subjects per group)according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL+nalbuphine 0.5 mg/mL(group LN),hydromorphone 0.05 mg/mL+nalbuphine 0.7 mg/mL(group MN),and hydromorphone 0.05 mg/mL+nalbuphine 0.9 mg/mL(group HN)using patient-controlled analgesia(PCA)pump.Visual analog scale(VAS)for pain,PCA bolus demands,cumulative PCA dose,satisfaction score,Ramsay score,and side-effects such as urinary retention were recorded.Results:The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN(21±16 bolus,129±25 mL)than those in group MN(15±10 bolus,120±16 mL)(both P<0.05)and group HN(13±9 bolus,117±13 mL)(both P<0.01),but no difference was found between group HN and group MN(both P>0.05).VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS(all P<0.01)and VAS scores were significantly higher in group LN than those in groupMNand group HN when oxytocin was intravenously infused within 3 days after CS(all P<0.05),whereas VAS scores were not statistically different among groups for incisional pain(all P>0.05).Ramsay sedation scale score in groupHNwas significantly higher than that in group MN at 8 and 12 h after CS(all P<0.01)and group LN at 4,8,12,24 h after CS(all P<0.05).Conclusions:Hydromorphone 0.05 mg/mL+nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS.

瑞芬太尼静脉自控镇痛与罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛的比较

目的比较瑞芬太尼静脉自控镇痛(PCIA)与罗哌卡因复合舒芬太尼硬膜外自控镇痛(PCEA)在分娩镇痛中的效果及对胎儿的影响。方法选择单胎足月初产妇80例,随机均分为两组:PCEA组硬膜外腔注射0.1%罗哌卡因+0.5μg/ml舒芬太尼的混合药液10ml负荷量,然后连接硬膜外镇痛泵;PCIA组先静脉注射25μg负荷剂量的瑞芬太尼,然后连接静脉电子镇痛泵。测定患者VAS疼痛评分和Bromage评分,记录产程、分娩方式、新生儿Apgar评分及不良反应。结果镇痛后1～3h,PCEA组VAS评分明显低于PCIA组(P<0.05)。结论瑞芬太尼PCIA镇痛效果不及罗哌卡因复合舒芬太尼PCEA,但操作简单、起效快。

水针联合瑞芬太尼PCIA分娩镇痛对母婴的影响

目的:探讨水针联合瑞芬太尼PCIA分娩镇痛效果及对母婴的影响。方法:90例单胎初产妇随机分为3组,每组30例,Ⅰ组(水针联合瑞芬太尼PCIA分娩镇痛),Ⅱ组(舒芬PCEA分娩镇痛),Ⅲ组(无分娩镇痛)。记录T0:[镇痛前(宫口3 cm)],T1:[镇痛后1 h(宫口3 cm后1 h)]3组初产妇β内啡肽浓度(β-EP)、应激激素水平(肾上腺皮质激素ACTH和皮质醇COR)、VAS评分及不良反应情况、新生儿1 min和5 min Apgar评分和出生后15 min、24 h神经行为评分(NBNA)。结果:与Ⅲ组或T0比较,T1时Ⅰ组β-EP明显升高,Ⅰ组和Ⅱ组ACTH、COR和VAS评分都降低;与Ⅱ组比较,Ⅰ组不良反应减少(P<0.05)。Ⅰ组和Ⅱ组VAS评分和3组新生儿Apgar评分和NBNA评分比较差异无统计学意义(P>0.05)。结论:水针联合瑞芬太尼PCIA分娩镇痛效果确切,对母婴无影响,是理想的分娩镇痛方法。

不同给药模式在瑞芬太尼静脉分娩镇痛中的应用

目的观察不同给药模式在瑞芬太尼静脉分娩镇痛中的应用,为临床提供安全有效的镇痛方式。方法选择2014年6月—2015年4月武汉市妇女儿童医疗保健中心收治的450例拟行阴道分娩的产妇,其中未采用分娩镇痛150例(无分娩镇痛组);选择分娩镇痛的300例按照抽签法随机分入瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组,每组150例,分别以瑞芬太尼0.1μg/(kg·min)静脉持续输注和每隔3min单次给予5μg/mL瑞芬太尼20μg。记录并比较3组产妇分娩过程中不同时间点的疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分和血流动力学指标,各产程时间和分娩过程中胎心率,剖宫产率、催产素使用率、器械助产率和不良反应发生率,以及瑞芬太尼静脉持续输注组、瑞芬太尼静脉间断单次输注组的瑞芬太尼总用药量和脐动脉/脐静脉血药浓度比。记录并比较3组新生儿娩出后1和5min时的Apgar评分,以及脐动脉血气分析指标。结果瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇活跃期每间隔15min、宫口开全时、胎儿娩出时的疼痛VAS评分分别显著低于无分娩镇痛组同时间点(P值均<0.05),活跃期每间隔15min、宫口开全时、胎儿娩出时的Ramsay镇静评分分别显著高于无分娩镇痛组同时间点(P值均<0.05),前两组间各时间点的疼痛VAS评分和Ramsay镇静评分的差异均无统计学意义(P值均>0.05)。3组产妇不同时间点的心率、平均动脉压的差异无统计学意义(P值均>0.05)。瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇的第一产程活跃期时间均显著短于无分娩镇痛组(P值均<0.05),前两组间的差异无统计学意义(P>0.05);3组间产妇的第二、第三产程时间和分娩过程中胎心率的差异均无统计学意义(P值均>0.05)。瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇的剖宫产率、催产素使用率、器械助产率均显著低于无分娩镇痛组(P值均<0.05)。3组间产妇恶心呕吐、呼吸抑制、心率减慢、宫缩乏力发生率的差异均无统计学意义(P值均>0.05)。瑞芬太尼静脉持续输注组与瑞芬太尼静脉间断单次输注组间产妇的瑞芬太尼总用药量和脐动脉/脐静脉血药浓度比的差异均无统计学意义(P值均>0.05)。3组新生儿均未发生新生儿窒息,娩出后1和5min时的Apgar评分,以及脐动脉血气分析各指标的差异均无统计学意义(P值均>0.05)。结论瑞芬太尼静脉持续和间断单次输注用于分娩镇痛的效果均较明显。

不同浓度的瑞芬太尼用于分娩镇痛的研究

目的:探讨瑞芬太尼用于无痛分娩的镇痛效果对产妇产程进展的影响。方法:150例阴道分娩健康初产妇的临床资料根据静脉输注瑞芬太尼浓度的不同分为A、B、C 3组,每组50例,瑞芬太尼背景输注浓度分别为0.02μg/kg/min、0.04μg/kg/min、0.06μg/kg/min。比较3组产妇产程时间及宫缩疼痛视觉模拟评分(VAS)、Ramsay镇静评分、应用催产素情况、剖宫产率及新生儿Apgar评分。结果:3组产妇第一产程活跃期分别为(255±112)min、(274±136)min及(214±106)min,第二产程时间分别为(54±39)min、(59±41)min及(66±45)min,第三产程时间分别为(15±9)min、(9±9)min、(12±10)min。VAS评分C组最高,A组最低,Ramsay评分C组最高且2例出现过度镇静,3例胎心监测出现心率减慢,停用瑞芬太尼后好转。3组产妇在宫缩、应用催产素及器械助产的情况、剖宫产率及新生儿Apgar评分无显著性差异(P>0.05)。结论:瑞芬太尼实施分娩镇痛,对产妇产程无明显影响,瑞芬太尼背景输注速度不宜超过0.04μg/kg/min。

瑞芬太尼静脉自控镇痛在分娩中的应用模式

目的：探讨瑞芬太尼静脉自控镇痛的分娩镇痛模式及效果、对产程和母婴的影响及不良反应。方法：单胎、头位、孕38-42周自然分娩初产妇65例,进入第1产程活跃期后分为3组,A组应用瑞芬太尼静脉电子泵镇痛,设置后自控按压给药每次0.5μg·kg^-1,锁定时间3 min;B组单次剂量同A组,复合瑞芬太尼0.05μg·kg^-1·min^-1背景输注,宫口开全后AB组均停药;C组常规产科处理。记录宫缩疼痛视觉模拟评分（VAS）,镇静评分（Ram say）、呼吸循环指标、产妇宫缩、胎心监测情况、新生儿Apgar评分、催产素应用及器械助产情况、剖宫产率等指标。结果：A和B组镇痛20 min后各时段疼痛评分均低于C组（P〈0.01）,镇痛满意度均显著高于C组（A组为17/21,B组21/21,C组0/23）,产力满意度三组间比较差异无统计学意义（P〉0.05）。B组总按压次数（50次）0.05）。无胎儿宫内窘迫或新生儿呼吸抑制发生、无产妇循环抑制、镇静过度或低氧血症发生（鼻导管低流量吸氧下）。结论：瑞芬太尼静脉自控镇痛用于分娩镇痛安全有效,复合背景剂量的产妇可减少按压次数。

瑞芬太尼病人静脉自控镇痛用于分娩镇痛

目的评价瑞芬太尼静脉自控镇痛(PCIA)的分娩镇痛效果及安全性。方法 ASAⅠ、单胎初产妇60名,分为瑞芬太尼PCIA组及罗哌卡因硬膜外自控分娩镇痛(PCEA)组,每组30例。产妇宫口开张≥3cm时,0.001%瑞芬太尼PCIA组参数设定为:单次剂量1.5ml、锁定时间3min、无背景剂量;0.15%罗哌卡因PCEA组于L3～4间隙行硬膜外穿刺置管后,推注罗哌卡因10ml;20min后硬膜外导管接入PCA仪,PCEA参数设定为:单次剂量2ml、锁定时间15min、背景剂量6ml/h。以视觉模拟评分法(VAS)、警觉-镇静(OAA/S)法、改良Bromage法分别评估两组产妇的镇痛效果、镇静及运动神经阻滞程度,并记录两组产妇第1、第2、第3产程时间、PCA总按压次数与有效按压次数比、新生儿Apgar评分、脐动脉血气、产妇分娩镇痛期间头晕、恶心、呕吐、瘙痒、血压/心率下降、呼吸抑制、尿潴留、发热等不良反应发生情况。结果两组产妇镇痛实施前后疼痛程度均下降。活跃期每30min及宫口开全、胎儿娩出时间点VAS评分PCIA组均高于PCEA组(P<0.05),表明PCIA组虽有一定的镇痛效果,但不及PCEA组;与PCEA组相比,PCIA组活跃期缩短(P<0.05);两组的剖宫产、器械助产及顺产数相似;PCIA组产妇头晕、恶心/呕吐、瘙痒及尿潴留的发生率明显高于PCEA组(P<0.05),而产后发热PCEA组较高。两组产妇分娩镇痛期间均未出现呼吸、循环抑制,新生儿Apgar评分及脐动脉血气亦在正常范围。结论 0.001%瑞芬太尼以单次剂量1.5ml、锁定时间3min的PCIA模式行分娩镇痛,具有一定的镇痛效果;不良反应特别对母婴的呼吸、循环影响轻微。对存在椎管内穿刺禁忌或穿刺操作失败的产妇,瑞芬太尼PCIA可作为一种替代的分娩镇痛模式。

不同药物术后静脉自控镇痛效果和对免疫功能的影响

目的比较吗啡、曲马多、芬太尼和雷米芬太尼术后静脉自控镇痛(PCIA)的临床效果及其副作用。方法140例腹部手术患者,随机分为吗啡(M)组、曲马多(T)组、芬太尼(F)组、雷米芬太尼(R)组。记录不同时段的视觉模拟评分(VAS)、24h的按压次数、胃肠功能恢复时间、镇痛满意度及不良反应发生情况;同时检测血清白细胞介素(IL)-2和可溶性IL-2受体(sIL-2R)水平。结果F组的镇痛效果最为理想,且副作用和免疫抑制现象亦较少(P<0.05)。M组不良反应发生率高达37.5%(P<0.05),且有更明显的免疫抑制现象(P<0.05)。T镇痛时间较短,有效按压次数略高于其他三组(P<0.05)。结论芬太尼术后静脉PCIA的临床效果理想,副作用和免疫抑制的发生率低。

瑞芬太尼静脉PCIA与腰麻-硬膜外联合麻醉后PCIA用于分娩镇痛的比较

目的通过与腰麻-硬膜外联合麻醉(CSEA)后病人自控硬膜外镇痛法(PCEA)进行比较,观察瑞芬太尼病人自控静脉镇痛法(PCIA)用于分娩镇痛的效果及其对分娩过程和胎儿的影响。方法选择单胎足月初产妇90例,随机分为3组。对照组(n=30)按产科常规处理,未行分娩镇痛。A组(n=30):蛛网膜下腔注射罗哌卡因2.5mg+芬太尼5μg,然后连接硬膜外镇痛泵;B组(n=30):先静脉注射25μg负荷剂量的瑞芬太尼,然后连接静脉电子镇痛泵。连续检测产妇基本生命体征,采用视觉模拟疼痛评分(VAS)评估镇痛效应,运动阻滞程度按改良的Bromage标准进行测定,记录产程、分娩方式、新生儿Apgar评分及不良反应。结果第一产程中A、B组的VAS评分与对照组比较显著减低(P<0.01),A、B组间也有显著性差异(P<0.05)。A组与B组的各时点的Apgar评分无明显差异(P>0.05)。对照组的剖宫产率明显高于A组和B组,但A、B组间的剖宫产率无显著性差异。产妇的生命体征、宫缩、胎心及运动神经阻滞程度间无显著性差异。结论瑞芬太尼PCIA镇痛效果虽不及CESA-PCEA,但操作简单、起效快,临床满意率较高,新生儿的Apgar评分与CSEA-PCEA相近。但是瑞芬太尼的呼吸抑制仍不能忽视,临床使用需谨慎。

瑞芬太尼静脉自控给药与硬脊膜外腔阻滞用于分娩镇痛的对比研究

目的探讨瑞芬太尼用于无痛分娩的镇痛效果及对整个产程的影响。方法孕38～42周健康初产妇70例,单胎头位,按镇痛方法分为静脉瑞芬太尼自控单次给药复合持续背景输注给药组(PCIA组)和硬脊膜外腔罗哌卡因复合芬太尼自控单次给药组(PCEA组),每组35例。PCIA组使用瑞芬太尼静脉自控镇痛,背景剂量为0.05μg·kg-1·min-1,单次剂量0.5μg/kg,锁定时间3min。PCEA组以2mg/mL罗哌卡因+2μg/mL芬太尼,首次剂量3mL,单次剂量5mL,锁定时间10min。宫口开全后两组均停药。分别在镇痛前,镇痛开始后5、10、20、30min,以及宫口开全时,应用疼痛视觉模拟评分(VAS评分,0分为无痛,10分为不能忍受的剧痛)评价宫缩痛情况。应用Ramsay镇静评分评价镇静情况。记录两组产妇的产程持续时间、新生儿1和10min Apgar评分、产科干预情况及药物不良反应。结果开始镇痛后,两组产妇的宫缩痛均迅速缓解,镇痛10min后直至宫口开全时,PCEA组的疼痛VAS评分均显著低于PCIA组(P值均<0.01)。PCIA组的第一、二产程均显著短于PCEA组(P值均<0.01)。两组间器械助产率、剖宫产率和催产素使用率的差异均无统计学意义(P值均>0.05)。两组新生儿1min Apgar评分为7分各1例,8分各1例,均为自然分娩;其余新生儿1min Apgar评分及所有新生儿10min Apgar评分均为10分。两组均无镇静过度和低氧血症发生。结论瑞芬太尼静脉自控给药用于分娩镇痛安全有效,可作为椎管内分娩镇痛的有效补充。目的探讨瑞芬太尼用于无痛分娩的镇痛效果及对整个产程的影响。方法孕38～42周健康初产妇70例,单胎头位,按镇痛方法分为静脉瑞芬太尼自控单次给药复合持续背景输注给药组(PCIA组)和硬脊膜外腔罗哌卡因复合芬太尼自控单次给药组(PCEA组),每组35例。PCIA组使用瑞芬太尼静脉自控镇痛,背景剂量为0.05μg·kg-1·min-1,单次剂量0.5μg/kg,锁定时间3min。PCEA组以2mg/mL罗哌卡因+2μg/mL芬太尼,首次剂量3mL,单次剂量5mL,锁定时间10min。宫口开全后两组均停药。分别在镇痛前,镇痛开始后5、10、20、30min,以及宫口开全时,应用疼痛视觉模拟评分(VAS评分,0分为无痛,10分为不能忍受的剧痛)评价宫缩痛情况。应用Ramsay镇静评分评价镇静情况。记录两组产妇的产程持续时间、新生儿1和10min Apgar评分、产科干预情况及药物不良反应。结果开始镇痛后,两组产妇的宫缩痛均迅速缓解,镇痛10min后直至宫口开全时,PCEA组的疼痛VAS评分均显著低于PCIA组(P值均<0.01)。PCIA组的第一、二产程均显著短于PCEA组(P值均<0.01)。两组间器械助产率、剖宫产率和催产素使用率的差异均无统计学意义(P值均>0.05)。两组新生儿1min Apgar评分为7分各1例,8分各1例,均为自然分娩;其余新生儿1min Apgar评分及所有新生儿10min Apgar评分均为10分。两组均无镇静过度和低氧血症发生。结论瑞芬太尼静脉自控给药用于分娩镇痛安全有效,可作为椎管内分娩镇痛的有效补充。

咪达唑仑-瑞芬太尼清醒镇静镇痛用于高强度聚焦超声治疗的可行性研究

目的观察和探讨咪达唑仑-瑞芬太尼清醒镇静镇痛用于高强度聚焦超声(HIFU)治疗的有效性、安全性和可行性。方法选择行肝脏、胰腺、乳腺肿瘤和子宫肌瘤HIFU治疗的患者各20例,分为4组。给予咪达唑仑0.02 mg·kg-1和瑞芬太尼1μg.kg-1负荷,再分别以0.05 mg·kg-·1h-1和0.05μg·kg-·1min-1持续泵注,调整速度/3min,Ramsy评级3～4级和疼痛评分≤4分时开始HIFU治疗。记录麻醉前(T0)、麻醉开始3 min(T1)、5 min(T2)、10 min(T3)、治疗开始(T4)、治疗中(T5,30 min记录1次,取均值)、治疗结束后5 min(T6)、10 min(T7)时的收缩压(SP)、舒张压(DP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)、脑电双频指数(BIS)、药物泵注速度和不良反应,治疗结束后行患者满意度评分和术者满意度评分。结果各组SP、DP在麻醉后显著降低,治疗中显著升高(P<0.05),麻醉结束后恢复;HR也表现类似的变化。麻醉后RR显著降低(P<0.05),但SpO2值均>93.9%,麻醉结束后迅速恢复;麻醉中BIS波动于88.7～90.3之间,麻醉结束后恢复至基础值;Ramsy评级为3.95～4.15级,疼痛评分为0～1分;患者满意度评分和术者满意度评分均>3分。乳腺组的药物泵注速度显著高于其他3组(P<0.05)。各组均未发生麻醉不良反应和并发症。结论咪达唑仑-瑞芬太尼清醒镇静镇痛用于HIFU治疗肝脏、胰腺、乳腺肿瘤和子宫肌瘤时麻醉效果良好,是一种安全、有效、可行的麻醉方法。

瑞芬太尼和芬太尼用于开胸术后病人自控静脉镇痛的比较

目的：观察比较等效剂量瑞芬太尼和芬太尼用于开胸术后病人自控静脉镇痛（Patient-controlled intravenous anagesia，PCIA）的镇痛效果及其不良反应。方法：选择ASAⅠ～Ⅱ级、年龄40～60岁择期全麻下行开胸手术患者40例，随机分为芬太尼组（F组）和瑞芬太尼组（R组），每组20例。全麻诱导后双腔管气管内插管，术中异氟烷吸入维持全麻，罗库溴铵维持肌松。病人清醒拔管后接韩国奥美2300电子镇痛泵行PCIA。F组：芬太尼2mg＋咪唑安定10mg＋生理盐水至200ml；R组：瑞芬太尼0．2mg＋咪唑安定10mg＋生理盐水至200ml。背景剂量2．0ml／h，指令剂量2．0ml／次，锁定时间15min。所有术后病人鼻导管吸氧2～31／min，分别记录术后24h、48h的疼痛（视觉模拟评分VAS法）、镇静、恶心和呕吐评分，记录脉搏氧饱和度（SpO2）、心率（HR）、呼吸频率（RR）、平均动脉压（MAP）和累计镇痛药消耗量（CAC）。结果：R组术后24h、48h镇痛药耗量和VAS评分均低于F组，其中术后48hVAS评分有显著性差异（P〈0．05）；R组术后24h、48h镇静评分达2分者明显多于F组，其中术后24h两组有显著性差异（P〈0、05）；两组术后48h呕吐者和静息时感恶心者无显著差异（P〉0．05）；两组术后48h内无l例呼吸抑制（Sp02持续低于90％者）发生。两组术后24h、48h脉搏氧饱和度、心率、呼吸频率和平均动脉压均无显著差异。结论：等效剂量的瑞芬太尼用于开胸术后PCIA，镇痛、镇静效果优于芬太尼，而恶心、呕吐及呼吸抑制发生率低，是开胸术后更为安全、有效的镇痛方法。

腹腔镜胆囊切除术后应用舒芬太尼与应用曲马多行镇痛处理的效果比较

目的比较舒芬太尼和曲马多两种药物在减轻以瑞芬太尼/丙泊酚进行全凭静脉麻的腹腔镜胆囊切除术患者术后早期疼痛的效果及安全性。方法40名患者随机分为舒芬太尼组(S组)和曲马多组(T组),每组20例。手术结束前20分钟,S组静注舒芬太尼0.15μg/kg,T组静注曲马多1.5mg/kg。患者再次出现中等程度疼痛时追加曲马多1.5mg/kg。记录并比较两组心率(HR)、平均动脉压(MAP)、苏醒后的镇痛评分(VRS)和镇静评分(SS)、苏醒时间和不良事件发生例数。结果S组患者拔管时及拔管后5分钟心率、苏醒后5分钟和10分钟的VRS评分较T组显著降低(P<0.05);两组的血压、镇静评分、苏醒时间相近(P>0.05),不良事件发生例数无明显差异。结论舒芬太尼在术后早期镇痛中的效果较曲马多更佳,并可有效控制麻醉苏醒期的心率,适合应用于以短效药物瑞芬太尼复合丙泊酚进行全凭静脉麻醉的腹腔镜胆囊切除术。