Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy

Objective:Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy(RRP)is one of the first-line treatment.However,RRP has some side effects and can lead to chronic perineal pain.The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain.Methods:Forty patients were explored by a specific and validated questionnaire,the Neuropathic Pain Symptom Inventory(NPSI).Patients were divided into two groups:Group A with an NSPI score≥4 was considered as suffering from neuropathic pain,and Group B was considered as a control group without neuropathic pain(NSPI score<4).All patients had a perineal electrophysiological testing to confirm the possibility of a neurogenic damage.Results:Group A was composed by 13 men and Group B by 27 men,with mean age 72.45 years and mean duration of pain 2.7 years.In Group A,the most frequent symptoms were burning sensation,electrical shock and numbness.Location of the pain was global perineal area(8/13),anus(10/13),penis(5/13)and glans penis(2/13).Electromyography(EMG)findings confirmed the presence of denervation and neurogenic damages compared with controls(p<0.001).Conclusion:One third of the patients consulting for chronic pain following RRP had probably a neuropathic lesion leading to a chronic perineal pain as suggested by an NSPI score≥4 and EMG alterations.

颈项功治疗颈型颈椎病60例的疗效观察

目的:通过对颈型颈椎病患者进行锻炼干预,比较颈项功和常规米字操治疗颈型颈椎病的临床疗效及对颈痛、压痛阈(Pressure Pain Threshold,PPT)的影响。方法:选择2020年11―12月浙江中医药大学纳入的60例颈型颈椎病患者,应用随机数字表法将60例颈型颈椎病患者分为功法组和常规米字操组,每组各30例。功法组患者采用功法“仙鹤点水”锻炼,常规米字操组患者采用常规米字操锻炼,两组患者每天早晚各锻炼1次,以锻炼4周为一个疗程。锻炼前对两组患者进行压痛点筛查,结果得到两组患者压痛点多在肩井穴和C3夹脊穴,并以此作为PPT值的采集点。观察各组患者在锻炼前后的视觉模拟评分法(Visual Analogue Scale,VAS)评分、Northwick Park颈痛量表(Northwick Park Neck-pain Questionnaire,NPQ)评分及肩井穴和C3夹脊穴的PPT值,并综合评定各组的临床疗效。结果:锻炼4周后两组患者的VAS评分和NPQ评分均较锻炼前降低(P<0.05),两组患者肩井穴的PPT值均较锻炼前升高(P <0.05),功法组C3夹脊穴的PPT值较锻炼前升高(P <0.05),常规米字操组C3夹脊穴的PPT值与锻炼前差异无统计学意义(P> 0.05)。功法组的总有效率为86.67%(26/30),优于常规米字操组的63.33%(19/30)(P <0.05)。结论:功法和常规米字操均能改善颈型颈椎病患者的颈部疼痛和压痛,但功法的疗效更加显著。

腹腔镜胃肠肿瘤手术患者急性术后疼痛与疼痛敏感性的相关性

目的探讨腹腔镜胃肠肿瘤手术患者急性术后疼痛与疼痛敏感性的相关性。方法选取择期行全身麻醉下腹腔镜胃肠肿瘤手术的患者50例,性别不限,年龄≥18岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级。根据术前疼痛敏感性问卷(PSQ)评分结果分为疼痛高敏感性组(PSQ评分≥5.0分,n=19)和低敏感性组(PSQ评分<5.0分,n=31)。记录两组患者的一般情况、手术情况,术后24 h内镇痛泵按压次数、补救镇痛次数,以及术后恶心、呕吐、嗜睡、腹胀等并发症的发生情况。采用视觉模拟量表(VAS)评分评估患者外周静脉置管及术后24 h内疼痛程度。结果两组患者的年龄、性别、ASA分级、BMI、手术时间、全身麻醉苏醒时间、气管导管拔管时间、术后24 h镇痛泵按压次数、术后并发症发生率比较差异均无统计学意义(均P>0.05)。与低敏感性组比较,高敏感性组外周静脉置管及术后清醒即刻、1 h、2 h的VAS评分较高(均P<0.05)。术前PSQ评分与外周静脉置管VAS评分呈正相关(r=0.693,P<0.05),与术后清醒即刻、1 h、2 h的VAS评分呈正相关(r=0.917、0.901、0.841,均P<0.05)。高敏感性组术后2 h补救镇痛次数较低敏感性组多(P<0.05)。以术前PSQ评分为检验变量、是否发生急性术后疼痛为状态变量绘制ROC曲线,其AUC为0.909,通过约登指数计算出PSQ评分最佳临界值为4.85分,提示采用PSQ评分可预测腹腔镜胃肠肿瘤手术患者急性术后疼痛的发生。结论疼痛敏感性与腹腔镜胃肠肿瘤手术患者急性术后疼痛的发生有关,可能成为急性术后疼痛发生的预测指标,术前PSQ≥4.85分者发生急性术后疼痛的可能性更高。

针刺联合悬吊运动治疗非特异性下腰痛的临床观察

目的研究针刺联合悬吊运动治疗非特异性下腰痛(nonspecific low back pain,NLBP)的临床效果。方法采用随机数字表法,将2020年3月至2023年1月在湖南中医药大学第一附属医院针灸推拿康复科进行治疗的60例NLBP患者分为观察组、对照组,各30例。两组患者在常规处理的基础上,对照组采用针刺治疗,观察组采用针刺联合悬吊运动治疗,均治疗4周。观察两组患者疼痛视觉模拟评分(visual analogue scale,VAS)、功能障碍问卷(roland morris disability questionnaire,RMDQ)、中医症候积分、肌肉紧张度、生物力学特征、生活质量综合评定问卷(generic quality of life inventory 74,GQOL-74)、生活活动能力(Barthel指数)及疗效。结果治疗后,两组患者VAS、RMDQ评分、中医症候积分、两侧竖脊肌、多裂肌紧张度及腰背屈/伸比值(flexion/extension,F/E)均较治疗前下降(P<0.05),且观察组上述指标均低于对照组(P<0.05);治疗后,两组患者腰背伸状态下峰力矩(peak torque,PT)、平均功率(average power,AP)、GQOL-74及Barthel评分较治疗前升高(P<0.05),且观察组上述指标均高于对照组(P<0.05);经过治疗后,观察组总有效率(93.33%)高于对照组的(73.33%)(P<0.05)。结论单纯针刺和针刺联合悬吊运动在治疗NLBP上均有一定的疗效,可有效缓解患者疼痛,改善竖脊肌、多裂肌主动活动功能,提高生活质量,且针刺结合悬吊运动疗效优于单纯针刺治疗,值得临床推广应用。

Validation of neuropathic pain assessment tools among Chinese patients with painful diabetic peripheral neuropathy

Objective:This study aims to evaluate the reliability and validity of neuropathic pain assessment tools among Chinese patients with painful diabetic peripheral neuropathy(PDPN).Methods:One hundred patients with PDPN and 70 patients with non-neuropathic pain were recruited from five grade III general hospitals in Guangzhou.Pain was assessed using the Leeds Assessment of Neuropathic Symptoms and Signs(LANSS),Douleur Neuropathique 4 questionnaire(DN4),and Brief Pain Inventory for Painful Diabetic Peripheral Neuropathy(BPI-DPN).Reliability was evaluated by internal consistency of the Cronbach's a coefficient and Guttman split-half.Construct validity was analyzed by factor analysis and Spearman correlation coefficients.Sensitivity and specificity were also assessed.Results:The Cronbach's a coefficients of the LANSS,DN4,and BPI-DPN were 0.735,0.750,and 0.898,respectively.The Guttman split-half coefficients of the LANSS,DN4,and BPIDPN were 0.660,0.726,and 0.849,respectively.The cumulative contributions of the LANSS,DN4,and BPI-DPN to the total variance were 61.945%,57.010%,and 66.056%,respectively.The items of the LANSS,DN4,and BPI-DPN presented high factorial loads,ranging from 0.387 to 0.841,0.137 to 0.948,and 0.487 to 0.953,respectively.The LANSS and DN4 exhibited sensitivities of 58.0%and 82.7%,respectively,and specificity of 97.1%.Conclusions:The LANSS or DN4 can be used to detect neuropathic pain in Chinese patients with PDPN.The BPI-DPN can be employed to monitor the effectiveness of pain intervention.

Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome(IC/BPS)is a debilitating,chronic condition characterized by chronic pelvic pain,urinary urgency,and frequency and is well-known to be associated with a decrease in work productivity,emotional changes,sleep,sexual dysfunction,and mobility.Many metrics of quality of life(QoL)in this patient population have been developed;however,a unified,standardized approach to QoL in these patients has not been determined.The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics.Next,data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed.While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS,addressing QoL in this patient population remains a significant challenge,as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL,including depression,poor sleep,and inability to work.Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics,and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.

Quality of Life in Women with Endometriosis Pelvic Pain Treated with the Levonorgestrel-Releasing Intrauterine System

Objective: To evaluate the quality of life in patients with endometriosis pelvic pain before and after the application of the levonorgestrel-releasing intrauterine system (LNG-IUS). Design: Open non-comparative study. Setting: Obstetrics and Gynecology Hospital at Monterrey, Mexico. Sample: 29 women aged 18 to 40 years with pelvic pain associated with endometriosis confirmed by laparoscopy. Methods: After laparoscopy but before LNG-IUS insertion (basal visit) and 6 months afterwards, modified Endometriosis Health Profile (EHP-30) was applied. Main outcomes measures: Size of change of questionnaire scores, need of additional analgesic therapy and adverse effects. Statistical Analysis: Differences in the questionnaire scores before and after intervention were analyzed by Student t-test. Results: Final analysis set included 29 women aged 31.7 ± 4.7 years years. The ASRM surgical staging of endometriosis was mild in 19.3 moderate in 13.7 and severe in 76% of the patients. The general perception of quality of life improved from 52 at baseline to 98% at six months (p < 0.001). Adverse events were mild in nature, 19 patients reported no adverse events during the study (65.5%). Two patients (6.9%) required the use of concomitant therapy with non-steroidal analgesics for relief of pain. Conclusion: The application of LNG-IUS in patients with pelvic pain associated with endometriosis improved significatively all aspects related with quality of life as measured with Endometriosis Health Profile (EHP-30). We concluded that LNGIUS may be an effective and convenient therapeutic alternative for the management of pain associated with endometriosis.

Identifying pain-related concerns in routine follow-up clinics following oral and oropharyngeal cancer

AIM:To describe clinical characteristics of head and neck cancer(HNC)patients with pain and those wishing to discuss pain concerns during consultation.METHODS:Cross-sectional,questionnaire study using University of Washington Quality of Life,version 4(UWQOL)and the Patients Concerns Inventory(PCI)in disease-free,post-treatment HNC cohort.Significant pain on UW-QOL and indicating"Pain in head and neck"and"Pain elsewhere"on PCI.RESULTS:One hundred and seventy-seven patientscompleted UW-QOL and PCI.The prevalence of selfreported pain issues was 38%(67/177)comprising25%(44/177)with significant problems despite medications and 13%(23/177)with lesser or no problems but wishing to discuss pain.Patients aged under 65years and patients having treatment involving radiotherapy were more likely to have pain issues.Just over half,55%(24/44)of patients with significant pain did not express a need to discuss this.Those with significant pain or others wanting to discuss pain in clinic had greater problems in physical and social-emotional functioning,reported suboptimal QOL,and also had more additional PCI items to discuss in clinic compared to those without significant pain and not wishing to discuss pain.CONCLUSION:Significant HNC-related pain is prevalent in the disease-free,posttreatment cohort.Onward referral to a specialist pain team may be beneficial.The UW-QOL and PCI package is a valuable tool that may routinely screen for significant pain in outpatient clinics.

Spinal accessory neuropathy in patients with chronic neck pain

AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.

Diagnosis and pharmacologic management of neuropathic pain among patients with chronic low back pain

Chronic low back pain consists of both nociceptive and neuropathic mechanisms and can be classified as a mixed pain syndrome. Neuropathic component of chronic low back pain has often been under-recognized and under-treated by the physicians. Recent studies have demonstrated that approximately 20%-55% of chronic low back pain patients have neuropathic pain symptoms. An altered peripheral, spinal, and supraspinal processing of pain arising as a result of a lesion affecting the nerves system are the major contributor to neuropathic low back pain. The clinical evaluation is still the gold standard for assessment and diagnosis of neuropathic low back pain. Although diagnosis can be difficult due to the lack of reliable gold standard diagnostic test for neuropathic low back pain, screening tools may help non-specialists, in particular, to identify potential patients with neuropathic low back pain who require further diagnostic evaluation and pain management. Several screening tools for neuropathic pain have been developed and tested with different patient populations. Among the screening tools, the pain DETECT questionnaire and the Standardized Evaluation of Pain are validated in patients with low back pain. The Standardized Evaluation of Pain may lead to more effectivein discriminating between neuropathic and nociceptive pain in patients with low back pain according to the higher rate of sensitivity and its validity in patients with low back pain. However, the most appropriate approach is still to combine findings on physical and neurologic examinations and patient's report in distinguishing neuropathic pain from nociceptive pain. The clinical examination including bedside sensory tests is still the best available tool for assessment and diagnosis neuropathic pain among patients with chronic low back pain. Due to the fact that chronic low back pain consists of both nociceptive and neuropathic mechanisms, a multimodal treatment approach is more rational in the management of patients with chronic low back pain. Therefore, combination therapy including drugs with different mechanisms of action should be given to the patients with chronic low back pain.

A Quality Improvement Survey to Assess Pain Management in Cardiac Surgery Patients

Objective: To evaluate the quality of pain management in cardiac ICU patients by using a questionnaire. Methodology: All post cardiac surgery patients between 18 and 75 years old were included in this survey. Chronic pain patients, paediatric patients, emergency surgeries were excluded. A predesigned proforma was prepared according to American Pain Society recommendations and distributed among Cardiac ICU patients after 24 hours of extubation. This proforma was explained to the patients and collected later. The questionnaire was related to pain severity, aggravating and relieving factors, side effects of analgesics, affective experience and satisfaction with pain management. Results: Total 308 patients participated in one year period. 243 (78.9%) were male and 65 (21.1%) were female. Multimodal analgesia was used in most of the patients. Severity of pain was described as mild 70% and moderate 28.6%. Most of the patients complained of sharp pain 100 (37.5%), mainly at the site of incision 129 (41.9%). The main aggravating factor associated with increased pain was deep breathing 118 (39.8%) while pain was minimized by taking pain medications 40.6%. A significant association was found between preoperative counseling about pain options and satisfaction. 96.8% reported satisfaction with pain management. Conclusion: Although overall pain control was reported as adequate and patients were highly satisfied, there were areas which need further improvement. These include strategies to provide preoperative information about postoperative pain management and better training of medical staff to assess and manage pain. Additionally, the concerns and fears of patients about pain treatment need to be addressed.

Difference of the Pain during the DPT (Diphtheria-Pertussis-Tetanus) Vaccination

Background: The objective of this study is to determine whether analyze of the infant’s pain associated with diphtheria-pertussis-tetanus (DPT) immunization is useful for vaccination in children. It is not known whether the immunization pain can be prevented with the adequate choice of DPT vaccines among several manufacturers in Japan. Further, it is not clear whether the difference of the reaction during vaccination between gender and age. Design: Three manufacturer’s Japanese DPT vaccines were used in this study. The parents assessed their infant’s pain on a modified visual analogue scale (MVAS), the start of the crying and total crying time during the immunization. Results: The A manufacturer’s DPT vaccine was significantly lower on the proportion of crying, the duration of crying and MVAS score than the other two manufacturer’s DPT vaccines. The proportion of crying, the duration of crying and MVAS score was lower in the boy than in the girl. On the other hand, it had not found the difference of their reactions with age. Conclusions: Our studies have found that the adequate choice of DPT vaccine decreased vaccination pain. The studies also indicate that some tendencies with vaccinations were shown in children. To consider these tendencies was useful in performing less painful vaccination.

护士对儿童临床疼痛管理障碍认知情况的调查分析

目的为提升儿童慢性疼痛诊疗水平,探索影响儿童疼痛管理的干扰因素。方法2020年5-12月对郑州市某三甲医院的在职护士就儿童疼痛管理的障碍进行了问卷调查。调查问卷有19项潜在的疼痛管理中的障碍,涉及患者和家长、医生和护士以及医疗法规和医院管理。结果126名某三甲医院的护士自愿参与了这项研究。影响儿童疼痛管理的前5项主要障碍分别为患儿疼痛评估不足、处方止痛药剂量不足、家长不愿让孩子服止痛药、对患儿及父母疼痛知识宣教不够以及工作繁重导致处理疼痛的时间不足。而在受教育程度和工作年限评分的比较中,受教育程度高较受教育程度低患者克服障碍的能力更好(P<0.001),而工作年限在克服障碍的能力方面差异无统计学意义(P=0.309)。结论干扰儿童最佳疼痛管理的因素是多方面的,疼痛管理知识和医患沟通不足是主要障碍。

电针缓解癌痛患者阿片耐受的临床观察

目的观察电针缓解癌痛患者阿片耐受的临床疗效。方法将60例癌痛患者随机分为电针组和对照组,每组30例。两组均使用阿片类药物进行镇痛治疗,电针组取双侧内关和足三里穴进行电针治疗,对照组取双侧内关和足三里穴旁开15 mm处非穴位点进行电针治疗。观察两组阿片耐受指数、爆发痛的次数和疼痛缓解持续时间,比较两组治疗前后数字等级评定量表(numeric rating scale,NRS)和欧洲癌症研究与治疗组织生命质量核心量表(European Organization for Research and Treatment of Cancer quality of life questionnaire-C30,EORTC QLQ-C30)评分变化,并比较两组不良反应发生率。结果电针组阿片耐受指数低于对照组(P<0.05),爆发痛次数低于对照组(P<0.05),疼痛缓解持续时间长于对照组(P<0.05)。电针组治疗后情绪、躯体、认知和社会功能及总体健康评分高于治疗前和对照组(P<0.05);电针组治疗后疲倦、恶心呕吐、疼痛、气促、失眠、食欲丧失和便秘评分低于治疗前和对照组(P<0.05)。电针组恶心呕吐和便秘的发生率低于对照组(P<0.05)。结论电针可减少癌痛患者镇痛治疗期间阿片耐受的发生,减轻疼痛,提高生活质量。

椎针力敏穴治疗神经根、椎动脉混合型颈椎病的临床疗效观察

【目的】探讨椎针力敏穴治疗神经根、椎动脉混合型颈椎病的临床疗效。【方法】将120例神经根、椎动脉混合型颈椎病患者随机分为试验组和对照组,每组各60例。试验组给予椎针力敏穴治疗,对照组给予常规针刺联合推拿治疗,每日1次,10次为1个疗程,共治疗1个疗程。观察2组患者治疗前后颈痛量表评分、 McGill疼痛量表(MPQ)评分[包括疼痛分级指数(PRI)的感觉项、情感项评分和视觉模拟量表(VAS)评分]以及血流动力学相关指标的变化情况,并评价2组患者的临床疗效。【结果】(1)经过1个疗程治疗后,试验组的总有效率为91.67%(55/60),对照组为75.00%(45/60),组间比较,试验组的疗效明显优于对照组(P<0.05)。(2)治疗后,2组患者的颈痛量表评分均较治疗前明显降低(P<0.05),且试验组的降低幅度明显优于对照组(P<0.05)。(3)治疗后,2组患者MPQ量表的PRI感觉项、 PRI情感项评分和VAS评分均较治疗前明显降低(P<0.05);组间比较,试验组在PRI感觉项评分方面的降低幅度明显优于对照组(P<0.05),而在改善PRI情感项、VAS评分方面,试验组和对照组无显著性差异(P>0.05)。(4)经颅多普勒检查结果显示,治疗后,2组患者的左、右椎动脉(LVA、RVA)及基底动脉(BA)的收缩峰血流速度(Vp)、舒张末血流速度(Vd)、平均血流速度(Vm)等血流动力学指标均较治疗前明显改善(P<0.05),且试验组的改善幅度均明显优于对照组(P<0.05)。【结论】椎针力敏穴治疗神经根、椎动脉混合型颈椎病疗效确切,相较常规针刺联合推拿治疗,椎针力敏穴能更有效缓解患者颈部疼痛和上肢麻木情况,改善血流动力学指标,提高患者生活质量。

针刺联合手法治疗神经根型颈椎病的疗效评估

目的:观察针刺联合中医推拿手法治疗神经根型颈椎病的疗效并探究其机制。方法:选取2021年1月至2022年10月辽宁中医药大学附属第二医院骨科收治的神经根型颈椎病患者120例作为研究对象,按照随机数字表法分为对照组和观察组,每组60例。2组患者均行常规牵引疗法。对照组配合单纯中医推拿手法治疗,观察组在中医推拿手法治疗基础上联合针刺治疗。疗程均为1个月。比较治疗前后2组患者麻木评分、颈部残障指数(NDI)、简化McGill疼痛问卷(MPQ)评分、血清白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、血清白细胞介素-1β(IL-1β)、血液流变学指标水平变化情况,以及治疗有效率。结果:观察组治疗有效率(91.67%)明显高于对照组(73.33%),2组比较,差异有统计学意义(P<0.05);治疗后2组患者MPQ、NDI、麻木3个评分均显著下降(均P<0.05),与对照组比较,观察组改善明显(P<0.05);治疗后2组患者血液流变学各项指标表达水平均显著下降(P<0.05),且观察组改善更为显著(P<0.05)。结论:针刺联合中医推拿手法治疗神经根型颈椎病疗效突出,可改善患者颈部麻木、疼痛等症状,同时改善颈部功能障碍状态,降低血黏度,下调血清IL-6、TNF-α和IL-1β表达水平。

王氏围剿推拿治疗颈型颈椎病颈痛的临床疗效观察

【目的】观察王氏围剿推拿疗法治疗颈型颈椎病颈痛的临床疗效及在自我操作下的疗效维持情况。【方法】将70例颈型颈椎病患者随机分为观察组和对照组,每组各35例。2组患者均给予相同的常规针刺治疗(取双侧C4-C7颈夹脊、天柱、颈百劳、肩井等穴),在此基础上,观察组给予王氏围剿推拿疗法治疗,对照组给予传统推拿疗法治疗。每天治疗1次,连续治疗5 d为1个疗程,共治疗1个疗程。疗程结束后,2组患者均进行2周4次的随访。随访期间,观察组患者在医者指导下行围剿推拿疗法自我操作,对照组患者未施加任何干预措施。观察2组患者治疗前后Northwick Park颈痛量表(NPQ)评分、疼痛视觉模拟量表(VAS)评分的变化情况,评价2组患者治疗1个疗程后的临床疗效;并于治疗结束后第7天和第14天进行VAS随访评分,以观察2组患者的疗效维持情况。【结果】(1)脱落情况:研究过程中,观察组和对照各有1例患者脱落,最终各有34例患者纳入疗效统计。(2)疗效情况:经1个疗程治疗后,观察组的总有效率为88.24%(30/34),对照组为76.47%(26/34);组间比较(Mann-Whitney U检验),观察组的疗效明显优于对照组(P<0.05)。(3)NPQ评分情况:治疗后,2组患者NPQ量表的各项评分及总分均较治疗前明显降低(P<0.01),且观察组对疼痛程度、睡眠、持续时间、阅读评分及总分的降低幅度均明显优于对照组(P<0.05或P<0.01)。(4)VAS评分情况:治疗后,2组患者的疼痛VAS评分均较治疗前明显降低(P<0.01),且观察组对疼痛VAS评分的降低幅度明显优于对照组(P<0.01)。(5)随访情况:在疗程结束后第7天和第14天,观察组患者的疼痛VAS评分均无明显升高(P>0.05),而对照组患者的疼痛VAS评分均较治疗后明显升高(P<0.05);组间比较,观察组患者在疗程结束后第7天和第14天的疼痛VAS评分均明显低于对照组(P<0.01)。【结论】王氏围剿推拿疗法治疗颈型颈椎病疗效确切,可有效缓解颈枕部疼痛症状,促进颈部生理功能恢复;其自我操作可更好地维持疗效、预防再发。

腰痛知识问卷的汉化及信效度分析

目的探讨中文版腰痛知识问卷(LKQ)在护理人群中的信效度。方法根据Brislin翻译原则,将英文版LKQ翻译成中文版。采用便利取样法,于2021年10月至12月对某三甲医院166名护理工作者进行问卷调查(删除无效问卷2份,有效问卷164份),评价问卷的信度和效度。结果问卷的平均量表水平内容效度指数(S-CVI/Ave)为0.96。除条目2和6外,中文版LKQ其余各条目得分与总分的相关系数均>0.3(P≤0.01)。问卷的Cronbach'sα系数为0.741,重测信度为0.898。通过探索性因子分析,5个公因子累积方差贡献率为53.369%。问卷与中文版罗兰-莫里斯残疾问卷(SC-RMDQ)效标关联系数为-0.371(P<0.01)。结论中文版LKQ在护理人群中具有良好的信效度,可用于我国护士腰痛知识水平的评估。

泛长三角地区助产机构分娩镇痛服务实施现况的横断面调查

目的调查助产机构分娩镇痛服务的临床实施现状及存在的问题,为构建符合国情的分娩镇痛循证实践方案提供依据。方法采用便利性抽样方法,选取国内泛长三角地区江浙沪皖4个省、直辖市内的8所助产机构,其中三级甲等妇产专科医院5所,三级甲等综合医院2所,二级乙等妇产专科医院1所。采用横断面研究中的问卷调查法进行现况调查和描述分析,包括助产机构基本信息、非药物分娩镇痛实施情况和药物镇痛实施情况。采用关键知情人访谈法对12名助产机构产房护理管理者进行半结构式访谈。结果8所助产机构均采用了不同类型的药物或非药物分娩镇痛技术。8所机构均开展了产时陪伴分娩、自由体位、拉玛泽分娩呼吸法和音乐疗法;7所机构开展产时按摩;5所机构开展热敷;4所机构开展淋浴/浸浴和经皮神经电刺激疗法(transcutaneous nerve electrical stimulation therapy,TENS);3所机构开展芳香、催眠和穴位按压;尚无助产机构开展水针注射镇痛疗法。1所机构缺乏药物分娩镇痛相关的孕产妇教育;2所机构在产时分娩疼痛评估方面缺乏科学工具;各机构在疼痛评估时机和频次上存在不一致性,且缺乏统一的分娩镇痛护理常规和工作流程。结论助产机构实施分娩镇痛服务的差异性较大,普遍缺乏基于证据的临床实践规范和循证实践意识,需要进一步规范助产机构分娩镇痛服务,更好地推进分娩镇痛服务的临床实施。