经皮穴位电刺激对经皮椎体后凸成形术术中镇痛效果观察

目的回顾分析经皮穴位电刺激在椎体后凸成形术中多模式镇痛的效果;方法选取本院2021年7月至2022年12月住院行椎体后凸成形术手术患者82例,其中常规镇痛(氟比洛芬酯超前镇痛+局麻)为对照组38例,穴位电刺激+常规镇痛为观察组44例,观察两组患者术前术中术后各个时间点的疼痛评分及心率、平均动脉压值;结果两组患者术前及术后的疼痛评分、心率及平均动脉压值无统计学意义(P>0.05),两组患者穿刺椎体时观察组的疼痛评分、心率及平均动脉压值明显低于对照组(P<0.05);结论经皮穴位电刺激可以运用到椎体后凸成形手术多模式镇痛组成部分中,在常规镇痛的基础上,对增加患者舒适感,可以起到明显辅助效果。

硬膜外导管辅助双路置管术与传统术式在泪小管断裂吻合术中的疗效比较

目的:比较硬膜外导管辅助双路置硅胶管术与传统双路置硅胶管术在泪小管断裂吻合术中的疗效。方法:随机将连云港市第二人民医院52例(52眼)行泪小管断裂吻合术的患者分成两组,使用硬膜外导管辅助双路置硅胶管术为A组(30例);使用传统手术方式(双路置硅胶管术)为B组(22例)。比较两组患者术中置管时间、平均手术时间、鼻腔出血率、术中疼痛评分、一次性吻合成功率的差异。结果:在术中置管时间方面,A组为(11.20±3.80)min,B组为(21.50±12.60)min;在平均手术时间方面,A组为(42.70±5.50)min,B组为(62.20±15.20)min;在术中疼痛评分方面,A组为(3.10±0.80)分,B组为(4.60±1.25)分;在鼻腔出血率方面,A组为3.33%(1/30),B组为18.2%(4/22),以上差异均有统计学意义(均P<0.05);但在一次性吻合成功率方面,A组有效率为93.3%(28/30),B组有效率为86.4%(19/22),差异无统计学意义(P>0.05)。结论:在泪小管断裂吻合术中,应用硬膜外导管辅助双路置硅胶管术较传统双路置硅胶管术,在术中置管时间、手术平均时间、鼻腔出血率、患者疼痛程度等方面具有优势,2种置管一次性成功率的差异无统计学意义,硬膜外导管辅助双路置硅胶术方法安全、可靠、优势明显,值得临床手术推广。

考酮联合曲马多在蛛网膜下腔麻醉预防剖宫产术寒战的疗效

目的:探讨考酮联合曲马多在蛛网膜下腔麻醉预防剖宫产术寒战的临床疗效。方法:通过对2017-07~2018-12在我院剖宫产的118例产妇随机分组,对照组患者给予曲马多治疗,实验组应用羟考酮联合曲马多治疗,观察比较两组治疗效果、SpO2、MAP水平、细胞因子水平、寒战复发率、恶心呕吐发生率差异。结果:实验组总有效率94.92%明显高于对照组(P<0.05);治疗15min实验组SpO2(96.01%±2.31%)、MAP(79.07mmHg±3.42mmHg)较对照组明显下降(P<0.05);治疗后实验组NF-κB(33.09pg/L±8.52pg/L)、hs-CRP(11.34mg/L±2.53mg/L)、VEGF(195.42ng/L±21.01ng/L)同对照组比较明显下降(P<0.05);实验组寒战复发率3.39%、恶心呕吐发生率5.08%均明显低于对照组(P<0.05)。结论:针对蛛网膜下腔麻醉的剖宫产患者应用羟考酮联合曲马多治疗可有效缓解疼痛,改善炎症因子水平,降低并发症发生率。

Analysis of the Long-term Effect of Intraoperative Radiotherapy (IORT) for Non-Small Cell Lung Carcinoma (NSCLC)

OBJECTIVE To analyze the long-term effects of treatment with an op-eration + postoperative irradiation (A group) and an operation+intraoperative radiotherapy+postoperative irradiation (B group) in non-small cell lung cancer patients. METHODS Through a prospective randomized clinical trial, a total of 154 patients with non-small cell lung carcinoma were divided into two groups of 77 cases. Among the 154 cases, there were 134 squamous carcinomas, 17 adenocarcinomas and 3 adeno-squamous carcinomas. TNM staging: there were 17 in StageⅠ, 76 in Stage Ⅱ and 61 in Stage Ⅲ. A dosage of 15～25 Gy IORT, energy 9～16 MeV electrons, was delivered to the tumors. The doses given were 40～60 Gy postoperation. RESULTS The local control rates in A and B groups were 49.4% and 62.3% respectively (P<0.05). The survivals at 3, 5 and 7 years for group A were 40.3%, 27.3%, and 5.2% and for group B 44.2%, 28.6% and 6.5% (P>0.05). There were 16 deaths from radiotherapy complications, with 2 cases in group A and 14 in group B. CONCLUSION IORT+postoperative irradiation can enhance the local control rate of non-small cell lung cancer patients and reduce the recurrent rates, but it can not improve long-term survival.

Minimally invasive plate internal fixation for calcaneal fractures

Objective： To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures. Methods： Manual reduction, rectification of deformity, and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union. Results： All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%. Conclusion： Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation, good recovery, and rare complications in the treatment of intraarticular fractures.