肋间神经冷冻止痛和镇痛泵止痛在开胸术病人的应用

目的探讨减轻和消除开胸手术后剧烈胸痛的方法。方法对150例需开胸手术的患者随机分为冷冻治疗组、镇痛泵组与对照组,每组50例。以视觉模拟(VAS)评分法评价术后切口疼痛以及镇痛药使用情况,并于术后第3,7,15,30,90天测定肺功能。结果冷冻组止痛总有效率(0～6级)为98%,显著优于镇痛泵组的54%(P<0.01)。三组术后肺功能检测结果,差异无显著性意义。结论冷冻肋间神经能够有效地预防开胸术后切口疼痛,方法简便易行,而且神经的病理改变是可逆的。

镇静止痛条件下高强度聚焦超声治疗子宫肌瘤的护理体会

目的总结镇静止痛条件下高强度聚焦超声治疗子宫肌瘤的护理体会。方法 87例子宫肌瘤患者作为研究对象,所有患者均在镇痛止痛条件下手进行高强度聚焦超声治疗。对患者术前、术中、术后给予对应护理。结果 87例子宫肌瘤患者中,术中出现血尿3例(3.4%)、臀部皮肤Ⅰ度烫伤2例(2.3%)、腿部放射性疼痛9例(10.3%)、阴道排液16例(18.4%)。通过及时治疗和精心护理,患者均痊愈。结论在为子宫肌瘤患者镇痛止痛情况下,采取高强度聚焦超声治疗,要制定科学合理的治疗方案,并做好术前准备、术后处理,能够取得良好临床治疗效果,值得推广。

巧用静脉营养输液袋制作镇痛泵保护套

外科中大型术后病人经常使用镇痛泵止痛,由于镇痛泵无挂扣固定,放在床上很容易滑掉床下,影响病人活动,极不安全,而且使床单位看起来较杂乱。为此,我科2010年1月采用一次性静脉营养输液袋制作成镇痛泵保护套,经临床使用效果良好,

头皮针保护套的再利用

在临床工作中留置胃管或留置静脉BD针的患者很多。往常胃管封管是将胃管末端反折,用纱布包扎后再用胶布固定,或用橡皮筋套紧或用夹子夹紧,防止胃内容物反流溢出,这种方法不可取,容易造成污染和胃胀气。此外,因个体需求经同一根Y型BD留置针进行输液及镇痛泵止痛患者也很多,当镇痛泵使用完毕,临床上均使用肝素帽封管,而肝素帽价格比一次性头皮针贵,同时临床工作也存在的弊端：（1）当Y型留置针两个出口端均使用同种肝素帽,输液过程中容易混淆,不方便操作。

Efficacy and safety of transnasal butorphanol for pain relief after anal surgery

AIM:To compare the analgesic properties and efficacy of transnasal butorphanol with intramuscular meperidine after anal surgery.METHODS: Sixty patients who underwent fistulectomy were enrolled in the study from January 2006 to December 2007. They were randomly divided into transnasal butorphanol (n=30) or intramuscular meperidine (n=30) treatment groups. Assessment of postoperative pain was made using a visual analogue scale (VAS). The VAS score was recorded 6 h after the completion of surgery, before receiving the first dose of analgesic, 60 min after analgesia and the next morning. Any adverse clinical effects such as somnolence, dizziness, nausea or vomiting were recorded. Satisfaction with narcotic efficacy, desire to use the particular analgesic in the future and any complaints were recorded by patients using questionnaires before being discharged.RESULTS: Forty-two men and eighteen women were included in the study. There were no significant differences in VAS scores between the groups within 24 h. Length of hospital stay and the incidence of adverse effects between the groups were similar. In addition, most patients were satisfied with butorphanol nasal spray and wished to receive this analgesic in the future, if needed.CONCLUSION: Butorphanol nasal spray is effective for the relief of pain after fistulectomy. However, it offered patients more convenient usage and would be suitable for outpatients.

改良骶管阻滞辅助静脉麻醉在特殊体型患者宫腔镜手术中的临床研究

目的:探讨改良骶管阻滞辅助静脉麻醉在特殊体型患者宫腔镜手术中的临床研究。方法:将64例肥胖宫腔镜手术患者分为对照组与治疗组,对照组静脉麻醉治疗,治疗组给予骶管麻醉辅助静脉麻醉治疗。对照组患者给予丙泊酚、芬太尼麻醉;治疗组患者则用0.75%盐酸布比卡因3ml-5ml+2%盐酸利多卡因5ml--8ml+l0.9%氯化钠注射液15ml+芬太尼0.015mg骶管阻滞麻醉,观察并比较两组患者术中麻醉效果、麻醉管理难度及术后止痛效果,并对麻醉并发症及术后疼痛程度进行评估。结果:与对照组相比,治疗组患者手术大夫满意度(P<0.05),且术后患者疼痛程度明显减轻(P <0.05);两组出血量无显著差异(P>0.05)。结论:在骶管麻醉辅助静脉麻醉治疗麻醉效果、镇痛效果显著,可使盆底肌肉松弛,降低手术难度,便于麻醉管理,且不增加产后出血,值得临床推广应用。

乳癌患者108例护理体会

我院1998年6月～2006年12月共收治乳癌患者108例。年龄28岁～60岁，按TNM分期Ⅰ期22例，Ⅱ期74例，Ⅲ期12例。所有患者分别实施了改良根治术、标准根治术，均采取硬外＋气管插管全麻，并为每位患者使用硬膜外自控镇痛泵止痛。其中除6例患者发生切口周围部分皮瓣坏死延期愈合外，其余患者切口均Ⅰ期愈合。