Wavelet and pain rating index for inhalation anesthesia: A randomized controlled trial

BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.

Validation of the functional rating index for the assessment of athletes with neck pain

AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated and responded to the PFRI. Fifty athletes with NP completed the PFRI for at least 7 d later to establish test-retest reliability. RESULTS: The athletes with NP responded to all items, indicating excellent clinical utility. No floor and ceiling effects were found, indicating content validity and responsiveness. The PFRI revealed capability to discriminate between the athletes with NP and healthy athletes. The PFRI demonstrated strong correlation with the Numerical Rating Scale(Spearman's rho = 0.94), and the Persian Neck Disability Index(Pearson r = 0.995), supporting criterion and construct validity. Internal consistency reliability was high(Cronbach's α coefficient: 0.97). The test-retest reliability was excellent(ICCagreement = 0.96). The absolute reliability values of standard error of measurement and smallest detectable change were 3.2 and 8.84, respectively. An exploratory factor analysis yielded one factor explaining 78.03% of the total variance. CONCLUSION: The PFRI is a valid and reliable measure of functional status in athletes with NP.

The Good Pain Management(GPM) Ward Program in China and its impact on Chinese cancer patients: the SYSUCC experience

To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center(SYSUCC) launched the Good Pain Management(GPM) Ward Program, which has been recognized by the Chinese Ministry of Health and promoted throughout the nation. This retrospective case-control study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of the GPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The pain-reporting rate and pain management index(PMI) were calculated. The pain levels before and after pain management were compared. A total of 475 patients(244 in the control group and 231 in the GPM group) were analyzed. The pain-reporting rate of the GPM group was significantly higher than that of the control group(62.8% vs. 37.7%, P < 0.001). The PMI of the GPM group was significantly higher than that of the control group(0.083 vs.-0.261, P < 0.001). Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.

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.

超声引导下RISS平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响

目的 探究超声引导下菱形肌-肋间肌-低位前锯肌(RISS)平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响。方法 选取2021年1月至2022年7月入住秦皇岛市第一医院接受胸腹部手术的患者126例,按照随机掷硬币法分为观察组和对照组,各63例,两组进行常规麻醉诱导,气管插管后观察组行超声引导下RISS平面阻滞,对照组不行神经阻滞。比较两组术后疼痛视觉模拟(VAS)评分及镇静Ramsay评分、手术麻醉药物用量、围术期血流动力学指标(收缩压、舒张压、心率)及炎症应激指标[皮质醇(Cor)、P物质(SP)、前列腺素E2(PGE2)、白细胞介素-6(IL-6)]水平、不良反应发生情况。结果 手术结束后2 h、12 h、24 h,观察组VAS评分和Ramsay评分均显著低于对照组,差异均有统计学意义(P<0.05);术中及术后24 h,观察组舒芬太尼使用量显著低于对照组,差异有统计学意义(P<0.05);插管后两组收缩压、舒张压和心率均低于插管前,差异有统计学意义(P<0.05),插管后10 min和停药后10 min,观察组收缩压、舒张压心率显著低于对照组,差异有统计学意义(P<0.05);术后两组外周血中Cor、SP、PGE2、IL-6水平均低于术前,差异有统计学意义(P<0.05);术后12 h、24 h,观察组Cor、SP、PGE2、IL-6水平均低于对照组,差异有统计学意义(P<0.05);观察组麻醉不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论 超声引导下RISS平面阻滞具有良好镇痛镇静效果,能减轻胸腹部手术患者应激及炎症反应,安全性较高,值得临床应用推广。

PTI、IoC2和SPI在全身麻醉患者镇痛深度监测中的价值

目的探讨镇痛指数(PTI)、伤害敏感指数(IoC2)和手术容积指数(SPI)在全身麻醉患者镇痛深度监测中的价值。方法选取择期行腹腔镜胆囊切除术患者90例,采用区组随机法,按照不同镇痛深度监测指标分为IoC2组(A组)、SPI组(B组)和PTI组(C组),每组各30例。记录并比较各时间点患者心率(HR)、平均动脉压(MAP)、IoC2、SPI、PTI,测定并比较术前、术中和术后血清炎症因子(IL-6、IL-10)的水平。结果T2时IoC2、SPI和PTI与T1时比较(P<0.001);T3时SPI和PTI与T2时比较(P<0.05);T4时PTI和SPI与T3时比较(P<0.05);T4时IoC2与T2、T3时比较(P<0.001);T6时SPI和PTI与T5时比较(P<0.05);T7时IoC2、SPI、PTI与T5时比较(P<0.05);T8时IoC2、SPI和PTI与T7时比较(P<0.05)。各组内比较,IoC2、SPI和PTI具有时间变化趋势,且随着时间点不同均发生变化(P<0.001)。三组组间比较,HR、MAP、IoC2、SPI和PTI时间与组间存在交互效应,具有不相等的变化趋势(P<0.001)。IoC2、SPI、PTI与HR和MAP均呈正相关(P<0.05)。三组患者IL-6和IL-10术前、术中和术后比较,差异无统计学意义(P>0.05)。结论IoC2、PTI和SPI可作为全身麻醉术中疼痛监测的可靠指标,减轻术中应激反应,准确性优于HR、MAP。

感觉饱和疗法对缓解重症监护病房患儿操作性疼痛的效果研究

目的探讨感觉饱和疗法对缓解新生儿重症监护病房(neonatal intensive care unit,NICU)患儿操作性疼痛的效果。方法选取2022年7月-2023年7月NICU收治的104例患儿为研究对象,采用随机数表法将其分为对照组及观察组,各52例,对照组采用静脉穿刺常规护理,观察组在对照组的基础上实施感觉饱和疗法,比较两组疼痛评分及生理指标。结果观察组操作时及操作后5 min疼痛评分均低于对照组(t=11.421,P<0.001;t=25.490,P<0.001),操作后观察组心率、呼吸及血氧饱和度均优于对照组(t=8.471,P<0.001;t=2.590,P=0.011;t=12.120,P<0.001)。结论感觉饱和疗法能有效缓解NICU患儿静脉穿刺的疼痛感,并维持患儿生理指标的稳定。

闭环式管理模式对门诊癌痛患者的护理效果评价

目的探索闭环式管理模式对门诊癌痛患者的镇痛效果及可行性。方法收集2019年12月—2020年6月在江苏省肿瘤医院镇痛门诊首诊并使用阿片类药物(羟考酮缓释片)进行镇痛治疗的癌痛患者112例为研究对象。按照组间基本特征具有可比性的原则将患者分为对照组和观察组,每组56例,对照组给予常规管理;观察组接受闭环式管理模式,包括对患者首诊、复诊、定期随访、宣教、用药记录、指导等,同期疼痛门诊专科医师、药师、护士对患者制订个体化规范、合理、有效的镇痛方案及随诊计划,重点解决患者镇痛用药依从性,随诊反馈中存在的问题。两组患者均接受持续1个月的管理,记录并比较两组患者管理前后的服药依从率、数字评分量表(NRS)、爆发痛次数、疼痛控制满意程度,外周血β-内啡肽(β-EP)、前列腺素E-2(PGE-2)、内皮素-1(ET-1)、体质状况(KPS)评分,记录两组患者管理后对护理满意程度及管理期间发生的不良反应。结果管理前,两组患者的服药依从率、NRS、爆发痛次数、β-EP、PGE-2、ET-1、KPS评分比较差异均无统计学意义(P>0.05);管理后,观察组患者的服药依从率、镇痛满意程度、β-EP、护理满意程度和KPS评分高于对照组,差异均有统计学意义(P<0.05)。观察组患者的NRS、PGE-2、ET-1和不良反应发生程度均低于对照组,爆发痛次数少于对照组,差异均有统计学意义(P<0.05)。结论闭环式管理模式可有效提升门诊癌痛患者服药依从,有效控制疼痛,改善患者体质。

Impact of pain on health-related quality of life in patients with inflammatory bowel disease

AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed and analyzed the responses of 334 patients to a specifically designed questionnairebased on the short inflammatory bowel disease questionnaire (SIBDQ) and the German pain questionnaire. Pain intensity, HRQOL, Crohn’s disease activity index (CDAI) and colitis activity index (CAI) were correlated and verified on a visual analog scale (VAS). RESULTS: 87.9% of patients reported pain. Females and males reported comparable pain intensities and HRQOL. Surgery reduced pain in both genders (P = 0.023), whereas HRQOL only improved in females. Interestingly, patients on analgesics reported more pain (P = 0.003) and lower HRQOL (P = 0.039) than patients not on analgesics. A significant correlation was found in UC patients between pain intensity and HRQOL (P = 0.023) and CAI (P = 0.027), and in CD patients between HRQOL and CDAI (P = 0.0001), but not between pain intensity and CDAI (P = 0.35). No correlation was found between patients with low CDAI scores and pain intensity. CONCLUSION: Most IBD patients suffer from pain and have decreased HRQOL. Our study reinforces the need for effective individualized pain therapy in IBD patients.

髌股关节痛业余跑者的下肢肌力特征分析

目的:研究髌股关节痛(patellofemoral pain,PFP)业余跑者的下肢肌力特征。方法:招募PFP业余跑者30例(男性20例,女性10例)作为膝痛组,并匹配30例无损伤的业余跑者作为非膝痛组,采集所有受试者的髋关节外展力量、股四头肌力量、腘绳肌力量,并计算腘绳肌/股四头肌比值、双侧肢体力量对称指数等。采用独立样本t检验对不同组别的各项指标进行统计学检测。结果:男性PFP业余跑者的髋关节外展力量及对称指数、股四头肌力量及对称指数显著小于非膝痛组,腘绳肌/股四头肌比值显著大于非膝痛组;女性PFP业余跑者的髋关节外展力量及对称指数显著小于非膝痛组。结论:PFP业余跑者与非膝痛跑者表现出不同的下肢肌力特征,其男性与女性PFP业余跑者下肢力量特点表现并不一致,PFP康复训练中应考虑功能性及性别差异。

Comparing the Effectiveness of Motor Control Exercises versus Mckenzie Exercises for Work Related Back Pain

Background: Work related low back pain has been identified as a one of the most costly disorders among the worldwide working population. This condition was highly prevalent that approximately 85% patients having back pain were brought on by prolonged sitting. With the rapid development of modern technology, sitting has now become the most common posture in today’s work- place. Idea of using motor control learning approach provides the optimal control and coordination of the spine. The McKenzie evaluation was received using repeated movements and sustained positions. Therefore high quality randomized clinical trial was required to compare the effectiveness of these treatments for work related low back pain. Objectives: To compare the effectiveness of motor control exercises and McKenzie exercises in reducing pain and disability in work related low back pain. Method: The study included 40 subjects with work related low back pain due to prolonged sitting. They were randomly allocated into two groups (Group A and Group B). Group A was treated with motor control exercises and group B was treated with McKenzie exercises for 4 weeks. Results: Both the groups have shown statically significant improvement in vas with p < 0.0001 and ODI with p < 0.0001. When the comparison was done after the 4 weeks, the percentage of improvement in group A was much higher than Group B. Conclusion: The study concluded that motor control exercises have shown statically and clinically significant improvement in reducing pain and disability when compared to McKenzie exercises among work related low back pain subjects.

犀角地黄汤治疗五步蛇咬伤的临床效果

目的探讨犀角地黄汤治疗五步蛇咬伤的临床效果。方法选择2020年1月至2023年6月在我院治疗的五步蛇咬伤患者86例作为研究对象。采用随机数字表法将所有患者分为对照组和观察组,每组43例。对照组给予基础治疗及抗蛇毒血清治疗,观察组在对照组治疗基础上给予犀角地黄汤治疗。观察比较两组患者的临床疗效、纤维蛋白原(FIB)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、白细胞(WBC)计数、肿瘤坏死因子-a(TNF-a)、高敏C-反应蛋白(hs-CRP)、患肢与健肢周径差、患肢疼痛程度评分及肿胀缓解时间。结果观察组的治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的FIB、TT、APTT、PT、WBC、TNF-a、hs-CRP、患肢与健肢周径差及患肢疼痛程度评分比较,差异均无统计学意义(均P>0.05)。观察组治疗后的FIB高于对照组,TT、APTT、PT均低于对照组,差异均有统计学意义(均P<0.05)。观察组治疗后的WBC、TNF-a、hs-CRP、患肢与健肢周径差、患肢疼痛程度评分均低于对照组,差异均有统计学意义(均P<0.05)。结论犀角地黄汤治疗五步蛇咬伤可有效缓解患肢肿胀、疼痛程度,减轻炎症反应,改善凝血功能指标,值得临床应用。

推拿联合塞来昔布治疗腰椎间盘突出症的疗效观察

目的:观察推拿手法联合塞来昔布治疗腰椎间盘突出症的临床疗效,为临床应用提供可靠循证医学证据。方法:选取2021年3月至2022年1月上海中医药大学附属岳阳中西医结合医院推拿科就诊的腰椎间盘突出症患者80例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组40例。观察组采用推拿联合塞来昔布治疗;对照组单纯口服塞来昔布治疗,干预周期为4周。测量的结果变量包括视觉模拟评分(VAS)、简化McGill疼痛问卷简表(SF-MPQ)和Oswestry残疾指数(ODI)。结果:观察组有效率显著高于对照组(P<0.01);2组都能显著降低患者疼痛评分(P<0.001),但观察组疗效更优(P<0.001);2组都能显著降低患者ODI功能障碍指数(P<0.01),观察组疗效更优(P<0.01)。结论:推拿手法结合塞来昔布治疗腰椎间盘突出症在缓解腰部疼痛、改善腰椎功能方面,优于单纯口服塞来昔布治疗。

子宫内膜异位症患者腹腔镜手术后不同分型对消化功能的影响

目的探讨不同临床病理分型子宫内膜异位症(EMs)患者腹腔镜术后消化功能的影响。方法收集2018年12月至2022年12月期间115例腹腔镜诊断为EMs患者的临床资料,根据患者临床病理分型将患者分为腹膜型内异症(PEM)组(n=35)、卵巢内异症(OMA)组(n=37)、深部浸润型内异症(DIE)组(n=43)。收集患者一般资料,通过视觉模拟评分(VAS)评估所有患者术后6个月和12个月疼痛情况,并通过胃肠道生活质量指数(GIQLI)和诺尔斯爱克斯里斯科特症状量表(KESS)比较3组术后消化功能变化情况。结果3组研究对象在一般资料方面无显著差异,具有可比性。OMA组的手术时间显著长于PEM组,而DIE组的手术时间、出血量和住院时间均显著高于其他两组(P<0.01)。DIE组有88.37%的患者接受肠道手术,显著高于其他两组(P<0.01)。3组患者术后并发症发生率较低,无统计学意义(P>0.05)。DIE组在术前GIQLI评分较低,KESS评分较高,表明其胃肠功能较差。术后GIQLI评分和KESS评分相比于其他两组,差异有统计学意义(P<0.01)。3组患者术前和术后12月的VAS得分无显著差异,但DIE组在术后1年的GIQLI评分和KESS评分显著低于PEM组和OMA组(P<0.01)。结论不同临床病理分型的EMs患者腹腔镜术后消化功能存在差异,DIE组的消化功能受损最严重,需要更多的关注和干预。

腰椎间盘突出症患者积极度与疼痛自我效能、功能障碍的关系

分析腰椎间盘突出症患者积极度与疼痛自我效能、功能障碍的关系,为改善患者的健康结局提供理论依据。本研究对260例腰椎间盘突出症患者进行问卷调查,构建腰椎间盘突出症患者积极度与疼痛自我效能、功能障碍指数的结构方程模型。结果表明,腰椎间盘突出症患者积极度得分为(51.86±11.37)分,说明腰椎间盘突出症患者对健康管理信心和知识的掌握仍有所欠缺;患者积极度与疼痛自我效能、功能障碍指数之间存在相关关系,并具有显著影响(P<0.01)。结构方程模型拟合良好,患者积极度在疼痛自我效能和功能障碍指数之间存在中介效应。疼痛自我效能可通过患者积极度来影响腰椎间盘突出症患者的功能障碍程度,应鼓励患者积极主动参与疼痛自我管理,不断提高其生活质量。

自发性气胸患者应用单孔胸腔镜肺大疱切除术的治疗效果观察

目的探究单孔胸腔镜肺大疱切除术在自发性气胸患者中的治疗效果。方法回顾性分析2020年1月至2023年6月期间成都大学附属医院收治的94例自发性气胸患者,按照治疗方式不同将其分为A组(50例)与B组(44例)。A组行单孔胸腔镜下肺大刨切除术,B组行双孔胸腔镜下肺大疱切除术。对比2组手术指标,术后12、24、48、72 h疼痛情况,术前与术后1周血清指标、血气指标、术后并发症及术后6个月复发情况。结果A组手术时长高于B组,术中出血量、置管时长、胸腔引流量及住院时长均短于B组;术后12、24、48 h时,2组视觉模拟评分量表(VAS)评分均呈现降低趋势,且A组术后24 h和48 h VAS评分均低于B组;术后1周,2组TGF-β1、IL-1β、FGF-10、PaCO_(2)水平均降低,且A组均低于B组(P<0.05);术后1周,2组PaO_(2)均升高,且A组高于B组(P<0.05);2组并发症比较(8%和16%)差异无统计学意义(P>0.05);术后随访6个月,2组总复发率比较(2%与7%)差异无统计学意义(P>0.05)。结论相较于双孔胸腔镜技术,单孔胸腔镜肺大疱切除术用于自发性气胸治疗更具优势,可减少术中出血量,降低术后疼痛程度,改善炎症反应与血气状态,安全可靠。

全程护理优化方案对内镜下行内痔套扎术围手术期患者疼痛指数、生活质量及并发症的影响

目的分析镜下行内痔套扎术围手术期应用全程护理优化方案对患者疼痛指数、生活质量及并发症的影响。方法收集2022年1月至2023年1月收治的70例内镜下行内痔套扎术治疗的内痔患者临床资料,根据围手术期干预方式差异分为对照组(常规干预)与观察组(全程护理优化方案干预),每组35例。记录并对比2组手术时间、术中出血量、创面愈合时间、疼痛情况[视觉模拟疼痛评分(VAS)]、生活质量[生活质量综合评定问卷-74(GQOLI-74)]及并发症发生情况[肛门坠胀感、水肿、术后出血、尿潴留]。结果观察组手术时间及创面愈合时间均短于对照组,术中出血量少于对照组(P<0.05);2组术后24 h VAS评分比较差异无统计学意义(P>0.05),观察组术后3 d、7 d VAS评分均低于对照组(P<0.05);2组干预前生活质量四个维度比较差异无统计学意义(P>0.05),干预后2组患者四个维度评分均提高,观察组干预后物质生活、躯体、心理以及社会功能评分均高于对照组(P<0.05);术后观察组并发症总发生率为2.22%,对照组为4.44%,差异无统计学意义(P>0.05)。结论内镜下行内痔套扎术围手术期应用全程护理优化方案可降低患者疼痛指数及并发症发生率,同时提高患者生活质量水平,值得临床推广。

易筋经康复干预对膝骨关节炎患者不良情绪及慢性疼痛的影响研究

目的探讨易筋经康复干预对膝骨关节炎患者情绪及慢性疼痛的影响。方法选取2021年12月至2022年12月该院收治的106例膝骨关节炎患者作为研究对象,采用随机数字表法将其分为对照组、观察组,各53例。对照组实施本体感觉+平衡训练干预,观察组实施易筋经康复干预。评估并比较2组干预前后膝骨关节炎严重程度、炎症因子水平、本体感觉敏感度、平衡能力、疼痛程度、不良情绪。结果干预后,2组西安大略马斯特大学骨关节炎指数量表、焦虑自评量表、抑郁自评量表、视觉疼痛模拟量表评分及白细胞介素-1β、肿瘤坏死因子-α、白细胞介素-6水平均低于干预前(P<0.05),且观察组低于对照组(P<0.05)。与干预前比较,干预后,2组平均轨迹误差(ATE)均降低、本体感觉测试执行时间(TTE)均缩短、睁眼及闭眼椭圆面积均缩小,差异均有统计学意义(P<0.05);与对照组比较,观察组干预后ATE较低,TTE较短,闭眼运动椭圆面积较小,差异均有统计学意义(P<0.05);干预后2组睁眼运动椭圆面积比较,差异无统计学意义(P>0.05)。结论易筋经康复干预可改善患者临床症状,提高患者关节稳定性,缓解患者慢性疼痛,改善患者焦虑抑郁情绪。

不同镍钛弓丝对拔牙和非拔牙矫治患者正畸排齐效率和疼痛感知程度的影响

目的:探讨应用低摩擦自锁托槽的拔牙和非拔牙矫治患者中超弹性镍钛弓丝(SENT)与热激活镍钛弓丝(HANT)对下前牙初期排齐效率和患者疼痛程度的影响,为正畸临床中最适弓丝的选择提供依据。方法:将80例接受固定正畸治疗并应用自锁托槽的40例拨牙矫治患者(拔牙矫治组)和40例非拨牙矫治患者(非矫治拔牙组)随机分配到SENT亚组和HANT亚组,由同一名操作者将0.014英寸平直弓丝完全入槽。患者、操作者和数据测量人员均实行盲法。观察各组患者初始弓丝的临床排齐效率并计算患者Little’s指数,记录各组患者在初粘矫治器4 h后及矫治第1周的每天早饭前视觉模拟量表(VAS)评分和疼痛感知情况,对患者初始Little’s指数、性别和年龄进行多元回归分析,分析影响患者疼痛的影响因素。结果:拔牙矫治组和非拔牙矫治组患者年龄、性别和初始Little’s指数比较差异无统计学意义(P>0.05)。治疗4周后,非拔牙矫治组中HANT和SENT亚组患者的Little’s指数均较治疗前降低,但组间比较差异无统计学意义(P>0.05);与非拔牙矫治组中SENT亚组比较,非拔牙矫治组中HANT亚组患者Little’s指数降低(P<0.05);拔牙矫治组中HANT和SENT亚组患者治疗前后的Little’s指数比较差异无统计学意义(P>0.05)。患者初粘矫治器后的疼痛感在第1天达到峰值,随后逐渐降低至基础水平;在拔牙矫治组和非拔牙矫治组患者中,SENT和HANT亚组患者表现出相同的疼痛变化模式;SENT和HANT亚组患者各时间点VAS评分平均值和最高疼痛强度评分比较差异均无统计学意义(P>0.05)。弓丝类型对疼痛程度无明显影响,时间明显影响患者的疼痛程度。多元回归分析,拔牙矫治组患者初始Little’s指数与VAS最高评分间有明显相关性(b=0.359,P=0.033),性别和年龄均不会对2组患者疼痛程度产生影响。结结论论:应用低摩擦自锁托槽正畸治疗时,非拔牙矫治组患者使用0.014英寸HANT弓丝的初始排齐效率优于0.014英寸SENT弓丝;SENT弓丝和HANT弓丝对正畸患者初始疼痛程度无影响。

浓缩生长因子在促进下颌阻生第三磨牙拔除后创面愈合及术后反应中的应用

目的:探究浓缩生长因子(concentrated growth factor,CGF)在促进下颌阻生第三磨牙拔牙创面愈合中的疗效,及对第二磨牙远中骨缺损深度(osseous defect depth,ODD)、临床附着水平(clinical attachment level,CAL)及疼痛应激指标的影响。方法:选择2022年1月至2022年12月于我院拔除下颌阻生第三磨牙的患者共96例,按照随机数表法将患者随机分为研究组(n=48)及对照组(n=48)。对照组在拔牙后不填入任何植入物,研究组填入CGF凝冻物。比较2组患者的术后视觉模拟评分法(visual analogue scale,VAS)评分、面部肿胀情况、疼痛应激指标[5-羟色胺(5-hydroxytryptamine,5-HT)、半乳糖胺(galactosamine,Gal)、降钙素基因相关肽(calcitonin gene related peptide,CGRP)]含量、ODD、CAL及术后生活质量[术后症状严重程度(postoperative symptom severity,PoSSe)量表]。结果:术后1、3 d,研究组的VAS评分分别为(3.72±0.56)、(2.94±0.43)分,均显著低于对照组的(4.81±0.61)、(3.86±0.57)分(P<0.001);术后研究组的面部肿胀度为(2.79±0.64)mm,低于对照组的(5.46±1.22)mm(P<0.001);2组术后3 d的5-HT、Gal、CGRP水平均高于术前,研究组分别为(2.46±0.68)ng/mL、(9.56±1.42)nmol/mL、(1.76±0.52)ng/mL,均低于对照组的(3.15±0.46)ng/mL、(13.19±1.08)nmol/mL、(2.89±0.44)ng/mL(P<0.001);术后6个月,2组的ODD、CAL水平均低于术后1周,研究组分别为(4.21±0.87)、(0.48±0.12)mm,均低于对照组[(5.75±0.61)、(0.73±0.19)mm,P<0.001];研究组的各项PoSSe评分均低于对照组(P<0.01)。结论:CGF可降低下颌阻生第三磨牙拔牙后患者术后疼痛应激指标水平,改善其拔牙后的疼痛及面部肿胀情况,提高患者术后生活质量。