BACKGROUND Uterine fibroids are common benign gynecological conditions.Patients who experience excessive menstruation,anemia,and pressure symptoms should be administered medication,and severe cases require a total hys...BACKGROUND Uterine fibroids are common benign gynecological conditions.Patients who experience excessive menstruation,anemia,and pressure symptoms should be administered medication,and severe cases require a total hysterectomy.This procedure is invasive and causes severe postoperative pain,which can affect the patient’s postoperative sleep quality and,thus,the recovery process.AIM To evaluate use of dezocine in patient-controlled epidural analgesia(PCEA)for postoperative pain management in patients undergoing total myomectomy.METHODS We selected 100 patients undergoing total abdominal hysterectomy for uterine fibroids and randomized them into two groups:A control group receiving 0.2%ropivacaine plus 0.06 mg/mL of morphine and an observation group receiving 0.2%ropivacaine plus 0.3 mg/mL of diazoxide in their PCEA.Outcomes assessed included pain levels,sedation,recovery indices,PCEA usage,stress factors,and sleep quality.RESULTS The observation group showed lower visual analog scale scores,shorter postoperative recovery indices,fewer mean PCEA compressions,lower cortisol and blood glucose levels,and better polysomnographic parameters compared to the control group(P<0.05).The cumulative incidence of adverse reactions was lower in the observation group than in the control group(P<0.05).CONCLUSION Dezocine PCEA can effectively control the pain associated with total myomectomy,reduce the negative impact of stress factors,and have less impact on patients’sleep,consequently resulting in fewer adverse effects.展开更多
目的观察不同剂量右美托咪定（Dex）单次硬膜外注射对地佐辛0.3 mg/m L配伍0.2%罗哌卡因硬膜外患者自控镇痛（PCEA）对腹式全子宫切除手术后患者的镇痛效应和不良反应。方法择期腹式全子宫切除手术患者80例（ASAⅠ~Ⅱ级）,年龄45~64岁,...目的观察不同剂量右美托咪定（Dex）单次硬膜外注射对地佐辛0.3 mg/m L配伍0.2%罗哌卡因硬膜外患者自控镇痛（PCEA）对腹式全子宫切除手术后患者的镇痛效应和不良反应。方法择期腹式全子宫切除手术患者80例（ASAⅠ~Ⅱ级）,年龄45~64岁,体重44~70 kg,随机分成4组（C组、D1组、D2组和D3组）,每组20例。4组患者PCA泵内药物配方均为地佐辛0.3 mg/m L配伍0.2%罗哌卡因镇痛液50 m L,PCEA均采用LCP模式：负荷剂量（LD）5 m L＋持续输注剂量（CI）1 m L＋单次自控按压剂量（Bolus）2 m L,锁定时间10 min,镇痛24 h。C组LD为镇痛液5 m L;D1组LD为5 m L＋Dex 0.3μg/kg;D2组LD为5 m L＋Dex 0.4μg/kg;D3组LD为5 m L＋Dex 0.5μg/kg。观察各组患者硬膜外用药量,运动阻滞功能恢复至0级的时间,开启PCA泵后各时段伤口静息疼痛和动态疼痛的VAS评分,PCA泵的按压次数和实际有效次数及Ramesay镇静评分、改良Bromage分级,记录可能发生的不良反应和患者对其镇痛效果的综合满意度。结果 4组患者PCEA用药总量、地佐辛和罗哌卡因用药量为C组≈D1组〉D2组≈D3组（P〈0.05）;D2组、D3组静息痛和动态痛VAS评分在4~16 h明显低于C组（P〈0.05）,而D1组静息痛和动态痛VAS评分在8~12 h明显低于C组（P〈0.05）,D3组动态痛VAS评分在6~8 h明显低于D2组（P〈0.05）;在4~16 h各时段,D2组、D3组患者按压次数明显少于C组和D1组（P〈0.05）;D3组运动恢复时间明显比C组延长（P〈0.05）;D1组、D2组、D3组恶心、呕吐和寒战发生率明显少于C组（P〈0.05）;D2组和D3组的综合满意度高于C组（P〈0.05）。结论单次硬膜外注射Dex可增强腹式全子宫切除手术后患者早期地佐辛联合罗哌卡因硬膜外镇痛的效应,有利于提高患者的满意度,减少不良反应,其应用Dex最佳推荐剂量为0.4μg/kg,可在临床中选用。展开更多
Objective: To study the effect of hydromorphone hydrochloride combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after transurethral resection of prostate on pain mediators and stress response....Objective: To study the effect of hydromorphone hydrochloride combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after transurethral resection of prostate on pain mediators and stress response. Methods: A total of 138 patients who received transurethral resection of prostate in Ankang Central Hospital between May 2014 and October 2016 were selected and randomly divided into group A and group B, group A received postoperative hydromorphone hydrochloride combined with ropivacaine for PCEA, and group B received postoperative morphine hydrochloride combined with ropivacaine for PCEA. The serum contents of pain mediators, inflammatory response cytokines and stress hormones of the two groups were detected before surgery as well as 12 h, 24 h and 48 h after surgery. Results: 12 h, 24 h and 48 h after surgery, serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of both groups of patients were significantly higher than those before surgery, and serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of group A were significantly lower than those of group B. Conclusion: Hydromorphone hydrochloride combined with ropivacaine for PCEA can effectively reduce the pain and stress after transurethral resection of prostate.展开更多
OBJECTIVE: To assess the clinical effect and safety of direct current(DC) pulse produced by Han's Acupoint Nerve Stimulator in reduction(HANS) of labor pain.METHODS: Totally 120 participants were enrolled in this ...OBJECTIVE: To assess the clinical effect and safety of direct current(DC) pulse produced by Han's Acupoint Nerve Stimulator in reduction(HANS) of labor pain.METHODS: Totally 120 participants were enrolled in this clinical trial, and were randomly divided into4 groups including: HANS group, patient controlled intravenous analgesia(PCIA) group, patient-controlled epidural analgesia(PCEA) group and control group. The HANS group was treated by stimulating the acupoints of Jia Ji(T10-L3) and Ciliao(BL 32)with DC pulse of 100 Hz and 15-30 m A produced by a portable battery-powered Han's Acupoint Nerve Stimulator for 30 min. The PCIA group was intravenously infused Ondansetron(8 mg) for 5 min,then tramadol injection(1.5 mg/kg) was slowly dripped by using Baxter APⅡ electronic pump with50 m L tramadol(0.70%) + ondansetron(8 mg),background infusion 2 m L/h, PCA dose of 2 m L,lockout interval of 10 min. In PCEA group, women received intrathecal injection ropivacaine(3 mg) in L2-3, and epidural catheter was connected to Baxter APⅡ electronic pump, with 100 m L Ropivacaine(0.1%) and Sufentanil(50 ug), background infusion5 m L, Patient controlled analgesia(PCA) dose of 5m L, lockout interval of 10 min. The control group was not received analgesia. The visual analogue scale(VAS), stage and manner of labor, Apgar score of newborn, neonatal weights, oxytocin dosage,postpartum hemorrhage and side effects were monitored in all groups.RESULTS: The vital signs were all stable in the four analgesic groups. After analgesia, there was statistical difference in VAS score between HANS group and control group, between PCEA group and the control group, between PCIA group and control group. The analgesic effect in the PCEA group was significantly better than that of other two groups.The second stage of labor in the PCEA group was longer than the other three groups, showing significant difference between them. The Apgar score of newborn 1min after birth in the PCIA group was slightly lower than that of the other two groups,showing significant difference between them. The neonatal weights between four groups were not significantly different. The rate of cesarean sectionin the control group was significantly higher than that of the labor analgesia group, there was statistically difference in four groups. The number of PCIA group that used oxytocin was lower than that of other three groups. There was no significant difference in postpartum hemorrhage between four groups. The side effects of the PCEA group were itching, uroschesis and neonatal asphyxia and PCIA group were nausea and vomiting and neonatal asphyxia. However, fewer side effects were observed in the HANS group.CONCLUSION: The DC pulse produced by HANS may be a non-pharmacological alternative to labor pain with fewer side effects.展开更多
基金Natural Science Foundation of Gansu Provincial Science and Technology Department(Basic Research Program),No.23JRRA1385.
文摘BACKGROUND Uterine fibroids are common benign gynecological conditions.Patients who experience excessive menstruation,anemia,and pressure symptoms should be administered medication,and severe cases require a total hysterectomy.This procedure is invasive and causes severe postoperative pain,which can affect the patient’s postoperative sleep quality and,thus,the recovery process.AIM To evaluate use of dezocine in patient-controlled epidural analgesia(PCEA)for postoperative pain management in patients undergoing total myomectomy.METHODS We selected 100 patients undergoing total abdominal hysterectomy for uterine fibroids and randomized them into two groups:A control group receiving 0.2%ropivacaine plus 0.06 mg/mL of morphine and an observation group receiving 0.2%ropivacaine plus 0.3 mg/mL of diazoxide in their PCEA.Outcomes assessed included pain levels,sedation,recovery indices,PCEA usage,stress factors,and sleep quality.RESULTS The observation group showed lower visual analog scale scores,shorter postoperative recovery indices,fewer mean PCEA compressions,lower cortisol and blood glucose levels,and better polysomnographic parameters compared to the control group(P<0.05).The cumulative incidence of adverse reactions was lower in the observation group than in the control group(P<0.05).CONCLUSION Dezocine PCEA can effectively control the pain associated with total myomectomy,reduce the negative impact of stress factors,and have less impact on patients’sleep,consequently resulting in fewer adverse effects.
文摘目的观察不同剂量右美托咪定（Dex）单次硬膜外注射对地佐辛0.3 mg/m L配伍0.2%罗哌卡因硬膜外患者自控镇痛（PCEA）对腹式全子宫切除手术后患者的镇痛效应和不良反应。方法择期腹式全子宫切除手术患者80例（ASAⅠ~Ⅱ级）,年龄45~64岁,体重44~70 kg,随机分成4组（C组、D1组、D2组和D3组）,每组20例。4组患者PCA泵内药物配方均为地佐辛0.3 mg/m L配伍0.2%罗哌卡因镇痛液50 m L,PCEA均采用LCP模式：负荷剂量（LD）5 m L＋持续输注剂量（CI）1 m L＋单次自控按压剂量（Bolus）2 m L,锁定时间10 min,镇痛24 h。C组LD为镇痛液5 m L;D1组LD为5 m L＋Dex 0.3μg/kg;D2组LD为5 m L＋Dex 0.4μg/kg;D3组LD为5 m L＋Dex 0.5μg/kg。观察各组患者硬膜外用药量,运动阻滞功能恢复至0级的时间,开启PCA泵后各时段伤口静息疼痛和动态疼痛的VAS评分,PCA泵的按压次数和实际有效次数及Ramesay镇静评分、改良Bromage分级,记录可能发生的不良反应和患者对其镇痛效果的综合满意度。结果 4组患者PCEA用药总量、地佐辛和罗哌卡因用药量为C组≈D1组〉D2组≈D3组（P〈0.05）;D2组、D3组静息痛和动态痛VAS评分在4~16 h明显低于C组（P〈0.05）,而D1组静息痛和动态痛VAS评分在8~12 h明显低于C组（P〈0.05）,D3组动态痛VAS评分在6~8 h明显低于D2组（P〈0.05）;在4~16 h各时段,D2组、D3组患者按压次数明显少于C组和D1组（P〈0.05）;D3组运动恢复时间明显比C组延长（P〈0.05）;D1组、D2组、D3组恶心、呕吐和寒战发生率明显少于C组（P〈0.05）;D2组和D3组的综合满意度高于C组（P〈0.05）。结论单次硬膜外注射Dex可增强腹式全子宫切除手术后患者早期地佐辛联合罗哌卡因硬膜外镇痛的效应,有利于提高患者的满意度,减少不良反应,其应用Dex最佳推荐剂量为0.4μg/kg,可在临床中选用。
文摘Objective: To study the effect of hydromorphone hydrochloride combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after transurethral resection of prostate on pain mediators and stress response. Methods: A total of 138 patients who received transurethral resection of prostate in Ankang Central Hospital between May 2014 and October 2016 were selected and randomly divided into group A and group B, group A received postoperative hydromorphone hydrochloride combined with ropivacaine for PCEA, and group B received postoperative morphine hydrochloride combined with ropivacaine for PCEA. The serum contents of pain mediators, inflammatory response cytokines and stress hormones of the two groups were detected before surgery as well as 12 h, 24 h and 48 h after surgery. Results: 12 h, 24 h and 48 h after surgery, serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of both groups of patients were significantly higher than those before surgery, and serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of group A were significantly lower than those of group B. Conclusion: Hydromorphone hydrochloride combined with ropivacaine for PCEA can effectively reduce the pain and stress after transurethral resection of prostate.
基金Supported by The Scientific Achievement and Appropriate Technology Extension Project of Beijing Municipal Commission of Health and Family Planning(TG-2014-12)
文摘OBJECTIVE: To assess the clinical effect and safety of direct current(DC) pulse produced by Han's Acupoint Nerve Stimulator in reduction(HANS) of labor pain.METHODS: Totally 120 participants were enrolled in this clinical trial, and were randomly divided into4 groups including: HANS group, patient controlled intravenous analgesia(PCIA) group, patient-controlled epidural analgesia(PCEA) group and control group. The HANS group was treated by stimulating the acupoints of Jia Ji(T10-L3) and Ciliao(BL 32)with DC pulse of 100 Hz and 15-30 m A produced by a portable battery-powered Han's Acupoint Nerve Stimulator for 30 min. The PCIA group was intravenously infused Ondansetron(8 mg) for 5 min,then tramadol injection(1.5 mg/kg) was slowly dripped by using Baxter APⅡ electronic pump with50 m L tramadol(0.70%) + ondansetron(8 mg),background infusion 2 m L/h, PCA dose of 2 m L,lockout interval of 10 min. In PCEA group, women received intrathecal injection ropivacaine(3 mg) in L2-3, and epidural catheter was connected to Baxter APⅡ electronic pump, with 100 m L Ropivacaine(0.1%) and Sufentanil(50 ug), background infusion5 m L, Patient controlled analgesia(PCA) dose of 5m L, lockout interval of 10 min. The control group was not received analgesia. The visual analogue scale(VAS), stage and manner of labor, Apgar score of newborn, neonatal weights, oxytocin dosage,postpartum hemorrhage and side effects were monitored in all groups.RESULTS: The vital signs were all stable in the four analgesic groups. After analgesia, there was statistical difference in VAS score between HANS group and control group, between PCEA group and the control group, between PCIA group and control group. The analgesic effect in the PCEA group was significantly better than that of other two groups.The second stage of labor in the PCEA group was longer than the other three groups, showing significant difference between them. The Apgar score of newborn 1min after birth in the PCIA group was slightly lower than that of the other two groups,showing significant difference between them. The neonatal weights between four groups were not significantly different. The rate of cesarean sectionin the control group was significantly higher than that of the labor analgesia group, there was statistically difference in four groups. The number of PCIA group that used oxytocin was lower than that of other three groups. There was no significant difference in postpartum hemorrhage between four groups. The side effects of the PCEA group were itching, uroschesis and neonatal asphyxia and PCIA group were nausea and vomiting and neonatal asphyxia. However, fewer side effects were observed in the HANS group.CONCLUSION: The DC pulse produced by HANS may be a non-pharmacological alternative to labor pain with fewer side effects.
