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注射,硬膜外

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注射,硬膜外

-研究学者

  • 侯京山
  • 朱新杰
  • 高谦
  • 何亮亮
  • 徐华琴
  • 徐振兴
  • 王福根
  • 翁浩
  • 蔡明珍
  • 丁正年
  • 期刊论文
  • 专利文献

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    • 王泽茂; 张国忠; 郝连付; 吾不力·阿扎提
    • 摘要: 目的 观察小针刀联合硬膜外注射对腰椎间盘突出症患者疼痛及腰椎功能恢复的治疗效果.方法 将80例腰椎间盘突出症患者按随机数字表法分为2组.对照组40例予小针刀治疗;治疗组40例在对照组基础上联合硬膜外注射治疗.2组均治疗4周后统计疗效,观察比较2组治疗前及治疗1、2、4周后疼痛视觉模拟评分法(VAS)评分变化情况,比较2组治疗后腰椎功能改善恢复情况,并对2组治疗期间满意度情况进行比较.结果 2组治疗1、2、4周后疼痛VAS评分与本组治疗前比较均明显降低(P<0.05),且治疗组治疗1、2周后疼痛VAS评分均低于对照组同期(P<0.05);治疗组治疗后腰椎功能改善恢复情况明显优于对照组(P<0.05),治疗期间满意度明显高于对照组(P<0.05).结论 小针刀联合硬膜外注射治疗腰椎间盘突出症临床疗效确切,可明显缓解患者疼痛症状,促进腰椎功能恢复,操作简单方便,患者治疗满意度高.
    • Li Yunze; Guo Xuejiao; Rao Yuefeng; Feng Zhiying
    • 摘要: 硬膜外腔糖皮质激素注射(ESI)是将局麻药或/和糖皮质激素(GCS)等注射入病灶等相应部位的硬膜外腔,抑制局部炎性反应、阻断恶性神经传导,从而缓解、消除疼痛.虽然ESI技术历史悠久、受众面广,但ESI可引起严重神经系统不良事件,甚至致死,而备受关注.《糖皮质激素在疼痛微创介入治疗中的应用——中国专家共识》也建议ESI应由经过专业培训的专科医师进行操作.本文结合文献,就ESI操作时,与GCS相关严重不良反应及其防治措施展开解读.%Epidural steroid injection (ESI), the injection of local anesthetics or glucocorticoids (GCS) into the epidural space, is the most commonly performed procedure for the treatment of spinal pain worldwide. The epidural approach is most often used to optimize the local, anti-inflammatory effects of corticosteroid at the nerve root level. An additional warning emphasized that epidural injections of steroids may cause spinal cord infarction, paraplegia, quadriplegia, cortical blindness and stroke, spoken by USA Food and Drug Administration in 2014 for ESI. Application of glucocorticoids in minimally invasive interventional treatment for pain (Chinese expert consensus) also suggested that this procedure should be done by trained physicians. This paper summarized the literatures in order to interpret the Chinese expert consensus about the untoward effects and its prevention during the manipulation of ESI in detail.
    • 曾渊; 杭博; 蒯建科; 毛延坤
    • 摘要: 目的:比较右美托咪定静脉输注与硬膜外注射对再次剖宫产术产妇硬膜外麻醉效果.方法:选择单胎足月妊娠再次剖宫产术,拟行连续硬膜外麻醉产妇80例,随机分为右美托咪定静脉输注(A组)与右美托咪定硬膜外注射(B组)各40例.硬膜外穿刺术毕,排除脊麻征象后,A组硬膜外腔给予15ml 0.75% 罗哌卡因+2ml 0.9% 氯化钠溶液,并予1μg/kg右美托咪定静脉输注;B组硬膜外腔给予15ml 0.75% 罗哌卡因+1μg/kg右美托咪定.硬膜外腔给药速率0.5ml/s.比较两组麻醉起效时间、达峰效应时间、感觉阻滞时间,评定Ram say镇静评分及牵拉反应,抽取胎儿脐静脉血行血气分析,并记录新生儿体重及Apgar评分,观察术中低血压、寒战、心动过缓、呼吸抑制等情况及瑞芬太尼使用率.结果:B组麻醉起效时间显著提前,达峰效应时间显著缩短,感觉阻滞时间更长,差异有统计学意义(P0.05).结论:右美托咪定静脉输注与硬膜外注射均可增强再次剖宫产术硬膜外麻醉效果,且对新生儿无不良影响;较之于静脉输注,右美托咪定硬膜外注射的麻醉起效时间更快,阻滞效果更好.
    • 赵晓亮; 陈晓芳; 徐桂萍
    • 摘要: 目的 探讨罗哌卡因规律间断硬膜外分娩镇痛对于分娩结局的影响.方法 选取2016年1月至2017年1月本院妇产科收治的96例无妊娠并发症、合并症的初产妇为研究对象,根据产妇意愿,其中有分娩镇痛要求产妇72例(观察组),无分娩镇痛要求产妇24例(对照组),将72例有镇痛要求产妇按随机数字表法分为A、B组,每组36例,对照组生产过程不给予任何镇痛药物,观察组给予0.15%罗哌卡因+0.4 μg/ml舒芬太尼行硬膜外镇痛,其中A组规律间断给药,B组持续输注给药,观察并比较三组产妇疼痛评分、缩宫素使用情况、分娩方式、新生儿窒息发生情况、产妇满意情况.结果 分娩镇痛后60 min、宫口开至6~7 cm以及宫口全开时,观察组VAS评分均明显低于对照组(P<0.05);硬膜外分娩镇痛前,A、B组VAS评分比较差异无统计学意义(P>0.05),分娩镇痛后,两组各时间点VAS评分均明显低于镇痛前(P<0.05),且A组各时间点VAS评分均明显低于B组(P<0.05);对照组缩宫素使用率明显低于观察组(P<0.05),A组与B组缩宫素使用率比较,差异无统计学意义(P>0.05);A组镇痛药物罗哌卡因、舒芬太尼总用量明显少于B组(P<0.05);观察组剖宫产率、新生儿窒息率明显低于对照组,差异有统计学意义(P<0.05);A组剖宫产率明显低于B组(P<0.05);且A组新生儿窒息发生率少于B组,但差异无统计学意义(P>0.05);观察组产妇对分娩结果满意率明显高于对照组,差异有统计学意义(P<0.05);B组满意率明显低于A组(P<0.05).结论 罗哌卡因规律间断硬膜外分娩镇痛安全有效,镇痛疗效确切,有利于降低临床剖宫产率及新生儿窒息率,产妇满意度较高.
    • 吉杰; 徐振东; 刘志强
    • 摘要: 背景 近年来,间断硬膜外间隙给药(intermittent epidural bolus,IEB)作为分娩镇痛的一种新型给药方式逐渐受到临床的关注. 目的 阐述当前IEB进行分娩镇痛的进展. 内容 综述IEB的局部麻醉药消耗量、镇痛效果、运动阻滞发生情况和对分娩结局的影响. 趋向 随着认识的深入,IEB将在分娩镇痛中得到更广泛的应用.%Background In the recent years,intermittent epidural bolus (IEB) for labor analgesia is drawing increasing concern as a new method of administration.Objective The aim of this article is to address the role of IEB in labor analgesia.Content This article reviews the pharmacokinetics of local anesthetics,the degree of analgesia and motor blockage,as well as the effects of IEB on labor outcomes.Trend IEB may be widely accepted as an effective method of administration in labor analgesia through intense research and expanding procedural experience.
    • 赵娜; 安民; 李有长; 金菊英; 刘朝文
    • 摘要: 目的 探讨硬膜外注射舒芬太尼联合静脉自控镇痛(PCIA)用于剖宫产术后镇痛的有效性及安全性.方法 将160例足月剖宫产的初产妇分为观察组和对照组各80例.观察组术毕时经硬膜外导管给予0.10μg/kg舒芬太尼,再拔管行PCIA镇痛;对照组术毕后即拔出硬膜外导管行PCIA镇痛.观察两组产妇术后2、6、12、24、48 h静息及运动状态下疼痛视觉模拟评分(VAS)、初次泌乳时间,以及术后48 h内恶心呕吐等不良反应发生情况.结果 两组产妇术后各时间点静息VAS评分比较,差异无统计学意义(P=0.112);观察组术后6、12、24 h运动状态VAS评分低于对照组(P<0.01);观察组术后平均初次泌乳时间较对照组早(P<0.01);两组产妇术后48 h内恶心呕吐、皮肤瘙痒、呼吸抑制、嗜睡、尿潴留等不良反应发生率比较,差异无统计学意义(P>0.05).结论 剖宫产术后采用硬膜外单次注射舒芬太尼与PCIA联用,可改善PCIA术后镇痛效果,并促进产妇早期泌乳.
    • 曹勇; 田晓燕; 张苒; 代玉川; 赵家琦; 安毅
    • 摘要: 目的:观察高位胸段硬膜外阻滞(HTEB)对长期右心耳快速起搏诱发心房颤动(房颤)犬心房自主神经重构的影响,并探讨心房肌神经生长因子(NGF)在心房自主神经重构中的作用。  方法:18只犬随机分为假手术组、对照组和HTEB组。对照组和HTEB组犬给予持续快速心房起搏建立房颤模型, HTEB组给予硬膜外腔注射0.5%利多卡因行高位胸段硬膜外阻滞。通过Masson染色检测犬心房肌胶原容积分数(CVF)改变,免疫组化法测定犬心房肌神经生长相关蛋白43(GAP43)及酪氨酸羟化酶(TH)表达,蛋白免疫印迹法检测犬心房肌NGF、GAP43及TH蛋白表达情况。  结果:与对照组相比,右心耳快速起搏6周后,HTEB组犬心房肌CVF值显著降低; GAP43及TH神经萌出量显著减少(P<0.05); NGF、GAP43及TH蛋白表达量显著减少(P<0.05~0.01)。与假手术组比较,HTEB组犬心房肌CVF值显著增加;GAP43及TH神经萌出量显著增加(P<0.05~0.01); NGF、GAP43及TH蛋白表达量显著增加(P<0.05)。  结论:长期右心耳快速起搏诱发犬房颤致心房肌神经不均一萌出,诱发自主神经重构,而NGF在其中发挥重要作用。HTEB可有效阻止房颤犬心房肌NGF表达上调,减轻自主神经重构。%Objective: To observe the impact of high thoracic epidural blockade (HTEB) on atrial autonomic nerve remodeling in dogs with atrial ifbrillation (AF) induced by long-term rapid right atrial appendage pacing and to explore the effect of nerve growth factor (NGF) on atrial autonomic nerve remodeling. Methods: AF model was established by consistent rapid atrial pacing for 6 weeks. 18 experimental dogs were randomly divided into 3 groups: Sham group, the dogs had no pacing while received normal saline injection; Control group, the dogs had pacing and normal saline injection; HTEB group, the dogs had pacing and 0.5% lidocaine injection for HTEB.n=6 in each group. Atrial myocardium collagen volume fraction (CVF) was examined by Masson staining; sprouting of NGF related protein 43 (GAP43) and tyrosine hydroxylase (TH) were assessed by immunohistochemistry; protein expressions of NGF, GAP43 and TH were measured by Western blot analysis. Results: Compared with Sham group, HTEB group showed decreased CVF and sprouting of GAP43, TH,P<0.05;reduced protein expressions of NGF, GAP43 and TH,P<0.05-0.01. Compared with Sham group, HTEB group presented increased CVF and sprouting of GAP43, TH,P<0.05-0.01; elevated protein expressions of NGF, GAP43 and TH,P<0.05. Conclusion: Long-term rapid atrial pacing induced AF dog had inhomogeneous sprouting of atrial myocardial nerve which may cause autonomic nerve remodeling; NGF played the important role in such process. HTEB could effectively inhibit NGF up-regulation and suppress the autonomic nerve remodeling in experimental dogs.
    • 何非方; 钟泰迪; 刘敏君; 乔世娜; 田素明; Shinichi Yishikawa; Morita Kiyoshi
    • 摘要: 目的 多区域脑脊液漏致自发性颅内低压患者36例,其中30例患者实施2次,6例患者实施3次靶向硬膜外自体血介入治疗后临床症状完全缓解.自体血注射过程中,发生24例穿刺部位注射痛、5例上肢放射性疼痛、9例上肢麻木、6例下肢疼痛、7例下肢麻木、4例头痛,3例头晕,3例一过性心动过缓;上述不良反应多数在停止注射自体血或减慢注射速度后缓解,部分在数小时后缓解;2例颈部僵硬感,术后数小时至数天后缓解,未见严重神经系统并发症.治疗结束后3个月2例复发,再次靶向硬膜外自体血介入治疗后缓解.术后随访15~ 36月,均未见严重神经系统并发症.由此可见,靶向硬膜外自体血介入术用于多区域脑脊液漏致自发性颅内低压的治疗是安全、有效的.%Thirty-six spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid were enrolled in the study.After 30 patients received targeted epidural blood intervention for 2 times and 6 patients received targeted epidural blood intervention for 3 times,the clinical symptoms were completely relieved.During injection of autologous blood,pain at the puncture site occurred in 24 cases,radiating pain in upper extremities in 5 cases,numbness in the upper extremity in 9 cases,radiating pain in lower extremities in 6 cases,numbness in lower extremities in 7 cases,headache in 4 cases,dizziness in 3 cases and transient bradycardia in 3 cases.Most of these symptoms were self-relieved after the end of injection or after slowing the injection rate,and some were self-relieved hours later.Neck stiffness was found in 2 cases and self-relived within a few hours or days after operation,and no severe nervous systemrelated complications were found.Recurrence happened in 2 cases at 3 months after the end of treatment,and the symptoms were self-relieved after receiving targeted epidural blood intervention for a second time.The patients were followed up for 15-36 months,and no serious nervous system-related complications were observed.Therefore,targeted epidural blood intervention is safe and effective when used to treat spontaneous intracranial hypotension caused by multiple-level leakages of cerebrospinal fluid in patients.
    • 韩雪萍; 陈淼; 王勇; 尚学栋; 任小栋; 黄运里; 李平乐
    • 摘要: Objective To evaluate the value of ultrasound-guided epidural puncture in the patients with chronic axial lower back pain caused by degenerative spinal diseases.Methods One hundred and sixtyeight patients with chronic axial lower back pain caused by degenerative spinal diseases,aged 47-60 yr,with body mass index of 18-25 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,with visual analogue scale score ≥6 and the course of the disease >3 yr,undergoing epidural puncture were randomly divided into 3 groups (n=56 each) using a random number table:hand positioning group (group H),X-ray guidance group (group X),and ultrasound guidance group (group U).The puncture site was determined by hand positioning,and the epidural puncture was performed routinely in group H.In X and U groups,the puncture site was determined under the guidance of X-ray and ultrasound,respectively,and then the epidural puncture was performed.The operating time,the number of needle insertion at the puncture site,the number of needle passing through tissues,the successful puncture at 1st attempt,and the occurrence of pain at the puncture site were recorded.Results Compared with group H,the operating time was significantly shortened,the number of needle passing through tissues was significantly decreased,the rate of successful puncture at 1st attempt was significantly increased (P<0.05),and no significant difference was found in the number of needle insertion at the puncture site in X and U groups (P>0.05).There was no significant difference in the incidence of pain occurred at the puncture site between the three groups (P>0.05).Conclusion The efficacy of epidural puncture guided by ultrasound is similar to that guided by X-ray and better than that guided by hand positioning in the patients with chronic axial lower back pain caused by degenerative spinal diseases.%目的 评价退行性脊椎病变致轴向慢性腰背部疼痛患者超声引导硬膜外穿刺术的价值.方法 拟行硬膜外穿刺术的退行性脊椎病变致轴向慢性腰背部疼痛患者168例,年龄47~60岁,性别不限,BMI 18~25 kg/m2,ASA分级Ⅰ或Ⅱ级,VAS评分≥6分,病程超过3年,采用随机数字表法,将其分为3组(n=56):手法定位组(H组)、X线透视引导组(X组)和超声引导组(U组).H组采用手法定位进行硬膜外穿刺间隙的选择,常规进行穿刺,X组和U组分别在X线和超声引导下进行硬膜外间隙的选择和穿刺.记录操作时间、穿刺点进针次数、穿刺针在组织中穿过次数、首次穿刺成功情况和穿刺部位疼痛发生情况.结果 与H组比较,X组和U组操作时间缩短,穿刺针在组织中穿过次数减少,首次穿刺成功率升高(P<0.05),穿刺点进针次数差异无统计学意义(P>0.05);X组与U组上述各指标比较差异无统计学意义(P>0.05);3组间穿刺部位疼痛发生率比较差异无统计学意义(P>0.05).结论 退行性脊椎病变致轴向慢性腰背部疼痛患者超声引导硬膜外穿刺术的效果与X线透视引导的效果相同,且优于手法定位.
    • 常刚; 左金良
    • 摘要: 目的观察经椎间孔注药联合臭氧治疗腰椎间盘突出症的临床效果。方法后外侧旁突型腰椎间盘突出症病人130例,随机分为两组,A组行单纯椎间孔注药治疗,B组行椎间孔注药联合臭氧治疗,比较两组临床疗效。结果两组治疗后1、3、6个月疗效比较,差异有显著性(U_c=4.10~5.39,P〈0.05)。结论经椎间孔注药联合臭氧治疗腰椎间盘突出症安全、有效,近中远期效果稳定可靠。
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