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局部麻醉下微波治疗痔的临床观察

【摘要】　目的　探讨局部麻醉下微波治疗痔的可行性及疗效。方法　回顾云南省鲁甸县人民医院2000 年4月至2007 年4 月期间局部麻醉下微波治疗痔85 例(微波治疗组) ,硬膜外麻醉下行痔切除80 例(常规治疗组) ,并对2 组的手术时间、并发症及治疗效果进行比较分析。结果　微波治疗组: 手术时间(10 ±5) min ; 并发症中渗血4 例(4. 7 %) ,肛门狭窄1 例(1. 2 %) ,复发6 例(7. 1 %) ; 治愈74 例(87. 1 %) ,好转及无效11 例(12. 9 %) 。常规治疗组: 手术时间(40 ±5) min ; 并发症中渗血6 例(7. 5 %) ,肛门狭窄2 例(2. 5 %) ,复发7 例(8. 8 %) ; 治愈65 例(81. 3 %) ,好转及无效15 例(18. 8 %) 。2 组的手术时间、并发症总发生率及治愈率比较差异有统计学意义( P lt;0. 05) 。结论　局部麻醉下微波治疗痔安全可行,具有微创、简单、有效、并发症少及手术时间短的优点,有临床推广价值。

The Experience of Application in Tension-Free Herniorrhaphy Under Local Anesthesia in Senile Inguinal Hernia

ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia. MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients. ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05). ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.

Treatment of 32 Cases of Severe Hemorrhoids Underwent PPH with Local Anesthesia

目的　探讨在局部麻醉下行痔上黏膜环形切除钉合术（procedure for prolapse and hemorrhoids，PPH）治疗重度内痔的可行性及临床应用价值。方法　笔者所在医院科室从2005年起对32例Ⅲ度及Ⅳ度脱垂性内痔（含1例混合痔）患者均采用苯巴比妥＋氢溴酸东莨菪碱＋利多卡因肛管直肠环形局部浸润麻醉行PPH术，对其麻醉效果、手术时间、术中及术后疼痛、尿潴留、术后感染、肛门狭窄、住院时间、治疗满意度等进行分析。结果　32例患者均顺利完成手术，有1例术中改行低位连续硬膜外麻醉，1例辅加镇静剂及镇痛剂。术后28例对疼痛能耐受，4例需镇痛药物；1例患者有肛门坠胀感；所有患者伤口均一期愈合，无尿潴留、术后感染、出血、肛门狭窄等并发症发生；31例对疗效满意，有1例感肛门坠胀，行温水坐浴及痔疮膏纳肛治疗1周后缓解。住院时间3～6d，平均4d。32例患者均进行有效随访，随访时间2～4个月，平均3个月，无大便失禁或复发，肛门控便能力均可。结论　局部麻醉下行PPH术治疗重度内痔是一种安全可行的手术方法，麻醉操作护理简单，疗效确切，术后并发症少，术后恢复快，并可减少医疗费用。

隆鼻术局部麻醉致眼动脉阻塞一例

Evaluation of Efficacy of Local Spraying Anaesthesis in Preoperative Implantation of Nasogastric Tube inPatients with Laryngeal Carcinoma

目的：比较常规鼻胃管置入法与鼻咽部局部喷雾麻醉后置胃管法对喉癌患者的影响。方法：将需要安置胃管的100例患者随机分成两组，每组50例。实验组行鼻咽部喷雾麻醉，对照组按常规操作，比较两组患者流泪、恶心、呕吐、咳嗽反应，一次成功率及插管所需要时间、插入中暂停次数。结果：实验组一次成功率高，患者反应轻，插管所需时间有显著差异。结论：常规置胃管常因病员难受而中途暂停置管，实验组置胃管前先作鼻咽部局部喷雾麻醉，可明显减轻患者的痛苦，提高插胃管的一次成功率，插管过程中因病员难受暂停次数也明显减少，使临床护理工作时间缩短，对临床护理工作有积极意义。

利多卡因衍生物QX-314的局部麻醉作用的研究进展

近年研究发现，通过辣椒素等激活与疼痛相关的瞬时感受器电位香草酸受体1（TRPV1），可以使以往不能通过细胞膜的利多卡因四价阳离子衍生物QX-314，进入与疼痛相关的神经元细胞内产生长时选择性感觉阻滞作用。由此，TRPV1受体激动剂与QX-314联用已逐渐成为局部麻醉的研究热点。现对QX-314的发现、特性、局部麻醉作用及其作用机制作一综述。

局部麻醉药在腹腔镜中胆囊切除术的应用

摘要:目的:探讨通过腹腔内注射局部麻醉药在腹腔镜胆囊切除术中的镇痛效果。方法:52例患者随机分为4组,Ⅰ组术前腹腔内喷洒0.75％罗哌卡因20 mL;Ⅱ组术后腹腔内喷洒0.75％罗哌卡因20 mL;Ⅲ组为术后腹腔内喷洒0.5％布比卡因20 mL;Ⅳ组术后腹腔内喷洒生理盐水20 mL。麻醉方法均为全凭静脉麻醉。术后1、2、3、4 h 4个时间点记录患者术后疼痛视觉模拟评分(VAS)。并观察4组术后使用镇痛药物的例数和肩背痛、恶心呕吐发生率。结果:术后1、2、3、4 h VAS评分Ⅱ组lt;Ⅲ组lt;Ⅰ组lt;Ⅳ组(Plt;0.05)。Ⅳ组使用镇痛药物的例数明显高于Ⅰ组、Ⅱ组和Ⅲ组(Plt;0.05)。4组术后肩背痛、恶心呕吐发生率差异无显著性(Pgt;0.05)。结论:经腹腔给局麻药镇痛效果明显,术毕给药镇痛效果优于术前给药,罗哌卡因镇痛效果优于布比卡因。Abstract: Objective: To investigate the effect of intraperitoneal local anesthetic on patients undergone laparoscopiccho1ecystectomy.Methods:Fiftytwo patients were randomly divided into four groups. Group Ⅰ received preoperational anesthetic spary with 20 mL of 0.75％ ropivacaine. Group Ⅱ was given the anesthetic ata same dosage after the operation. Group Ⅲ received preoperational anesthetic spary with 20 mL of 0.5％ bupivacaine. Group Ⅳ received preoperational anesthetic spary with 20 mL saline. The LC was completed under general anesthesia.After the operation,visual analog scale (VAS)was recorded at 1,2,3 and 4 hours to evaluate the degree of postoperative pain.Meanwhile,the number of the patients who received anesthetics after the surgery,as well as the incidence rates shoulder or back pain and nausea or vomiting were recorded. Results: Postoperative VAS of the group Ⅱ was significantly lower than that of the other three groups, while the VAS of group Ⅲ was significantly lower than that in group Ⅰ(both Plt;0.05).Compared to groups Ⅰ, Ⅱ and Ⅲ,more patients in the group Ⅳ needed anesthetics after the operation (Plt;0.05).No significant diference was noticed in the incidence rates of shoulder or back pain and nausea or vomiting among the four groups (Pgt;0.05).Conclusions: Intraperitoneal local anesthetic can significantly reduce postoperative pain after LC. It is more effective to give local anesthetic at the end of the procedure than using it before operation. The effect of ropivacaine is better than bupivacaine.

完全清醒无止血带局部麻醉技术在手外科手术中的应用

目的总结完全清醒无止血带局部麻醉技术（wide awake local anesthesia no tourniquet，WALANT）在手外科手术中的应用效果。方法 2021年4月—10月，采用WALANT为28例手外伤患者实施麻醉并手术。男18例，女10例，年龄15～55岁，平均35岁。急诊手术22例，择期手术6例。骨折切开复位内固定术5例，骨折内固定物取出术l例，肌腱探查断裂修复术18例，肌腱粘连松解术4例。采用疼痛视觉模拟评分（VAS）评估疼痛情况，术中观察出血情况，术后观察麻醉维持时间、手指血供变化及有无并发症发生，采用主动运动总和法（TAM）评定手部功能。结果 术中麻醉与止血效果满意，患者未诉疼痛。第1针刺入皮肤时VAS评分为2～4分；术中操作未引起明显疼痛，VAS评分为0～1分；麻醉效果可持续6～8 h，VAS评分为2～6分。术后手术区域麻醉效果逐渐消失后，所有患者口服或静脉滴注非甾体止痛药能有效缓解疼痛。术后24 h内患者无头痛、头晕、恶心、呕吐、乏力、皮疹等药物不良反应，术后8 h手指皮温及毛细血管反应同正常手指。术后未出现血运障碍等麻醉不良反应。28例患者均获随访，随访时间6～12个月，平均8个月。末次随访时TAM评定获优20例、良8例。结论手外科手术中应用WALANT止痛和止血效果良好、操作简单、安全有效，术中能即刻观察手术效果。

Multi-center randomized double-blinded controlled clinical t ri al on local anesthetic efficacy of scndonest 2% special and its safety

Objective　To assess efficacy of mepivacaine on local anesthesia in dentistry and oral surgery and its safety. Methods　Parallel group, stratified randomization, double blinded, muti-center clinical trial was designed. Two percent lidocaine with adrenaline in same cartridge was as control. Healthy patients with deep decay, pulpitis needed operative dentistry, or indication for extraction of the teeth, which located in the maxilla or front part of the mandible were included. Results　Except 17 cases, 127 patients fulfilled inclusion criteria: 66 in treatment group and 61 in control group, dental filling for 60 and extraction for 67 cases, male 55 and female 72, average at 38.84 + 12.06 years. Submucous infiltration of 1.5 ml mepivacaine at labial or buccal side of the alveolar process produced onset of anesthesia in the median of 60 seconds which was same as that of lidocaine, anesthesia duration for 146.7 minutes with the median of 125 minutes, permitting painless filling or extractions. In the treatment group 81.82% freed of pain, while 15.15% had slight pain but received no extra local anesthetic for implementation of the treatment procedures, making the successful rate of 96.97%. In the mepivacaine group, 13.64% of the cases had transient elevation of the systolic pressure to the level of 145-162 mmHg, 8.33% diastolic pressure to the level of 91-93 mmHg. Only one case had transient palpitation in half minute after one minute injection of the drug with no medical care needed. All the cardiovascular reactions might result from adrenaline containing in the injections. Conclusion　Mepivacaine is an effective, safe and reliable anesthetic agent for dentistry and oral surgery.

局部麻醉药心脏毒性不良反应的研究进展

自局部麻醉药应用于临床以来，临床上出现了许多局部麻醉药心脏毒性不良反应的案例，但目前对这方面的认识仍然存在争议。该文对局部麻醉药心脏毒性不良反应的构效关系、量效关系、诊断、预防及治疗方面的研究进展进行了综述。