目的：观察利多卡因宫旁阻滞联合宫腔灌注在人流术中镇痛的效果。方法:收集我院2005年1～2月门诊终止妊娠的早孕妇女共94例并分为两组:单纯宫旁阻滞组（简称单纯组）35例，宫旁阻滞联合宫腔灌注（简称联合组）59例。比较两种利多卡因局麻方式的效果。结果:（1)两组的止痛效果无明显差异(P=0.893);(2)联合组对宫颈的松弛作用优于宫旁阻滞(Ｐ=0.000);(3)联合组较多病例出现眩晕、耳鸣等副反应。结论:与单纯宫旁阻滞相比，宫旁阻滞联合宫腔灌注并无明显优势。
目的 探讨围手术期超前平衡镇痛在肛肠手术中止痛的临床效果。方法 回顾性分析2009年11月至2010年10月期间巴中市中医院肛肠科123例采用腰俞穴麻醉的肛肠手术患者的临床资料，患者被分成超前平衡镇痛组（60例）和传统镇痛组（63例）2组。2组术前准备相同，术后均口服布洛芬缓释胶囊300mg止痛，2次/d。对Ⅲ～Ⅳ度内痔及内括约肌痉挛的患者术中均常规行内括约肌松解术，对VAS评分6分以上的患者选择使用盐酸曲马多注射止痛。超前平衡镇痛组术前0.5h肌注安定10mg，口服布洛芬缓释胶囊300mg，术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml、芬太尼50 μg、地塞米松5mg用生理盐水稀释成20ml行腰俞穴麻醉并止痛，术毕肛内塞用双氯芬酸钠栓1枚。传统镇痛组术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml用生理盐水稀释成20ml行腰俞穴麻醉。比较2组术后4、6、8、12、24及48 h VAS评分、盐酸曲马多使用率及恶心、呕吐及尿潴留的发生率。结果 术后4、6、8、12、24及48 h VAS评分超前平衡镇痛组均明显低于传统镇痛组（P＜0.01），术后盐酸曲马多使用率超前平衡镇痛组明显低于传统镇痛组（P＜0.05），恶心、呕吐及尿潴留的发生率2组比较差异均无统计学意义（P＞0.05）。结论 围手术期超前平衡镇痛用于肛肠手术止痛是一种疗效肯定、安全、不良反应少而又简单易行的镇痛方法。
ObjectiveTo observe the clinical efficacy of temperature-controlled self-heated pain relief plasters in the treatment of chronic nonspecific lower back pain, and to investigate the quality of life of patients. MethodsPatients with chronic nonspecific lower back pain were randomly divided into a trial group and a control group. The trial group was treated with temperature-controlled self-heated pain relief plasters, while the control group was treated with meloxicam tablets for oral use. The outcome measures including the visual analogue pain scale (VAS), Japanese Orthopedic Association (JOA) scores for the management of lower back pain, and Oswestry disability index (ODI score) were collected before treatment and after 6-month follow-up. SPSS 13.0 software was used for statistical analysis. ResultsA total of 96 patients was included (48 patients in each group), of which 68 patients (36 in the trial group and 32 in the control group) completed the treatment. The results of intention-to-treat (ITT) and per-protocol (PP) analyses showed that the total effectiveness rate of the trial group was higher than that of the control group with significant differences (all P values < 0.05). Compared with those before treatment, the JOA scores and ODI scores of the two groups were all improved after 6-month follow-up (all P values < 0.05). But no significant difference was found between the two groups in the two scores after 6-month follow-up (all P values > 0.05). During the follow-up, there were 3 and 8 patients with recurrence of lower back pain in the trial group and the control group, respectively. ConclusionThe clinical effect of temperature-controlled self-heated pain relief plasters in the treatment of chronic nonspecific lower back pain is satisfactory, the quality of life of patients is improved obviously, and the therapy is simple, safe, inexpensive, and worthy of clinical promotion.