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find Keyword "硬膜外镇痛" 7 results
  • Effectiveness and Safety of Thoracic Epidural Analgesia for Postoperative Complications after Cardiac Surgery: A Systematic Review

    Objective To systematically review the effectiveness and safety of thoracic epidural analesis (TEA) for postoperative complications after cardiac surgery. Methods Such databases as PubMed, Science Citation Index, EMbase, The Cochrane Library, CNKI and CBM were electronically searched from inception to October 2012 for collecting the randomized controlled trials on the effectiveness and safety of thoracic epidural analgesisa for postoperative complications after cardiac surgery. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally 14 studies were eligible, involving 1 942 patients. The results of meta-analysis showed that, TEA combined with general anesthesia (GA) was superior to GA alone in reducing the incidences of myocardial ischemia/infarction (RR=0.63, 95%CI 0.41 to 0.96, P=0.03), respiratory complications (RR=0.55, 95%CI 0.40 to 0.75, P=0.000 1), supraventricular arrhythmias (RR=0.64, 95%CI 0.47 to 0.88, P=0.005), and duration of mechanical ventilation (MD= –2.15, 95%CI –3.72 to –0.58, P=0.007), with significant differences. Conclusions Current evidence shows that, TEA after surgery is effective in reducing the incidences of myocardial ischemia/infarction, respiratory complications, supraventricular arrhythmias, and duration of mechanical ventilation. There is the lack of data on the adverse events of TEA (mainly referring to epidural hematoma). Due to limited quality and quantity of the included studies, patients’ conditions should be fully considered before applying TEA in clinical practice.

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  • 罗哌卡因复合芬太尼分娩镇痛的临床观察

    目的:观察低浓度罗哌卡因复合芬太尼应用于分娩镇痛的有效性和安全性。方法:选择足月妊娠、头位、单胎、无明显头盆不称,无椎管内硬膜穿刺禁忌且自愿要求分娩镇痛的初产妇60例为观察组,以同期的头位、单胎、无明显头盆不称的初产妇60例作对照组,产程中不用镇痛药。观察两组产妇的镇痛效果(VAS评分)、下肢运动神经阻滞MBS(modified bromage score)产程进展、分娩方式、新生儿Apgar评分、产后出血量。结果:镇痛组产妇镇痛有效率100%,下肢运动神经阻滞轻,宫口扩张速度快、活跃期缩短、剖宫产率低,与对照组比较差异有显著性(Plt;0.05);两组第二、三产程、器械助产率、产后出血量、新生儿Apgar评分均无统计学差异。结论:采用低浓度罗哌卡因复合芬太尼用于分娩镇痛安全、有效,是理想的分娩镇痛方法。

    Release date:2016-08-26 02:21 Export PDF Favorites Scan
  • Comparison of Patient-controlled Intravenous and Epidural Analgesia on Postoperative Complications after Abdominal and Thoracic Surgery: A Meta-Analysis

    Objective To compare the effect of intravenous and epidural analgesia on postoperative complications after abdominal and thoracic surgery. Methods A literature search was conducted by using computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1985 to Jan 2009. Further searches for articles were conducted by checking all references describing postoperative complications with intravenous and epidural anesthesia after abdominal and thoracic surgery. All included randomized controlled trials (RCTs) were assessed and data were extracted by the standard of Cochrane systematic review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results Thirteen RCTs involving 3 055 patients met the inclusion criteria. The results of meta-analyses showed that, a) pulmonary complications and lung function: patient-controlled epidural analgesia can significantly decrease the incidence of pneumonia (RR=0.66, 95%CI 0.53 to 0.83) and improve the FEV1 (WMD=0.17, 95%CI 0.05 to 0.29) and FVC (WMD=0.21, 95%CI 0.1 to 0.32) of lung function after abdominal and thoracic surgery, but no differences in decreasing postoperative respiratory failure (RR=0.77, 95%CI 0.58 to 1.02) and prolonged ventilation (RR=0.75, 95%CI 0.51 to 1.13) compared with intravenous analgesia; b) cardiovascular event: epidural analgesia could significantly decrease the incidence of myocardial infarction (RR=0.58, 95%CI 0.35 to 0.95) and arrhythmia (RR=0.64, 95%CI 0.47 to 0.88) than the control group, but could not better reduce the risk of heart failure (RR=0.79, 95%CI 0.47 to 1.34) and hypotension (RR=1.21, 95%CI 0.63 to 2.29); and c) Other complications: epidural and intravenous analgesia had no difference in decreasing the risk of postoperative renal insufficient (RR=0.78, 95%CI 0.53 to 1.14), gastrointestinal hemorrhage (RR=0.78, 95%CI 0.49 to 1.23), infection (RR=0.89, 95%CI 0.70 to 1.12) and nausea (RR=1.03, 95%CI 0.38 to 2.81). Conclusions Epidural analgesia can obviously decrease the risk of pneumonia, myocardial infarction and severe arrhythmia, and can improve the lung function after abdominal or thoracic surgery.

    Release date:2016-09-07 11:09 Export PDF Favorites Scan
  • Effects of Epidural Analgesia on Prognosis after Intestinal Surgery: A Meta-analysis

    Objective To systematically evaluate the effect of epidural analgesia on prognosis after intestinal surgery. Methods Such databases as PubMed, EBSCO, Springer, Ovid and CNKI were searched to identify randomized controlled trials (RCTs) about the effects of epidural analgesia on prognosis after intestinal surgery published from 1985 to 2010. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Handbook, and then the meta-analyses were conducted by using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that compared with the patient controlled analgesia (PCA), the patient controlled epidural analgesia (PCEA) significantly reduced the waiting time for having first flatus, first defecation, and the length of hospital stay (MD= –1.07, 95%CI –1.63 to –0.50; MD= –0.63, 95%CI –1.19 to –0.08; MD= –1.36, 95%CI –2.28 to –0.44; respectively), lowered the frequency of vomiting on the first and second day after operation (OR=0.33, 95%CI 0.13 to 0.82; OR=0.3, 95%CI 0.13 to 0.84; respectively), and obviously declined the visual analog scale (VAS) scores of rest pain on the first, second and third day after operation (MD= –26.60, 95%CI –33.06 to –20.15; MD= –25.98, 95%CI –30.98 to –20.97; MD= –15.59, 95%CI –27.29 to –3.88; respectively), and the VAS scores of motion pain on the first, second and third day after operation (MD= –26.00, 95%CI –36.00 to –16.00; MD= –27.89, 95%CI –35.70 to –20.08; MD= –11.79, 95%CI –21.28 to –2.30; respectively). There were no significant differences between the two groups in the incidence of urinary tract infection, urinary retention, anastomotic leak and ileus. Conclusion PCEA significantly reduces the waiting time for having first flatus and first feces, the length of hospital stay, the VAS scores of pain, and the incidence of postoperative vomiting.

    Release date:2016-09-07 11:06 Export PDF Favorites Scan
  • 三种分娩镇痛方法的临床比较

    【摘要】目的 观察全程陪伴分娩、罗哌卡因复合芬太尼患者自控硬膜外镇痛、潜伏期陪伴分娩加罗哌卡因复合芬太尼患者自控硬膜外镇痛分娩临床效果及对母婴的影响。方法 足月单胎头位初产妇(美国麻醉师协会ASAⅠ~Ⅱ级)150例,随机分为3组,A组(对照组,n=50)由助产士全程陪伴分娩,不使用镇痛药;B组(n=50)为活跃期后使用罗哌卡因1 g/L加芬太尼1.5 mg/L;C组(n=50)为潜伏期陪伴分娩加活跃期后使用罗哌卡因1 g/L加芬太尼1.5 mg/L。观察镇痛效果、用药量、分娩方式、产后出血量、对产程、新生儿的影响及产妇满意度。结果 3组镇痛质量分数为A组<B组<C组(Plt;0.01),用药总量为B组gt;C组(Plt;0.05),产妇满意率为A组<B组<C组,剖宫产率为A组>B组>C组。新生儿Apgar评分及产后出血量各组间比较差异均无统计学意义。结论 潜伏期陪伴分娩加罗哌卡因复合芬太尼患者自控硬膜外镇痛分娩镇痛效果好,用药量少,可缩短产程,降低剖宫产率,产妇满意度高。

    Release date:2016-09-08 09:31 Export PDF Favorites Scan
  • Effect of Postoperative Patient-Controlled Epidural Analgesia with Different Doses of Sufentanil after Cesarean Section

    【摘要】 目的 观察不同剂量的舒芬太尼用于剖宫产术后硬膜外自控镇痛的效果比较。 方法 将2009年4-11月60例硬膜外麻醉下行剖宫产手术术后的患者随机分为三组,术后镇痛液A组采用0.125%罗哌卡因复合0.3 μg/mL舒芬太尼;B组为0.125%罗哌卡因复合0.4 μg/mL舒芬太尼;C组0.125%罗哌卡因复合0.5 μg/mL舒芬太尼,观察三组患者的术后镇痛效果(视觉模拟法评分,即VAS评分)及不良反应。 结果 A组VAS评分高于B组和C组,B组VAS评分高于C组(Plt;0.05)。三组患者术后恶心呕吐、运动阻滞、嗜睡及肠蠕动抑制等并发症无统计学差异(Pgt;0.05)。 结论 0.125%罗哌卡因复合0.5 μg/mL舒芬太尼以4 mL/h持续输注用于剖宫产术后患者自控硬膜外镇痛术后疼痛VAS评分最小,患者镇痛满意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.

    Release date:2016-09-08 09:50 Export PDF Favorites Scan
  • 肠蠕医用胶贴对胸部手术后患者肠蠕动恢复的效果观察

    目的探讨肠蠕医用胶贴对开胸手术硬膜外镇痛患者肠蠕动恢复的作用。 方法将2011年1月至2012年9月山东省青州市人民医院120例行开胸手术、术后应用硬膜外镇痛泵患者分为两组,每组各60例。常规组:男33例,女27例;年龄42~77岁,中位年龄62.6岁;术后给予常规护理。肠蠕医用胶贴组:男31例,女29例;年龄32~78岁,中位年龄64.9岁;术后使用肠蠕医用胶贴。术后观察两组患者的肠蠕动恢复时间、肛门排气时间和腹胀情况。 结果肠蠕医用胶贴组患者术后肠蠕动恢复时间[(12.3±4.6)h vs.(17.6±5.3)h,P<0.05]和肛门排气时间[(25.6±6.3)h vs.(28.7±5.5)h,P<0.05]均较常规组缩短,差异有统计学意义(P<0.05),腹胀发生率较常规组低,差异有统计学意义(P<0.05)。 结论肠蠕医用胶贴可有效促进开胸硬膜外镇痛手术患者术后肠蠕动的恢复。

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