ObjectiveTo compare postoperative patient-controlled epidural analgesia (PCEA) and intravenous patient-controlled analgesia (PCIA) on maternal low back pain after caesarean section. MethodsSixty cases of American Society of Anesthesiology gradeⅠ-Ⅱ single-birth full-term elective caesarean delivery primiparae chosen between July to September 2012 were divided into 3 groups randomly, 20 in each group. Group A accepted sufentanil 1 μg/mL and ropivacaine 1 mg/mL PCEA; group B had sufentanil 1.5 μg/mL PCEA; group C was given sufentanil 1.5 μg/mL and ondansetron 0.16 mg/mL PCIA. Background dose was 2 mL/h, patient-controlled analgesia dose was 2 mL, and locking time was 20 min. Visual analogue pain score was used to assess the effect of postoperative analgesia, and we recorded analgesia pump usage, adverse reactions, and at the same time investigated the onset of maternal low back pain. ResultsNo obvious postoperative pain was found, and the analgesic effect was good in all the three groups, and the differences were not statistically significant (P>0.05). All three groups of women had a certain proportion of low back pain, and the differences were not statistically significant (P>0.05). After operation, group A had 5 cases of leg numbness, group B had 1, and group C had none. Leg numbness occurred significantly more in group A than in group B and C (P<0.05). Group B had one case of nausea and vomiting, while none occurred in group A and C (P>0.05). ConclusionWith the same effect of postoperative analgesia, compared with PCIA, PCEA does not increase postoperative low back pain incidence after caesarean section.
ObjectiveTo systematically review the efficacy and safety of primary percutaneous coronary intervention (PCI) via radial access versus via femoral access for patients with acute ST-segment elevation myocardial infarction (STEMI). MethodsRandomized controlled trials (RCTs) about the clinical efficacy and safety of radial access for PCI in patients with acute STEMI were searched in PubMed, EMbase, CBM, The Cochrane Library (Issue 6, 2014), CNKI, VIP, and WanFang Data from 2000 to November 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment of included studies were completed by two reviewers independently. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of fourteen RCTs involving 5 212 patients were enrolled. The results indicated that:a) radial access was associated with decreased risks of mortality (OR=0.54, 95%CI 0.40 to 0.74, P=0.000 1); decreased incidences of major bleeding (OR=0.50, 95%CI 0.34 to 0.74, P=0.000 8), major adverse cardiac events (MACE) (OR=0.65, 95%CI 0.50 to 0.83, P=0.000 6), and puncture site complications (OR=0.35, 95%CI 0.25 to 0.49, P < 0.000 01); and decreased hospital duration (MD=-2.14, 95%CI-3.97 to-0.31, P=0.002). b) However, the two groups were alike in the success rate of operation, exposure time of X ray, risk of stroke, and the rate of CABG. PCI via radial access took more operation time than that via femoral access, and PCI via radial access had a higher incidence of changing puncture access. ConclusionFor acute STEMI patients undergoing PCI, radial access could significantly reduce mortality, and incidences of major bleeding, MACE and puncture site complications. Therefore, under the conditions of strict indication control and increased operation skills, PCI via radial access is effective and safe in the treatment of acute STEMI. Due to limited quality and quantity of the included studies, more large-scale, multi-centre, high quality RCTs are needed to verify the above conclusion.