目的观察程序间歇式输注在腹股沟韧带上髂筋膜间隙阻滞用于老年髋部骨折术后镇痛效果。方法前瞻性研究2020年4月—2020年9月河北省保定市第一中心医院麻醉科髋部骨折手术患者60例,男性31例,女性29例;年龄65~92岁,平均78.5岁。美国麻醉...目的观察程序间歇式输注在腹股沟韧带上髂筋膜间隙阻滞用于老年髋部骨折术后镇痛效果。方法前瞻性研究2020年4月—2020年9月河北省保定市第一中心医院麻醉科髋部骨折手术患者60例,男性31例,女性29例;年龄65~92岁,平均78.5岁。美国麻醉医师学会(American society of anesthesiologists,ASA)Ⅱ或Ⅲ级。随机分为程序间歇式输注组和恒速输注组,各30例。超声引导下腹股沟韧带上髂筋膜间隙阻滞给予0.33%罗哌卡因40mL,并留置神经周围导管,蛛网膜下腔注射0.5%等比重罗哌卡因2.0mL,并留置硬膜外导管。术后连接患者自控神经阻滞镇痛泵,药物配方为0.2%罗哌卡因200mL。程序间歇式输注组单次自动给药剂量为10mL,间歇时间为60min;恒速输注组背景剂量为10mL/h。两组患者单次按压剂量为5mL,锁定时间为30min。当视觉模拟评分(VAS)>4分时,按压镇痛泵。若30min后无缓解,皮下注射盐酸羟考酮5mg,进行镇痛补救。记录术后4h(T1)、8h(T2)、24h(T3)及48h(T4)的VAS。记录48h内镇痛补救率、患者满意度及不良反应发生情况。结果程序间歇式输注组患者T3时点静态VAS2(2-2)及T2~4时点动态VAS2(2-2),3(2-3),2(2-3)较恒速输注组2(2-3),2.5(2-3),4(3-4),2(2-3)明显降低,镇痛补救率(6.67%)较恒速输注组(30%)明显降低,满意度8(8-9)较恒速输注组7(6-8)明显增加(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论与恒速输注比较,程序间歇式输注在腹股沟韧带上髂筋膜间隙阻滞用于老年髋部骨折手术患者的镇痛效果更加完善,并可减少阿片类药物的应用。展开更多
The authors reported the case of a 27- year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular frag...The authors reported the case of a 27- year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular fragment. After two attempts to reduce the hip with muscle paralysis under general anaesthesia failed, the patient was treated by immediate open reduction through a posterolateral approach. Surgical exploration of the hip revealed a small osteochondral fragment attached to a large piece of labrum and capsule, clogging the acetabulum. The femoralhead crossed over the torn capsule with a buttonhole effect. These elements were relieved, the bone fragment was fixed with a 2 mm screw and the capsule was repaired. At the 10- year follow-up, the functional outcome was excellent with a Harris score of 100 points and no signs of necrosis or osteoarthritis. The authors propose a literature review of this uncommon lesion.展开更多
A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via medi...A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.展开更多
文摘目的观察程序间歇式输注在腹股沟韧带上髂筋膜间隙阻滞用于老年髋部骨折术后镇痛效果。方法前瞻性研究2020年4月—2020年9月河北省保定市第一中心医院麻醉科髋部骨折手术患者60例,男性31例,女性29例;年龄65~92岁,平均78.5岁。美国麻醉医师学会(American society of anesthesiologists,ASA)Ⅱ或Ⅲ级。随机分为程序间歇式输注组和恒速输注组,各30例。超声引导下腹股沟韧带上髂筋膜间隙阻滞给予0.33%罗哌卡因40mL,并留置神经周围导管,蛛网膜下腔注射0.5%等比重罗哌卡因2.0mL,并留置硬膜外导管。术后连接患者自控神经阻滞镇痛泵,药物配方为0.2%罗哌卡因200mL。程序间歇式输注组单次自动给药剂量为10mL,间歇时间为60min;恒速输注组背景剂量为10mL/h。两组患者单次按压剂量为5mL,锁定时间为30min。当视觉模拟评分(VAS)>4分时,按压镇痛泵。若30min后无缓解,皮下注射盐酸羟考酮5mg,进行镇痛补救。记录术后4h(T1)、8h(T2)、24h(T3)及48h(T4)的VAS。记录48h内镇痛补救率、患者满意度及不良反应发生情况。结果程序间歇式输注组患者T3时点静态VAS2(2-2)及T2~4时点动态VAS2(2-2),3(2-3),2(2-3)较恒速输注组2(2-3),2.5(2-3),4(3-4),2(2-3)明显降低,镇痛补救率(6.67%)较恒速输注组(30%)明显降低,满意度8(8-9)较恒速输注组7(6-8)明显增加(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论与恒速输注比较,程序间歇式输注在腹股沟韧带上髂筋膜间隙阻滞用于老年髋部骨折手术患者的镇痛效果更加完善,并可减少阿片类药物的应用。
文摘The authors reported the case of a 27- year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular fragment. After two attempts to reduce the hip with muscle paralysis under general anaesthesia failed, the patient was treated by immediate open reduction through a posterolateral approach. Surgical exploration of the hip revealed a small osteochondral fragment attached to a large piece of labrum and capsule, clogging the acetabulum. The femoralhead crossed over the torn capsule with a buttonhole effect. These elements were relieved, the bone fragment was fixed with a 2 mm screw and the capsule was repaired. At the 10- year follow-up, the functional outcome was excellent with a Harris score of 100 points and no signs of necrosis or osteoarthritis. The authors propose a literature review of this uncommon lesion.
文摘A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.
