肾石通颗粒联合盐酸坦洛新缓释胶囊治疗输尿管下段结石的疗效观察

目的:探讨肾石通颗粒联合盐酸坦洛新缓释胶囊治疗输尿管下段结石的临床疗效,为其临床应用提供参考资料。方法:选择189例自2013年6月至2016年6月在我院确诊为单侧输尿管下段结石患者随机分为对照组(n=93)和观察组(n=96),对照组给予肾石通颗粒治疗,观察组给予肾石通颗粒联合盐酸坦洛新缓释胶囊治疗。治疗2周后,观察两组患者的临床有效率、结石排出率、结石排出时间、肾绞痛发生率、肾绞痛视觉模拟量表(VAS)评分及不良反应发生率。结果:观察组临床总有效率为90.62%(87/96),高于对照组的77.42%(72/93);观察组结石排出率为67.79%(67/96),高于对照组的53.76%(50/93);观察组结石排出时间为(7.15±2.67)d,少于对照组的(10.47±3.23)d;观察组肾绞痛发生率为16.67%(16/96),低于对照组32.26%(30/93);观察组VAS评分为(3.15±0.98)分,低于对照组的(4.37±1.25)分,以上比较差异均具有统计学意义(P0.05)。观察组和对照组的不良反应发生率分别为14.58%(14/96)、12.90%(12/93),两组比较差异无统计学意义(P0.05)。结论:在肾石通颗粒基础上加用盐酸坦洛新缓释胶囊可提高输尿管下段结石患者的临床有效率、结石排出率、缩短结石排出时间和减少肾绞痛的发生率。     

氯丙嗪联合间苯三酚治疗顽固性肾绞痛的疗效观察

目的观察间苯三酚联合氯丙嗪治疗顽固性肾绞痛的疗效及安全性。方法采用氯丙嗪联合间苯三酚对阿托品、颅痛定、曲马多、哌替啶、吗啡等治疗无效的顽固性肾绞痛的治疗,并与对照组进行比较。结果治疗组有效率99.2%,疼痛消失时间、临床症状缓解时间均优于对照组(P0.05)。结论氯丙嗪联合间苯三酚对顽固性肾绞痛的临床治疗效果显著,主要副作用为头晕、乏力、低血压。     

腰麻硬膜外联合麻醉在老年下肢手术中的临床观察

目的:比较罗哌卡因、左旋布比卡因和布比卡因在老年患者下肢手术腰麻—硬膜外联合麻醉(combined spinal epidural anesthesia,CSEA)应用中的麻醉效果.方法:60例拟行下肢手术的老年患者随机分为罗哌卡因组、左旋布比卡因组和布比卡因组,每组各15例,均采用CSEA麻醉方法.比较各组感觉、运动麻醉阻滞情况,以及血流动力学变化.结果:罗哌卡因组麻醉效果不及其他两组,而布比卡因组与左旋布比卡因组间比较麻醉效果差异不明显;与其他两组比较,罗哌卡因组麻醉起效时间及最大运动阻滞时间均显著延长,而阻滞恢复时间明显缩短(P＜0.05或0.01),且Bromage评分及麻醉满意率低于布比卡因组(P＜0.05);罗哌卡因组与左旋布比卡因组患者循环系统稳定性优于布比卡因组.结论:腰麻—硬膜外联合麻醉中罗哌卡因、左旋布比卡因和布比卡因对于老年患者下肢手术均有较好的麻醉效果,其中罗哌卡因、左旋布比卡因对于心血管影响较小.     

坦洛新对输尿管下段结石患者体外冲击波碎石术后排石及血清IL-6，IL-10和CRP水平的影响

目的:探讨输尿管下段结石行体外冲击波碎石术(ESWL)后应用坦洛新辅助排石的临床效果及对患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)水平的影响。方法:选取我院2015年1月～2016年12月收治的122例输尿管下段结石患者,采用随机数字表法均分为两组。于ESWL术后,对照组给予硝苯地平治疗,观察组予以坦洛新治疗。记录比较两组术后排石效果、疼痛情况,治疗前后血清IL-6、IL-10和CRP水平的变化及不良反应的发生情况。结果:治疗后,观察组无石率(91.8%)明显高于对照组(78.7%)(P0.05);观察组排石时间短于对照组,排石直径大于对照组(P0.05);观察组患者血清IL-6,IL-10及CRP水平均显著低于对照组(P0.05)。与对照组相比,观察组肾绞痛发生率、镇痛剂使用率及VAS评分均较低(P0.01)。用药期间,两组均未发生明显不良反应(P0.05)。结论:坦洛新能有效提高输尿管下段结石患者体外冲击波碎石术的排石效果,减轻机体损伤,缓解术后疼痛,并且安全性较高。     

微创经皮肾镜取石术治疗输尿管上段结石合并轻度肾积水疗效观察

目的探讨微创经皮肾镜取石术治疗输尿管上段结石合并轻度肾积水的临床疗效。方法选取我院收治的140例输尿管上段结石合并轻度肾积水患者为研究对象,将患者随机分为对照组和观察组各70例,对照组70例行经后腹腔镜输尿管、肾盂切开取石术治疗,观察组行微创经皮肾镜取石术治疗,比较两组患者的治疗效果。结果两组患者在手术时间、术中出血量、胃肠道功能恢复时间及住院时间、血清炎性因子水平方面比较,观察组均明显优于对照组(P0.05);观察组患者的结石清除率与对照组比较,差异无统计学意义(P0.05)。结论输尿管上段结石合并轻度肾积水患者实施微创经皮肾镜取石术治疗的效果显著,有利改善患者血清炎性因子水平,值得推广应用。     

赖氨匹林和654—2治疗肾绞痛的比较

赖氨匹林组与６５４—２组各４０例,对肾石致肾绞痛的疗效,赖氨匹林组总有效率（９２．５％）、显效率（７２．５％）和镇痛起效时间（１５±５．８）ｍｉｎ与６５４—２组比较分别为７０．０％、２２．５％、（２６±１０．４）ｍｉｎ,差异具有高度显著性（３项指标均为Ｐ＜０．０１）。表明赖氨匹林治疗肾绞痛的疗效明显优于６５４—２。     

不同剂量及注药方向罗哌卡因对肛肠手术麻醉效果的影响

目的:研究不同剂量及注药方向罗哌卡因对肛肠手术麻醉效果的影响及安全性。方法:选择2015年1月~2016年12月在我院进行肛肠手术治疗的患者148例,按照麻醉方法的不同分为四组,每组各37例,即罗哌卡因8 mg向头注药组、罗哌卡因8mg向尾注药组、罗哌卡因10 mg向头注药组以及罗哌卡因10 mg向尾注药组。比较四组患者的感觉阻滞恢复时间、感觉阻滞起效时间以及运动阻滞恢复时间及恶心呕吐、尿潴留、腰部不适、头痛等术后不良反应的发生情况。结果:罗哌卡因10 mg向头注药与向尾注药的感觉阻滞起效时间比较差异均无统计学意义(P0.05),10 mg向头注药组的运动阻滞恢复时间明显短于10 mg向尾注药组(P0.05),以10 mg向头注药组感觉阻滞恢复时间最短(P0.05),8 mg向尾注药比10 mg向尾注药阻滞起效明显减慢(P0.05),运动以及感觉阻滞恢复时间均明显缩短(P0.05),10 mg向头注药组的感觉阻滞起效时间明显短于8 mg向头注药组(P0.05),运动以及感觉阻滞恢复时间均明显延长(P0.05)。四组均未发生恶心呕吐以及头痛等术后不良反应,罗哌卡因8 mg向尾注药组的尿潴留以及腰部不适的发生率均明显低于其他三组(P0.05)。结论:向尾端迅速注射罗帕卡因8 mg进行蛛网膜下隙阻滞对肛肠手术患者的麻醉效果最好,且安全性最高。     

输尿管镜下钬激光治疗输尿管结石疗效分析

目的:探讨输尿管镜下钬激光治疗输尿管结石的疗效。方法:2010年2月到2012年8月我院共收治输尿管结石患者60例,随机分为治疗组与对照组,每组各30例。对照组采用传统的冲击波碎石手术进行治疗,治疗组则采用输尿管镜钬激光治疗。观察两组患者的手术时间、住院时间、结石排除情况和尿常规等指标的变化情况,并评定患者的治疗效果。结果:治疗组患者的手术时间为(46.25±24.53)min与住院时间(3.51±0.62)d明显少于对照组手术时间(54.93±20.81)min,与住院时间(4.90±1.26)d,组间对比差异明显(P0.05)。治疗组的有效率与对照组的有效率分别为96.7%和86.7%,组间对比差异明显(P0.05)。结论:输尿管镜下钬激光治疗输尿管结石具有手术快、创伤少、恢复快等优点,值得推广应用。     

Ⅱ期经皮输尿管镜治疗输尿管上段结石梗阻致孤立肾急性肾功能衰竭

目的:探讨经皮肾微造瘘术后Ⅱ期经皮输尿管镜治疗输尿管上段结石致孤立肾急性肾功能衰竭的安全性与有效性。方法:从2004年7月～2009年5月,利用经皮肾微造瘘建立经皮肾通道,引流1周后肾功能明显好转,再行经皮肾输尿管镜碎石治疗孤立肾输尿管上段结石。结果:16例患者中,所有患者均为单通道取石,结石清除率例(81.2%),未出现高热、出血等并发症。术后1月复查13例无结石残留。结论:微创经皮输尿管镜分期治疗输尿管上段结石致孤立肾急性肾功能衰竭是安全、有效的,同传统经皮肾镜相比,具有对病人创伤小,易恢复等优点。     

妊娠合并上尿路结石致肾绞痛的临床诊治策略

目的:探讨妊娠期上尿路结石致肾绞痛的诊断和治疗方法.方法:对103例妊娠期上尿路结石致肾绞痛患者的临床资料及诊治过程进行分析,结合文献讨论本病的临床特点及诊治方法.结果:92例B型超声检查发现结石,11例仅发现患侧肾脏积水.所有患者均先行保守治疗;期间14例行输尿管置管术,7例行输尿管镜下气压弹道碎石术,2例行经皮肾穿刺造瘘术;101例患者顺利足月分娩;2例终止妊娠,孕妇平安.结论:妊娠期上尿路结石的诊断首选超声检查.对于有症状发作者保守治疗是主要治疗方法.治疗用药物应注意保护胎儿.对于顽固性肾绞痛患者,外科治疗首选逆行插管引流尿液,必要时可选择输尿管镜检查或经皮肾穿刺.开放手术为最后的治疗手段.     

Prospective double-blind comparison of buprenorphine and pethidine in ureteric colic.

In a double-blind prospective trial 26 consecutive patients with proved ureteric colic were allocated at random to receive 100 mg pethidine or 0.3 mg buprenorphine by intramuscular injection. Pain relief was assessed by standard linear analogue and ordered categories scales. The mean pain relief on the linear analogue scale was 3.80 +/- SEM 0.64 in patients receiving pethidine and 6.86 +/- 0.40 in those receiving buprenorphine (p less than 0.001). The corresponding values for mean pain relief in the ordered categories scale was 1.78 +/- 0.26 v 2.76 +/- 0.20 (p less than 0.01). These observations suggest that buprenorphine is superior to pethidine as analgesia in ureteric colic.     

不同容量胸段经椎间孔硬膜外注射阻滞范围的CT影像研究及诊断性阻滞的可行性分析

摘要 目的：探讨不同容量对胸段经椎间孔硬膜外注射（TFEI）药液扩散范围和镇痛效果的影响以及胸段TFEI用于诊断性阻滞的可行性。方法：选择2021年1月至2022年12月南京大学医学院附属鼓楼医院收治的胸段带状疱疹相关疼痛患者140例,随机分为4组,实施单次TFEI并分别注入不同容量含造影剂局麻药（A组：0.2 mL;B组：0.5 mL;C组：1.0 mL;D组：2 mL）,CT扫描并观察造影剂在硬膜外向头侧、尾侧及总扩散节段,造影剂在椎间孔、同侧椎旁间隙、同侧及对侧硬膜外间隙扩散情况,判断是否为选择性神经根阻滞。评估注射前、注射后30分钟及24小时视觉模拟评分（VAS）。结果：头侧和尾侧扩散节段以及总扩散节段数,D组最多,A组最少（P<0.05）;C组、D组造影剂扩散≥3个节段发生率明显高于B组（P<0.05）;C组、D组病例造影剂扩散至同侧椎旁间隙和对侧硬膜外间隙的发生率明显高于A组、B组（P<0.05）,仅A组37.1%的病例实现选择性神经根阻滞,其余各组均无选择性阻滞病例。注射后30分钟,C、D组VAS评分显著低于A、B组（P<0.05）;注射后24小时,D组VAS评分显著低于A、B组（P<0.05）。结论：胸段带状疱疹相关疼痛患者TFEI药液扩散范围随注射容量的增加而扩大,且在硬膜外倾向于头侧扩散,2 mL容量单次TFEI可阻滞3个以上的神经节段,获得良好的镇痛效果。胸段TFEI行诊断性阻滞的可行性较差。     

Controlled Comparison of the Efficacy of Fourteen Preparations in the Relief of Postoperative Pain

Thirteen analgesic drugs, four of them at two dose levels, four analgesics in combination with antagonist or neuroleptic agents, and saline have been evaluated simultaneously in the relief of postoperative pain. The method of assessment was designed to favour drugs which provided freedom from pain with minimum depression of consciousness. Only levorphanol 2 mg proved significantly superior to pethidine 100 mg, which was used as the standard reference drug. Oxycodone 10 mg, pentazocine 20 mg, and the morphine 10 mg and cyclizine 50 mg combination were the most successful of the remaining drugs. None of the drug combinations was significantly better than the analgesic drug given alone.     

Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section

BACKGROUND: Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section. METHODS: Study was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 mug intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain. RESULTS: Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl. CONCLUSION: Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod) on bupivacaine (a local anesthetic) in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.     

Analysis of the analgesic effects of tricyclic antidepressants on neuropathic pain,diabetic neuropathic pain,and fibromyalgia in rat models

ObjectiveTo investigate the analgesic effect of amitriptyline on neuropathic pain model rats, diabetic neuropathic pain model rats and fibromyalgia model rats.MethodsThe healthy male Sprague wrote – Dawley (SD) rats were taken as the research object, and they were randomly divided into model group (group A), beside the sciatic nerve and injection of 5 mm amitriptyline group (group B), beside the sciatic nerve and injection of 10 mm amitriptyline group (group C), beside the sciatic nerve and injection of 15 mm amitriptyline group (group D), intraperitoneal injection of amitriptyline group (group E). Pain induced by selective injury of sciatic nerve branches in rats, pain induced by chronic compression of sciatic nerve, diabetic neuropathic pain and fibromyalgia were conducted to determine the pain threshold of mechanical stimulation in rats after drug administration.ResultsThe pain threshold of mechanical stimulation in the local amitriptyline group (group B, C, D) was significantly higher than that in the group A and group E at each time point after drug treatment, and the pain threshold of mechanical stimulation gradually increased with the increase of concentration. There was no statistically significant difference in mechanical stimulation pain threshold between group A and group E at each time point after drug treatment.ConclusionPara-sciatic injection of amitriptyline at different concentrations has analgesic effects on neuropathic pain, diabetic neuropathic pain and fibromyalgia in rat models, and amitriptyline directly ACTS on the local sciatic nerve.     

Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy

Background

Although the application of ureteroscopy in the treatment of ureteral calculi during pregnancy has been on the rise, for persistent renal colic patients without ultrasound-detected ureteral calculi, it may represent a clinical dilemma due to the potential risks for both mother and fetus.

Objective

The aim of the present study is to present our experience with the application of the ureteroscope in the emergency treatment of persistent renal colic patients during pregnancy.

Methods

From March 2009 to September 2014, a total of 117 pregnant women who received ureteroscopy for persistent renal colic were retrospectively analyzed. Patients were divided into three groups according to duration of the persistent renal colic: Group A (within 12 hours; 24 cases); Group B (12 to 24 hours; 76 cases); and Group C (more than 24 hours; 17 cases). The stone-free rate, complications, and other qualitative data were analyzed.

Results

Of the 117 patients, 31 patients who were found not to have renal or ureteral calculi received ureteroscopic double-J (DJ) stent insertion, whereas 86 patients who were found with ureteral calculi received ureteroscopic lithotripsy (URSL) and DJ stent insertion. Among them, 24 patients (27.9%) were found with ureteral calculi by ureteroscopy rather than ultrasound. In addition, 73 patients (84.9%) had complete fragmentation of calculi; 12 patients (10.3%) had a threatened abortion (the rates of threatened abortion in Groups A, B and C were 8.3% vs. 6.5% vs. 29.4%; Group C compared with Groups A and B, p<0.05), and one patient (1.2%) had urosepsis (in Group C). However, these complications were cured with conservative treatment, without postpartum infant and maternal complications.

Conclusion

For pregnant patients with persistent renal colic/ureteral calculi and hydronephrosis, ureteroscopic DJ stent insertion and URSL are effective and safe options when conservative treatment fails, even if no urinary calculi were found by ultrasound. At the same time, for patients with persistent renal colic during pregnancy, early application of ureteroscopy may reduce the risk of preterm birth.     

延胡索乙素与白芷总香豆素、总挥发油配伍药效学比较研究

目的：评价延胡索乙素、白芷总香豆素及总挥发油配伍的药效学比较研究。方法：小鼠醋酸扭体法、热板镇痛法、甩尾法三种模型比较元胡止痛片（A组）、延胡索乙素（B组）、白芷总香豆素（C组）、白芷总挥发油（D组）、延胡索乙素与白芷总香豆素配伍（E组）、延胡索乙素与白芷总挥发油配伍（F组）及延胡索乙素与白芷总香豆素、白芷总挥发油配伍（G组）后的镇痛作用。结果：A、G组镇痛效果最佳,B、E、F组具显著的镇痛作用,C、D组与模型组相比,有一定的镇痛作用,但较弱。结论：延胡索乙素与白芷总香豆素、总挥发油配伍使用,具有显著的镇痛作用,类似于元胡止痛片中元胡白芷的配伍作用,但成分更为明确,标准可控,使用量小,属于分子中药组方范畴。元胡的主要有效成分延胡索乙素与白芷的主要成分白芷总香豆素、总挥发油均具有镇痛作用,符合中药元胡及白芷的功效,本实验采用药物有效成分进行配伍,成分明确,结果可控。     

神经刺激仪经肌间沟定位臂丛神经分支行臂丛麻醉效果分析

目的：比较神经刺激仪经肌间沟定位臂丛神经分支行肌间沟臂丛神经阻滞麻醉的效果及安全性。方法：选择拟行肌间沟臂丛神经阻滞的上肢手术的患者80例,ASAI或II级,随机均分为A组和B组,每组40例患者。两组均给予1％的利多卡因＋0．375％耐乐品20mL。记录完成操作所需时间、感觉神经阻滞起效时间、感觉神经阻滞完善时间、运动神经阻滞起效时间、运动神经阻滞完善时间;评价手术区域麻醉效果（优、良、差、失败）;观察并记录并发症。结果：A组完成操作所需时间（5．01±1．40）min,明显长于B组（2．83＋O．87）min（P〈0．01）。A组感觉阻滞起效时间（4．48±1．36）min,明显短于B组（7．0±2．06）min（P〈0．01）;A组运动阻滞起效时间（4．88＋±1．18）min,明显短于B组（7．0±1．67）min（P〈0．01）。A组感觉阻滞完善时间（11．73±3．62）短于B组（13．33±3．02）min（P=0．033）。A组运动阻滞完善时间（11．18±2．73）短于B组（12．41±2．48）min（P=0．038）;麻醉效果优等率A组为87．5％,B组为67．5％,差异有统计学意义x^2=4．588,P=0．032;优良率A组为97．5％,B组为90．0％,差异无统计学意义x2=1．920,P=0．166;A组、B组均未出现严重麻醉并发症。结论：A组行肌间沟臂丛神经阻滞比B组阻滞操作时间长,但神经阻滞麻醉效果好,神经阻滞完善率高。