目的報(bào)告在局麻下行疝環(huán)充填式無(wú)張力疝修補(bǔ)術(shù)治療腹股溝疝的體會(huì)。方法對(duì)該院70例腹股溝疝患者行疝環(huán)充填式無(wú)張力修補(bǔ)術(shù)后的早期自主活動(dòng)、進(jìn)食、排尿以及住院日期等情況進(jìn)行觀察。結(jié)果在局麻下行疝環(huán)充填式無(wú)張力疝修補(bǔ)術(shù)較之硬膜外麻醉或全麻有更寬的手術(shù)指征，且術(shù)后進(jìn)食早，下床早,排尿困難明顯降低,住院時(shí)間縮短，費(fèi)用也較低。結(jié)論在局麻下行疝環(huán)充填式無(wú)張力疝修補(bǔ)術(shù)，是一種對(duì)人體生理功能干擾小、術(shù)后恢復(fù)快、并發(fā)癥少、簡(jiǎn)單易掌握的理想方法之一。
目的 研究膝關(guān)節(jié)腔內(nèi)聯(lián)合應(yīng)用羅哌卡因與利多卡因的鎮(zhèn)痛效果。 方法 采用隨機(jī)雙盲安慰劑對(duì)照的試驗(yàn)方法，將90例膝關(guān)節(jié)鏡手術(shù)患者分為3組，每組分別在術(shù)畢膝關(guān)節(jié)腔內(nèi)注入0.9%生理鹽水（NS組）和羅哌卡因（R組）、羅哌卡因+利多卡因（R+L組），并進(jìn)行鎮(zhèn)痛評(píng)估，記錄術(shù)后補(bǔ)救性鎮(zhèn)痛藥總用量。 結(jié)果 R組術(shù)后2h休息時(shí)、術(shù)后1~8h運(yùn)動(dòng)時(shí)的視覺(jué)模擬評(píng)分(VAS評(píng)分)明顯低于NS組（P lt;0.05）。RL組術(shù)后0.5～2h休息時(shí)及術(shù)后清醒至術(shù)后24 h運(yùn)動(dòng)時(shí)的VAS評(píng)分明顯低于NS組（P lt;0.05）。 結(jié)論 膝關(guān)節(jié)腔內(nèi)注射羅哌卡因能明顯減輕患者術(shù)后疼痛程度。羅哌卡因+利多卡因關(guān)節(jié)腔內(nèi)注射能減輕患者術(shù)后清醒即刻的疼痛程度，達(dá)到術(shù)后早期鎮(zhèn)痛的目的。
【摘要】 目的 觀察小劑量氯胺酮在健忘鎮(zhèn)痛麻醉輔助局部麻醉（局麻）剖宮產(chǎn)中的應(yīng)用。方法 選擇1200例剖宮產(chǎn)的孕婦,隨機(jī)分為單純局麻組(L組)、氟芬強(qiáng)化局麻組(F組)和健忘鎮(zhèn)痛麻醉組(J組),每組400例。L組單純局麻;F組局麻術(shù)中輔以氟哌利多500 mg,芬太尼015 mg;J組在F組基礎(chǔ)上輔以氯胺酮,觀察各組患者麻醉誘導(dǎo)至胎兒娩出時(shí)間;新生兒1、5 min Apgar評(píng)分;手術(shù)中血壓相對(duì)于基礎(chǔ)值的波動(dòng)情況;手術(shù)中及手術(shù)后出血情況及麻醉滿意度。 結(jié)果 J組與L組和F組比較,胎兒娩出時(shí)間無(wú)顯著差別;Apgar評(píng)分提高;手術(shù)中孕婦血壓波動(dòng)不明顯;手術(shù)中及手術(shù)后出血量無(wú)明顯增加,麻醉滿意度明顯提高。 結(jié)論 由小劑量氯胺酮輔助實(shí)施的健忘鎮(zhèn)痛麻醉在局麻剖宮產(chǎn)中優(yōu)于單純局麻和氟芬強(qiáng)化局麻,在剖宮產(chǎn)中尤其急診剖宮產(chǎn)中值得推廣。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.
目的 探討局麻下經(jīng)胸前入路行腔鏡甲狀腺手術(shù)的體會(huì)。方法 對(duì)2009年3月至2010年3月期間四川省南充市中心醫(yī)院普外科收治的28例在局麻下行腔鏡甲狀腺手術(shù)患者術(shù)中及術(shù)后情況進(jìn)行回顧性分析。結(jié)果 1例因術(shù)中冰凍檢查發(fā)現(xiàn)為甲狀腺癌而轉(zhuǎn)開(kāi)放性手術(shù)未納入分析。視覺(jué)模擬鎮(zhèn)痛評(píng)分（VAS）: 術(shù)中評(píng)分結(jié)果為0～5分，平均2.2分; 術(shù)后評(píng)分結(jié)果為0～3分，僅2例口服布洛芬緩釋膠囊鎮(zhèn)痛，其余25例未使用鎮(zhèn)痛藥物。手術(shù)時(shí)間為95～215 min，平均117 min; 術(shù)中出血量為50～150 ml，平均84 ml。術(shù)后引流量為25～70 ml，平均34 ml； 引流管放置時(shí)間為2～4 d。住院時(shí)間平均4.5 d。術(shù)后頸部及胸壁皮下無(wú)瘀血、腫脹，無(wú)聲嘶、嗆咳。經(jīng)隨訪2~10個(gè)月（平均8個(gè)月），未見(jiàn)切口處明顯瘢痕。結(jié)論 局麻下經(jīng)胸前入路行腔鏡甲狀腺手術(shù)切實(shí)可行，并具有良好的美容效果。