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臨床病理討論———口眼干、胸腔積液、右下肢疼痛

Clinical Comparative Study of Tension-Free Herniorrhaphy with Different Suture

目的　觀察運用兩種不同縫線固定修補材料對疝修補術后的復發、切口感染、慢性疼痛等并發癥發生情況。方法　對2008年4月至2010年4月期間筆者所在科室收治的250例腹股溝疝患者行無張力疝修補手術時，采用多股絲線或可吸收合成縫線固定修補材料進行前瞻性對比研究。結果　2組患者術后疝復發、切口感染和切口疼痛（包括慢性疼痛）發生率間的差異均無統計學意義（P＞0.05）。結論　腹股溝疝無張力修補術后的復發、切口感染、慢性疼痛等并發癥的發生與縫線選擇無關。術者的操作技巧、嚴格的無菌操作原則、徹底止血以及組織損傷小才是防止術后感染、慢性疼痛等并發癥發生的重要因素。

微創玻璃體切割手術中表面麻醉的鎮痛效果觀察

Pain Care in Patients with Gynecologic Cancer:Report of 60 Cases

目的：探討婦科癌癥患者疼痛的護理措施。方法：60例婦科癌癥患者隨機分為常規護理、特殊護理，觀察疼痛治療效果。結果：特殊護理患者疼痛緩解明顯。結論：護理干預能改善患者疼痛。

循證護理在甘露醇輸注疼痛中的應用

目的　探討緩解甘露醇快速滴注引起的疼痛護理對策。 方法　對2010年1月－8月102例靜脈滴注甘露醇治療患者，隨機分為兩組，對照組50例給予常規護理措施，干預組52例采用循證護理方案，并用χ2檢驗比較兩組患者疼痛的緩解效果。 結果　兩組數據進行比較，干預組患者的疼痛明顯低于對照組（P＜0.01）。 結論　循證護理可以緩解甘露醇快速滴注引起的肢體疼痛，提高患者舒適度，規避風險，提高護理質量。

疼痛和動脈血二氧化碳分壓作為肋骨骨折患者手術指征的臨床分析

目的 探討疼痛和動脈血二氧化碳分壓（PaCO2）作為胸外傷肋骨骨折手術指征的可行性，為肋骨內固定手術提供一條合理、可行的手術指征。 方法 選取2006年1月至2009年9月復旦大學附屬華山醫院南匯分院上海南匯中心醫院24例肋骨骨折3 d后主動疼痛評分gt;6分、伴或不伴有PaCO2gt;50 mm Hg患者，采取隨機抽簽法將24例患者分為兩組，手術固定組：12例，男8例，女4例；年齡 43.80±15.00歲；行爪形鋼板內固定手術；保守治療組：12例，男7例，女5例；年齡46.20±10.70歲；采取保守治療。術后1周、2周觀察疼痛評分、PaCO2和肺部感染發生率等。 結果 術后1周手術固定組疼痛評分小于保守治療組（1.25±0.97分vs. 6.17±1.03 分，Plt;0.05），PaCO2（44.00±5.00 mm Hg vs. 49.00±5.00 mm Hg，Plt;0.05）和肺炎發生率(8.33% vs. 50.00%，Plt;0.05)低于保守治療組。所有患者均得到隨訪，隨訪時間2周，術后2周手術固定組疼痛評分小于保守治療組(0.83±0.83分vs. 4.75±1.14分，Plt;0.05)。 結論 疼痛評分結合PaCO2作為肋骨內固定手術的手術指征具有可行性。

脫細胞異體真皮治療疼痛性瘢痕的療效觀察

復方利多卡因乳膏減輕血透內瘺穿刺疼痛效果的觀察

【摘要】目的觀察復方利多卡因乳膏在減輕血液透析內瘺血管穿刺疼痛中的效果。方法將52例首次使用內瘺穿刺的血透患者,隨機分為對照組和復方利多卡因乳膏組。對照組以常規方法進行穿刺;復方利多卡因乳膏組在穿刺前以穿刺點為中心涂擦復方利多卡因乳膏,60 min后進行穿刺。結果復方利多卡因乳膏組內瘺穿刺疼痛程度與對照組比較,差異有統計學意義(Plt;005)。結論復方利多卡因乳膏涂擦可減輕內瘺穿刺時的疼痛。

Observation on the effect of early rehabilitation training post operation in renal transplantation recipients

ObjectiveTo explore the effect of rehabilitation training focusing on early exercise on the time of first getting out of bed after surgery, pain during early activities, postoperative infection rate and the length of hospital stay for renal transplant recipients.MethodsThe clinical data of patients undergoing allogeneic renal transplantation in West China Hospital of Sichuan University from June to August 2020 were analyzed retrospectively. According to the time of multidisciplinary postoperative management and the time of early rehabilitation intervention, the patients were divided into the conventional group (from June 2020 to the beginning of multidisciplinary postoperative management) and the rehabilitation group (after multidisciplinary postoperative management). The time to get out of bed for the first time after surgery, the Visual Analogue Score (VAS) during weight monitoring on the second day post operation, the number of days required to complete an independent walk of 100 meters, postoperative complications, the incidence of postoperative infection and the length of hospital stay were compared between the two groups.ResultsA total of 79 patients were included. There were 46 cases in the conventional group and 33 cases in the rehabilitation group. Among the included patients, 14 patients had postoperative infection, 1 patients in the conventional group developed thrombosis, no catheter shedding or bleeding after exercise occurred. The differences between the rehabilitation group and the conventional group in the time to get out of bed for the first time after surgery [(1.1±0.2) vs. (2.2±0.4) d; t=13.224, P<0.001], the VAS during weight monitoring on the day post operation (2.5±0.9 vs. 3.4±1.4; t=3.267, P<0.001), the number of days required to complete an independent walk of 100 meters [(2.2±0.4) vs. (4.0±0.8) d; t=11.312, P<0.001], and the incidence of postoperative infection (6.1% vs. 26.1%; χ2=5.285, P=0.022) were statistically significant. There was no significant difference in the length of stay between the rehabilitation group and the conventional group [(19.8±5.8) vs. (20.7±7.4) d; t=0.584, P=0.561].ConclusionEarly postoperative rehabilitation training reduces the time required for renal transplant recipients to get out of bed for the first time post operation and to walk 100 meters independently, reduce the pain response during early activities, and reduce the incidence of postoperative infection.

唑來膦酸治療惡性腫瘤骨轉移患者不良反應的護理

目的　總結對惡性腫瘤骨轉移患者應用唑來膦酸不良反應的護理經驗，旨在為臨床護理提供指導。 方法　對2011年6月－12月28例惡性腫瘤骨轉移患者使用唑來膦酸治療后所產生的發熱、骨關節疼痛、消化道反應、低鈣性抽搐、骨壞死及心動過緩等不良反應予以對癥護理。 結果　治療中部分患者出現不良反應：發熱6例（21.4%），骨關節疼痛4例（14.3%），胃腸道反應4例（14.3% ），低鈣性抽搐2例（7.1%），經對癥治療及護理均予緩解。 結論　唑來膦酸治療惡性腫瘤骨轉移過程中出現的相關并發癥，只要采取積極對癥的治療護理措施均可控制。