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。
Objective To conduct a systematic review of the construction methods, predictive factors, and model quality of risk prediction models for postoperative chronic pain in knee replacement surgery patients, providing evidence for the development of nursing-sensitive dynamic prediction models. Methods A systematic review of risk prediction models for postoperative chronic pain in knee replacement surgery patients was conducted by searching PubMed, Web of Science, Cochrane Library, CINAHL, SinoMed, CNKI, Wanfang Database, and VIP Database. The search period was from the establishment of the databases to February 28, 2025. Two researchers independently screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies. Results A total of 10 studies involving 10 predictive models were included in this review. Among these, three models underwent internal validation, and one model underwent external validation. Commonly reported predictive factors included postoperative 24-hour Numerical Rating Scale scores, postoperative knee function scores, sleep disorders, preoperative depression, postoperative functional exercises, postoperative complications, preoperative pain, and postoperative C-reactive protein levels. All 10 studies had a high risk of bias and were generally applicable. Conclusions Existing risk prediction models generally rely on static indicators and lack dynamic monitoring of postoperative rehabilitation behaviors and psychosocial factors, with severe deficiencies in model validation. Future research should focus on developing nursing-led multidimensional dynamic models that incorporate functional exercise adherence data collected via wearable devices, standardize external model validation, and enhance clinical translation value.
Pain education based on biomedical models is currently a common approach to patient pain management. However, due to its inability to accurately explain pain, patients may develop incorrect beliefs and understandings about pain, leading to anxiety and fear of movement. Pain neuroscience education is based on a biological psychological social educational model, aiming to redefine the concept of pain. It has a positive effect on pain, catastrophizing, anxiety, and fear of movement, and is a reliable new method for pain rehabilitation therapy and management. This article provides a review of the concept, implementation principles, implementation methods, dosage factors, combination therapy, and clinical application of pain neuroscience education, in order to provide ideas for the rehabilitation therapy of pain.
目的：評價低分子肝素(Low molecular weight heparins，LMWH)皮下注射持續時間對注射后皮下出血和疼痛的影響。方法：納入2003年～2004年3月于我院行LMWH皮下注射的住院患者52例，以肚臍兩側作為注射點，任選一側行首次注射，12 h后于另一側以相同劑量注射。臍右注射持續10秒(對照組)，臍左持續30秒(實驗組)。于注射后48 h、72 h觀察注射點有無皮下出血，并用透明紙質毫米尺測量出血面積，用視覺類比量表(Visual analog scale，VAS)測量疼痛強度，記錄疼痛持續時間。采用卡方檢驗及配對t檢驗對兩組皮下出血發生率及面積、疼痛強度及持續時間等指標進行對比分析。結果：實驗組和對照組皮下出血的發生率分別為38.5%(n=20)和61.5%(n=32)(P=0.035)。注射后48h、72h，實驗組的出血面積均顯著低于對照組(48h：17.5±7.3 mm2 VS 101.2±15.0 mm2，P=0.008；72h：20.7±8.0 mm2 VS 110.4±13.5 mm2，P=0.016)。實驗組的注射后疼痛積分為13.0±6.4 mm，對照組為21.5±7.0 mm(P=0.021)。實驗組疼痛持續時間顯著低于對照組(42.5±14.2 s比73.2±20.0 s，P=0.030)。結論：肝素皮下注射持續時間能顯著影響注射后皮下出血和疼痛形成，注射時間持續至30秒能有效降低皮下出血發生率及面積，并顯著減輕疼痛強度、縮短疼痛時間。
目的：替扎尼定是具有解痙作用的α２腎上腺能受體激動劑，并具有一定的胃腸道保護作用，適用于單一治療或與非甾體消炎藥（NSAIDs）聯合治療急性痙攣性疼痛。通過替扎尼定和非甾體類抗炎藥物的聯合應用，臨床觀察和評估聯合用藥能否增強療效和增加安全性。方法：急性痙攣性疼痛70例，隨機分為兩組，一組服用替扎尼定2mg,bid+雙氯芬酸50 mg,bid，一組服用雙氯芬酸50 mg,bid+安慰劑2mg,bid。觀察藥物療效和不良反應。結果：聯用組的總有效率為70％，胃腸道不良反應發生率為12%,中樞神經系統不良反應發生率為18％；單用組的總有效率為56％，胃腸道不良反應發生率為32％，中樞神經系統不良反應發生率為10％。結論：替扎尼定和非甾體類藥物聯用具有更好的療效以及更高的藥物耐受性。