目的比较腰方肌阻滞(QLB)和腹横肌平面阻滞(TAPB)用于产科剖宫产手术术后镇痛的效果。方法择期行剖宫产术产妇184例,单胎,足月妊娠(孕周>37周),ASAⅠ或Ⅱ级,随机分为QLB组(n=94)和TAPB组(n=90),两组均行持续硬膜外麻醉,术后在超声引...目的比较腰方肌阻滞(QLB)和腹横肌平面阻滞(TAPB)用于产科剖宫产手术术后镇痛的效果。方法择期行剖宫产术产妇184例,单胎,足月妊娠(孕周>37周),ASAⅠ或Ⅱ级,随机分为QLB组(n=94)和TAPB组(n=90),两组均行持续硬膜外麻醉,术后在超声引导下分别行双侧QLB或TAPB,两组均每侧注射0.375%罗哌卡因20 ml,两组患者均行自控静脉镇痛(PCIA)。观察并记录两组患者首次按压镇痛泵的时间,术后24 h内PCIA有效按压次数,镇痛补救率,术后首次排气、坐起、站立、普通饮食和下床活动时间以及初乳时间,术后4、8、12、24和48 h患者的疼痛VAS评分,BCS舒适度评分,术后48 h内舒芬太尼的消耗量;记录术后过度镇静、恶心呕吐、尿潴留、眩晕、皮肤瘙痒等不良反应的发生情况。结果两组产妇均未观察到QLB和TAPB相关并发症。QLB组产妇术后首次按压镇痛泵的时间明显晚于TAPB组(14.3±3.2 vs 8.4±2.7,P<0.05),镇痛补救率更低,首次下床活动时间(7.5±1.7 vs 9.5±2.4,P<0.05)和初乳时间(22.9±2.3 vs 31.6±1.3,P<0.05)明显早于TAPB组;与TAPB组比较,QLB组术后8 h(3.3±0.2 vs 4.6±0.1)、12 h(2.1±0.2 vs 3.5±0.4)、24 h(1.3±0.3 vs 3.4±0.2)的VAS评分降低(P<0.05),术后8 h(3.6±0.4 vs 2.5±0.3)、12 h(3.8±0.3 vs 2.7±0.3)、24 h(3.9±0.2vs 3.2±0.4)的BCS评分升高(P<0.05);术后0~12 h(7.5±2.3 vs 17.4±3.2)、12~24 h(9.2±3.9 vs 29.5±4.3)、24~36 h(12.1±2.7 vs 28.4±5.6)QLB组舒芬太尼消耗量明显小于TAPB组(P<0.05)。QLB组术后过度镇静、恶心呕吐、尿潴留、眩晕的发生率明显低于TAPB组。结论QLB较TAPB能够更加有效地为剖宫产术后提供理想的多模式镇痛效果,并且可以减少术后阿片类药物用量及不良反应的发生,有利于促进患者康复。展开更多
A low-cost,highly efficient and strong durable bifunctional electrocatalyst is crucial for electrochemical overall water splitting.In this paper,a self-templated strategy combined with in-situ phosphorization is appli...A low-cost,highly efficient and strong durable bifunctional electrocatalyst is crucial for electrochemical overall water splitting.In this paper,a self-templated strategy combined with in-situ phosphorization is applied to construct hollow structured bimetallic cobalt-nickel phosphide(CoNiP_(x))nanocages.Owing to their unique hollow structure and bimetallic synergistic effects,the as-synthesized CoNiP_(x)hollow nanocages exhibit a high electrocatalytic activity and stability towards hydrogen evolution reaction in all-pH electrolyte and a remarkable electrochemical performance for oxygen evolution reaction in 1.0 mol L^(-1)KOH.Meanwhile,with the bifunctional electrocatalyst in both anode and cathode for overall water splitting,a low voltage of 1.61 V and superior stability are achieved at a current density of 20 mA cm^(-2).展开更多
肱骨外科颈骨折（fracture ofsurgical neck of humerus）以局部肿胀、疼痛、压痛和伤肢纵轴叩击痛,肩关节活动功能障碍,上臂上段可见瘀斑等为主要表现,发生在肱骨解剖颈下2～3cm处的骨折。是肱骨头松质骨和肱骨干皮质骨交界的部位,此...肱骨外科颈骨折（fracture ofsurgical neck of humerus）以局部肿胀、疼痛、压痛和伤肢纵轴叩击痛,肩关节活动功能障碍,上臂上段可见瘀斑等为主要表现,发生在肱骨解剖颈下2～3cm处的骨折。是肱骨头松质骨和肱骨干皮质骨交界的部位,此处由松质骨向密质骨过渡且稍细,是解剖上的薄弱环节,骨折较为常见。展开更多
文摘目的比较腰方肌阻滞(QLB)和腹横肌平面阻滞(TAPB)用于产科剖宫产手术术后镇痛的效果。方法择期行剖宫产术产妇184例,单胎,足月妊娠(孕周>37周),ASAⅠ或Ⅱ级,随机分为QLB组(n=94)和TAPB组(n=90),两组均行持续硬膜外麻醉,术后在超声引导下分别行双侧QLB或TAPB,两组均每侧注射0.375%罗哌卡因20 ml,两组患者均行自控静脉镇痛(PCIA)。观察并记录两组患者首次按压镇痛泵的时间,术后24 h内PCIA有效按压次数,镇痛补救率,术后首次排气、坐起、站立、普通饮食和下床活动时间以及初乳时间,术后4、8、12、24和48 h患者的疼痛VAS评分,BCS舒适度评分,术后48 h内舒芬太尼的消耗量;记录术后过度镇静、恶心呕吐、尿潴留、眩晕、皮肤瘙痒等不良反应的发生情况。结果两组产妇均未观察到QLB和TAPB相关并发症。QLB组产妇术后首次按压镇痛泵的时间明显晚于TAPB组(14.3±3.2 vs 8.4±2.7,P<0.05),镇痛补救率更低,首次下床活动时间(7.5±1.7 vs 9.5±2.4,P<0.05)和初乳时间(22.9±2.3 vs 31.6±1.3,P<0.05)明显早于TAPB组;与TAPB组比较,QLB组术后8 h(3.3±0.2 vs 4.6±0.1)、12 h(2.1±0.2 vs 3.5±0.4)、24 h(1.3±0.3 vs 3.4±0.2)的VAS评分降低(P<0.05),术后8 h(3.6±0.4 vs 2.5±0.3)、12 h(3.8±0.3 vs 2.7±0.3)、24 h(3.9±0.2vs 3.2±0.4)的BCS评分升高(P<0.05);术后0~12 h(7.5±2.3 vs 17.4±3.2)、12~24 h(9.2±3.9 vs 29.5±4.3)、24~36 h(12.1±2.7 vs 28.4±5.6)QLB组舒芬太尼消耗量明显小于TAPB组(P<0.05)。QLB组术后过度镇静、恶心呕吐、尿潴留、眩晕的发生率明显低于TAPB组。结论QLB较TAPB能够更加有效地为剖宫产术后提供理想的多模式镇痛效果,并且可以减少术后阿片类药物用量及不良反应的发生,有利于促进患者康复。
基金the National Key R&D Program of China(2017YFA 0208300 and 0700104)the National Natural Science Foundation of China(21671180)the State Key Laboratory of Organic Inorganic Composites(oic-201801007)。
文摘A low-cost,highly efficient and strong durable bifunctional electrocatalyst is crucial for electrochemical overall water splitting.In this paper,a self-templated strategy combined with in-situ phosphorization is applied to construct hollow structured bimetallic cobalt-nickel phosphide(CoNiP_(x))nanocages.Owing to their unique hollow structure and bimetallic synergistic effects,the as-synthesized CoNiP_(x)hollow nanocages exhibit a high electrocatalytic activity and stability towards hydrogen evolution reaction in all-pH electrolyte and a remarkable electrochemical performance for oxygen evolution reaction in 1.0 mol L^(-1)KOH.Meanwhile,with the bifunctional electrocatalyst in both anode and cathode for overall water splitting,a low voltage of 1.61 V and superior stability are achieved at a current density of 20 mA cm^(-2).
文摘肱骨外科颈骨折（fracture ofsurgical neck of humerus）以局部肿胀、疼痛、压痛和伤肢纵轴叩击痛,肩关节活动功能障碍,上臂上段可见瘀斑等为主要表现,发生在肱骨解剖颈下2～3cm处的骨折。是肱骨头松质骨和肱骨干皮质骨交界的部位,此处由松质骨向密质骨过渡且稍细,是解剖上的薄弱环节,骨折较为常见。
