RESUMO
Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.
RESUMO
Objective To evaluate the curative effect and safety of lumbar artery embolization in treating massive hemorrhage caused by percutaneous transforaminal endoscopic discectomy (PTED).Methods From January 2013 to December 2016,lumbar artery angiography was performed in 4 patients with massive hemorrhage caused by PTED.Based on the angiographic findings,lumbar artery embolization therapy with embolic microspheres and spring coils was carried out.Results Lumbar artery angiography revealed that extravasation of contrast agent was detected in 3 patients and pseudoaneurysm in one patient.The bleeding completely stopped immediately after lumbar artery embolization in all 4 patients.The patients were followed up for 1-3 months,and no re-bleeding or serious complications occurred.Conclusion It is very difficult to make medical and surgical management for massive hemorrhage caused by PTED.Lumbar artery embolization is safe,effective and minimally-invasive for the treatment of massive hemorrhage caused by PTED.This therapy is worthy of clinical use.
RESUMO
Objective To explore changes of blood anterior pituitary hormone and its related factors in patients with severe traumatic brain injury (TBI).Methods 113 patients diagnosed as severe TBI and met criterions were collected from Jun.2010 to Aug.2015 in the First Affiliated Hospital of Wenzhou Medical University.Clinical data such as age,gender,site of injury,epidural hematoma,subdural hematoma,basicranial fracture,injury time,Glasgow coma scale (GCS),middle line migration,diffuse axonal injury,brain hernia,traumatic subarachnoid hemorrhage were collected and recorded.Univariatex2 test and multivariate logistic regression analysis were used to explore risk factors for changes of blood anterior pituitary hormone.Results Abnormal secretion of the anterior pituitary occurred in 48 patients.10 cases had one kind of abnormal hormone secretion,while 38 cases had 2 and more than 2 kinds of abnormal hormone secretion.GH level decreased in 20 cases,TSH level decreased in 18 cases,FSH level decreased in 12 cases,PRL level increased in 10 cases,ACTH level decreased in 9 cases,and LH level decreased in 8 cases.Univariate x2 test revealed that basicranial fracture (P=0.006),middle line migration (P=0.007),GCS score (P=0.004),diffuse axonal injury (P=0.001),cerebral hernia (P=0.001),traumatic subarachnoid hemorrhage (P=0.001) were factors related to abnormal pituitary hormone levels.Multivariate logistic regression analysis revealed that basicranial fracture (P=0.019),middle line migration (P=0.015),GCS score (P=0.024),diffuse axonal injury (P=0.008),cerebral hernia (P=0.001),traumatic subarachnoid (P=0.010) were factors related to abnormal pituitary hormone levels.Conclusions The rates of abnormal pituitary hormone level were higher in patients with severe TBI.The basicranial fracture,middle line migration,GCS score,diffuse axonal injury,cerebral hernia,traumatic subarachnoid hemorrhage are factors related to abnormal pituitary hormone levels.