Objective To explore the effect of Frey procedure on patients with chronic pancreatitis, and evaluate pain control as well as the quality of life (QOL) after Frey procedure. Methods The clinical data of 81 patients with chronic pancreatitis who underwent Frey procedure in West China Hospital of Sichuan University from January 2010 to January 2015 were retrospectively analyzed. Izbicki pain score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were used to assess pain and QOL respectively. Results The mean value of operative time were (252±70) minutes (180-430 minutes), the mean value of blood loss were (220±142) mL (100-550 mL), and the mean value of hospital stay were (14.1±4.9) days (8-36 days). After Frey procedure, delayed gastric emptying occurred in 4 patients, hemorrhage occurred in 1 patient, wound infection or fat liquefaction occurred in 6 patients, abdominal infection and pyoperitoneum occurred in 4 patients, and pancreatic fistula occurred in 3 patients. All of the patients were followed up for 4-60 months, and the median time were 28 months. During the follow up period, 11 patients developed diabetes and 10 patients developed steatorrhea, respectively. In addition, the pain related score, including frequency of pain attacks, visual analogue scale of pain, analgetic medication, inability to work, and total pain score, were significantly reduced after Frey procedure (P＜0.001). Moreover, all the functional scales of EORTC -QLQ-C30, except for cognitive function, were improved postoperatively (P ＜0.001). Regarding to the symptom scales, the score of fatigue, pain, loss of appetite, and loss of body weight were significantly lower after surgery (P＜0.050). The scores of QOL after surgery were higher than before surgery (P＜0.001). Conclusion Frey procedure results in good post-operative pain control and significant improvement in qol.
Pain, as a complex physiological and pathological phenomenon, has always been a hot topic in medical research in terms of its mechanism of occurrence and influencing factors. Vitamin D, as a fat soluble vitamin, has been shown to be closely associated with pain in recent years, in addition to its classic role in regulating calcium and phosphorus metabolism. The polymorphism of the vitamin D receptor (VDR) gene can lead to changes in the structure and function of VDR, thereby affecting vitamin D levels. Meanwhile, VDR gene polymorphism can indirectly or directly participate in the occurrence and development of pain. This article aims to review the research on the relationship between vitamin D and its receptor gene polymorphism and pain, and provide reference for potential therapeutic targets and personalized intervention strategies for pain.
Objective To determine the efficacy of radioisotopes to control metastasic pain in patients with tumor bone metastases and complications due to bone metastases (hypercalcaemia, bone fracture and spinal cord compression). The effectiveness of radioisotopes in relation to patient survival and adverse effects were also assessed. Methods MEDLINE (1966 to April 2005),EMBASE (1966 to April 2005), The Cochrane Library (Issue 1, 2005) and CBMdisc (1979 to April 2005) were searched for randomized controlled trials (RCTs). Data were extracted by two reviewers using a designed extraction form. The quality of included RCTs was critically assessed. RevMan 4.2 software was used for data analysis. Results Four RCTs were included. The results of meta-analysis showed that small dose of radioisotopes couldn’t control metastatic pain in short term(2 months) with relative risk (RR) 1.13, 95%confidence interval (CI) 0.34 to 3.76, but large dose can significantly control metastatic pain in medium term(6 month) with RR 1.90, 95％CI 1.23 to 2.92; no evidence was available to assess long term(≥12 months) effects. No study provided data on quality of life, mortality, bone metastatic complications (hypercalcaemia, bone fracture) and analgesic use etc. Leukocytopenia and thrombocytopenia were secondary effects associated with the administration of radioisotopes. The incidences of leukocytopenia and thrombocytopenia were significantly greater in patients treated by radioisotopes with RR 8.28, 95％CI 2.24 to 30.67, and RR 3.70, 95％CI 1.59 to 9.04, respectively. Conclusions There is some evidence indicating that large dose of radioisotopes can relieve metastatic bone pain over one to six months, but adverse effects, particularly leukocytopenia and thrombocytopenia, have also been experienced.
Objective To investigate the status quo of knowledge and attitude towards pain among medical staff in West China Hospital of Sichuan University. Methods The medical staff in Emergency Department of West China Hospital of Sichuan University were investigated by the Chinese version of Knowledge and Attitudes Survey Regarding Pain (2008) questionnaire, the contents of which related to pain assessment, pain related knowledge, analgesic related knowledge, and comprehensive application, etc. And the questionnaire scores were compared among medical workers with different background. Results A total of 156 questionnaires were sent out and 130 valid ones were taken back, with an effective recovery rate of 83.3%. There was no statistically significant difference in questionnaire scores among the medical workers with different education background or different professional titles (P>0.05). The questionnaire scores were significantly different among nurses with different seniority (F=3.785, P=0.035), and the mean score of the nurses with more than 10 years of seniority was the highest (22.78±7.11). The questionnaire scores were significantly different among nurses working in different areas (F=3.043, P=0.033), and the mean score of the nurses working in rescue room was the highest (24.53±7.84).The erroneous items were concentrated on item 5, 17, 19. In the answers to the open questions, 97.7% (127/130) thought that the existing pain knowledge could not satisfy the needs of clinical work; 100.0% (130/130) believed that it was necessary to study pain related knowledge; 80.0% (104/130) acquired pain related knowledge from clinical experience, 40.0% (52/130) from books, 15.4% (20/130) from the network; 90% ( 117/130) commonly used numeric rating scale to evaluate the patients’ pain degree, 20.0% (26/130) evaluated the patients’ pain degree through facial expressions. Conclusions The overall level of pain management knowledge and attitude in medical staff in Emergency Department is low. The continuing education on pain knowledge should be strengthened, the attitude towards pain treatment and the importance of pain management should be paid more attention, and the standardized training and supervision should be enhanced.
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。
Objective To systematically evaluate the effects of magnesium sulfate on postoperative pain and complications after general anesthesia. Methods A literature search was conducted in following databases as The Cochrane Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date of establishment to September 2011 to identify randomized controlled trials (RCTs) about intravenous infusion of magnesium sulfate during general anesthesia. All included RCTs were assessed and the data were extracted according to the standard of Cochrane systematic review. The homogenous studies were pooled using RevMan 5.1 software. Results A total of 11 RCTs involving 905 patients were included. The results of meta-analyses showed that compared with the control group, intravenous infusion of magnesium sulfate during general anesthesia significantly reduced the visual analog scale (VAS) scores at the time-points of 2, 4, 6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24 hours morphine requirements, and the incidents of postoperative nausea and vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29, 95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia (RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse events or significant differences in the incidents of hypotension and serum concentration changes of magnesium. Conclusion Intravenous infusion of magnesium sulfate during general anesthesia may obviously decrease the pain intensity, and the incidents of nausea and vomiting and chilling after surgery, without increasing cardiovascular adverse events and risk of hypermagnesemia. The results still need to be confirmed by more high-quality and large-sample RCTs.
【摘要】 目的 觀察針刺法在治療痔瘺術后疼痛的臨床療效。 方法 2009年1-6月，將符合納入標準的93例痔瘺術后中度疼痛患者，隨機分為治療組49例與對照組44例。治療組采用針刺治療術后疼痛；對照組采用口服莫比可治療術后疼痛，觀察兩組患者疼痛的消除程度。 結果 消除疼痛有效率治療組為91.83%，對照組為68.18%，治療組鎮痛效果與對照組比較，差異有統計學意義（Plt;0.05）。 結論 痔瘺術后應用針刺法止痛效果好，有良好的臨床應用前景。【Abstract】 Objective To determine the effect of acupuncture on the treatment of pain after hemorrhoids and fistula operation. Methods Ninety-three participants who suffered from moderate pain after hemorrhoids and fistula operation in the West China Hospital of Sichuan University from January to June 2008 were enrolled prospectively and randomly assigned into treatment group (n=49) and control group (n=44). The treatment group was treated with acupuncture for postoperative pain relief, whilst Mobic was given orally to the control group. Relief degrees of pain in both groups were observed. Results Efficient power of pain relief was significantly higher in the treatment group compared with the control group (91.83% vs. 68.18%,Plt;0.05). Conclusion Application procedure of acupuncture can significantly relieve postoperative pain after hemorrhoids and fistula operation, which has a good prospect in clinical application.