纳布啡联合罗哌卡因切口浸润多模式镇痛对颅脑外科手术患者全麻苏醒期躁动的影响

目的探讨纳布啡联合罗哌卡因切口浸润的多模式镇痛对颅脑外科手术患者苏醒期躁动的影响。方法选择ASA I或Ⅱ级择期行颅脑肿瘤切除术的全麻患者60例,采用随机双盲设计方法分成4组,每组15例。罗哌卡因组(R组):手术切皮前10 min用0.5%罗哌卡因20 m L行切口浸润,手术结束前30 min静注生理盐水2 m L;纳布啡组(N组):切皮前10 min用生理盐水20 m L行切口浸润(1∶200 000肾上腺素),手术结束前30 min静注纳布啡10 mg;罗哌卡因+纳布啡组(RN组):手术切皮前10 min用0.5%罗哌卡因20 m L行切口浸润,手术结束前30 min静注纳布啡10 mg;对照组(C组):切皮前10 min用生理盐水20 m L行切口浸润(1∶200 000肾上腺素),手术结束前30 min静注生理盐水2 m L。记录用药前(T0)、手术结束时(T1)、拔管时(T2)、拔管后10 min(T3)患者MAP、HR和Sp O2的变化。观察患者在PACU的RSS躁动评分、拔管后Ramsay镇静评分、VAS疼痛评分和药物的不良反应。结果与T0时刻比较,R组T2时刻MAP升高,C组T2、T3时刻和HR升高(P0.05);与C组比较,R组、N组、RN组T2和T3时刻MAP和HR降低(P0.05);与R组比较,N组、RN组T2时刻MAP和HR降低(P0.05)。R、N、RN三组患者躁动发生率和评分低于C组(P0.05),而RN组又明显低于R组和N组(P0.05)。与R组和C组相比,T0时刻N组和RN组的Ramsay镇静评分升高(P0.05),无镇静过度的发生。与C组比较,R、N、RN组拔管后疼痛VAS评分显著降低,且RN组低于R组和N组(P0.05)。结论纳布啡联合罗哌卡因切口浸润,镇痛效果肯定,可减少颅脑外科手术患者全麻苏醒期躁动的不良影响。     

术毕前应用地佐辛对妇科腹腔镜手术患者术后复苏的影响及对术后疼痛的干预效果

目的探讨术毕前应用地佐辛对妇科腹腔镜手术患者术后复苏的影响及对术后疼痛的干预效果。方法 2013年6月至2014年6月择期接受妇科腹腔镜手术患者120例,按照随机数字表法将患者随机均分为地佐辛组和对照组,观察并记录患者诱导前(T0)、注药后10min(T1)、缝皮结束时(T2)、吸痰时(T3)、拔管时(T4)、拔管后10min(T5)、拔管后30min(T6)的MAP和HR。记录患者苏醒期躁动-镇静评分(RASS)和VAS评分。观察患者呼吸抑制、恶心、呕吐、眩晕、嗜睡等不良反应的发生情况。结果与T0时比较,T2~T6时两组患者MAP明显升高,T3~T6时HR明显增快(P0.05)。与对照组比较,T2~T6时地佐辛组MAP明显降低,HR明显减慢(P0.05)。与苏醒后30min比较,苏醒后1、2、4h对照组拔管后RASS、VAS评分明显降低(P0.05)。与对照组比较,苏醒后30min、1、2、4h地佐辛组拔管后RASS、VAS评分明显降低(P0.05)。两组患者呼吸抑制、眩晕、恶心呕吐、嗜睡等不良反应发生率差异无统计学意义。结论术毕前应用地佐辛对妇科腹腔镜手术镇痛可达到满意的镇痛效果,术后苏醒迅速、平稳,作用时间长,不良反应少。     

不同剂量纳布啡复合曲马多对妇科手术全麻苏醒期镇痛效果的影响

目的观察不同剂量纳布啡复合曲马多用于腹腔镜下全子宫切除术患者全麻苏醒期镇痛的效果和安全性。方法择期行全身麻醉腹腔镜全子宫切除术患者400例,年龄45～65岁,体重50～90 kg,ASAⅠ或Ⅱ级,按完全随机法分为四组:手术结束前30 min,A组静注纳布啡0.1 mg/kg+曲马多2 mg/kg;B组静注纳布啡0.2 mg/kg+曲马多2 mg/kg;C组静注纳布啡0.3 mg/kg+曲马多2 mg/kg;D组静注曲马多2 mg/kg。记录四组手术时间、苏醒时间;记录拔管时间;记录拔管后5、15、30 min警觉/镇静评分和VAS评分;记录手术后24 h内不良反应的发生情况。结果四组手术时间、苏醒时间和拔管时间差异无统计学意义。四组拔管后5、15、30 min警觉/镇静评分差异无统计学意义。拔管后15、30 min D组VAS评分明显高于B、C组(P0.05)。拔管后30 min A组VAS评分明显高于C组(P0.05)。四组拔管后呼吸抑制、头晕嗜睡发生率差异无统计学意义。D组恶心呕吐发生率明显高于A、B和C组(P0.05)。结论全麻手术结束前30 min采用纳布啡0.2～0.3 mg/kg复合曲马多2 mg/kg较纳布啡0.1 mg/kg复合曲马多2 mg/kg全麻苏醒期镇痛效果好,不增加不良反应。     

纳布啡对小儿唇腭裂修复术应激反应及苏醒期躁动的影响

目的:探讨纳布啡在预防小儿唇腭裂手术患者应激反应及苏醒期躁动方面的临床效果。方法:选取2019年9月-2019年12月在西安交通大学口腔医院整形外科就诊的100例小儿唇腭裂手术患者,随机分为纳布啡组(N组)和对照组(C组)。其中,N组患者在麻醉诱导时按公斤体重0.2mg推注纳布啡,而C组患者则给予同等剂量且含0.9%氯化钠的注射液。在麻醉诱导前(T0)、术毕(T1)和术后30min(T2)采集两组患者的外周静脉血测定应激反应指标(如:血糖、皮质醇和去甲肾上腺素),术毕记录苏醒指标(如:自主呼吸恢复时间和苏醒时间),并利用Riker镇静-躁动评分标准评价两组患者苏醒期的躁动情况。结果:T0时两组患者体内各项应激指标所呈现的差异性无统计学意义(P0.05);与T0时相比,两组患者体内各项应激指标含量在T1和T2时明显升高,且具有统计学意义(P0.05);与C组相应时刻相比,N组患者体内各项应激指标数值在T1和T2时期明显降低,且差异性具有统计学意义(P0.05)。与此同时,两组患者在术毕时苏醒指标差异性比较无统计学意义(P0.05)。与C组患者相比,N组患者在苏醒期的躁动发生率显著降低,且Riker镇静-躁动评分值也明显降低,其数值差异具有统计学意义(P0.05)。结论:在小儿唇腭裂手术中,纳布啡可有效降低患者的应激反应水平,能够降低患者在苏醒期躁动的程度及其发生频率,具有良好的镇静效果,且不会影响患者苏醒期的恢复情况,值得在小儿临床麻醉上推广应用。     

丙泊酚联合纳布啡用于血液病小儿深静脉穿刺的疗效观察

目的 探讨丙泊酚联合纳布啡静脉麻醉在血液病患儿深静脉穿刺置管术中的应用价值。方法 选择在手术室行深静脉穿刺置管的血液病患儿60例,随机分为观察组（丙泊酚联合纳布啡）和对照组（单纯丙泊酚）,每组各30例。观察组患者使用丙泊酚联合纳布啡麻醉,对照组患者单纯使用丙泊酚麻醉。比较两组患者的丙泊酚用量、穿刺时体动发生率、呼吸抑制发生率、手术时间及清醒时间;记录患儿术后清醒即刻（T₁）、术后30 min（T₂）、2 h（T₃）和6 h（T₄）躁动及镇静评分;记录两组患儿术后不良反应的发生情况。结果 对照组患者的丙泊酚用量、穿刺时的体动发生率和手术时间均显著高于观察组;两组患者清醒时间和呼吸抑制发生率比较差异无统计学意义;观察组患儿在T₁和T₂时刻的躁动和镇静评分较对照组更加理想,在T₃和T₄时刻两组躁动及镇静评分差异均无统计学意义;两组患儿术后不良反应比较差异无统计学意义。结论 丙泊酚联合纳布啡静脉麻醉在血液病患儿深静脉穿刺置管术中安全可行,减少术中丙泊酚用量,降低了术后躁动发生率,且不影响患儿清醒时间。     

右旋美托咪定抑制全麻患者苏醒期躁动与脑电分段频谱的关系

目的通过对患者脑电分段频谱的分析,研究术中短时间内输注右旋美托咪定对行腹腔镜胆囊切除术(LC)的全身麻醉患者苏醒期躁动抑制作用的电生理因素,并确认拔出气管导管前的脑电变化能否预测术后躁动的发生。方法选取2014年12月到2016年3月期间择期LC的全麻患者60例。采用两种分类方法进行数据统计:(1)将患者分为研究组(右旋美托咪定组,D组)和对照组(空白组,C组),每组各30例。D组于常规剂量静吸复合麻醉药物诱导插管后的10 min内给予0.5μg/kg的右旋美托咪定稀释液;C组则相应给与相同体积的生理盐水注射液。收集患者从麻醉前清醒状态到清醒拔管后30 min内经Narcotrend脑电监测仪器记录的脑电图数据(包括术前清醒时刻Base的脑电图和停止吸入麻药并wash out时刻T0的脑电图),记录拔管后即时(T1),拔管后10 min时(T2),拔管后20 min时(T3),拔管后30 min时(T4)的苏醒期RASS镇静评分以及患者术中的生命体征数据,比较D组与C组的苏醒期RASS镇静评分差异、脑电分段频谱差异。(2)根据苏醒期RASS镇静评分将所有患者重新分组为镇静组(AC组,T1、T2、T3、T4时刻的RASS评分均≤-1)和躁动组(EA组,T1、T2、T3、T4时刻至少有一个RASS评分≥1),通过比较AC组与EA组患者对应的T0时刻的脑电分段频谱,探讨拔管前脑电改变对术后躁动是否有预测作用。结果 (1)D组与C组在术中的平均动脉压(MAP);心率(HR);呼气末二氧化碳浓度(Et CO2);脉搏血氧饱和度(Sp O2)方面的比较没有统计学差异(P0.05)。(2)D组与C组苏醒期RASS镇静评分的比较,T1时刻,D组发生躁动(RASS评分≥1)的概率小于C组发生躁动(RASS评分≥1)的概率(P=0.022);T3时刻,D组发生躁动的概率小于C组发生躁动的概率(P=0.026);T2时刻,T4时刻D组与C组发生躁动的差异没有统计学意义;D组与C组中苏醒期躁动(RASS评分≥1)绝大部分发生在T1时刻(66.7%),少部分发生在T2时刻(33.3%)。(3)D组与C组各时间段脑电图分段频谱的比较中,D组与C组在Base、T0、T1、T2、T3、T4时刻的脑电NTI、α波β波θ波功率百分比比较,差异均无统计学意义;但D组在T0、T1时刻的脑电总功率power较C组降低,且T1时刻δ波的百分比增加(P0.05)。(4)EA组与AC组的T0时刻脑电图分段频谱的比较中,EA组较AC组T0时刻脑电总功率Power、β波百分比增加,δ波百分比降低(P0.05)。结论 (1)右旋美托咪定能够抑制LC患者全麻苏醒期躁动,使术后镇静情况更好;能够引起脑电信号总功率Power值降低,δ波的比例增加,这种脑电改变可能是抑制苏醒期躁动的电生理因素。(2)患者拔管前的脑电β波百分比增加、δ波的百分比下降,对术后躁动的发生可能有预测作用。     

右美托咪定复合氟比洛芬酯预防全麻苏醒期躁动的临床研究

目的观察右美托咪定复合氟比洛芬酯对全麻患者苏醒期躁动及拔管期心血管反应的影响。方法择期行全身麻醉的口腔颌面部肿瘤手术患者80例,ASAⅠ或Ⅱ级,随机分为氟比洛芬酯组(F组)、右美托咪定组(D组)、右美托咪定复合氟比洛芬酯组(DF组)和对照组(C组),每组20例。F组于手术结束前30min经静脉注射氟比洛芬酯50mg;D组于手术结束前30min经静脉注射右美托咪定0.5μg/kg;DF组手术结束前30min经静脉注射氟比洛芬酯50mg,同时经静脉注射右美托咪定0.25μg/kg;C组静脉注射与D组等容量的生理盐水。记录四组患者拔管前(T0)、拔管时(T1)、拔管后5min(T2)MAP、HR的变化;记录苏醒时间、拔管时间以及拔管前Riker镇静躁动评分、拔管后5min的Ramsay镇静评分。结果 T1、T2时F组、C组MAP明显高于,HR明显快于T0时(P0.05或P0.01);D组、DF组MAP明显低于,HR明显慢于C组(P0.01)。D组苏醒时间、拔管时间明显长于,Ramsay镇静评分明显高于其他三组(P0.05);D组、DF组Riker镇静躁动评分明显低于C组(P0.05);D组、DF组患者躁动发生率明显低于C组(P0.05或P0.01)。结论右美托咪定0.25μg/kg复合氟比洛芬酯50mg可有效降低全麻患者苏醒期躁动并能降低患者拔管期心血管反应,不会延长患者的苏醒时间和拔管时间。     

右美托咪定对预防老年手术患者七氟醚麻醉苏醒期躁动的效果

目的观察右美托咪定对预防老年手术患者七氟醚麻醉苏醒期躁动的效果。方法随机将接受七氟醚麻醉下行择期手术的96老年患者分为2组,各48例。手术结束前10 min,观察组静脉输注右美托咪定1.0μg/kg,对照组静脉输注等容量的生理盐水。输注时间均为10 min。比较2组苏醒期躁动发生率,及拔管时(T_0)和拔管后5 min(T_1)、10 min(T_2)、20 min(T_3)的Ramsay镇静评分。结果观察组患者苏醒期躁动发生低于对照组;各时点镇静评分优于对照组,差异均有统计学意义(P0.05)。结论在老年患者七氟醚麻醉手术结束前静脉输注右美托咪定,可有效降低苏醒期患者的躁动发生率,并可显著改善镇静评分。     

右美托咪定预防静吸全麻苏醒期患者躁动效果观察

目的探讨右美托咪定预防静吸全麻苏醒期患者躁动的效果。方法随机将60例静吸全麻下行择期手术的患者分为2组,各30例。手术结束后患者进恢复室。观察组:静脉输注右美托咪定0.4μg∕kg,输注时间10 min。对照组:10 min内静脉输注等容量的生理盐水。记录:(1)2组患者的自主呼吸恢复时间、拔管时间、定向力恢复时间、恢复室停留时间及躁动发生率。(2)2组患者在拔管时(T1)、拔管后5 min(T2)、拔管后10 min(T3)、拔管后20 min(T4)的RSS镇静评分。结果(1)2组患者的自主呼吸恢复时间、拔管时间、定向力恢复时间、恢复室停留时间比较,差异均无统计学意义(P0.05)。(2)观察组躁动发生率低于对照组,T1~T4各时点RSS镇静评分高于对照组,差异均有统计学意义(P0.05)。结论静吸全麻手术结束后,静脉输注右美托咪定,不延长患者的苏醒时间,可提高RSS镇静评分并降低苏醒期患者的躁动发生率。     

术前压力管理对全麻苏醒期躁动的影响

目的观察术前压力管理对全身麻醉患者苏醒期躁动发生率的影响。方法选择80例成年全身麻醉下行择期腹腔镜胆囊切除或子宫切除患者,无精神病、麻醉和手术史。随机分为压力管理组(P组)和对照组(C组),各40例。P组利用术前访视掌握患者心理情况,施行压力管理,向患者提供全身麻醉的客观存在和主观感受信息,帮助患者建立正确的心理防御机制。C组仅做常规访视。记录诱导前(T0)、术毕(T1)、拔管时(T2)、拔管后5 min(T3)、拔管后l0 min(T4)各时段HR、MAP、Sp O2,躁动评分,Ramsay镇静评分及苏醒时躁动发生率及程度。结果 2组术后清醒时间、拔管时间和Sp O2均无差异。麻醉苏醒期患者的HR、MAP升高幅度P组比C组低(P0.05)。P组躁动发生率低于C组,醒期躁动评分低于C组,2组相比有差异有统计学意义(P0.05)。结论手术前施行压力管理有助于降低全身麻醉患者苏醒期躁动的发生率。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果,提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件,并用于临床教学。结果:该课件在本校园网上运行半年余,2000余人次对其进行访问,受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法,实现护理教学的直观性和交互性,对护理教学和临床带教指导有一定的借鉴作用。     

Physiology and pharmacology of nausea and vomiting

The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D₂, 5-HT₃, histamine H₁ and neurokinin NK₁ receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV).