氟比洛芬酯超前镇痛对开胸患者术后芬太尼静脉自控镇痛的影响

目的 观察氟比洛芬酯超前镇痛对开胸术后病人自控静脉镇痛(PCIA)的影响.方法 30例ASA Ⅰ～Ⅱ级择期行开胸手术患者,随机均分为观察组和对照组,各15例.观察组在术前15 min及关闭胸腔前分别静注氟比洛芬酯50mg.两组术毕自控静脉镇痛均用0.001%芬太尼.用法芬太尼负荷剂量1 μg/kg,背景输注2mL/h,PCA量0.2mL,锁定时间为15min.术后2、8、16.24h随访行疼痛视觉模拟评分(Vas),并记录镇痛期间芬太尼用量及镇痛泵有效按压次数.结果 两组患者术后2,8、16、24h疼痛评分无明显差异(P＞0.05),观察组24h芬太尼用量明显少于对照组(P＜0.05),观察组各时段镇痛泵有效按压次数明显少于对照组(P＜0.05).结论 氟比洛芬酯超前镇痛用于开胸手术患者效果确切,能明显减少PCLA芬太尼用量.     

不同时间点应用氟比洛芬酯对开胸术后镇痛效果的影响

目的 观察不同时间点使用氟比洛芬酯对开胸术后患者镇痛效果的影响.方法 行开胸手术的患者113例,根据用药时间点的不同分为:组1,32例,为对照组;组2,43例,全麻诱导前静脉注射氟比洛芬酯50 mg;组3,38例,关胸时静脉注射氟比洛芬酯50 mg.3组均行静脉全身麻醉.术毕缝皮时3组开启同样配方的患者静脉自控镇痛(PCIA)泵(AutoMed 3300,韩国),2 mL/h,内含芬太尼1 mg、氟比洛芬酯200 mg、昂丹司琼8 mg,稀释至100 mL.术后患者根据疼痛视觉模拟评分(VAS评分)自行调控镇痛泵,静息时VAS评分≥4分另行镇痛处理.活动后VAS评分≥4分启动自控按钮给予一次补救剂量的镇痛药(单次自控剂量为0.5 mL,锁定时间为15 min).在术毕患者清醒后拔除气管导管即刻(T1)及术后24 h(T2)、48 h(T3)静息时对患者行疼痛VAS评分.并记录术毕～术后24 h、术后24～48 h患者的PCIA泵按压次数.结果 组2、组3在T1T2时间点的VAS评分及术毕～术后24 h、术后24～48 h患者的PCIA泵按压次数显著低于组1(P值均<0.05);组2在T1T2时间点的VAS评分及术毕～术后24 h、术后24～48 h患者的PCIA泵按压次数显著低于组3(P值均<0.05).结论 氟比洛芬酯有较强的镇痛作用,麻醉诱导前静脉注射及术后静脉维持联合使用能发挥最佳的镇痛效果.     

氟比洛芬酯术毕前给药对术后芬太尼镇痛的影响

目的观察氟比洛芬酯术毕前30min给药对术后芬太尼镇痛的影响。方法选择60例择期手术,随机分为2组。A组术毕前30min静注氟比洛芬酯50mg,镇痛泵加芬太尼1mg。B组无用药,镇痛泵加芬太尼1mg。记录患者术后2、5、10、20h的VAS评分及PCA按压次数、不良反应的发生情况。结果 A组术后各时点VAS和24h内PCA按压次数均明显低于B组（P〈0.05）,2组不良反应发生率低。结论氟比洛芬酯术毕前30min给药增强了芬太尼术后镇痛效果。     

氟比洛芬酯复合芬太尼用于术后静脉自控镇痛

目的观察氟比洛芬酯复合芬太尼用于术后静脉自控镇痛的效果和不良反应。方法择期腹部手术患者30例,随机分为两组:芬太尼组(对照组)和氟比洛芬酯复合芬太尼组(实验组),每组15例,术毕接PCA泵静脉自控镇痛,记录术后24h内镇痛评分(VAS)、镇静评分(SS)及不良反应。结果两组镇痛效果比较差异无统计学意义(P>0.05),对照组镇静程度和恶心、呕吐的不良反应明显高于实验组(P<0.05)。结论氟比洛芬酯复合芬太尼静脉自控镇痛,可减少芬太尼的不良反应,提高镇痛质量。     

氟比洛芬酯超前镇痛对心脏瓣膜置换术后镇痛效果和认知功能的影响

目的探讨氟比洛芬酯超前镇痛对心脏瓣膜置换术后镇痛效果和认知功能的影响。方法选取我院择期行心脏瓣膜置换术患者60例,性别不限,年龄22~54岁,体重指数16~23 kg/m2,美国麻醉医师协会（ASA）分级Ⅱ~Ⅲ级,随机分为对照组（C组）和氟比洛芬酯组（F组）,每组各30例。麻醉诱导前,F组静脉注射氟比洛芬酯100 mg,C组给予等容量脂肪乳剂。术后用芬太尼行静脉自控镇痛（PCIA）,记录术后48 h内镇痛泵有效按压次数和芬太尼使用量,并观察不良反应。于术后3、6、12、24、48 h采用视觉模拟评分法（VAS）进行疼痛评分,于术前1 d和术后2 d用简易精神状态检查表（MMSE）评估患者的认知功能。结果 F组在术后各时点的疼痛评分明显低于C组（t=16.258、17.881、8.693、12.755、8.564,均P〈0.05）,PCIA泵有效按压次数和芬太尼用量明显少于C组（t=7.171、15.411,均P〈0.05）,两组均无明显药物不良反应发生。F组术后2 d MMSE评分高于C组（t=2.209,P=0.031）,术后认知功能障碍（POCD）诊断人数低于C组（χ2=5.455,P=0.020）。结论氟比洛芬酯超前镇痛可有效减轻心脏瓣膜置换术后疼痛,减少术后镇痛药用量和POCD的发生。     

氟比洛芬酯联合吗啡用于术后镇痛的疗效观察

目的探讨氟比洛芬酯用于术后病人自控静脉吗啡镇痛的节俭作用。方法随机选择ASAⅠ～Ⅱ级择期行妇科恶性肿瘤根治手术的病人30例,随机分成三组,术后均采用病人自控静脉吗啡镇痛。M组：术毕缝皮时开启镇痛泵。F1组：手术结束前约30分钟静注氟比洛芬酯50mg,术毕开启镇痛泵。F2组：手术结束前约30分钟、术后8小时各静注氟比洛芬酯50mg,术毕开启镇痛泵。镇痛药液配制如下：吗啡0.3mg/ml,背景输注速度1ml/h,患者自控量（PCA）2ml,锁定时间5min。术后4小时、24小时、48小时随访,采用视觉模拟评分法（VAS）评估镇痛效果,并记录镇痛药物用量和不良反应。结果三组4hVAS评分有差异（p〈0.05）,24h和48hVAS评分无显著性差异（P〉0.05）。24h和48h吗啡总量、PCA按压次数和有效次数M组较F1及F2组多,有显著性差异（P〈0.01）。恶心、呕吐、瘙痒的发生以M组为多,F1及F2组较少。头晕的发生两组相似,无明显差异。结论氟比洛芬酯用于术后病人自控静脉镇痛,能够节俭吗啡的用量,减少吗啡的副作用,提高术后镇痛质量。     

氟比洛芬酯联合芬太尼在游离皮瓣移植术后镇痛的应用

目的:观察氟比洛芬酯联合芬太尼在游离皮瓣移植术后镇痛的效果。方法:选择ASAⅠ～Ⅱ级行游离皮瓣移植术病例60例,随机分成K组(氟比洛芬酯联合芬太尼)和F组(芬太尼组),每组30例。K组于手术结束前15 min静脉推注氟比洛芬酯50 mg,F组静脉推注0.9 NaCl溶液4 ml,术后均采用芬太尼自控静脉镇痛(PCIA)。记录术后2、6、12和24 h两组VAS评分和Ramsay评分,术后24 h两组PCA按压次数,芬太尼的用量及不良反应。结果:K组术后2、6、12 h VAS评分和Ramsay评分,术后24 h PCA按压次数,芬太尼用量均明显低于F组(P<0.05)。两组不良反应发生率的差异有统计学意义(P<0.05)。结论:氟比洛芬酯联合芬太尼用于游离皮瓣移植术后静脉镇痛效果更好,能减少术后芬太尼用量及不良反应。     

超前镇痛用于颌面外科围术期镇痛60例临床研究

目的:观察氟比洛芬酯用于口腔颌面外科手术超前镇痛的作用效果。方法:将60例ASA~级行口腔颌面外科手术的患者随机分为空白对照(对照组)、全麻诱导前静脉缓注氟比洛芬酯1 mg/kg(观察1组)、全麻诱导前及术后6 h分别静脉缓注氟比洛芬酯1 mg/kg(观察2组)三组,每组20例。三组均行静脉全身麻醉,术毕三组开启同样配方的患者静脉自控镇痛(PCIA)泵。分别记录术后1、4、6、12、24h的视觉模拟评分(VAS),PCIA泵的按压次数和不良反应。并在镇痛结束后统计患者对镇痛治疗的总体满意度。结果:VAS评分在术后6h以内观察1、2组显著低于对照组;术后6~12 h观察2组显著低于观察1组和对照组。术后PCIA泵按压次数观察1组显著低于对照组,而观察2组显著低于观察1组。镇痛结束后,观察1、2组患者对镇痛治疗总体满意度明显好于对照组。结论:诱导前及术后6 h追加氟比洛芬酯用于颌面外科围术期镇痛,能减少术后的芬太尼用量,并提高镇痛质量。     

氟比洛芬酯超前镇痛对胃癌术后镇痛的疗效观察

目的观察氟比洛芬酯超前镇痛对胃癌术后镇痛的临床效果。方法选择56例行胃癌手术的患者,随机分为对照组和观察组。对照组术后泵内应用芬太尼1mg＋生理盐水共100mL;观察组术前15min、关腹时分别静注氟比洛芬酯50mg,术后泵内应用芬太尼0.5mg＋生理盐水共100mL;观察术后24h内（2、4、8、24h）的镇痛评分（VAS）,PCA使用次数、不良反应及芬太尼的用量。结果术后2、4、8h观察组的VAS评分明显低于对照组组,差异有统计学意义（P〈0.05）。术后24h内PCA按压次数2组相比,差异无统计学意义（P〉0.05）。观察组的芬太尼用量明显少于对照组,差异有统计学意义（P〈0.05）。2组不良反应发生率差异无统计学意义。结论氟比洛芬酯复合芬太尼对胃癌术后静脉镇痛效果良好,且有一定超前镇痛作用。可明显减少PCIA期间芬太尼的用量,不增加不良反应的发生率。     

氟比洛芬酯超前镇痛对腰椎骨折术后静脉镇痛的影响

目的探讨氟比洛芬酯用于腰椎骨折超前镇痛对术后芬太尼静脉镇痛的影响。方法将36例单节段腰椎骨折行腰后路切开复位内固定患者随机分为两组各18例,A组术前15min静脉缓注氟比洛芬酯50mg,B组术前15min缓注生理盐水20mg,两组患者术后均接电子镇痛泵止痛,内置镇痛药物为芬太尼,剂量为0.1mg/kg＋生理盐水共100ml,观察术后24h内两组的镇痛评分（VAS）、PCA使用次数及不良反应的发生率,并在镇痛结束后统计患者对镇痛效果的总体满意度。结果术后3h、6hVAS评分A组低于B组（P〈0.05）,术后12h、24hVAS评分两组间无显著性差异（P〉0.05）。24h内电子镇痛泵按压次数A组低于B组（P〈0.05）,不良反应的发生率A组低于B组（P〈0.05）,镇痛结束后患者对镇痛效果的总体满意度A组高于B组（P〈0.05）。结论腰椎骨折术前采用氟比洛芬酯行超前镇痛可减少术后芬太尼的用量和不良反应的发生率,并能提高术后早期镇痛效果,进而提高术后总体镇痛效果。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.