右美托咪定复合酒石酸布托啡诺用于ICU机械通气患者镇痛镇静的病例对照研究

目的探讨右美托咪定用于ICU机械通气患者镇痛镇静的临床疗效。方法选择2011-01-2014-05间在我科使用右美托咪定和咪达唑仑复合酒石酸布托啡诺镇静镇痛治疗机械通气的40例患者,右美托咪定组20例,给予右美托咪定复合酒石酸布托啡诺镇静镇痛治疗;咪达唑仑组20例,给予咪达唑仑复合酒石酸布托啡诺镇静镇痛治疗;维持Ramsay镇静评分3-4分,记录两组患者布托啡诺用量、达到目标镇静所需的时间、停药后唤醒时间、谵妄发生率,以及两组患者用药前（T0）,用药后1 h（T1）,用药后6 h（T6）,用药后12 h（T12）的血氧饱和度、心率、收缩压、舒张压、呼吸频率等数值。结果右美托咪定组布托啡诺用量、达到目标镇静所需的时间、停药后唤醒时间、谵妄发生率均低于咪达唑仑组,差异有统计学意义（P〈0.05）;与T0比较,两组不同时间点心率、收缩压、舒张压、呼吸频率均降低,差异有统计学意义（P〈0.05）,两组血氧饱和度变化不大（P〉0.05）;用药后各时间点两组间比较,右美托咪定组心率、收缩压,舒张压降低幅度小于咪达唑仑组（P〈0.05）,两组间血氧饱和度和呼吸频率无显著差异（P〉0.05）。结论右美托咪定用于ICU机械通气患者镇静起效快,易唤醒,具有一定镇痛作用,可减少布托啡诺用量,镇静过程中血流动力学稳定,呼吸抑制作用轻微,谵妄等不良反应发生率低。     

早期目标导向镇静下不同镇静药物对谵妄发生的影响

目的研究在早期目标导向镇静策略下,右美托咪定、咪达唑仑、丙泊酚三种药物对谵妄发生的影响。方法选取川北医学院附属医院重症医学科需要接受镇静治疗的患者100例(2016年1月至2017年6月),随机分配接受右美托咪定(A组)、咪达唑仑(B组)、丙泊酚(C组)镇静治疗。躁动镇静评分量表评估各组镇静的水平,以达到躁动镇静评分-2~+1分镇静目标。用重症监护病房意识模糊评估法评估患者是否发生谵妄及持续时间。结果 A组能维持更长时间的浅镇静水平。A组谵妄的发生率,谵妄持续时间和身体约束比例优于其他两组,三组机械通气时间、住ICU时间、ICU病死率没有统计学差异。C组的血流动力学变化差异有统计学意义。结论在早期目标导向镇静策略下,右美托咪定能更好的预防谵妄发生,减少谵妄持续时间,维持血流动力学稳定,促进人文关怀。     

咪唑安定序贯盐酸右美托咪定对ICU机械通气患者镇静的临床研究

目的研究咪唑安定序贯盐酸右美托咪定用于重症加强护理病房（ICU）机械通气患者镇静的临床效果。方法将河北医科大学第四医院150 例ICU 机械通气患者抽签随机分为A～C 3组,每组50 例。A 组：咪唑安定+ 盐酸右美托咪定疗程序贯镇静,B 组：咪唑安定+ 盐酸右美托咪定每日序贯镇静,C 组单纯咪唑安定镇静,3 组均配合舒芬太尼基础镇痛,以Riker 镇静和躁动评分系统（SAS）指导镇静深度,以危重症疼痛观察工具（CPOT）监测镇痛效果,比较3 组恢复性指标差异及舒芬太尼用量,观察3 组镇静、唤醒过程中不良事件 （低血压、心动过缓、谵妄）发生率及临床转归（ICU 死亡、院内死亡）。结果3 组机械通气时间与每日唤醒时间呈A0.05）,但A、B 两组均低于C 组;3 组镇静、唤醒过程低血压、心动过缓、谵妄发生率比较差异无统计学意义（P >0.05）,C 组低血压、谵妄发生率稍高于A、B 组,B 组谵妄稍高于A组;3组ICU 死亡及院内死亡发生率比较差异无统计学意义（P >0.05）。结论咪唑安定序贯盐酸右美托咪定用于ICU 机械通气患者可缩短机械通气时间,降低ICU 总花费,缩短每日唤醒时间,并可降低镇痛药用量,未见明显严重不良反应发生,其中疗程序贯镇静方式具有更高的安全性。     

右美托咪定联合咪达唑仑用于ICU患者镇静的效果

目的探讨右美托咪定联合咪达唑仑用于ICU行机械通气患者的镇静效果及安全性。方法选择ICU行呼吸机辅助通气患者90例,按随机数字表法分为3组,每组30例。A组、B组、C组分别予咪达唑仑、右美托咪定、右美托咪定联合咪达唑仑镇静。3组均予芬太尼持续静脉泵入镇痛。观察各组患者低血压、心动过缓、谵妄、呼吸抑制等不良反应发生情况,并记录其芬太尼及咪达唑仑用量、停药后唤醒时间。结果 3组均能达到镇静及镇痛目标评分状态。与A组比较:C组芬太尼及咪达唑仑用量更少(P<0.01),谵妄和呼吸抑制发生率更低(P=0.012,P=0.049),停药后唤醒时间更短(P<0.01),低血压和心动过缓发生率显差异无统计学意义(P=0.754,P=0.290)。与B组比较:C组芬太尼用量、心动过缓、瞻妄、呼吸抑制发生率差异无统计学意义(P=0.386,P=0.445,P=0.639,P=0.639),低血压发生率更低(P=0.031),停药后唤醒时间更长(P<0.01)。结论右美托咪定联合咪达唑仑用于ICU机械通气患者镇静效果确切,停药后较易唤醒,谵妄发生率低,呼吸抑制、低血压及心动过缓发生率较低,可减少咪达唑仑及芬太尼用量,是一种较为理想的ICU镇静方式。     

右美托咪定与咪达唑仑用于ICU机械通气患者镇静疗效比较

目的:比较右美托咪定与咪达唑仑用于ICU患者镇静疗效。方法:选择80例气管插管机械通气患者,随机分为右美托咪啶组和咪达唑仑组,每组40例。两组均常规给予芬太尼持续静脉泵入镇痛,咪达唑仑组:首次负荷剂量,静脉推注0.05 mg/kg,以后0.02~0.08 mg/(kg·h)静脉推注维持。右美托咪定组:首次负荷剂量,静脉推注1μg/kg(>10 min),以后0.2~0.7μg/(kg·h)静脉推注维持。目标为Ramsay镇静深度2~4级。观察镇静效果及用药后呼吸、心率、血压的变化,谵妄发生率。结果:两组达到镇静效果时间相似,右美托咪定组停药后唤醒时间短,发生呼吸抑制2例,低血压3例,谵妄1例,均明显低于咪达唑仑组。但右美托咪定组心动过缓发生率较高。结论:右美托咪定用于ICU机械通气镇静易唤醒,不良反应发生率低,效果优于咪达唑仑。     

右美托咪定和咪达唑仑用于ICU患者镇静效果的系统评价

目的 比较右美托咪定和咪达唑仑用于ICU患者中的镇静效果.方法 通过计算机检索PubMed图书馆和医学文摘Embsse数据库,手动检索以右美托咪定、咪达唑仑、ICU和镇静为关键词,以1999年1月~2014年4月为检索年限的临床试验研究资料.资料提取后,采用RevMan 5.0软件进行统计学分析.结果 通过检索后,发现共有12篇相关文献,共计1700例患者,其中,右美托咪定组有870例患者,咪达唑仑组有830例患者.根据Meta分析可以得出:(1)右美托咪定组中的ICU患者在平均住院时长、机械通气时间方面均比咪达唑仑组短,差异具有统计学意义(P<0.05).(2)右美托咪定组中的ICU患者并发谵妄的发生率明显低于咪达唑仑组,差异具有统计学意义(P<0.05).(3)2组药物的镇静起效时长和患者的醒药时程之间的差异无统计学意义.结论 右美托咪定和咪达唑仑在应用于ICU患者的镇静效果中,均有肯定的应用价值.但右美托咪定更能有效降低ICU患者的机械通气时间和患者的住院时长,可以有效减少患者谵妄的发生率.因此,右美托咪定是ICU患者镇静的更好选择.     

右美托咪定对老年机械通气患者睡眠与认知的影响

目的 探讨老年机械通气患者使用右美托咪定对睡眠和认知功能的影响。方法 自2018年1月～2019年12月,将我院ICU老年呼吸机患者随机分为右美托咪定组和咪达唑仑组,每组30例。用脑电双频指数监测镇静深度,以多导睡眠检测仪记录睡眠脑电图。记录两组呼吸机使用期间不良反应的发生次数。通过ICU模糊评估方法(CAM-ICU)评估两组患者在7 d内出现谵妄的病例数。使用PSQI和MMSE量表追踪患者3个月的睡眠质量和认知功能状态。结果 右美托咪定组的睡眠效率显著更高(P0.05)。7 d内谵妄发生率右美托咪定组较咪达唑仑组患者显著减少(P0.05)。两组患者在ICU期间发生呼吸抑制不良事件发生率有显著差异(P0.05),但意外脱管和心血管事件的不良事件发生率无显著差异(P0.05)。两组在3个月时的MMSE评分有显着差异(P0.05),但PSQI检查无统计学差异(P0.05)。结论 对于有短期机械通气的老年患者,右美托咪定的镇静作用是理想的。     

右美托咪啶与丙泊酚用于老年患者术后谵妄治疗的比较研究

目的 探讨右美托咪定和丙泊酚应用于老年术后谵妄患者的治疗效果及安全性。方法 选择术后发生谵妄的48例老年患者,按随机数字表法分为右美托咪定组（23例）和丙泊酚组（25例）,分别给予右美托咪定和丙泊酚治疗,根据重症谵妄筛查表（ICDSC）评估治疗效果,并结合Riker镇静和躁动评分（SAS）调整镇静药剂量,使镇静深度评分控制在2～4分,同时比较两组在ICU住院天数及副作用的差异。结果 给予右美托咪定与丙泊酚治疗后,患者的谵妄症状均缓解,两组的ICDSC评分分别为（1.6±1.0）分和（1.9±0.9）分,两组比较差异无统计学意义（P〉0.05）;右美托咪定组与丙泊酚组的ICU平均住院天数分别为（2.3±1.0）d和（3.1±1.4）d,两组比较差异有统计学意义（P〈0.05）;在心血管不良事件发生方面,右美托咪定组的低血压发生率为30.4%,明显低于丙泊酚组的60.0%（P〈0.05）;右美托咪定组的心动过缓发生率为17.4%,明显低于丙泊酚组的44.0%（P〈0.05）;呼吸抑制的发生率方面两组比较差异无统计学意义（P〉0.05）。结论 右美托咪定与丙泊酚治疗老年术后谵妄均有效,但在减少副作用方面,右美托咪定具有明显优势,是一种较为理想的ICU治疗谵妄的药物。     

右美托咪定对无创通气AECOPD患者镇静的安全性及有效性研究

目的评估右美托咪定对慢性阻塞性肺部疾病急性发作期患者需要使用无创通气支持下镇静的安全性及有效性。方法选取2015年3月~2017年2月我院入住重症医学科的AECOPD并需要无创通气支持的患者64例,随机分为右美托咪定组和对照组,每组32例,两组均给予无创通气和常规治疗,右美托咪定组予右美托咪定维持量(0.2~0.7)μg/(kg·h),维持RASS评分-1~+1分,比较两组患者0h、6h、12h、24h、48h的氧合指数、二氧化碳分压、平均动脉压、心率。并比较两组患者的无创机械通气时间、有创通气率、ICU住院时间及谵妄的发生率及患者28 d生存率,观察右美托咪定组有无戒断症状。结果右美托咪定组6h后二氧化碳明显较对照组下降(P0.05),24h后氧合明显较对照组改善(P0.05),6h、12h平均动脉压较对照组下降(P0.05),心率6h后均较对照组明显下降(P0.05),但无明显心动过缓。右美托咪定组无创通气时间、留住ICU时间较对照组明显缩短(P0.05),有创通气率及谵妄发生率降低,有显著差异(P0.05)。右美托咪定组无明显戒断症状发生,两组患者的28d生存率无明显差异。结论右美托咪定联合无创机械通气支持显著改善AECOPD患者氧合,减少机械通气时间及住ICU时间,减少插管率及谵妄发生率,且安全性较高。     

右美托咪定对胃肠手术全麻患者苏醒期恢复及血流动力学的影响

目的 探讨右美托咪定对全麻胃肠手术患者苏醒期恢复和血流动力学的影响。 方法 选择浙江省肿瘤医院2013年1月-2015年12月胃肠外科全麻手术患者148例作为研究对象,将其分为右美托咪定组和对照组,右美托咪定组麻醉诱导前给予右美托咪定泵注,对照组麻醉诱导前给予咪达唑仑静滴。观察2组患者麻醉诱导期、手术期、拔管期的血流动力学变化,并观察2组患者拔管后Ramsay镇静评分和RASS评分情况。 结果 右美托咪定组插管时、插管5 min、插管10 min的收缩压、舒张压、平均动脉压、心率低于入手术室时(P<0.05);对照组插管时、插管5 min的收缩压、舒张压、平均动脉压、心率均高于入手术室时(P<0.05),且高于右美托咪定组(P<0.05)。右美托咪定组手术期及拔管期各时间段收缩压、舒张压、平均动脉压、心率与切皮时比较均无明显变化(P>0.05);对照组胃肠探查和胃肠切除时的收缩压、舒张压、平均动脉压、心率均高于切皮时(P<0.05),且高于右美托咪定组(P<0.05)。对照组拔管1 min、拔管5 min、拔管10 min时的收缩压、舒张压、平均动脉压、心率均高于拔管前(P<0.05),且高于右美托咪定组(P<0.05)。右美托咪定组拔管后10 min、拔管后20 min的Ramsay镇静评分均明显高于对照组(P<0.05),右美托咪定组拔管后10 min、拔管后20 min的RASS评分均明显低于对照组(P<0.05)。 结论 右美托咪定可以稳定全麻胃肠手术患者围手术期血流动力学,有利于苏醒期的恢复。      

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.