布托啡诺超前镇痛用于妇科腹腔镜术后疼痛30例临床观察

超前镇痛是近年来疼痛研究的重要进展之一。基础研究表明，伤害性刺激能导致外周和中枢神经致敏，如在伤害性刺激发生前给予镇痛治疗能减轻伤害后疼痛。超前镇痛的概念和价值已得到了普遍认可。临床研究也证实，手术前预先应用阿片类药如吗啡、芬太尼等具有超前镇痛作用。妇科腹腔镜术切口虽较开腹手术小，但术后疼痛仍然存在，需要采用有效的镇痛措施，目前仍没有一种较为满意的镇痛方法。本文采用随机双盲对照法于术前及术毕分别给予布托啡诺镇痛，以观察其超前镇痛的效果。     

曲马多超前镇痛对腹腔镜胆囊切除术后疼痛的临床观察

超前镇痛是近年来疼痛研究的重要进展之一。基础研究表明，伤害性刺激能导致外周和中枢神经致敏，如在伤害性刺激发生前给予镇痛治疗能减轻伤害后疼痛。超前镇痛的概念和价值已经得到了普遍认可。临床研究也证实，手术前预先应用阿片类药如吗啡、芬太尼等具有超前镇痛作用。腹腔镜胆囊切除术切口较开腹手术小，但术后疼痛仍然存在，需要采用有效的镇痛措施。但目前仍没有一种较为满意的镇痛方法。     

曲马多超前镇痛用于膀胱镜前列腺汽化电切术疗效观察

前列腺增生行膀胱镜汽化电切术的患者基本是高龄患者，常合并高血压、冠心病、糖尿病及肺功能障碍。前列腺汽化电切术虽无皮肤切口，但术后疼痛仍存在。为确保患者围手术期的安全，减少心脑血管并发症，选择合适的麻醉及有效的术后镇痛至关重要。采用超前镇痛是在伤害性刺激作用于机体之前采取的一种措施，防止神经中枢敏化，减少或消除伤害引起的疼痛。     

两种超前镇痛法的术后镇痛疗效

两种超前镇痛法的术后镇痛疗效赵建英１林财珠１林健清１黄品芳２杨锡馨１关键词超前镇痛；吗啡控释片；布洛芬；儿茶酚胺近年来，随着急性疼痛机理和神经生理学的研究进展，提出“超前镇痛”新概念，目的是预先提高脊髓中枢对伤害刺激传入的保护作用，消除或减轻手术伤害...     

超前镇痛的有关进展

“超前镇痛”(preemptine analgesia)概念是本世纪初由Crle提出的[1],他首先用全麻辅助外周神经阻滞方法防止由于全麻镇痛不全使手术有害刺激的传入,兴奋中枢神经系统(CNS)产生疼痛。其广义是指减轻术后一段时间内疼痛,其狭义是指镇痛措施应用于术前较术后更有效,超前镇痛就是在伤害性刺激作用于机体之前,采取一定措施防止CNS敏化,以消除或轻术后疼痛。1 疼痛的分类及病理生理 疼痛分为二类[1]:一类是生理性疼痛,日常生活常经历,短时,是机体保护性机制。二类是病理性疼痛,可分为炎性疼痛和神经病理性病痛。前者指外周组织损伤引起的疼痛…     

腹腔镜手术术后镇痛

腹腔镜手术由于创伤小术后恢复快,越来越多的应用于外、妇科手术,但是术后切口疼痛仍然存在,尤其是术后24小时内.超前镇痛是指术前既对伤害性感受加以阻滞,而达到术后止痛或减轻疼痛的目的,曲马多是中枢性镇痛药,作用于阿片受体及下行镇痛系统的去甲肾上腺素(NE)和5-羟色胺(5-HT)神经系统.而下行镇痛系统的激活对伤害信息在脊髓后脚的整合有直接效应,因此我们推测曲马多可通过作用于下行镇痛系统阻止伤害性刺激的传递而产生超前镇痛的作用.     

氯胺酮超前镇痛对患者术后镇痛效果的观察

超前镇痛是在伤害性刺激作用于机体前采取一定措施防止中枢神经系统敏感，以减轻术后疼痛。本文旨在探讨气管插管全身麻醉前运用氯胺酮超前镇痛对术后镇痛效果及副反应的影响。     

地佐辛超前镇痛用于腹腔镜下卵巢囊肿摘除术的镇痛效果观察

全身麻醉患者的围术期镇痛往往单纯采用术后镇痛,缺点是止疼药用量大,止疼效果较差且副作用较多。超前镇痛可以有效减少围手术期伤害性刺激冲动传入所致的神经敏感化,从而减少手术患者术中和术后的疼痛反应以及围手术期镇痛药物的使用量[1]。本研究检验了地佐辛超前镇痛对腹腔镜下卵巢囊肿摘除术患者的镇痛效果,现报道如下。     

曲马多超前镇痛在腹腔镜胆囊切除术中的应用

目的 观察曲马多是否具有超前镇痛作用，对腹腔镜胆囊切除术（LC）术后疼痛是否有效。方法 将36例择期LC患者（ASA分级Ⅰ～Ⅱ级）随机分成超前镇痛组和术后镇痛组。超前镇痛组在全麻诱导后消毒铺巾时静脉缓慢推注曲马多2．5mg／kg，术后镇痛组在手术结束关闭腹腔时静脉缓慢推注曲马多2．5mg／kg。采用视觉模拟评分法（VAS），于手术结束后2、4、8、24h对患者术后的疼痛程度进行评分。结果 术前应用曲马多2．5mg／kg比手术结束时应用能有效减轻腹腔镜胆囊切除术的术后疼痛，起到超前镇痛作用，是一种理想的长效中枢性镇痛方法。结论 曲马多术前应用在腹腔镜胆囊切除术中能起到超前镇痛作用，有效减轻术后疼痛。     

曲马多超前镇痛用于腹腔镜胆囊切除术

目的 观察曲马多是否具有超前镇痛作用，对腹腔镜胆囊切除术术后疼痛是否有效。方法 观察44名择期腹腔镜胆囊切除术患者，ASA分级Ⅰ～Ⅱ级，随机分成二组，超前镇痛组和术后镇痛组。超前镇痛组在全麻诱导后消毒铺巾时静脉缓慢推注曲马多2．5mg／kg，术后镇痛组在手术结束关闭腹腔镜时静脉缓慢推注曲马多2．5mg／kg，于手术结束后2h、4h、8h、24h对病人的疼痛程度进行评价，采用VAS语言描述法进行评分。结果 曲马多2．5mg／kg术前应用比手术结束时应用能有效减轻腹腔镜胆囊切除术的术后疼痛，起到超前镇痛作用，是一种理想的长效中枢性镇痛方法。     

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…     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.