不同阿片类镇痛药对体外人精子活力的影响

目的 探讨阿片类镇痛药芬太尼、阿芬太尼、舒芬太尼、布托啡诺、地佐辛和喷他佐辛对体外人精子活力的影响.方法 男性患者20例,取20份活力正常的精液标本,密度(40～ 80)×106个/ml,接种于培养皿,每皿50μl.采用随机区组设计,分别接受下述处理.对照组:每皿加入等渗盐水50μl;单独用药组:6种阿片类镇痛药分别加入到培养皿中,使其终浓度为10-3、10-4、10-5和10-7mol/L;联合用药组:纳洛酮加入培养皿中,使其终浓度为2× 10-8、1 × 10-7、2×10-7 mol/L,孵育5min后分别加入各浓度的芬太尼、阿芬太尼、舒芬太尼、布托啡诺、地佐辛25μl,各组孵育1h.计算精子活力变化幅度、半数抑制浓度(IC50)和完全抑制浓度(IC100).结果 芬太尼、阿芬太尼和舒芬太尼浓度与精子活力变化幅度的量效曲线均呈直线,精子活力最大降低幅度分别为(56±5)％、(58±7)％和(79±6)％;布托啡诺、地佐辛和喷他佐辛浓度与精子活力变化幅度的量效曲线均呈S型曲线,低浓度均对精子活力无影响,中、高浓度布托啡诺和地佐辛可抑制精子活力,精子活力最大降低幅度均为100％,高浓度喷他佐辛显著增加精子活力,精子活力最大升高幅度(19±6)％.纳洛酮使芬太尼、阿芬太尼、舒芬太尼浓度与精子活力变化幅度的量效曲线右移,最大效应降低,且呈浓度依赖性(P<0.05),使布托啡诺、地佐辛浓度与精子活力变化幅度的量效曲线右移,最大效应不变(P＞0.05),呈浓度依赖性(P<0.05).IC50排列顺序为阿芬太尼≈芬太尼＞地佐辛＞舒芬太尼≈布托啡诺,IC100排列顺序为地佐辛＞布托啡诺.结论 芬太尼、阿芬太尼、舒芬太尼可通过激动精子阿片受体直接抑制精子活力;布托啡诺和地佐辛对精子活力的抑制作用与浓度有关,该作用可能与阿片受体和非阿片受体途径有关;喷他佐辛增强精子活力的作用与浓度有关.     

雷米芬太尼和纳洛酮联合体外应用对人精子运动功能的影响

目的:观察雷米芬太尼和纳洛酮联合应用对体外人精子运动功能的影响并探讨其机制。方法:实验选取20例a+b级精子百分率正常的精液标本,每例精液均一式13份,分别经过不同浓度雷米芬太尼或联合不同浓度纳洛酮处理35 min,在计算机辅助的精子分析下观察精子5、10、15、20、35 min时的运动情况。结果:①与对照组相比,0.1～100μg/L雷米芬太尼作用精子5、10 min时a+b级精子百分率降低,并呈浓度依赖性降低,而作用精子15、30 min时a+b级精子百分率无显著性差异;②与对照组相比,0.004～0.04 mg/L纳洛酮作用精子5～35 min时,a+b级精子百分率无显著性差异;0.4～4 mg/L纳洛酮作用精子5～20 min时a+b级精子百分率无显著性差异,而作用精子35 min时a+b级精子百分率显著增加;③与同浓度雷米芬太尼组相比,0.004、0.04、0.4、4 mg/L纳洛酮依次联合0.1、1、10、100μg/L雷米芬太尼共同作用精子5、10 min时a+b级精子百分率显著提高,而作用15、35 min时无显著性差异。结论:雷米芬太尼对精子运动的抑制作用起效和消失快,其抑制作用可被纳洛酮所拮抗,推测可能与μ受体有关。     

“益精方”对小鼠精子尾部特异性钙通道CatSper1的影响

目的:观察"益精方"对环磷酰胺所致少弱精子症模型小鼠精子尾部特异性钙通道CatSper1的影响。方法:将40只雄性昆明小鼠随机分为对照组(CG)、模型组(MG)、小剂量中药治疗组(SG)和大剂量中药治疗组(LG),按60mg/kg体重给CG小鼠腹腔注射生理盐水(NS),给MG、SG、LG小鼠腹腔注射环磷酰胺,每天1次,连续5d,第6d开始按体重分别给SG和LG小鼠灌服"益精方",剂量分别为人类常规用量(以60kg为标准)的1倍和5倍,MG小鼠给予等体积的NS灌胃,每天1次,连续34d,CG常规饲养,然后对小鼠进行精液常规分析,并用RT-PCR法检测小鼠精子CatSper1的表达。结果:CG、MG、SG和LG组小鼠附睾精子密度分别为(5.20±1.34)、(1.73±0.03)、(2.08±0.01)、(3.31±0.56)×106/ml,a+b级精子百分率分别为(14.49±0.30)%、(6.64±1.88)%、(11.99±1.01)%、(19.40±3.13)%,a+b+c级精子百分率分别为(68.39±15.13)%、(39.96±4.89)%、(62.28±4.43)%、(73.61±5.05)%,MG组精子密度、a+b级精子百分率、a+b+c级精子百分率显著低于CG组(P<0.05),经治疗后LG组精子密度、a+b级精子百分率、a+b+c级精子百分率明显增加,与MG组比较有显著性差异(P<0.05),而与CG组在a+b级精子百分率和a+b+c级精子百分率上没有明显区别。CatSper1的表达量在CG、MG、SG和LG组分别为0.76±0.05、0.73±0.03、0.75±0.12、0.85±0.04,LG组显著高于MG组(P<0.05),而与CG组比较没有明显区别。结论:腹腔注射环磷酰胺可使小鼠精子密度、a+b级精子百分率、a+b+c级精子百分率降低,CatSper1表达量下降,大剂量"益精方"可以通过提高CatSper1的表达量,增加小鼠精子密度、a+b级和a+b+c级精子百分率,从而达到治疗少弱精子症的目的。     

布托啡诺调节CCL2-CCR2轴对食管癌细胞增殖、凋亡和迁移的影响

目的 探讨布托啡诺对食管癌细胞增殖、凋亡、迁移的影响及其对CCL2-CCR2轴的调节作用。方法 使用0～400 ng/ml梯度浓度布托啡诺处理人食管癌KYSE30细胞,MTT法检测细胞增殖能力;将KYSE30细胞分为对照组、布托啡诺L组、布托啡诺M组、布托啡诺H组和布托啡诺H+CCL2组,EdU法检测细胞增殖能力;Hoechst法检细胞凋亡;细胞划痕实验检测细胞迁移;Transwell法检测细胞侵袭;Western blot技术验证CC类趋化因子配体2(CCL2)、CC类趋化因子受体2(CCR2)蛋白表达。结果 50 ng/ml、100 ng/ml、200 ng/ml、400 ng/ml浓度布托啡诺能显著抑制KYSE30细胞增殖;与对照组相比,布托啡诺L、M、H组和布托啡诺H+CCL2组KYSE30细胞增殖、迁移、侵袭能力以及CCL2、CCR2蛋白表达水平显著下降,差异有统计学意义(P<0.05);与布托啡诺H组相比,布托啡诺H+CCL2组细胞增殖、迁移、侵袭能力以及CCL2、CCR2蛋白表达水平显著升高,差异有统计学意义(P<0.05)。结论 布托啡诺能够显著抑制食管癌K...     

酒石酸布托啡诺对舒芬太尼诱发咳嗽反射的影响

目的观察酒石酸布托啡诺对舒芬太尼诱发咳嗽反射的影响。 方法择期行腹腔镜胆囊切除术患者82例,ASAⅠ或Ⅱ级,随机分为两组,分别于麻醉诱导前静注以生理盐水稀释至5 ml的酒石酸布托啡诺1 mg (试验组)或生理盐水5 ml(对照组),5 min后在3 s内静注舒芬太尼0.3 μg/kg,观察并记录两组患者2 min内咳嗽反射的发生率和强度。 结果试验组患者咳嗽反射的发生率、强度明显低于对照组。 结论酒石酸布托啡诺1 mg可以抑制舒芬太尼诱发的咳嗽反射。     

广东某市农村地区正常生育力男性精液参数的研究

目的探索现阶段正常生育力的健康男性精液的各项参数及其相互关系。方法采用WHO最新推荐的方法,对广东某市农村312例具有生育力的健康志愿者进行精液检测分析。结果(1)具有(a+b)级活动力精子率(60.63±11.76)%;(2)精子存活率(80.89±10.49)%;(3)精子密度(60.09±30.25)×106/ml;(4)不同年龄组间(a+b)级活动力精子、精子存活率及精子密度的参数比较,无显著差异(P>0.05);(5)禁欲时间与(a+b)级活动力精子、精子存活率间的关系呈负相关(P<0.05),与精子密度间的关系呈正相关(P<0.01),但不同禁欲时间组间与(a+b)级活动力精子、精子存活率及精子密度的比较,无显著差异(P>0.05);(6)精子密度与(a+b)级活动力精子和精子存活率无明显的相关关系(P>0.05),且(a+b)级活动力精子和精子存活率始终保持着平衡状态,并在50%以上。结论(1)(a+b)级活动力精子>50%、精子存活率>50%,即使精子密度偏低或<20×106/ml仍不影响正常男性的生育能力;(2)(a+b)级活动力精子、精子存活率以及精子密度与年龄(20~45岁)无关;(3)精子密度的高低对(a+b)级活动力精子和精子存活率无明显影响。     

布托啡诺与吗啡用于腹部手术后硬膜外镇痛效果的比较

目的 研究不同剂量布托啡诺用于腹部手术患者术后硬膜外镇痛的效果及副作用,并与吗啡硬膜外镇痛进行比较. 方法 择期腹部手术ASAⅠ～Ⅱ级患者75例,按术后镇痛用药不同随机分为3组(n=25):M组(吗啡12 mg+0.1%罗哌卡因共150ml),B1组(布托啡诺9mg+0.1%罗哌卡因共150 ml),B2组(布托啡诺12mg+0-1%罗哌卡因共150ml).负荷量为0.25%罗哌卡因5 ml加吗啡2 mg或布托啡诺2 mg,持续背景输注剂量均为1-5 ml/h,按压追加药量均为2 ml/次,按压锁定时间20 min.观察记录3组患者术中芬太尼的总药量;术后1、4、8、12、18、24、36、48 h各时间点的疼痛视觉模拟评分(pain visual analogue scores,VAS);术后1、4、8、12 h的警觉镇静评分(observer's assessment ofalertness/sedation scores,OAA/S);术后48 h内按压总次数及总药量;肛门排气时间;术后镇痛副作用(头痛头晕、嗜睡、呼吸抑制、搔痒、恶心、呕吐、腹胀)的发生情况.结果 术后4 h时间点B1组VAS评分为2.8±1.0,高于M组的2.0±0.7及B2组的2.0±0.9(P<0-05),其余时间点3组间比较差异无统计学意义(P>0.05).M组的头痛头晕、恶心、呕吐,腹胀,搔痒发生例数分别为3、11、7、4、5例,而B1组仅有1例头痛头晕,B2组有2例头痛头晕,1例恶心,发生率均低于M组(P<0.05).3组患者术中芬太尼的总药量、48 h内按压总次数及总药量、术后不同时间点OAA/S评分及肛门排气时间的比较差异无统计学意义(P>0.05). 结论 每天3 mg～4 mg布托啡诺应用于腹部手术后硬膜外镇痛,镇痛效果确切,且其副作用发生率较吗啡明显降低.     

精液留取后不同时间分析对精子运动参数的影响

目的:探讨精液留取后不同时间进行计算机辅助精液分析系统(CASA)分析对精子运动参数的影响。方法:选择92例精液标本,精子密度均大于20×106/ml,液化时间均小于20min。精液留取后置37℃孵箱,在20、30、60、90min时,采用CASA进行精液参数分析。结果:30、60、90min时a级精子百分率、b级精子百分率分别显著低于20min时的a级精子百分率、b级精子百分率(P<0.05)。60min、90min时c级精子百分率分别显著低于20min、30min时的c级精子百分率(P<0.05)。c级精子百分率在20min和30min时无明显差异(P>0.05)。30、60、90min时(a+b)级精子百分率、(a+b+c)级精子百分率则均显著低于20min时(a+b)级精子百分率、(a+b+c)级精子百分率(P<0.05)。鞭打频率(BCF)在30min时则显著高于20min(P<0.05)。90min时侧摆幅度(ALH)与30min时相比显著降低(P<0.05)。90min时摆动性(WOB)与20、30min时比显著增高(P<0.05)。90min时曲线速度(VCL)显著低于20、30min时的曲线速度(P<0.05)。30、60、90min时的前向性(STR)与20min相比显著降低(P<0.05)。9min时的平均路径速度(VAP)、直线速度(VSL)分别均显著低于20min时的平均路径速度、直线速度(P<0.05)。精子密度、平均移动角度(MAD)、直线性(LIN)在4个不同时间点分析时均无显著性差异(P>0.05)。结论:精液常规分析中精液留取后至分析的时间需要标准化,对正常液化标本,精子留取后30～60min精子运动参数分析相对恒定。     

布托啡诺抑制全麻气管插管应激反应的效果

目的比较布托啡诺与芬太尼抑制全麻气管插管应激反应的临床效果。方法拟在全麻下行择期上腹部手术患者60例,ASAⅠ或Ⅱ级,随机均分为两组。全麻诱导前5min,布托啡诺组静脉注射布托啡诺40μg/kg,芬太尼组静脉注射芬太尼4μg/kg。全麻诱导时,两组均靶控输注效应室浓度为4μg/ml的丙泊酚,患者意识消失后给予维库溴铵行气管插管。记录全麻诱导前7min(T0)、气管插管前即刻(T1)、插管后1min(T2)、3min(T3)和10min(T4)各时点MAP、HR,并于T0、T2、T4时采集桡动脉血,测定血浆肾上腺素(E)和去甲肾上腺素(NE)浓度。结果芬太尼组T1、T4时HR比T0时明显减慢(P<0.05),且芬太尼组T1时HR明显慢于布托啡诺组(P<0.05);两组气管插管前后及两组间比较,MAP、血浆E和NE浓度差异无统计学意义。结论布托啡诺和芬太尼均可以有效地抑制全麻气管插管应激反应,与芬太尼相比,布托啡诺对心率的影响较小。     

右美托咪定不同配伍镇痛对腹腔镜结直肠癌手术ASA Ⅲ级患者术后谵妄与胆碱酯酶的影响

目的:探讨右美托咪定配伍舒芬太尼或地佐辛或布托啡诺静脉镇痛对腹腔镜结直肠癌手术ASAⅢ级结直肠癌患者术后谵妄(POD)及胆碱酯酶的影响。方法:共240例腹腔镜结直肠癌手术患者纳入此项前瞻、随机、双盲、对照研究。按随机数表法分为S组(舒芬太尼组)、D组(地佐辛组)与B组(布托啡诺组),每组80例,行复合右美托咪定静脉镇痛。利用护理谵妄筛查量表筛选术后第1天、第2天、第3天POD发生情况,并检测术前及术后第1天、第3天血清胆碱酯酶活性。结果:POD总体发生率为13.79%,3组间POD发生率差异无统计学意义(P0.05),POD患者术前血清胆碱酯酶活性略低于正常值,术后有增高趋势,POD组内、与非POD患者组间相比差异均有统计学意义(P0.05),其他观察指标差异无统计学意义(P0.05)。结论:右美托咪定伍用舒芬太尼或地佐辛、布托啡诺静脉镇痛的腹腔镜结直肠癌术后POD发生率仍高,血清胆碱酯酶活性可部分预测POD的发生。     

Alfentanil Causes Less Postoperative Nausea and Vomiting than Equipotent Doses of Fentanyl or Sufentanil in Outpatients

Background: The relative potencies of alfentanil, fentanyl, and sufentanil as a risk factor for postoperative nausea and vomiting have not been determined. They were compared in a randomized study designed to obtain equipotent plasma concentrations of these three opioids at the beginning of the recovery period.

Methods: The study included 274 patients treated on an outpatient basis. The steady state opioid plasma concentration providing a predicted 50% reduction of the minimum alveolar concentration of isoflurane was used to determine the relative potency of the opioids. The opioids were prepared in equal volumes at concentrations of alfentanil 150 [mu]g/ml, fentanyl 50 [mu]g/ml, and sufentanil 5 [mu]g/ml and were administered in vol/kg. Anesthesia was induced in a blinded fashion with a bolus of the study opioid (0.05 ml/kg) and 4-6 mg/kg thiopental and was maintained with isoflurane (0.6-1%) in a nitrous oxide-oxygen mixture with a continuous infusion of the study opioid (0.06 ml [middle dot] kg-1 [middle dot] h-1). If necessary, up to five additional boluses of opioid (0.02 ml/kg) could be given. This opioid administration protocol was tested by pharmacokinetic simulations.

Results: The incidence of postoperative nausea and vomiting was not different in the postanesthesia care unit, but in the ambulatory surgery unit it was significantly lower for alfentanil compared with fentanyl and sufentanil (12, 34, and 35%, respectively P< 0.005). Pharmacokinetic modeling showed that the end-anesthesia opioid plasma concentrations were approximately equipotent in the three groups. However, modeling does not support that the difference between groups in the postoperative period can be explained by a more rapid disappearance of alfentanil from the plasma.     

Alfentanil causes less postoperative nausea and vomiting than equipotent doses of fentanyl or sufentanil in outpatients

BACKGROUND: The relative potencies of alfentanil, fentanyl, and sufentanil as a risk factor for postoperative nausea and vomiting have not been determined. They were compared in a randomized study designed to obtain equipotent plasma concentrations of these three opioids at the beginning of the recovery period. METHODS: The study included 274 patients treated on an outpatient basis. The steady state opioid plasma concentration providing a predicted 50% reduction of the minimum alveolar concentration of isoflurane was used to determine the relative potency of the opioids. The opioids were prepared in equal volumes at concentrations of alfentanil 150 microg/ml, fentanyl 50 microg/ml, and sufentanil 5 microg/ml and were administered in vol/kg. Anesthesia was induced in a blinded fashion with a bolus of the study opioid (0.05 ml/kg) and 4-6 mg/kg thiopental and was maintained with isoflurane (0.6-1%) in a nitrous oxide-oxygen mixture with a continuous infusion of the study opioid (0.06 ml x kg(-1) x h(-1)). If necessary, up to five additional boluses of opioid (0.02 ml/kg) could be given. This opioid administration protocol was tested by pharmacokinetic simulations. RESULTS: The incidence of postoperative nausea and vomiting was not different in the postanesthesia care unit, but in the ambulatory surgery unit it was significantly lower for alfentanil compared with fentanyl and sufentanil (12, 34, and 35%, respectively P < 0.005). Pharmacokinetic modeling showed that the end-anesthesia opioid plasma concentrations were approximately equipotent in the three groups. However, modeling does not support that the difference between groups in the postoperative period can be explained by a more rapid disappearance of alfentanil from the plasma. CONCLUSIONS: Alfentanil, compared with approximately equipotent doses of fentanyl and sufentanil, is associated with a lower incidence of postoperative nausea and vomiting in outpatients.     

Transdermal nitroglycerine enhances spinal sufentanil postoperative analgesia following orthopedic surgery

BACKGROUND: Sufentanil is a potent but short-acting spinal analgesic used to manage perioperative pain. This study evaluated the influence of transdermal nitroglycerine on the analgesic action of spinal sufentanil in patients undergoing orthopedic surgery. METHODS: Fifty-six patients were randomized to one of four groups. Patients were premedicated with 0.05-0.1 mg/kg intravenous midazolam and received 15 mg bupivacaine plus 2 ml of the test drug intrathecally (saline or 10 microg sufentanil). Twenty to 30 min after the spinal puncture, a transdermal patch of either 5 mg nitroglycerin or placebo was applied. The control group received spinal saline and transdermal placebo. The sufentanil group received spinal sufentanil and transdermal placebo. The nitroglycerin group received spinal saline and transdermal nitroglycerine patch. Finally, the sufentanil-nitroglycerin group received spinal sufentanil and transdermal nitroglycerine. Pain and adverse effects were evaluated using a 10-cm visual analog scale. RESULTS: The time to first rescue analgesic medication was longer for the sufentanil-nitroglycerin group (785+/-483 min) compared with the other groups (P<0.005). The time to first rescue analgesics was also longer for the sufentanil group compared with the control group (P<0.05). The sufentanil-nitroglycerin group group required less rescue analgesics in 24 h compared with the other groups (P<0.02) and had lesser 24-h pain visual analog scale scores compared with the control group (P<0.005), although these scores were similar to the sufentanil and nitroglycerin groups (P>0.05). The incidence of perioperative adverse effects was similar among groups (P>0.05). CONCLUSIONS: Transdermal nitroglycerine alone (5 mg/day), a nitric oxide generator, did not result in postoperative analgesia itself, but it prolonged the analgesic effect of spinal sufentanil (10 microg) and provided 13 h of effective postoperative analgesia after knee surgery.     

Sufentanil, alfentanil, and fentanyl: impact on cerebrospinal fluid pressure in patients with brain tumors

In order to evaluate the safety of the new synthetic opioids, alfentanil and sufentanil, in neurosurgical patients, we administered sufentanil 1 microg/kg i.v., alfentanil 50 microg/kg i.v. followed by an infusion of 1 microg/kg/min, or fentanyl 5 microg/kg i.v. to 30 patients with supratentorial tumors anesthetized with nitrous oxide (N2O), 60% in O2. Lumbar cerebrospinal fluid pressure (CSFP) and mean arterial pressure (MAP) responses were recorded for 10 min thereafter, while ventilation was held constant [mean PaCO2 = 36.1 +/- 1.0 mm Hg (SEM)]. There was no change in CSFP after fentanyl. In contrast, both sufentanil and alfentanil caused increases in CSFP, equal to 89 +/- 31 % SE (p < 0.05) and 22 +/- 5% (p < 0.05), respectively. MAP decreased after administration of each opioid. Peak decreases in cerebral perfusion pressure (MAP - CSFP) were 14 +/- 3% after fentanyl, 25 +/- 5% after sufentanil, and 37 +/- 3% after alfentanil. It is concluded that because sufentanil increased CSFP in patients who have brain tumors, it also may be contraindicated in other neurosurgical patients at risk for intracranial hypertension. Alfentanil may share this propensity, since CSFP increased despite a profound reduction in MAP. Among the three opioids evaluated, only fentanyl appears to be appropriate for supplementing N2O-2 anesthesia in patients who have compromised intracranial compliance.     

Dose-related changes in the rate of CSF formation and resistance to reabsorption of CSF during administration of fentanyl, sufentanil, or alfentanil in dogs

The rate of cerebrospinal fluid (CSF) formation (Vf) and resistance to reabsorption (Ra) of CSF were determined in dogs at four doses of fentanyl (0.05, 0.18, 0.60, and 3.0 microg.kg. min), sufentanil (0.01, 0.04, 0.13, and 0.60 microg.kg min) and aflentanil (1.4, 4.0, 13.0, and 40.0 microg.kg min). Results were compared within and between groups and to previously reported normal values (obtained during a variety of background anesthetics) for Vf (0.030-0.054 ml/min) and Ra (220-253 cm H2O ml min) in dogs. At the two lower doses of fentanyl and at all doses of sufentanil and alfentanil, Vf values were not significantly different from previously reported normal values. At the two higher doses of fentanyl, Vf decreased by 24 and 49%, respectively. At the two lower doses of all three drugs, Ra was significantly decreased, with mean values 40-52% below previously reported normal values. At the two higher doses of alfentanil, Ra values were not significantly different from previously reported normal values, and at the two higher doses of fentanyl and sufentanil, Ra was unchanged or increased. It is concluded that, among these three narcotics, reduction of CSF volume (as determined by the balance between Vf and Ra) is favored most by fentanyl, and ease of CSF volume contraction (as determined by Ra) is favored most by alfentanil.     

地佐辛复合氟比洛芬酯用于上腹部手术术后镇痛的多中心临床研究

目的观察地佐辛联合氟比洛芬酯用于上腹部手术术后镇痛的有效性及安全性。方法本研究为多中心、前瞻、随机、单盲和对照临床研究。择期行上腹部手术患者216例,ASAⅠ或Ⅱ级,计算机信封法随机均分为地佐辛组(D组)和舒芬太尼组(S组)。D组于手术结束前30 min缓慢静注地佐辛5 mg+氟比洛芬酯50 mg,继之用生理盐水将地佐辛25 mg+氟比洛芬酯250 mg配制成100 ml,以2 ml/h的速率持续静脉输注48 h;S组于手术结束前30min缓慢推注舒芬太尼3μg,此后用生理盐水将3μg/kg的舒芬太尼配制成100 ml持续泵注。分别记录患者术后1、4、8、12、24、36、48 h安静和90°翻身活动时的疼痛VAS评分、Ramsay镇静评分、镇痛泵按压次数、副作用等。结果两组术后各时点安静状态VAS评分及Ramsay镇静评分差异均无统计学意义,90°翻身活动时D组各时点VAS评分均低于S组(P<0.05)。出汗、恶心和寒战发生率D组明显低于S组(P<0.05)。结论与单用舒芬太尼比较,地佐辛联合氟比洛芬酯对术后运动痛有较好的疗效,且副作用少。     

地佐辛对老年胸腔镜手术患者围拔管期反应的影响

目的 对比观察地佐辛与舒芬太尼对老年胸腔镜手术患者围拔管期反应的影响。方法 60例胸腔镜切除术老年患者随机分为D1、D2和SF三组，手术结束前15min，D1组和D2组分别静脉注射地佐辛0.1mg/kg和0.15mg/kg，SF组静脉注射舒芬太尼0.1μg/kg。在围拔管期，观察血压、心率、睁眼时间、拔管时间和定向力恢复时间；记录拔管后疼痛、躁动评分、需要再次镇痛的例数、不良反应和动脉血气分析等。结果 三组患者在拔管时血流动力学、烦躁评分、疼痛评分无明显差异(p>0.05)；与D1组相比，SF组患者拔管后SpO2明显降低(p<0.05)，三组拔管后PaO2、PaCO2无明显差异(p>0.05)。结论 与舒芬太尼相比,地佐辛抑制老年胸腔镜手术患者围拔管期的不良反应效果相当。     

Pharmacokinetics of Human Cerebral Opioid Extraction: A Comparative Study on Sufentanil, Fentanyl, and Alfentanil in a Patient after Severe Head Injury

Background: The pharmacodynamic differences in time to onset and dissipation of effect of sufentanil, fentanyl, and alfentanil probably result from different rates of blood-brain equilibration. The authors investigated this hypothesis in humans.

Methods: After simultaneous central venous bolus application of sufentanil (10 [mu]g), fentanyl (100 [mu]g), and alfentanil (1,000 [mu]g), arterial and jugular bulb blood samples were drawn simultaneously at 20, 30, 45, 60, 75, 90, 105, 120, 140, 160, 180, 210, 240, 300, 360, and 420 s from 19 patients during the postacute stage of head injury with normal intracranial pressure, cerebral perfusion pressure, and cerebral oxygen metabolism during normocapnia.

Results: Peak brain concentration, indicated by equilibrium between arterial and jugular bulb opioid concentrations, was achieved for alfentanil at 45 s, for sufentanil at 5 min, and for fentanyl at 6 min. The corresponding median time intervals (fifth and ninety-fifth percentiles) to reach 50% of peak brain concentration were 15 (14-18), 25 (18-38) and 35 (25-45) s, respectively. Uptake was highest 20 s after bolus and decreased continuously for fentanyl and sufentanil, whereas alfentanil uptake was biphasic. The ratio of the relative amounts of sufentanil, fentanyl, and alfentanil retained in the brain at peak brain concentration was 1x:x6x:x90.     

帕瑞昔布钠复合吗啡与地佐辛复合氟比洛芬酯用于结肠癌患者术后镇痛效果比较

目的比较帕瑞昔布钠复合吗啡与氟比洛芬酯复合地佐辛用于结肠癌手术患者自控静脉镇痛（PCIA）的效果,探讨合适的镇痛方案。 方法选择ASAⅠ-Ⅱ择期行结肠癌手术的患者90例,随机分为帕瑞昔布钠组（P组）、地佐辛组（D组）和芬太尼组（F组）,每组各30例。3组患者均采用气管内插管全身麻醉,术后行PCIA。PCIA设置背景剂量2ml/h,按压剂量2ml/次,锁定时间15min。P组于气管插管前静脉注射帕瑞昔布钠40mg,并于术后12、24、36、48 h静注帕瑞昔布钠40mg,PCIA使用吗啡20 mg+0.9%氯化钠溶液至100ml;D组于气管插管前静脉注射地佐辛5mg,PCIA使用地佐辛30 mg+氟比洛芬酯200mg+0.9%氯化钠溶液至100 ml;F组PCIA使用芬太尼1.0mg+0.9%氯化钠溶液至100 ml。观察3组患者术后30min（T_30min）、2h（T_2h）、4h（T_4h）、12h（T_12h）、24h（T_24h）、48h（T_48h）VAS镇痛评分、Ramsay镇静评分及不良反应的情况;术后48h记录PCIA泵按压次数及患者总体满意度。 结果P组及D组在T_30min-T_12h时点VAS评分显著低于F组（P﹤0.05）;T_30min-T_4h时点,P组Ramsay评分显著低于D组和F组（P﹤0.05）;术后48h内P组、D组患者头晕发生率显著低于F组（P﹤0.05）。 结论帕瑞昔布钠复合吗啡、地佐辛复合氟比洛芬酯用于结肠癌患者术后的镇痛效果确切,不良反应发生率低。