氟比洛芬酯和曲马多超前镇痛用于腹腔镜胆囊切除术的临床比较

目的 比较研究氟比洛芬酯和曲马多超前镇痛用于腹腔镜胆囊切除术的效果及不良反应.方法 择期行腹腔镜胆囊切除手术患者42例,随机分为氟比洛芬酯组(A组)、曲马多组(B组)及氯化钠溶液对照组(C组),每组各14例.术前10 min,A组静脉注射氟比洛芬酯50 mg,B组静脉注射曲马多100 mg,C组静脉注射氯化钠溶液5ml.术后随访24 h,记录生命体征、疼痛程度和恶心呕吐情况.结果 各时间点3组患者的生命体止差异无统计学意义;A组与B组各时间点视觉模拟评分(VAS)差异无统计学意义,但两组分别与C组比较VAS评分均显著降低(P<0.05);B组与A、C组比较,术后恶心呕吐(PONV)的发生率明显升高(P<0.05).结论 氟比洛芬酯和曲马多超前镇痛应用于腹腔镜胆囊切除术,能明显减缓术后疼痛,氟比洛芬酯与曲马多相比恶心呕吐的不良反应小,因而更具优势.     

氟比洛芬酯对腹腔镜下胆囊切除术超前镇痛的临床研究

目的 比较氟比洛芬酯超前镇痛的临床镇痛效应.方法 腹腔镜下胆囊切除术患者64例,随机分为两组,即全身麻醉组(对照组)和全身麻醉后使用氟比洛芬酯100 mg进行超前镇痛组(氟比洛芬酯组).分别记录术后2、4、8、16、24 h的视觉模拟评分(VAS),观察术前、术后血小板计数、出凝血时间和凝血酶原时间以及不良反应的发生情况.结果 术后2 h时对照组的VAS显著高于氟比洛芬酯组(P《0.05),而4、8、16、24 h的VAS两组间比较差异无统计学意义(P》0.05).不良反应的发生率两组差异无统计学意义(P》0.05).术后的血小板计数、出凝血时间和凝血酶原时间差异无统计学意义(P》0.05).结论 氟比洛芬酯超前镇痛的全身麻醉患者术后疼痛显著缓和,不延长出凝血时间和凝血酶原时间,芬太尼用晕均等的条件下不良反应发生率差异无统计学意义.     

氟比洛芬酯用于全凭静脉麻醉下腹腔镜胆囊切除术后的镇痛效果

目的:观察不同剂量氟比洛芬酯用于全凭静脉麻醉下腹腔镜胆囊切除术后的镇痛效果和安全性。方法:将60例在全凭静脉麻醉下择期行腹腔镜胆囊切除术患者随机分为A1组(术后给予氟比洛芬酯2mg/kg,n=20)、A2组(术后给予氟比洛芬酯1mg/kg,n=20)、C组(对照组,给予生理盐水10mL,n=20)。3组均在术后患者意识恢复、VAS评分达7分时给药,记录给药后不同时间点的镇痛效果和常见不良反应的发生率。结果:A1、A2组VAS评分在12、15、20、30min和1、4、8、12、24h均显著低于C组(P<0.05),A1组VAS评分在9、12、15、20、30min和1、4、8h均显著低于A2组(P<0.05);术后因镇痛不全需哌替啶A1、A2组显著少于C组(P<0.05)3组患者不良反应的发生率无统计学意义(P>0.05)。结论:氟比洛芬酯可安全地用于腹腔镜下胆囊切除术术后静脉镇痛,尤其给予2mg/kg氟比洛芬酯具有起效时间短、镇痛效果强且完全、持续时间长和副作用未增加的优点。     

氟比洛芬酯注射液用于腹腔镜下胆囊切除术的术后镇痛观察

目的：观察患者应用氟比洛芬酯注射液对腹腔镜下胆囊切除术的预先镇痛作用和术后镇痛效果。方法：根据是否使用氟比洛芬酯，将腹腔镜下胆囊切除术的40名患者随机分为两组进行比较。Ⅰ组：全身麻醉组（全麻组），Ⅱ组：使用氟比洛芬醋50mg进行前处理的全身麻醉组（氟比洛芬酯组）。根据术后患者要求使用镇痛药的平均时间评价氟比洛芬酯的术后镇痛效果。结果：两组患者要求使用镇痛药的平均时间分别是3．8小时和22．5小时。氟比洛芬酯组显著长于全麻组，具有统计学意义，并且接受氟比洛芬酯前处理的全身麻醉患者术后疼痛显著缓和。结论：使用氟比洛芬酯50mg进行预先镇痛会明显缓和腹腔下胆囊切除的术后疼痛。     

氟比洛芬酯用于全凭静脉麻醉下胆囊切除术后的镇痛效果

目的 观察不同剂量氟比洛芬酯用于全凭静脉麻醉下腹腔镜胆囊切除术后的镇痛效果和安全性。方法 采用完全随机设计方法将病例分为A1组（术后给予氟比洛芬酯2mg/kg）、A2组（术后给予氟比洛芬酯1mg/kg）、C组(对照组：生理盐水10ml)。三组均在术后病人意识恢复、VAS评分达7分时给药，记录给药后不同时间点的镇痛效果和常见不良反应的发生率。 结果 A1、A2组VAS评分在12min、15min、20min、30min、1h、4h、8h、12h、24h均显著低于C组（P＜0.05），A1组VAS评分在9min、12min、15min、20min、30min、1h、4h、8h均显著低于A2组（P＜0.05）；术后因镇痛不全需哌替啶A1、A2组显著低于C组（P＜0.05）；三组患者不良反应的发生率无统计学意义（P＞0.05）。 结论 氟比洛芬酯可安全地用于腹腔镜下胆囊切除术术后静脉镇痛，尤其给于2mg／kg氟比洛芬酯具有起效时间短、镇痛效果强且完全、持续时间长和副作用未增加的优点。     

氟比洛芬酯复合芬太尼用于胆囊术后镇痛的观察

目的比较氟比洛芬酯复合芬太尼与单纯芬太尼术后静脉镇痛的临床效果。方法择期行胆囊切除术患者50例,术毕按随机数字表法分为2组进行自控静脉镇痛：对照组（n=25）芬太尼1.2 mg＋生理盐水共100 mL;研究组（n=25）氟比洛芬酯100 mg＋芬太尼0.6 mg＋生理盐水共100 mL。记录术后24 h内镇痛评分（VAS）、镇静评分（SS）及不良反应。结果 2组VAS评分、24 h用药量、皮肤瘙痒发生率比较差异无统计学意义（P〉0.05）,对照组SS评分和恶心呕吐的发生率明显高于研究组（P〈0.05）。结论氟比洛芬酯复合芬太尼用于胆囊术后镇痛效果良好,可明显减少芬太尼不良反应。     

氟比洛芬酯用于淋巴静脉吻合术术后镇痛效果的观察

目的探讨氟比洛芬酯用于原发性淋巴水肿淋巴静脉吻合术患者术后镇痛效果。方法选择全麻下淋巴静脉吻合术A组和甲状腺肿物切除术患者B组各30例,手术结束前10-20min静注氟比洛芬酯100mg。观察术后1、2、6、12h和24h的VAS评分、镇痛药的补救措施和术后不良反应。结果与A组相比,B组术后1和2hVAS评分具有统计学差异(P0.05),6h、12h和24hVAS评分无统计学差异(P0.05);两组发生不良反应无统计学差异。结论淋巴静脉吻合术患者使用氟比洛芬酯不能取得较好的术后镇痛效果。     

氟比洛芬脂超前镇痛对腹腔镜胆囊切除术术后疼痛的观察

目的:观察氟比洛芬酯超前镇痛对腹腔镜胆囊手术术后疼痛的有效性和安全性。方法:60例腹腔镜胆囊切除患者随机分为A、B、C三组,每组各为20例,均采取气管内全麻。A组(n=20)在全麻诱导后手术切皮前术前静注氟比洛芬酯50 mg(用生理盐水稀释至10 mL);B组(n=20)在手术结束气管拔管后静注氟比洛芬酯50 mg(稀释法同A组);C组(n=20)为对照组,在诱导后和手术结束时分别前静注生理盐水10 mL。术后用视觉模拟评分法(VAS)评估患者术后0.5、1、62、4 h的疼痛感觉程度,并观察各组苏醒期躁动、术后咽喉部疼痛不适及恶心、呕吐等不良反应发生情况。结果:A组病人术后24 hVAS评分明显低于C组(P<0.05),A组苏醒期躁动和咽喉部疼痛发生率低于B、C两组(P<0.05),三组的恶心、呕吐不良反应发情况差异无显著意义。结论:氟比洛芬酯超前镇痛可有效地运用于腹腔镜胆囊手术患者术后疼痛。     

氟比洛芬酯超前镇痛用于显微支撑喉镜下成人声带息肉摘除术的临床观察

目的 观察氟比洛芬酯注射液(凯纷)超前镇痛用于显微支撑喉镜下成人声带息肉摘除术的镇痛效果及安全性.方法 择期行声带息肉摘除患者50例,随机分为氟比洛芬酯组(F组,n=25)和对照组(C组,n=25),F组于麻醉诱导前缓慢静注氟比洛芬酯1 mg/kg(用生理盐水稀释至10 ml),C组以生理盐水10 ml缓慢静入注,注药时间均为2 min.观察术后1、2、4、8、12、24 h疼痛评分;凝血功能异常及恶心、呕吐等不良反应.结果 F组术后各时点疼痛评分明显低于C组(P<0.05).两组各时点均无呼吸抑制、凝血功能异常发生,两组术后恶心、呕吐等不良反应发生率差异无统计学意义(P>0.05).结论 氟比洛芬酯超前镇痛能有效减轻显微支撑喉镜下声带息肉摘除术患者术后急性疼痛,且无明显不良反应,可安全用于术后镇痛.     

氟比洛芬酯超前镇痛对妇产科病人术后芬太尼镇痛的影响

目的:观察氟比洛芬酯超前镇痛对妇产科病人术后自控静脉镇痛(PCIA)芬太尼用量的影响。方法:38例妇产科手术病人,随机分成观察组和对照组,观察组于手术前5min静脉注射氟比洛芬酯50mg,术毕两组均采用芬太尼加氟哌利多镇痛配方行PCIA,镇痛期间定时行视觉模拟镇痛评分(VAS)。结果:两组病人镇痛效果相似,VAS比较差异无统计学意义(P>0.05);观察组24h内芬太尼用药量明显少于对照组(P<0.05),病人无不良反应。结论:氟比洛芬酯超前镇痛能明显减少妇产科手术患者PCIA期间芬太尼用药量及不良反应发生率。     

ON THE PHYSICOCHEMICAL REGULATION OF THE GROWTH OF TISSUES : THE EFFECTS OF THE DILUTION OF THE MEDIUM ON THE GROWTH OF THE SPLEEN.

It may be concluded that the degree of dilution of the culture medium has a marked influence on the rate of growth of splenic tissue. The maximum acceleration was obtained in a medium composed of three volumes of normal plasma and two volumes of distilled water. The growth in this hypotonic plasma was very much larger than in normal plasma. On the contrary, the growth of the spleen in hypertonic plasma was always less than in normal plasma. In other experiments, we found that in diluted plasma there was also an acceleration of the growth of the skin, the heart, and the liver of chickens. The skin of adult frogs also grew more actively in this plasma. The optimum degree of dilution varied according to the nature of the tissues and to the species of the animals. While the plasma containing two fifths distilled water produced the largest growth of splenic tissue, a slightly less diluted medium was more favorable for the liver and the heart, and generally for the skin also. The action of hypertonic plasma varied also in a large measure. While the spleen did not grow at all in the medium containing 0.0124 and 0.0144 sodium chlorid, the skin, on the other hand, could stand a high concentration of the sodium chlorid. Even its growth was activated in media containing 0.0094 and 0.0124 sodium chlorid and was greater than with normal plasma. The spleen of kittens was very easily affected by the changes of the dilution of the plasma, while the skin of the frog presented its best growth in plasma containing one half distilled water. Marked variations in the sensitiveness of tissues to hypertonic and hypotonic media will probably be observed in animals of different species. From these experiments, three conclusions can be drawn: namely, that certain laws of growth, discovered by Loeb, in lower organisms are true also for higher organisms; that normal plasma is not the optimum medium for the growth of tissue; and that each tissue has probably its optimum medium. The growth of the spleen is, without doubt, considerably modified by the variations of the dilution and perhaps of the osmotic tension of the plasma. It is possible then that the influence of osmotic tension, discovered by Loeb, in the growth of certain organisms, is a general law applicable as well to higher forms of life— frogs, cats, and chickens—as to lower organisms—tubularia and sea-urchins. In placing tubularia in different dilutions of sea-water and distilled water, Loeb found that the greatest rate of regeneration was observed when two volumes of distilled water were added to three volumes of sea-water. But fertilized eggs of sea-urchins were more sensitive to the action of hypertonic plasma, and they all died in a dilution of sea-water with two fifths distilled water. If only one fifth distilled water was added to the sea-water they developed normally. We found that the cells of certain tissues of the chicken follow a similar rule, since the maximal growth of the spleen is obtained in plasma containing two fifths distilled water, while other tissues grow better in a less hypotonic medium. Normal plasma is certainly not the ideal medium for the growth of tissues, since slight modifications of the tension, the alkalinity, or the addition of certain inorganic salts to normal plasma, increase the rate of the growth of tissues.     

THE EXTENT OF THE CAPILLARY BED OF THE HEART

By means of injections made into the coronary arteries of beating hearts it has been possible to determine the number of capillaries in the normal heart muscle. This study has shown a very rich blood supply with an average of approximately one capillary for each muscle fibre in the ventricular walls and papillary muscles, and a less abundant supply in the auricular muscle and Purkinje system. The number of capillaries per sq. mm. of ventricular wall or papillary muscle is about twice that found by Krogh in skeletal muscle. Capillaries were not found constantly in the valves of hearts in which there was apparently a complete injection of the capillary bed. The method described for injecting the capillaries of the heart also provides a means of studying the blood supply to the muscle, valves and aortic wall in pathological hearts.     

THE STRUCTURE AND DIFFERENTIATION OF THE SPECIFIC CELLULAR ELEMENTS OF THE PARS INTERMEDIA OF THE HYPOPHYSIS OF THE DOMESTIC PIG

The bearing of these results on the Herring-Cushing theory of pituitary secretion is apparent. For the first time a true secretion antecedent has been demonstrated in the cells of the pars intermedia, an antecedent which appears in the cells at the same period of development at which active pressor effects may be obtained from the gland extracts. The route of export of this material from the gland to its point of utilization, however, is unknown; it may go by way of the blood or, as required by the Herring theory, by the transneural route to the third ventricle. The objections to the latter conclusion have been amply expanded in the introduction to this paper, but here may be emphasized the fact that the fetal pig hypophysis contains no hyaline bodies. Indeed they are rare in the adult, though there may be seen in the cells of the pars nervosa in the processes of its intrinsic cells, granular deposits which we believe to be the antecedents of the hyaline bodies but which in the pig rarely are discharged and aggregated into discrete masses as in other mammals. The fact that some observers have obtained positive pressor effects from the nervous part of the posterior lobe, exclusive of the pars intermedia, need not weigh very heavily in attempting to trace the course of the secretion, when we reflect that the difficulties of making such a mechanical separation are almost insuperable, and that the chemical product of the pars intermedia is so soluble and vanishes from the cells so rapidly that it may well be diffusible through the thin membranes which intervene and penetrate post mortem into adjacent parts. We are inclined, therefore, to the view that the secretion leaves the gland by the vascular route rather than by way of the interfibrillar spaces of the pars nervosa.     

THE PATHOGENESIS OF THE HEMORRHAGIC DISEASES OF THE NEW-BORN

Those conditions of the new-born characterized by a hemorrhagic tendency, icterus, and fatty changes, are probably all syndromes which may occur as the result of a number of toxic agents. All of them, however, have been produced, in these experiments, by the action of a single experimental agent. Thus, a picture indistinguishable from that called Buhl''s disease has been obtained by the use of chloroform, as have also the pictures known as Winckel''s disease, melæna neonatorum, etc. Chloroform is not held to be the only substance that has this power. It stands rather as one member of a group of agents, the effects of which in general and in individual organs are similar to those caused by lack of oxygen. The essential features of these conditions have also been produced by direct asphyxiation of the fetus. The suggestion is therefore made that underlying all these symptoms and pathological complexes, there is a deficiency of oxidation, general, local, or selective, thus bringing this group of diseases into the general category of acute yellow atrophy of the liver, eclampsia, pernicious vomiting, cyclic vomiting, phosphorus poisoning, etc. In human beings, chloroform and asphyxia must, in many instances, be the determining causes. There remain, however, other cases in which different factors are to be sought.     

THE INFLUENCE UPON THE SPLEEN AND THE THYROID OF THE COMPLETE REMOVAL OF THE EXTERNAL FUNCTION OF THE PANCREAS

The complete removal of the function of the pancreas concerned in digestion is followed by marked changes in the spleen and in the thyroid apparatus. Second, the spleen shows an extreme simple atrophy. Third, the thyroid apparatus exhibits a constant change shown by the macroscopic transparency of the gland, by the microscopic increase in the amount of colloid, by the chemical increase of the iodine content of the gland, and by the functional test of the delayed appearance of tetany after the complete removal of the thyroid apparatus.     

THE INDUCED SUSCEPTIBILITY OF THE GUINEA-PIG TO THE TOXIC ACTION OF THE BLOOD SERUM OF THE HORSE

Following the divisions before used, the results presented in the preceding pages may be briefly stated. I. The particular method of sensitization and the place where the test injection is made have an important bearing on the results obtained by various workers. Comparing the results obtained by the various methods, we may conclude that the incubation period of the hypersensitive reaction is not sharply limited, but that there is a progressive increase in sensitiveness from the sixth day, and presumably before that, extending over a period of several weeks. It seems very probable that the degree of hypersensitiveness attained where the sensitizing dose consists of a mixture of diphtheria toxin and serum is greater than when a single dose of the same small quantity of serum is given alone. II. Our early experiments, the first in this field, are in thorough agreement with those first reported by Otto, and shortly after him by Rosenau and Anderson. III. This hypersensitive reaction is transmissible from mother to offspring. The transmission is probably not equally effective in all cases, and individual young guinea-pigs probably vary greatly in the rate with which they lose their ability to react. As a result not all of the young of a hypersensitive mother react to a subcutaneous dose of five cubic centimeters of serum given when they are four or five weeks old. The reaction in the young animals differs quite markedly from that in those actively sensitized. These differences are such as to indicate that in the mother there is a considerable localization of the reaction in tissues and organs whose destruction does not cause sudden death. This local reaction is a protective factor and is not transmitted to the same degree as the factors involved in the fatal acute reaction. IV. The hypersensitive reaction to horse serum depends on the development of a special anti-body during the incubation period, which anti-body may be passively transferred to a fresh animal. If the dose of hypersensitive serum be sufficient, and the intoxicating injection be given directly into the circulation, this passive hypersensitiveness may be enough so that the animal will die when tested. There is also in the serum of hypersensitive guinea-pigs an uneliminated horse serum element or "rest," which is distinct from this antibody, and probably without influence on the course of the acute reaction. V. The anti-body on which the hypersensitive reaction depends may be entirely neutralized by horse serum without causing symptoms. The gradual introduction of increasing doses over a total period of twenty-four hours suffices for this. The animal is then, properly speaking, neither immune nor refractory, but is essentially in the condition of a normal animal which has recently had a large dose of horse serum. This rapid neutralization is made possible by the great binding power which the subcutaneous and other relatively unimportant tissues have for the toxic element of the serum. The so-called "Phenomenon of Arthus" is probably the same reaction for the rabbit that we have here dealt with in the guinea-pig. The fact that the manifestation is more prominently a local one depends on racial differences. I have encountered cases in the guinea-pig in which the conditions in the rabbit are closely simulated.