肛肠手术后奈福泮和曲马朵患者自控静脉镇痛效果比较

目的 对比观察肛肠手术后奈福泮和曲马朵患者自控静脉镇痛的效果.方法 ASA Ⅰ～Ⅱ级60例择期骶管阻滞下行肛肠手术的患者,随机分为N组(奈福泮组)30例、T组(曲马朵组)30例,骶管阻滞用药含0.5%罗哌卡因.手术结束时开启静脉自控镇痛泵,N组给奈福泮160mg 格拉司琼3mg,T组给曲马朵800mg 格拉司琼3mg,均稀释至100ml,背景量2ml/h,自控剂量0.5ml/次,锁定时间20min.术后48h内应用疼痛视觉模拟评分(VAS)对两组患者进行镇痛效果评估,并记录不良反应.结果 两组患者的术后疼痛明显减轻(VAS均<3),镇痛效果无统计学差异,N组患者的不良反应明显少于T组.结论 奈福泮与曲马朵的肛肠术后镇痛效果相近,但前者不良反应明显少.     

舒芬太尼、奈福泮用于全麻术后静脉镇痛临床应用

目的 观察舒芬太尼、奈福泮在全麻术后病人自控静脉镇痛中的效果.方法 选择80例择期全麻手术患者,均分为二组.A组术后镇痛采用舒芬太尼150mg+奈福泮80mg+阿扎司琼4mg用生理盐水稀释至100ml.B组术后镇痛采用芬太尼1mg+曲马多300mg+阿扎司琼4mg用生理盐水稀释至100ml.观察全麻术后4h、8h、12h、24h、48h病人各项生理指标及疼痛评分、恶心呕吐分级及不良反应.结果 A组术后4h、8h、12h、24h、48h痛疼评分均低于B组各相应阶段(P<0.05).A组与B组不良反应及生命体征比较,差异无显著变化.结论 舒芬太尼、奈福泮用于全麻术后自控静脉镇痛疗效确切、安全可靠.     

奈福泮复合曲马多术后静脉镇痛的临床应用

目的:研究奈福泮复合曲马多术后静脉镇痛的临床效果。方法:40例ASAⅠ～Ⅱ级泌尿系手术患者,随机分为两组,A组曲马多800 mg加氟哌啶5 mg,B组曲马多400 mg加奈福泮80 mg和氟哌啶5 mg,两组均以生理盐水稀释到100 ml,按2 ml/h速度使用一次性静脉持续镇痛泵镇痛48 h,比较两组镇痛效果,以及恶心、呕吐、皮肤瘙痒、尿潴留、嗜睡、呼吸抑制等并发症的发生率。结果:两组患者术后48 h镇痛效果均满意,视觉模拟评分VAS差异无显著性,但B组术后恶心、呕吐、皮肤瘙痒、尿潴留、嗜睡发生率显著低于A组(P<0.01)。结论:奈福泮复合曲马多术后静脉镇痛安全有效,可减少曲马多用量及其不良反应的发生。     

奈福泮复合曲马多在术后静脉镇痛中的应用

目的：观察静脉给予奈福泮复合曲马多和曲马多术后镇痛的临床效果及不良反应。方法：ASAI-II级60例手术患者,随机分为奈福泮复合曲马多组（Ⅰ组）和曲马多组（Ⅱ组）各30例,Ⅰ组奈福泮100mg＋曲马多400mg＋生理盐水稀释至80ml;Ⅱ组曲马多800mg＋生理盐水稀释至80ml,2ml/h持续静注。48小时最大用量奈福泮200mg或曲马多800mg。手术结束前5-10分钟给予负荷剂量后接镇痛泵,进行持续静脉镇痛,采用视觉模拟评分法（VAS）对镇痛效果进行评定,统计不良反应发生情况。结果：VAS评分组间比较差异无统计学意义（P〉0.05）,但不良反应发生率Ⅱ组明显高于Ⅰ组（P〈0.05）。结论：奈福泮与曲马多联合用于手术后镇痛,效果与单独使用曲马多相当,但不良反应发生率明显降低,两种药物联合应用更为安全。     

奈福泮复合曲马多术后静脉镇痛的临床应用

目的：研究奈福泮复合曲马多术后静脉镇痛的临床效果。方法：40例ASAⅠ～Ⅱ级泌尿系手术患者,随机分为两组,A组曲马多800 mg加氟哌啶5 mg,B组曲马多400 mg加奈福泮80 mg和氟哌啶5 mg,两组均以生理盐水稀释到100 ml,按2 ml/h速度使用一次性静脉持续镇痛泵镇痛48 h,比较两组镇痛效果,以及恶心、呕吐、皮肤瘙痒、尿潴留、嗜睡、呼吸抑制等并发症的发生率。结果：两组患者术后48 h镇痛效果均满意,视觉模拟评分VAS差异无显著性,但B组术后恶心、呕吐、皮肤瘙痒、尿潴留、嗜睡发生率显著低于A组（P〈0.01）。结论：奈福泮复合曲马多术后静脉镇痛安全有效,可减少曲马多用量及其不良反应的发生。     

舒芬太尼和芬太尼用于下肢骨科手术静脉自控镇痛的对比研究

目的 比较等效剂量国产舒芬太尼和芬太尼复合盐酸奈福泮用于下肢骨科手术患者静脉自控镇痛(PCIA)的效果及不良反应.方法 选择ASAⅠ～Ⅱ级,年龄20～60岁,择期全麻下肢骨科手术患者60例,随机分为舒芬太尼组(S组)和芬太尼组(F组)各30例.术毕即接电子泵行PCIA.S组:舒芬太尼100μg、奈福泮100mg、格拉斯琼3mg、生理盐水稀释至100ml;F组:芬太尼1mg、奈福泮100mg、格拉斯琼3mg、生理盐水稀释至100ml.背景剂量1.5ml/h,PCA剂量1.0ml,锁定时间15min.记录术后4,12,24,48h的血压、心率、呼吸频率、SpO2;静息及活动时的疼痛评分(VAS法);镇痛、恶心、呕吐评分及尿潴留、皮肤瘙痒、呼吸抑制等不良反应的发生情况;记录患者PCA总按压次数;记录患者镇痛满意评分及其它镇痛药物的情况及其剂量和次数.结果 术后血压、心率、呼吸频率、SpO2在两组比较差异无统计学意义(P＞0.05).S组术后4,12,24,48h的VAS评分均明显低于F组(P＜0.01).镇静评分在两组间比较差异无统计学意义(P＞0.05).S组术后恶心及呕吐者明显少于F组(P＜0.05).术后4,12,24h时间点S组的按压次数明显少于F组(P＜0.05).S组术后镇痛满意度评分明显优于F组(P＜0.05).结论 国产舒芬太尼复合奈福泮用于下肢骨科手术静脉自控镇痛,其效果优于芬太尼复合奈福泮静脉自控镇痛,无明显不良反应.     

氟比洛芬酯用于微血管减压术术后镇痛疗效的观察

目的 观察微血管减压术后患者自控静脉镇痛中应用氟比洛芬酯脂微球载体注射液的镇痛效果与不良反应.方法 选择ASAⅠ～Ⅱ级微血管减压术后行自控静脉镇痛的患者80例,随机分为4组.A组镇痛泵中给予芬太尼0.5mg+氟比洛芬酯100mg+生理盐水稀释至100ml,B组关硬膜前静脉给予氟比洛芬酯50mg,镇痛泵中芬太尼0.5mg+氟比洛芬酯100mg+生理盐水稀释至100ml, C组镇痛泵中芬太尼1mg+昂丹司琼16mg+生理盐水稀释至100ml,D组镇痛泵中曲马多800mg+昂丹司琼16mg+生理盐水稀释至100ml.四组均于术毕前1小时静脉给予昂丹司琼8mg.观察四组术后0、2、6、12、24h的镇痛评分、镇静评分和不良反应发生率.结果 四组术后24h内镇痛评分各时间点相比,B组明显优于A组,A组明显优于C组,C组明显优于D组;镇静评分各组间无显著差异;不良反应发生率中以恶心呕吐发生率最高,D组较其他各组更具显著差异.A组和B组不良反应发生率明显低于C组和D组.结论 氟比洛芬酯可安全应用于微血管减压术的术后镇痛,具有超前镇痛、镇痛效果好的特点,不良反应发生率明显低于单纯应用芬太尼或曲马多进行术后镇痛.     

剖宫产术后不同镇痛模式的应用比较

目的:比较剖宫产术后不同镇痛模式的镇痛效果和不良反应。方法:选择在我院择期行剖宫产的产妇60例,随机分为静脉曲马多组(T组)及硬膜外吗啡组(M组)。T组镇痛泵药液包含曲马多15mg/ml+格拉司琼0.06mg/ml,M组镇痛泵药液包含吗啡0.1mg/ml+布比卡因1.12mg/ml+格拉司琼0.06mg/ml。两组镇痛泵药液总量均为100ml。比较两种镇痛方式术后6h、12h、24h、48h四个时间点的躯体痛(静息疼痛及运动疼痛)、宫缩痛VAS评分、Ramsay镇静评分,两组患者术中、术后镇痛满意度、不良反应(包括寒战、恶心、呕吐、头晕、瘙痒)发生情况。结果:两组患者术后躯体疼痛VAS评分比较差异无统计学意义(P>0.05);术后各时间点T组宫缩疼痛VAS评分均低于M组(P<0.05),两组Ramsay评分差异无统计学意义(P>0.05)。T组的寒战、瘙痒发生率明显低于M组(P<0.05),产妇满意度高于M组(P<0.05)。结论:静脉使用曲马多用于剖宫产术后镇痛可以产生满意的镇痛效果,不良反应发生率低,产妇满意度高。     

氯诺昔康复合芬太尼用于乳腺癌根治术后静脉镇痛的观察

目的: 评价氯诺昔康复合小剂量芬太尼用于乳腺癌根治术后静脉自控镇痛(PICA)中的疗效与不良反应。方法: 选择ASAⅠ~Ⅱ级的乳腺癌根治术患者80例,随机分为两组,每组40例,氯诺昔康复合小剂量芬太尼组(L组)镇痛液为氯诺昔康56 mg、芬太尼0.3 mg加格拉斯琼3 mg,用生理盐水稀释至100 ml。曲马多组(T组)镇痛液为曲马多800 mg加格拉斯琼3 mg,用生理盐水稀释至100 ml。缝皮前给负荷量,L组为氯诺昔康8 mg,T组为曲马多100 mg(静脉滴注)后接镇痛泵,术后4 h、8 h、12 h、24 h和48 h观察并记录疼痛评分、镇静评分和副作用发生情况。结果: 两组间疼痛和镇静评分均无统计学意义(P>0.05)。恶心、呕吐和头晕副作用发生率L组均低于T组(P<0.01~P<0.05)。结论: 氯诺昔康复合小剂量芬太尼用于乳癌根治术后镇痛安全有效,且副作用小于曲马多。     

奈福泮复合舒芬太尼用于妇科手术后静脉镇痛的疗效观察

目的观察奈福泮复合舒芬太尼用于妇科手术患者术后静脉镇痛的临床效果及不良反应。方法60例ASAⅠ～Ⅱ级择期妇科手术患者,随机分为3组,每组20例。奈福泮组（N组）为奈福泮2mg·ml^-1;舒芬太尼组（S组）为舒芬太尼1．2μg·ml^-1;奈福泮复合舒芬太尼组（N＋S组）为奈福泮1mg·ml^-1与舒芬太尼0．6μg·ml^-1。三组均以生理盐水稀释到100ml,按2．0ml／h速度使用一次性镇痛泵经静脉持续镇痛48h。比较3组镇痛、镇静效果,以及不良反应。结果S组、N＋S组患者术后4h、8h、24h、48h镇痛效果优于N组,但N＋S组、N组术后恶心、呕吐等不良反应的发生率显著低于S组（P〈0．05或P〈0．01）。结论奈福泮复合舒芬太尼术后静脉镇痛是安全有效的,并且可以减少舒芬太尼的用量及其不良反应。     

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…     

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.     

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.     

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.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…