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1.
目的探讨适合剖宫产术后镇痛的理想方案。方法360例孕妇需剖宫产者分为静脉镇痛组和硬膜外镇痛组(吗啡组、芬太尼组),每组120例。静脉镇痛组(I组):芬太尼0.8mg+氟哌利多2.5mg+生理盐水(NS)至100ml,2ml/h;硬膜外镇痛组(芬太尼组)(Ⅱ组):芬太尼0.8mg+0.75%左旋布比卡因10ml+NS至100ml,2ml/h;硬膜外镇痛组(吗啡组)(Ⅲ组):吗啡6mg+0.75%左旋布比卡因10ml+盐酸异丙嗪12、5mg+NS至60ml,1ml/h,手术结束前10min硬膜外腔给饱和量(吗啡1,5mg+盐酸异丙嗪5mg+NS至10ml,根据产妇情况一次注入7~10ml)。结果各组镇痛效果差异明显,硬膜外镇痛吗啡组〉硬膜外镇痛芬太尼组〉静脉镇痛组,副作用发生率Ⅰ组稍高于Ⅱ组,Ⅱ组稍高于Ⅲ组(P〈0.05),皮肤瘙痒发生率Ⅲ组稍大于Ⅰ、Ⅱ组(P〉0.05),锥体外系发生率Ⅰ组大于Ⅱ、Ⅲ组(P〈0.05)。结论硬膜外吗啡镇痛组效果优良,吾4作用发生率低,易被产妇接受,适宜剖宫产术后镇痛。  相似文献   

2.
杜海靖  刘明基 《海南医学》2005,16(10):99-100
目的 观察吗啡、芬太尼复合布比卡因行蛛网膜下腔阻滞在剖腹产手术术后镇痛的效果和副作用的发生率。方法 120例ASAⅠ~Ⅱ剖腹产手术病人,随机分3组,A组0.75%布比卡因1.6ml,B组吗啡0.3mg+0.75%布比卡因1.6ml,C组芬太尼25ug+0.75%布比卡因1.6ml均行蛛网膜下腔阻滞。结果 B、C组术后镇痛效果明显优于A组(P〈0.05),C组副作用发生率低于B组(P〈0.05)。结论 吗啡、芬太尼复合布比卡因行蛛网膜下腔阻滞术后均有明显镇痛效果,芬太尼组术后的不良反应发生率要比吗啡少。  相似文献   

3.
目的探讨芬太尼配伍小剂量吗啡用于成人硬膜外术后镇痛的效果。方法将33例择期手术患者随机分3组,组Ⅰ:o.125%盐酸罗哌卡因+0.004%芬太尼。组Ⅱ:0.125%盐酸罗哌卡因+0.006%芬太尼。组Ⅲ:0.125%盐酸罗哌卡因+0.004%芬太尼+0.03%吗啡。术后定时进行镇痛、镇静评分及不良反应的观察。结果镇痛评分组Ⅱ、组Ⅲ明显低于组Ⅰ(P〈0.05),镇静评分组Ⅰ明显低于组Ⅱ、组Ⅲ,不良反应率组Ⅰ、组Ⅲ明显低于组Ⅱ(P〈0.05)。结论芬太尼配伍小剂量吗啡用于成人硬膜外术后镇痛能取得较满意的效果。  相似文献   

4.
目的:比较低浓度甲磺酸罗哌卡因氯化钠注射液(威赛因)复合吗啡、芬太尼术后镇痛对肠蠕动的影响.方法:选择120例择期手术病人,ASA Ⅰ~Ⅱ级,其中妇产科、普通外科各60例.各科手术病人根据不同的镇痛方法随机等分成三组,组Ⅰ:0.178%罗哌卡因+0.005%吗啡+0.005%氟哌利多,组Ⅱ:0.178%罗哌卡囚+0.0005%芬太尼+0.005%氟哌利多,组Ⅲ:对照组.于镇痛治疗后4、8、12、24、36h进行随访,观察疼痛程度、镇静状态、平均动脉压、心率、呼吸频率、脉搏氧饱和度,并记录肠蠕动恢复时间.结果:组Ⅰ与组Ⅱ均取得较好的镇痛效果,VAS评分显著低于组Ⅲ(P<0.01);普通外科病人肠蠕动恢复时间较妇产科病人长(P<0.05);组Ⅱ较组Ⅰ、Ⅲ肠蠕动恢复时间明显缩短(P<0.05).结论:低浓度罗哌卡因复合吗啡、芬太尼行病人术后自控镇痛均能获得良好的效果,且罗哌卡因与芬太尼联用可缩短肠蠕动的恢复时间.  相似文献   

5.
吗啡和芬太尼用于术后镇痛效应与不良反应的临床观察   总被引:3,自引:2,他引:3  
目的 观察吗啡、芬太尼用于患者自控硬膜外镇痛(PCEA)的镇痛效应及不良反应。方法 择期手术患者110例,ASAⅠ~Ⅱ级,随机分为两组,Ⅰ组(n=55例)选用吗啡10mg(1ml)加2%利多卡因和0.75%布比卡因各20ml加生理盐水59ml;Ⅱ组(n=55例)选用芬太尼0.5mg(10ml)(代替Ⅰ组配方中的吗啡)加生理盐水50ml。以LCP模式(负荷剂量5ml加持续剂量2ml/h加PCA每次0.5ml)进行镇痛。结果 Ⅰ组与Ⅱ组镇痛效果差异无统计学意义(P〉0.05);Ⅰ组出现恶心、呕吐、尿潴留、皮肤瘙痒等不良反应发生率较Ⅱ组高(P〈0.01)。结论 吗啡较芬太尼的不良反应更多,应谨慎选用。  相似文献   

6.
吗啡复合布吡卡因在术后病人硬膜外自控镇痛的临床观察   总被引:1,自引:0,他引:1  
目的 观察吗啡在PCEA中的镇痛效应及临床应用价值。方法 选择80例ASAⅠ~Ⅱ级拟在硬膜外麻醉下行下腹部手术的病人,随机分为4组。Ⅰ组为4mg吗啡,75mg布吡卡因;Ⅱ组为0.6mg芬太尼,75mg布吡卡因;Ⅲ组为4mg吗啡;Ⅳ组为75rag布吡卡因。各组均加入咪唑安定5mg,并用生理盐水稀释至100ml。手术结束时各组均给于0.25%的布吡卡因,1mg吗啡混合液10ml作负荷剂量。PCEA方法、持续剂量2ml/h,PCEA剂量0.5ml锁定时间15min,镇痛总时间为48h。观察镇痛效果,并发症及不良反应。结果 Ⅰ、Ⅱ组镇痛效果明显优于Ⅲ、Ⅳ组,Ⅰ、Ⅱ组间无明显差异,不良反应无统计学意义。结论 吗啡复合布吡卡因用于术后病人硬膜外自控镇痛为一种有效的镇痛方法,可以应用于临床。  相似文献   

7.
罗哌卡因复合吗啡、芬太尼术后镇痛对肠蠕动的影响   总被引:8,自引:3,他引:8  
目的比较罗哌卡因复合不同镇痛药物对手术后肠蠕动恢复情况的影响.方法选择180例择期手术病人,ASA Ⅰ,Ⅱ级,其中妇产科、普通外科各90例.各科手术病人根据不同的镇痛方案随机等分成3组,组Ⅰ0.125%罗哌卡因+0.005%吗啡+0.005%氟哌利多,组Ⅱ0.125%罗哌卡因+0.0005%芬太尼+0.005%氟哌利多,组Ⅲ对照组(不实施病人术后自控镇痛).于镇痛治疗后4,8,12,24,36 h进行随访,观察疼痛程度、镇静状态、平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏氧饱和度(SpO2),并记录肠蠕动恢复时间.结果组Ⅰ与组Ⅱ均取得较好的镇痛效果,VAS评分显著低于组Ⅲ(P<0.01);普通外科病人肠蠕动恢复时间较妇产科病人长(P<0.05);组Ⅱ较组Ⅰ、Ⅲ肠蠕动恢复时间明显缩短(P<0.05).结论罗哌卡因复合吗啡、芬太尼行病人术后自控镇痛均能获得良好的效果,且罗哌卡因与芬太尼联用可缩短肠蠕动的恢复时间.  相似文献   

8.
目的:研究剖宫产术后硬膜外镇痛对产妇泌乳及肠蠕动的恢复情况及不良反应。方法:选择AsAⅠ级~Ⅱ级足月产妇60例,年龄在20岁~35岁,随机分为三组,每组20例。Ⅰ组用0.75%布比卡因20ml、吗啡6mg氟哌利多5mg加生理盐水至100ml,以2.0ml/h硬膜外止痛泵输注;Ⅱ组用吗啡1.5mg、氟哌利多2mg0.75%布比卡因2ml加生理盐水至6ml,从硬膜外导管中注入后拨管;Ⅲ组术毕拔管,分别观察镇痛时间、镇痛效果、肠蠕动时间、不良反应发生情况及产妇泌乳时间。结果:Ⅰ组和Ⅱ组镇痛时间明显长于Ⅲ组。产妇泌乳时间、肛门排气时间Ⅰ组和Ⅱ组比Ⅲ组缩短。病人术后不良反应发生率Ⅰ组和Ⅱ组略高于Ⅲ组。结论:剖宫产术联合应用局麻药和阿片类药物在镇痛上具有优越性,且对产妇泌乳时间不产生影响。  相似文献   

9.
目的研究不同剂量舒芬太尼对左旋布比卡因硬膜外病人自控镇痛效应果影响。方法择期全子宫切除术后患者100例,术后行硬膜外自控镇痛(PCEA),ASAⅠ~Ⅱ级,年龄35~60岁;随机分为五组,Ⅰ组:0.125%左旋布比卡因;Ⅱ组:0.125%左旋布比卡因+0.25μg/ml舒芬太尼;Ⅲ组:0.125%左旋布比卡因+0.5μml舒芬太尼;Ⅳ组:0.125%左旋布比卡因+0.75μg/ml;Ⅴ组:0.125%左旋布比卡因+1.0μg/ml舒芬太尼,每组20例。采用视觉模拟评分(VAS)、Ramesay镇静评分、术后运动神经阻滞恢复评分(改良Bromage分级)观察镇痛效果;记录开机后4、8、16、20和24h共5个时点的BP、HR、RR、SpO2以及静息和咳嗽时VAS等数值、恶心和呕吐等不良反应及治疗措施。结果五组病人年龄、体重、ASA分级、手术时间、术中利多卡因用量和手术结束前硬膜外腔最后一次给药时间基本相同(P〉0.05)。与Ⅰ组比较,Ⅲ组、Ⅳ组和Ⅴ组4、8、16、20、24h时间点静息VAS和咳嗽VAS均显著降低(P〈0.05或0.01),Ⅰ组和Ⅱ组组间比较无统计学意义(P〉0.05),Ⅲ组、Ⅳ组和Ⅴ组组间比较无统计学意义(P〉0.05)。与Ⅰ组比较,Ⅲ组、Ⅳ组和Ⅴ组24h内恶心、呕吐及瘙痒等副反应发生率显著增高,Ⅰ组和Ⅱ组组间比较差异无统计学意义,Ⅳ组发生率明显低于Ⅳ、Ⅴ组。与Ⅰ组比较,Ⅲ组、Ⅳ组和Ⅴ组需追加曲马多辅助镇痛病例数减少。各组在4、8、16、20、24h时间点未观察到血压心率异常变化及呼吸抑制,下肢肌力恢复良好,改良Bromage评分均为0级。结论0.5μg/ml舒芬太尼是0.125%左旋布比卡因最佳配伍剂量,镇痛效果好,副反应少,可作为妇科术后病人首选镇痛方案之一。  相似文献   

10.
目的观察3种镇痛模式对原发性高血压患者肛肠术后镇痛及应激反应的效果,寻求更为合理的镇痛方法。方法择期行肛肠科手术的高血压患者60例,随机分为3组:左旋布比卡因局部浸润与可乐定口服组(Ⅰ组);静脉应用芬太尼与可乐定自控镇痛PCIA组(Ⅱ组);硬膜外应用左旋布比卡因与可乐定自控PCEA组(Ⅲ组)。记录VAS评分,同时监测血浆肾上腺素、去甲肾上腺素与血糖。结果三组VAS术后10h内无统计学差异(P〉0.05),其后Ⅰ组评分明显高于Ⅱ组和Ⅲ组(P〈0.05),Ⅱ组评分明显高于Ⅲ组(P〈0.05)。与术前比较,Ⅰ组术后SBP和HR明显升高(P〈0.05),Ⅱ组、Ⅲ组术后SBP和DBP均下降(P〈0.05)。Ⅰ组血中肾上腺素和去甲肾上腺素明显上升(P〈0.05),Ⅱ组和Ⅲ组均显著下降(P〈0.05);与术前比较,Ⅰ组血糖上升(P〈0.05),Ⅱ组、Ⅲ组无明显变化(P〉0.05)。结论可乐定与芬太尼PCIA和可乐定与左旋布比卡因PCEA用于原发性高血压患者的肛肠术后镇痛效果均佳,尤其PCEA镇痛效果更明显,两者抑制应激反应效果显著。  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

14.
Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.  相似文献   

15.
Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.  相似文献   

16.
A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care(~'4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.  相似文献   

17.
Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.  相似文献   

18.
Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.  相似文献   

19.
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.  相似文献   

20.
Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P<0.01);the MAP decreased(P<0.01)and the HR increased drastically(P<0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.  相似文献   

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