颈浅丛加C4横突阻滞用于锁骨骨折手术的体会

23例锁骨骨折患者，在做骨折内固定手术时采用颈浅丛加C4横突阻滞麻醉，获得较好的麻醉效果，所配局麻药为含1％利多卡因与0．25%布比卡因混合液（含1：20万肾上腺素）。     

颈浅丛复合肌间沟神经阻滞用于锁骨骨折手术的体会

我院近年用颈浅丛复合肌间沟神经阻滞用于锁骨骨折手术共52例，均获得较好的麻醉效果。所配局麻药为1％利多卡因与0．25％布比卡因（含1：20万肾上腺素）。     

布吡卡因和利多卡因合用于硬膜外阻滞612例体会

应用０．２５％布吡卡因和１．３３％利多卡因混合液用于硬膜外阻滞麻醉，进行各类手术麻醉６１２例。利多卡因和布吡卡因具有协同作用，缩短了手术开始时间，又减少了术中用药次数，避免了单一用药的不足。该混合液肌松效果好，对呼吸循环影响不大，硬膜外阻滞效果较好     

0.75%布比卡因与5%利多卡因用于腰-硬联合麻醉剖宫产手术的效果比较

目的 比较0.75%盐酸布比卡因与5%盐酸利多卡因重比重液用于腰-硬联合麻醉剖宫产手术的效果以及不良反应.80例拟行急诊剖宫产,随机分成两组:A组(n=40)为0.75%布比卡因2ml+50%葡萄糖0.5ml;C组(n=40)为5%利多卡因液2ml(含1:200000肾上腺素).L2～3椎间隙行硬膜外穿刺蛛网膜下腔给药,观察对比两组患者麻醉后血压、心率、血氧、呼吸、麻醉起效时间、作用时间、肌松作用及术后并发症情况.结果 C组感觉阻滞起效时间、运动阻滞起效时间均较A组快(P均＜0.01),两组麻醉效果、恶心呕吐发生率无显著性差异,C组给药后2～3min心率及血压降低较明显.结论 5%利多卡因和0.75%布比卡因用于腰麻时的效用性和安全性一样可靠,5%利多卡因起效更快阻滞更完善,但必须密切注意其对血流动力学的影响,两组局麻药均为重比重药,对循环影响较小、安全、不良反应少.     

不同浓度利多卡因与布比卡因用于小切口胆囊切除术60例报

60例ASAⅠ～Ⅱ级择期行小切口胆囊切除患者,分为3组A组,2％利多卡因+0．75％布比卡因;B组,2％利多卡因+0．5％布比卡因;C组,1％利多卡因与0．375％布比卡因混合液。A、B两组均用2％利多卡因作首剂试验量,术中麻醉维持分别用0．75％布比卡因、0．5％布比卡因;C组用1％利多卡因与0．375％布比卡因混合液作首剂试验量及术中麻醉维持。术中监测血流动力学指标,并进行麻醉效果评定。结果,利多卡因用量3组间无显著性差异(P＞0．05),布比卡因用量A组多于B、C两组(P<0．05);患者疼痛评分A、C两组优于B组(P＜0．05);肌松效果C组优于A组、A组优于B组。结果提示小切口胆囊切除术中硬膜外使用1％利多卡因与0．375％布比卡因混合液,镇痛好,肌松完善,麻醉效果满意,同单独使用0．75％布比卡因效果相仿,优于单独使用0．5％布比卡因。     

低浓度布吡卡因利多卡因混合液硬膜外阻滞用于胸腹部手术临床观察

本文将０．２５％布吡卡因和１％利多卡因混合液（简称低浓度布利混合液）硬膜外阻滞用于３２例胸腹部手术。结果３１例（９６．６％）镇痛、肌松满意，保有布吡卡因作用时间长的优点，无一例出现毒性反应。表明低浓度布利混合液硬膜外阻滞适用于胸腹部手术麻醉。     

低浓度布吡卡因利多卡因混合液硬膜外阻滞用于胸膜腹部手术临床观察

本文将０．２５％布吡卡因和１％利多卡因混合液（简称低浓度布利混合液）硬膜外阻滞用于３２例胸腹部手术。结果３１例（９６．６％）镇痛，肌松满意，保有布吡卡因作用时间长的优点，无一例出现毒性反应，表明低浓度布利混合液膜外阻滞适用于胸腹部手术麻醉。     

利多卡因加左旋布比卡因或布比卡因混合液用于臂丛阻滞的效果比较

目的:比较0.25%左旋布比卡因或0.25%布比卡因与利多卡因1∶1混合液用于臂丛阻滞的麻醉效果和并发症。方法:ASAⅠ～Ⅱ级病人60例,随机分两组行臂丛阻滞,LB组使用左旋布比卡因+利多卡因混合液,B组使用布比卡因+利多卡因混合液。观察两组的感觉阻滞起效时间、阻滞完全时间、麻醉效果优良率、镇痛维持时间、不良反应及麻醉过程中生命体征的变化。结果:两组患者感觉阻滞起效时间及镇痛维持时间LB组明显长于B组(P<0.05);阻滞完全时间、麻醉效果优良率及不良反应发生以及对循环的影响均相似(P>0.05)。结论:利多卡因+左旋布比卡因混合液用于臂丛神经阻滞更具有选择性而且安全有效。     

七种不同药液硬膜外术后止痛的临床观察

选择腹部手术病人130例(ASAI～Ⅱ),随机分成7组.应用吗啡、氯胺酮、布吡卡因等硬膜外术后止痛,并与生理盐水对照双盲法观察研究。结果显示:起效时间以布吡卡因类药物最快,吗啡次之,氯胺酮较慢(P>0.05)。镇痛效果以布吡卡因类及吗啡更为确切,氯胺酮较差,生理盐水亦有少数出现镇痛。镇痛持续时间:吗啡组>布吡卡因组>氯胺酮组>对照组, 在布吡卡因各组中,0.25%布吡卡因+维生素B_(12)>0.25%布吡卡因≈0.375%布吡卡因≈0.25%布吡卡因+肾上腺素。作者对不同药液硬膜外术后镇痛的并发症及药物选择进行了讨论。     

小儿骶管不同剂量氯胺酮超前注入用于术后镇痛的临床比较

目的 比较小儿骶管超前注入不同剂量氯胺酮（Ket)用于术后镇痛的效果及安全性。方法 120例在Ket基础麻醉和骶麻下行腹股沟斜疝修补术或隐睾下降术后小儿随机分为6组，骶管分别注入1％利多卡因、1％利多卡因＋0．15％布比卡因、1％利多卡因和含0．25、0．75、1．0mg/kg的Ket，注药容积均为1ml/kg（含1：40万肾上腺素）。观察术后48h的镇痛、镇静评分及副作用。结果 骶管注入4个剂量Ket均有良好的镇痛效应（P＜0．05），0．25及0.5mg/kg Ket组镇痛效果与0．15％布比卡因相似；0．75及1.0mg/kg Ket组镇痛效果优于低剂量Ket组和布比卡因组（P＜0．05），但镇静评分较高，恶心呕吐及Ket精神副作用发生增多（P＜0．05）。结论 在Ket基础麻醉的小儿，骶管超前注入Ket用量以不超过0.5mg/kg为宜，此剂量可安全用于术后镇痛。     

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…