纳络酮对硬膜外泵注芬太尼所致阿片类副反应的影响

目的　评估低浓度纳络酮对患者自控硬膜外镇痛(PCEA)引起阿片类药副反应的影响 .方法　选在腰麻和硬膜外联合麻醉下行全子宫切除术后患者 15 0例 ,ASA ～ 级 ,随机分成 3组行 PCEA.A组 :芬太尼 (4 mg· L- 1 ) +布吡卡因 (0 .5 g· L- 1 ) +肾上腺素 (2 mg· L- 1 ) .B组 :A组 + (4mg· L- 1 )纳络酮 .C组 :A组 + (6 m g· L- 1 )纳络酮 .定时记录视觉模拟疼痛评分 (VAS) ,芬太尼用量 ,恶心、呕吐、皮肤瘙痒发生率及评分 .结果　 3组芬太尼用量约为 0 .30 μg· kg- 1· h- 1 ,B,C两组纳络酮用量分别为 (0 .30± 0 .12 ) μg· kg- 1·h- 1 和 (0 .45± 0 .19)μg· kg- 1 · h- 1 ,2 4h内两种剂量纳络酮均可降低阿片类药副反应恶心、呕吐和皮肤瘙痒的发生率及评分 (P<0 .0 1) ,3组 2 4h内 VAS及芬太尼的用量相似 .结论　 PCEA泵注芬太尼与布吡卡因 ,伍用纳络酮 (0 .3～0 .45μg· kg- 1 · h- 1 )既保证镇痛质量 ,又明显降低阿片类副反应发生率及评分     

腹部手术后不同镇痛方法的镇痛效果及对儿茶酚胺的影响

目的 :观察腹部手术后不同镇痛方法的镇痛效果及对儿茶酚胺的影响。方法 :4 2例选择性开腹手术患者 ,随机分为 5组 ,罗哌卡因芬太尼 (ropivacainefentanyl,RF)、布比卡因芬太尼 (bupivacainefentanyl,BF)、布比卡因吗啡 (bupivacainemorphine,BM )组术中 1.2g·L-1硬膜外复合全麻 ,术后持续硬膜外镇痛 ,镇痛药物分别为 1.2g·L-1罗哌卡因 + 2mg·L-1芬太尼、1.2g·L-1布比卡因 + 2mg·L-1芬太尼、1.2g·L-1布比卡因 + 80mg·L-1吗啡 ;EM组术中硬膜外复合全麻 ,术后持续静脉吗啡 0 .5 g·L-1镇痛 ;静脉吗啡 (intravenousmorphine,M )组术中单纯全麻 ,术后持续静脉吗啡 0 .5g·L-1镇痛。记录镇痛效果 ,测定麻醉前、术后 1h、术后 2 4h血浆肾上腺素和去甲肾上腺素水平。结果 :各组均可获得有效的镇痛效果。VAS评分BM组、M组显著低于RF组 ,VRS评分BM组明显高于RF、EM、M组。BM、M、EM组副作用较多 ,M组恶心发生率最高 (5例 )。术后 1hBM组肾上腺素显著低于BF组 ,EM组去甲肾上腺素明显低于RF组。术后 2 4hM组肾上腺素和去甲肾上腺素均高于术前。结论 :目前常用的硬膜外或静脉病人自控镇痛方法都有明确的镇痛效果 ,术中复合硬膜外阻滞或术后硬膜外镇痛可以显著减轻术后应激反应的程度 ,是更有效的术后镇痛方法     

伍用小剂量氯胺酮对前列腺切除术后自控硬膜外镇痛效果的影响

目的:比较伍用小剂量氯胺酮对前列腺切除术后硬膜外自控镇痛效果的影响.方法:选择硬膜外腰麻联合麻醉下择期前列腺摘除术患者68例,术后随机分为A,B组,每组34例,均采用自控硬膜外镇痛(PCEA).A组:1.25 g/L罗哌卡因和2 mg/L芬太尼混合液,B组:A组 0.4 g/L盐酸氯胺酮.单次自控镇痛(PCA)背景剂量3 mL/h,PCA剂量2mL/次,锁定时间为10 min,限量16 mL/h.于术后4 h和术后第1,2日的08:00,13:00,18:00时定期随访并记录患者在安静时(RVAS),运动时(MRAS)和咳嗽时(CVAS)的疼痛评分,Bromage运动阻滞评分,膀胱痉挛发生率,芬太尼耗量,膀胱冲洗液转清时间以及其副反应.结果:4 h/24 h,A组术后4,24h的RVAS评分及4,24,48 h的芬太尼耗量均明显大于B组(P＜0.05);两组膀胱痉挛的发生率和持续时间分别为27%,12%和(1.6±0.5)min,(0.7±0.3)min(P＜0.05);膀胱冲洗液转清时间分别为(46±13)h,(34±11)h(P＜0.05);A组的Bromage评分稍高于B组,但无明显差异;两组镇静评分以及副反应发生率相似.结论:罗哌卡因、芬太尼伍用小剂量氯胺酮是较为理想的硬膜外镇痛药配方,其镇痛效果良好且副反应小.     

曲马多联合小剂量芬太尼用于术后硬膜外病人自控镇痛效果观察

目的:采用术后硬膜外病人自控镇痛(PCEA)对曲马多联合小剂量芬太尼镇痛效果的观察。方法:90例接受PCEA腹部手术的病人(ASAⅠ~Ⅱ)随机分为3组,每组30例。A组:镇痛液为0.6%曲马多+0.1%布比卡因;B组:镇痛液为0.0005%芬太尼+0.1%布比卡因;C组:镇痛液为0.3%曲马多+0.0003%芬太尼+0.1%布比卡因。采用相同的LCP参数,持续输注量为2mL/h,单次自控给药量1mL,锁定时间为15min。结果:C组在镇痛早期(4、8、12、24h)VAS评分明显低于A、B两组,在镇痛终点无显著差异;C组的PCEA按压次数及用药总量低于A、B两组;C组的副反应如恶心、呕吐、皮肤瘙痒等发生情况较少;C组总体满意度高于A、B两组。结论:曲马多联合小剂量的芬太尼用于PCEA较单用曲马多或芬太尼取得更佳效果。     

恩丹西酮对硬膜外泵注芬太尼引发瘙痒的影响

目的　评估恩丹西酮预防患者自控硬膜外镇痛(PCEA)泵注芬太尼引发皮肤瘙痒的有效性及安全性 .方法　选在腰麻和硬膜外联合麻醉下行子宫全切术及疝修补术患者 10 0例 ,术后 1h PECA泵注芬太尼和盐酸布吡卡因合剂 ,随机分成 2组 ,分别 iv恩丹西酮 8mg(A组 )及 iv生理盐水 4m L (B组 ) . 2 4h内定人定时记录皮肤瘙痒的发生率、评分 ,视觉模拟疼痛评分 (VAS) ,芬太尼用量 ,血氧饱和度 (Sa O2 ) ,心率 (HR)及血压 (BP) .结果　恩丹西酮组皮肤瘙痒的发生率及评分分别为 10 %和 0 .3± 0 .8,对照组分别为 2 6 %和 1.1±1.6 ,呈显著差异 (P<0 .0 5 ) ,两组 VAS,芬太尼用量 ,Sa O2 以及 BP相似 .结论　静注 8mg恩丹西酮能安全 ,有效地预防和减少 PCEA泵注芬太尼引发瘙痒的发生率及评分 .     

硬膜外芬太尼配伍布比卡因和静脉芬太尼用于上腹部手术后的镇痛研究

目的 :比较硬膜外病人自控镇痛 ( PCEA)用芬太尼配伍布比卡因和静脉病人自控镇痛 ( PCIA)用芬太尼在上腹部手术后的镇痛作用。方法 :60例病人 ,进行随机分组 ,PCEA组 0 .1 1 2 5 %布比卡因 +芬太尼 2 μg/ml+氟哌定 0 .5 mg/ml;PCIA组芬太尼 1 0 μg/ml+氟哌定 0 .5 mg/ml。参数设定 :负荷量 ( PCEA组 5 ml,PCIA组 3ml)、持续流量 2 ml/h、锁定时间 1 0 Min,病人自控量 ( PCA) 1 ml。结果 :PCEA组不论在休息或咳嗽时其镇痛评分均低于 PCIA组 ( P<0 .0 5 ) ,以咳嗽时评分较低为著。但两组均达到 80 %有效镇痛 ,PCEA组嗜睡发生率明显低于 PCIA组。结论 :硬膜外芬太尼配伍布比卡因和静脉芬太尼同样可以达到有效镇痛 ,但硬膜外芬太尼比静脉芬太尼更有优势 ,嗜睡发生率低     

低浓度罗哌卡因复合法硬膜外术后镇痛的临床观察

目的　对比观察硬膜外使用低浓度罗哌卡因进行术后镇痛的临床效果。方法　随机选择下腹部择期手术患者 4 0例 ,随机分为两组 (n =2 0 ) ,A组使用 0 15 %罗哌卡因 2mg吗啡 /10 0ml进行硬膜外术后镇痛 (PCEA) ;B组使用 0 15 %布比卡因 2mg吗啡 /10 0ml进行PCEA。临床观察两组患者术后 6h、12h、2 4h、36h、4 8h视觉模拟镇痛评分、运动评分及不良反应。 结果　两组术后镇痛评分及不良反应无显著差异。A组术后运动评分明显优于B组 (P <0 0 5 )。结论　 0 15 %罗哌卡因复合小剂量吗啡用于术后镇痛 ,作用确切 ,运动神经阻滞轻微 ,优于同等浓度布比卡因。     

小剂量氯胺酮在腹部手术术后硬膜外镇痛中的研究

目的：评价舒芬太尼、布比卡因和伍用小剂量氯胺酮对术后硬膜外腔镇痛（PCEA）的效果和副反应的发生率。方法：美国麻醉医师协会ASAⅠ～Ⅱ级硬膜外麻醉下行择期全子宫切除术和胆囊切除术的患者100例随机分为2组,每组50例。A组：布比卡因150mg＋舒芬太尼50μg＋0．9％NS至100ml;B组：A组＋氯胺酮100mg。术后50小时随访病人,用四级法评分镇痛效果和不良反应发生率。结果：B组镇痛效果明显好于A组,两组不良反应发生率无明显性差异。结论：小剂量氯胺酮伍用舒芬太尼、布比卡因PCEA优于舒芬太尼和布比卡因的联合。     

肺癌手术后不同药物镇痛效应的临床观察

目的观察肺切除手术后用舒芬太尼复合布比卡因行患者自控硬膜外镇痛（PCEA）的效应,并与等效价的芬太尼进行比较。方法60例ASAⅠ-Ⅱ级肺癌手术患者,随机分为2组,每组30例。两组术后均用PCEA。F组镇痛用药为3.3μg/mL芬太尼＋0.125%布比卡因;SF组为0.5μg/mL舒芬太尼＋0.125%布比卡因。术后测定VAS评分、记录首次使用PCEA时间、PCEA有效按压次数、镇痛药用量及不良反应。结果SF组在术后3、4、6、8、12h监测点VAS评分显著低于F组（P〈0.05）。首次使用PCEA时间：SF组明显晚于F组（P〈0.05）。PCEA有效按压次数：SF组在术后18、24、36、48 h明显少于F组（P〈0.05）。术后镇痛药累积用量：SF组明显少于F组（P〈0.05）。两组布比卡因用量,不良反应无明显差异。结论肺切除手术后患者采用0.5μg/mL舒芬太尼＋0.125%布比卡因进行PCEA,镇痛效果满意,安全可行。     

硬膜外腔注射布吡卡因-芬太尼-氟哌利多复合液用于剖宫产术后镇痛的研究

目的 :评价硬膜外腔注射布吡卡因 芬太尼 氟哌利多用于剖宫产术后的镇痛效果及不良反应。方法 :选择择期连续硬膜外麻醉下行剖宫产手术的病人 3 0例 ,ASAⅠ级 ,随机分为布吡卡因 芬太尼 氟哌利多组 (A组 )和布吡卡因 吗啡组 (B组 )各 15例。于手术结束时A组硬膜外腔注射 0 12 5 %布吡卡因 +芬太尼 0 0 5mg +氟哌利多 2 5mg 10ml;B组硬膜外腔注射 0 12 5 %布吡卡因 +吗啡 2mg 10ml,记录术后 1h、2h、4h、8h、16h、2 4h病人的Prince -Henry疼痛评分、SpO2 和恶心呕吐以及皮肤瘙痒等不良反应的发生情况。结果 :两组病人术后各个观察时点疼痛评分均 <3分 ,组间比较 ,1h、2h、4h两组间无显著性差异 8h、16h、2 4h时段镇痛效果A组优于B组 ,组间比较有显著性差异 (P <0 .0 5 ) ;两组病人术后 2 4h以内各个时点SpO2 >97% ;两组病人术后均无恶心呕吐和锥体外系症状 ,B组有 2例病人出现皮肤瘙痒(0 13 % )。结论 :①两种方法均可用于剖宫产病人的术后镇痛 ,其镇痛效果确切 ,未发现呼吸抑制 ;②芬太尼 氟哌利多的镇痛效果优于吗啡 ,无皮肤瘙痒等不良反应的发生     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.