小剂量纳洛酮用于预防术后吗啡静脉镇痛副作用的临床观察

目的比较两组剂量纳洛酮对吗啡静脉镇痛副作用及镇痛质量的影响。方法选择ASAI～II级子宫全切术患者60例,术后均接受病人自控镇痛,随机分为三组,小剂量纳洛酮(0.25μg(/kg·h))组(L组),高剂量纳洛酮(1μg(/kg·h))组(H组)和对照组(生理盐水)(P组)。术后持续静脉输注纳洛酮或生理盐水24h。镇痛评分采用视觉模拟法,并记录各组间副作用的发生率及需要止吐药的发生率,同时记录24h内各组需要吗啡的累积总量。结果与P组比较,L组和H组显著减少了吗啡所带来的恶心、呕吐及瘙痒等副作用(P<0.05),L组和H组在VAS评分方面没有差异,24h吗啡累积用量L组(42.3±24.1)mg,与P组(59.1±27.4)mg、H组(64.7±33.0)mg比较,用量最少(P<0.05)。结论小剂量纳洛酮具有预防PCA吗啡副作用的效果,0.25μg(/kg·h)连续输注纳洛酮不仅可预防吗啡副作用,同时可以节省术后PCA的吗啡用量。     

不同剂量纳洛酮对吗啡术后镇痛病人血浆阿片样物质的影响

目的:探讨不同剂量纳洛酮对吗啡术后镇痛效能及血浆阿片样物质的影响。方法:选择ASAⅠ￣Ⅱ级子宫切除、术后使用吗啡静脉自控镇痛病人60例,随机分成3组:M组,镇痛泵中使用吗啡10μg.kg-1.h-1;MN0.05组,在M组用药基础上加纳洛酮0.05μg.kg-1.h-1;MN0.2组:在M组用药基础上加纳洛酮0.2μg.kg-1.h-1。双盲随访3组病人镇痛效果。于入室、术毕、术后6 h、术后24 h及术后42 h采静脉血,用放免法检测血浆阿片样物质(β内啡肽、强啡肽、亮啡肽)水平。结果:MN0.05组视觉模拟评分(VAS)低于M组,MN0.2组在术后6 h VAS评分高于M组,差异均有显著性(P<0.05)。MN0.05组血浆强啡肽、亮啡肽水平在术后6 h、术后24 h均高于M组,β内啡肽水平在术后6 h低于M组,术后24 h高于M组,差异均有显著性(P<0.05);MN0.2组阿片样物质水平与M组比较无显著差异。结论:不同小剂量纳洛酮对吗啡的镇痛效能有不同的影响,其机制与影响阿片样物质的合成及释放有关。     

不同剂量纳洛酮联合吗啡在老年患者术后静脉镇痛疗效观察

目的探讨不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响.方法选择120例老年手术患者,随机分为4组,A、B、C、D各30例,A组仅给予吗啡镇痛,其它各组给予吗啡联合不同剂量纳洛酮,观察对术后静脉镇痛效能影响.结果0.3μg剂量纳洛酮的D组各各观察时间点视觉模拟标准评分与其它组比较明显增高,差异存在统计学意义(P<0.05);A组比其它三组不良反应发生率高,其中恶心呕吐发生率及肛门排气时间比较差异存在统计学意义(P<0.05).结论不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能不同,0.1-0.2μg表现为降低不良反应作用,而0.3μg纳洛酮则表现为降低吗啡镇痛效果.     

小剂量纳洛酮对阿片类静脉内自控镇痛副作用的影响

目的阿片药常引起恶心、呕吐等并发症。研究预防性持续应用纳洛酮是否可减少此类副作用,而不影响阿片药的镇痛及用量。方法对46例术后患者使用吗啡进行自控镇痛。患者随机给予生理盐水(26例)或纳洛酮0.2μg/(kg.h)。结果发现安慰剂组与纳洛酮组相比,瘙痒(77%)∶(20%),P<0.05、呕吐(70%)∶(35%),P<0.05%的发生率及严重程度前者显著高于后者,吗啡用量(0.5~0.8mg/(kg.d)),休息时疼痛评分(4±2∶3±2),咳嗽时疼痛评分(6±2∶6±2),无差别。结论对于术后患者来说,小剂量纳洛酮0.2μg/(kg.h)可显著减少阿片类副作用的发生率及严重程度,同时不影响其镇痛效果。当静脉给吗啡治疗中重度疼痛时,临床医师应充分考虑同时应用小剂量纳洛酮。     

不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响

目的:观察不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响。方法:择期静吸复合全麻下接受腹部手术的老年患者120例,随机均分为4组。A组吗啡剂量为10μg·kg-1·h-1,用生理盐水稀释至100 ml;B组在A组基础上加用纳洛酮0.1μg·kg-1·h-1;C组在A组基础上加用纳洛酮0.2μg·kg-1·h-1,;D组在A组基础上加用纳洛酮0.3μg·kg-1·h-1。使用背景输注+患者自控镇痛模式:背景剂量为2 ml/h;患者自控镇痛:每次1 ml;锁定时间为15 min。记录镇痛开始后2、6、12、24、48 h视觉模拟评分(VAS),评价镇痛效果,并记录术后恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生情况。结果:A、B、C各组间VAS各时点镇痛效果差异均无统计学意义(P0.05),D组2、6、12、24、48 h VAS均显著高于A、B、C组同时点VAS(P0.01)。B、C组6、12、24、48 h不良反应与D组2、6、12、24、48 h恶心呕吐评分和皮肤瘙痒评分均显著低于A组同时点(P0.01)。4组均未发生呼吸抑制。结论:纳洛酮复合吗啡用于老年患者术后镇痛,可以有效地缓解恶心、呕吐、皮肤瘙痒等不良反应,当纳洛酮剂量达到0.3μg·kg-1·h-1时对吗啡的镇痛效果有拮抗作用。     

氯诺昔康复合吗啡用于术后静脉镇痛

目的探讨氯诺昔康联合吗啡术后静脉镇痛的临床效果。方法选择腹部及四肢手术后患者90例,随机分为三组,每组30例,均以一次性镇痛泵(2m l/h)行静脉术后镇痛。LM组:氯诺昔康17.8μg/(kg.h)+吗啡5.6μg/(kg.h);M组:吗啡11.0μg/(kg.h);L组:氯诺昔康20μg/(kg.h)。观察术后各组患者48h内的镇痛评分(VAS)及并发症的发生情况。结果三组患者的静息评分在12 h内,LM组明显低于M、L组(P<0.05),而在12 h后无显著性差异(P>0.05);三组中均无呼吸抑制和胃肠道出血发生。结论氯诺昔康复合吗啡或芬太尼行术后静脉镇痛效果明显优于单纯氯诺昔康。     

小剂量纳洛酮对吗啡致大鼠自主活动的影响

目的 观察小剂量纳洛酮对吗啡致大鼠自主活动的影响.方法 36只雄性SD大鼠,根据皮下注射药物的不同将其随机分为6组,吗啡对照组(M组,皮下注射15 mg/kg的吗啡),吗啡复合纳洛酮组(MN组),根据纳洛酮的剂量大小(1 μg/kg,100 ng/kg,10 ng/kg,1 ng/kg和0.1 ng/kg),MN组分为MN1、MN2、MN3、MN4和MN5.测定药物注射前(T1)、注射后10 min(T2)、20 min(T3)、30 min(T4)、45 min(T5)、60 min(T6)、90 min(T7)、120 min(T8)对大鼠的自主活动评分(水平运动和垂直运动评分).结果 注射吗啡后,M组大鼠自主活动从T3点显著降低,持续至T5点(P<0.05);其他各时间点相互比较差异没有统计学意义(P>0.05);与M组比较,MN1、MN2、MN3组的自主活动评分在T3、T4、T5三个时间点显著升高(P<0.01).结论 10 ng/kg-1 μg/kg的纳洛酮对15 mg/kg的吗啡所引起大鼠自主活动减少有拮抗作用.     

纳络酮吗啡伍用于腹部手术硬膜外术后镇痛中的观察

目的 观察纳络酮与吗啡伍用于硬膜外术后持续给药PCEA方式的镇痛效果及不良反应.方法 选择用硬膜外术后吗啡镇痛的手术患者80例,随机分成两组,M组(n＝40)、MN组(n＝40),在手术结束前30min两组分别给予负荷剂量均为吗啡2mg 0.375%布比卡因6ml,设置和控制参数以吗啡浓度为设置依据,即两组均为0.05mg/ml吗啡,其中MN组另含纳络酮2.5μg/ml.PCA剂量为2ml,持续剂量2ml/h,锁定时间15min.观察术后48h镇痛效果及不良反应.结果 VAS评分M组高于MN组,差异有统计学意义(P＜0.01),PCA有效按压总次数以M组为多,差异有统计学意义(P＜0.01),瘙痒发生率M组为多,差异有统计学意义(P＜0.05).结论 小剂量纳络酮与吗啡伍用于硬膜外持续给药模式PCEA,能增强吗啡镇痛效果,减少吗啡耗量,降低其不良反应发生.     

不同剂量右美托咪定复合舒芬太尼用于小儿尿道下裂术后镇痛的效果观察

目的观察不同剂量右美托咪定(Dex)复合舒芬太尼在小儿尿道下裂术后镇痛的效果。方法择期尿道下裂手术患儿80例,随机均分4组:C组舒芬太尼0.04μg/(kg·h);D_1组舒芬太尼0.04μg/(kg·h)+Dex 0.02μg/(kg·h);D_2组舒芬太尼0.04μg/(kg·h)+Dex 0.04μg/(kg·h);D_3组舒芬太尼0.04μg/(kg·h)+Dex 0.06μg/(kg·h)。4组麻醉诱导及维持方法相同。术毕前30 min静脉推注舒芬太尼0.15μg/kg,术毕即刻连接术后静脉自控镇痛泵(PCIA)。记录术后2、4、8、12、24、48 h患儿HR、NBP、Sp O_2、脸谱疼痛评分法(FPS)评分及Ramsay镇静评分;记录PCIA按压次数、术后不良反应发生率。结果术后各时点,D_1、D_2、D_3组FPS评分均低于C组(P<0.05),且D_2、D_3组均低于D_1组(P<0.05);术后各时点,D_1、D_2、D_3组Ramsay评分均高于C组(P<0.05),且4 h内,Ramsay评分与Dex剂量呈正相关(P<0.05);D_2、D_3组PCIA按压次数、术后恶心呕吐发生率低于C、D_1组(P<0.05),但D_3组有2例镇静过度,4组均无心动过缓、低血压及呼吸抑制。结论小儿尿道下裂术后镇痛中,Dex有镇静、增强镇痛效应,并可减少不良反应,但需防止过度镇静,其中0.04μg/(kg·h)Dex为最佳剂量。     

小剂量纳洛酮在术后吗啡静脉自控镇痛中的应用

目的研究在术后吗啡静脉自控镇痛(PCA)中加用小剂量纳洛酮对镇痛效果、吗啡用药量及其副作用的影响.方法将59例术后中度以上疼痛的患者随机分为吗啡组和纳洛酮组接受术后静脉PCA治疗.吗啡组为150ml盐水中加入60 mg吗啡(PCA剂量为吗啡1 mg),纳洛酮组为在吗啡组的基础上加入6 μg/kg纳洛酮.记录启动PCA泵后0、2、4、6、8、12、24 h患者的血压、心率、呼吸等生命体征、视觉模拟评分(VAS)、吗啡的消耗量及恶心、呕吐等副作用.结果在启动PCA泵2 h时,吗啡组和纳洛酮组的VAS评分差异无显著性(P＞0.05).但4、6、8 h后安静时吗啡组VAS评分分别为(43.6±5.4)、(38.2±4.6)、(42.3±4.8)mm,纳洛酮组为(37.6±6.0)、(31.8±5.4)、(33.2±6.3)mm;活动时吗啡组VAS为(51.6±6.0)、(42.8±5.6)、(48.3±4.9)mm,纳洛酮组为(49.6±5.8)、(37.2±6.0)、(42.1±5.3)mm,两组VAS在安静和活动时差异均有显著性(P＜0.05).两组24 h吗啡总用药量纳洛酮组(36.6±13.5)mg较吗啡组(43.7±14.6)mg显著减少(P＜0.05);恶心、呕吐在4、8 h时纳洛酮组的发生率较吗啡组低(P＜0.05),头晕、瘙痒及呼吸频率、指脉搏血氧饱和度、术后排气时间、镇静评分两组间差异均无显著性(P＞0.05).结论在术后吗啡PCA治疗药液中加入小剂量纳洛酮可增加吗啡术后镇痛效果,减少吗啡消耗量,降低恶心、呕吐的发生率.     

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…