氯胺酮、芬太尼和曲马多防治瑞芬太尼麻醉术后急性疼痛的效果观察

目的比较氯胺酮、芬太尼、曲马多对瑞芬太尼麻醉术后疼痛的作用。方法选择100例择期行腹腔镜胆囊切除术的患者,ASAⅠ～Ⅱ级,随机分为四组:氯胺酮组(K组)、曲马多组(T组)、芬太尼组(F组)、空白对照组(P组),每组各25例。术毕前10min,K组静脉注射氯胺酮0.4mg/kg,T组注射曲马多1.5mg/kg,F组注射芬太尼50μg,P组注射等容量的生理盐水。观察患者的苏醒时间,拔管后0h、0.5h、1h、2h、4h、8h、12h、24h各点的VAS评分、瑞芬太尼的用量以及恶心、呕吐、尿潴留、皮肤瘙痒等并发症。结果 (1)VAS:K组、T组、F组在术后0～24h各个监测点显著低于P组(P<0.05),T组、K组与F组比较差异无统计学意义(P>0.05);(2)F组、K组苏醒时间显著长于P组与T组(P<0.05),而P组与T组间差异无统计学意义(P>0.05);(3)T组不良反应发生率明显高于P组、F组与K组(P<0.05),而P组、F组与K组间差异无统计学意义(P>0.05)。结论瑞芬太尼麻醉后,预防性的使用氯胺酮、芬太尼、曲马多都可以减轻瑞芬太尼引起的疼痛过敏以及术后伤口的疼痛;芬太尼,氯胺酮可使苏醒时间延长;曲马多,芬太尼的不良反应发生率相对较高。     

氯胺酮与氟比洛芬酯对小儿疝修补术超前镇痛效果的比较

目的:比较氯胺酮、氟比洛芬酯对疝修补术患儿超前镇痛的效果。方法:拟行疝修补术的患儿60例随机分为三组,氯胺酮组(K组)、氟比洛芬酯组(F组)和对照组(N组),每组20例。K组以氯胺酮0.3 mg/kg在手术开始前5 min静脉注射、F组以氟比洛芬酯1.25 mg/kg,在手术开始前15 min用生理盐水稀释至20 mL缓慢静脉注射。记录术后2 h、6 h、12 h、24 h患儿VAS评分;观察并记录首次追加镇痛药的时间、各组术后镇痛药应用次数及人数;可能出现的不良反应如嗜睡、恶心呕吐、呼吸抑制、异常出血、皮肤瘙痒等情况。结果:与N组比较,K组于术后2、6 h时间点VAS评分降低(P<0.05),F组于术后2、6、12 h时间点VAS评分明显降低(P<0.05);与K组比较,F组于术后2、6、12 h时间点VAS评分明显降低(P<0.05);24 h时间点VAS评分各组间无统计学意义(P>0.05)。各组的副作用间没有统计学意义(P>0.05)。F组术后镇痛药应用次数及术后用镇痛药人数明显少于N、K组(P<0.05)。结论:和氯胺酮比较,氟比洛芬酯显示出很强的超前镇痛作用,使手术镇痛维持时间延长,减少了术后其它镇痛药物的应用。     

小剂量氯胺酮联合曲马多用于腹部术后镇痛

目的 评估小剂量氯胺酮能否提高曲马多对腹部术后患者自控静脉镇痛(PCIA)的效果并减少不良反应.方法 60例ASA Ⅰ～Ⅱ级全麻下择期腹部手术的患者,随机分为K组(镇痛药配方为0.1%氯胺酮+0.5%曲马多混合液)和T组(镇痛药配方为1%曲马多).手术关腹时开始至术毕48h接镇痛泵行PCIA.观察并记录手术后1,4,8,12,24,32,48h患者疼痛评分(VAS评分)、曲马多消耗量以及恶心呕吐和幻觉等情况.PCIA结束后征询患者对镇痛的满意度.结果 与T组相比,K组患者获得了更好的镇痛满意度(P<0.05).K组VAS评分明显低于T组(P<0.05),且PCIA曲马多的总用量为(639±191.6)mg,明显少于T组[(1356±452.4)mg](P<0.05).两组患者恶心呕吐和幻觉等不良反应的发生率差异无统计学意义.结论 小剂量氯胺酮用于腹部术后PCIA能增强曲马多的静脉镇痛效果、减少曲马多的用量.     

全身麻醉苏醒早期应用不同镇痛药物效果观察

目的比较芬太尼、舒芬太尼及曲马多对全身麻醉苏醒早期疼痛患者的治疗效果。方法取全身麻醉术后苏醒早期疼痛患者60例,按使用镇痛药物的不同分为芬太尼组(F组)、舒芬太尼组(S组)和曲马多组(T组),各20例。分别给予静脉注射芬太尼1 g/kg、舒芬太尼0.1 g/kg及曲马多1mg/kg进行治疗,观察给药前后疼痛缓解情况(VAS评分),同时观察患者镇静程度(Ramsay评分)、呼吸、循环等指标的变化及在麻醉后恢复室(PACU)的停留时间。结果 3组患者在给药后VAS均有不同程度下降,其中S组下降最多(<0.05);F组和S组的Ramsay评分给药前后差异有统计学意义(<0.05)。3组MAP及HR在给药后均下降(均<0.05),S组和T组不引起血氧饱和度(SpO2)的下降(>0.05),而F组可引起SpO2的下降(<0.05);S组在PACU停留时间比F组和T组短(<0.05)。结论 3种药物对全身麻醉术后苏醒早期疼痛均有治疗作用,其中舒芬太尼镇痛效果最佳、不良反应最小。     

用不同镇痛药物对进行阑尾手术的患者进行超前镇痛的效果对比

目的：对比用不同镇痛药物对进行阑尾炎手术的患者进行超前镇痛的临床效果。方法：对近年来在我院进行手术治疗的90例阑尾炎患者的临床资料进行回顾性研究。我们将这90例患者随机分为K组、T组和F组,每组各有30例患者。我们在这三组患者进行阑尾炎手术时,给K组患者使用氯胺酮进行超前镇痛,给T组患者使用曲马多组进行超前镇痛,给F组患者使用芬太尼进行超前镇痛。手术结束后,比较三组患者疼痛症状的评分、镇静效果的评分和发生恶心呕吐的情况。结果：在手术结束后的0.5h、2h、4h和8h,T组患者疼痛症状的评分均明显低于K组和F组患者,三者相比差异具有显著性（P<0.05）。T组和F组患者的镇静评分明显低于K组患者,三者相比差异具有显著性（P<0.05）。在这三组患者苏醒后,T组患者发生恶心呕吐的几率为70%,K组患者发生恶心呕吐的几率为33%,F组患者发生恶心呕吐的几率为22%。T组患者发生恶心呕吐的几率明显高于K组和F组患者,三者相比差异具有显著性（P<0.05）。结论：用曲马多进行超前镇痛的效果要明显优于氯胺酮和芬太尼。因此曲马多可作为进行超前镇痛的优选药物使用。不过,用曲马多进行超前镇痛引起恶心呕吐的几率较高。因此临床医生在给患者使用曲马多进行超前镇痛时应同时给其使用具有止呕作用的药物。     

氟比洛芬酯超前镇痛在人工流产术中的应用

目的 探讨氟比洛芬酯超前镇痛复合丙泊酚静脉全麻在人工流产术中的作用.方法 175例ASAI级全麻下人工流产患者,随机均分为5组.K10组、K5组和K1组分别于麻醉前10、5和1 min静脉注射氟比洛芬酯50mg,F组于术前10min静脉注射芬太尼1μg/kg,P组为对照组.各组均静脉注射丙泊酚2mg/kg作全麻诱导,术中出现体动追加丙泊酚1mg/kg.观察各组术中血压、心率及血氧饱和度.记录丙泊酚总用量、麻醉诱导时间、唤醒时间和定向力恢复时间及丙泊酚注射痛、术中患者体动和呼吸抑制发生情况.术后作VAS评分及患者满意度调查.结果 研究组术中血压、心率、丙泊酚总用量、丙泊酚注射痛发生率、患者术中体动发生率、唤醒时间和定向力恢复时间较P组显著降低或缩短.F组术中呼吸抑制发生率显著高于其余4组.VAS评分,K10组与F组相似(P>0.05),显著低于K5组和K1组(P<0.05).K10组术后患者满意度显著优于其余4组.结论 氟比洛芬酯50mg超前镇痛用于人工流产术与芬太尼1μg/kg具有相似的镇痛效果.而无芬太尼的呼吸抑制作用,其较佳的给药时机为术前10min.     

曲马多术后镇痛对妇科腹腔镜手术患者全麻恢复的影响

目的:观察曲马多作为妇科腹腔镜瑞芬太尼、丙泊酚全静脉麻醉术后镇痛药物对患者麻醉恢复的影响。方法:将80例患者随机分为曲马多组40例,芬太尼组40例,分别使用曲马多或芬太尼作为术后镇痛药物,观察两组患者在麻醉恢复室的血流动力学变化,观察自主呼吸恢复时间、呼吸机使用时间,语言、定向、理解力恢复时间,总恢复室治疗时间,疼痛视觉模拟评分(VAS),恶心、呕吐,苏醒期躁动等指标。结果:曲马多组自主呼吸恢复时间、呼吸机使用时间,语言、定向、理解力恢复时间及总恢复室治疗时间均短于芬太尼组(P<0.01),芬太尼组苏醒期躁动较多(P<0.01),曲马多组血流动力学更加稳定(P<0.01),术后1h、离室时VAS评分,恶心、呕吐两组差异无统计学意义(P>0.05)。结论:曲马多作为全麻妇科腹腔镜术后镇痛药物优于芬太尼。     

芬太尼复合曲马多用于瑞芬太尼全麻苏醒期的观察

目的观察芬太尼复合曲马多减轻瑞芬太尼全麻苏醒期疼痛的效果。方法选择妇科宫外孕和卵巢囊肿患者共90例,ASA分级Ⅰ-Ⅱ级,手术时间1．5h以内,随机分为T组、F组和T＋F组,术中以持续靶控输注丙泊酚和瑞芬太尼,间断给予维库溴铵维持麻醉。T组患者手术结束前30min给予曲马多2mg／kg,F组患者手术结束前10min给予芬太尼2肛∥kg。T＋F组手术结束前30min给予曲马多1．5mg／kg,手术结束前10min再给予芬太尼1肛g／kg,记录呼吸恢复时间、苏醒时间,警觉／镇静评分（OAA／S）、拔管后VAS评分和不良反应。结果三组患者手术结束后呼吸恢复时间、苏醒时间、OAA／S评分和瘙瘁、躁动比较差异均无统计学意义（P〉0．05）,麻醉拔管后均无呼吸抑制、恶心、呕吐发生。拔管后T组、F组VAS评分比较差异无统计学意义（P〉0．05）,T＋F组VAS评分和T、F组比较差异有统计学意义（P〈0．05）。结论预防瑞芬太尼全麻术后苏醒期疼痛,芬太尼复合曲马多较单一使用芬太尼或曲马多更有优势。     

小剂量氯胺酮对丙泊酚无痛人工流产术后恢复的影响

目的 观察小剂量氯胺酮能否缓解无痛人工流产术后的疼痛及是否会增加术后不良反应的发生率.方法 400例拟行无痛人工流产术的患者,随机分为F1、F2、FK1和FK2共4组,每组100例.麻醉时,F1组静脉注射芬太尼1 μg/kg,F2组静脉注射芬太尼1.5 μg/kg,FK1组静脉注射芬太尼1 μg/kg +氯胺酮0.1 mg/kg,FK2组静脉注射芬太尼1 μg/kg+氯胺酮0.2 mg/kg,然后4组均静脉注射丙泊酚1.5 mg/kg.术中有体动时追加丙泊酚20 mg.记录4组患者术中丙泊酚用量,清醒即刻和术后6h疼痛数字分级评分(NRS评分)及术后6h内恶心、呕吐等不良反应的发生率.结果 4组间年龄、体重、体质指数、手术时间、术后平均留院时间的差异均无统计学意义(P值均>0.05),F2、FK1、FK2组的丙泊酚用量显著少于F1组(P值均<0.01),FK1、FK2组显著少于F2组(P值均<0.01),FK2组显著少于FK1组(P<0.01).清醒即刻,4组间疼痛NRS评分的差异无统计学意义(P>0.05);但术后6 h,F1组完全无痛(疼痛NRS评分为0分)率为73.2%,显著低于其余3组(P值分别<0.05,0.01),FK1、FK2组术后6h内恶心呕吐、呕吐的发生率均显著高于F1组(P值分别<0.05、0.01).结论 无痛人工流产麻醉诱导时辅以小剂量氯胺酮能显著缓解术后疼痛,但有增加术后恶心呕吐的风险,应注意预防.     

曲马多超前镇痛在全凭静脉麻醉妇科腹腔镜手术中的评价

目的评价妇科腹腔镜手术中曲马多超前镇痛两种用药模式的有效性及安全性。方法90例ASAⅠ～Ⅱ级妇科腹腔镜手术病例随机分为3组：以丙泊酚、芬太尼、琥珀胆碱麻醉诱导气管插管，术中瑞芬太尼、丙泊酚及维库溴铵维持麻醉，T1组术前静注曲马多100mg，T2组于术前、术毕分别静注100mg曲马多，C组为生理盐水对照组。观察术后苏醒时间及质量，术后随访24hVAS疼痛评分、镇痛药使用及不良反应发生情况等。结果术后苏醒时间3组无明显差异，但15min时镇静评分T2组明显高于另外两组（P〈0．05），30min之后3组无明显差异；术后虽然T1组0．5、1、2hVAS评分明显低于C组（P〈0．05），但仍有10例病人另外使用了镇痛药；T2组24h内各时点VAS评分都很低，0．5、1、2、4、6h的VAS显著低于T1组（P〈0．05），且无人另外使用镇痛药。T2组主诉视物模糊的病人显著多于另外两组．但术后1h均明显改善。结论仅术前静注曲马多产生的超前镇痛作用是有限的，曲马多术前和术毕各100mg静注可产生满意的超前镇痛效果，能有效地解除妇科腹腔镜微创手术后的疼痛，但术后早期可能镇静较深，还需加强监护。     

Value of D-Dimers in patients with acute aortic dissection

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.     

Research of combined liver-kidney transplantation model in rats

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.     

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…     

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.     

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.     

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.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

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.     

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.