Ambulatory laparoscopic fundoplication

Background: Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2–3 days. Our success with LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis. Methods: Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit. Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two were hospitalized for observation after experiencing intraoperative technical problems. Results: Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction with early discharge on follow-up interview. Conclusions: LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize nausea and provide adequate pain control. Received: 1 April 1996/Accepted: 29 May 1997     

痛力克对癌症疼痛镇痛效果的临床观察

应用印度ＬＵＰＩＮ公司提供的痛力克（酮酷酸氨丁三醇 ）对中重度癌症疼痛３０例进行镇痛效果的临床观察，有效率９３％，平均显效时间９ｍｉｎ，均数缓解时间５．１ｈ，并用哌替啶做了同期交叉自身镇痛对比研究，结果表明：两药的镇痛效果相似（Ｐ＞０．０５），但痛力克的不良反应发生率明显低于哌替啶。     

痛力克用于术后镇痛的临床观察

４５例ＡＳＡⅠ－Ⅱ级成人患者随机分为痛力克组，布比卡因－吗啡组和痛力克与布比卡因－吗啡联用组，比较术后镇痛效果。结果显示，痛力克具有良好的术后镇痛作用；痛力克与硬膜外吗啡混合液联用时可提供更为有效地术后镇痛，且能显著减少阿片药妲及其副作用。     

Lack of activity of ketorolac in hot-plate test and serotonin binding capacity of brain membranes in rats

An increasing number of observations indicate that prostaglandin synthesis inhibition is not a satisfactory explanation for the antinociceptive activity of the non-steroidal anti-inflammatory drugs.In the hot-plate test performed 1 or 2 h after ketorolac at 40, 70 and 100 mg/kg i.p., the drug does not display any significant antinociceptive activity. Nor, at the two higher doses used, does it affect the cortical and pontine serotonin binding capacity of rat brain membranes 2 h after treatment. The data suggest that this lack of antinociceptive activity in the hot-plate test is associated with the drug's inability to affect the central serotoninergic system.     

酮咯酸氨丁三醇滴眼地兔眼部炎症作用的研究

目的：研究酮咯酸氨丁三醇滴眼液（KTOS）对家兔化学性及外伤性眼部炎症的作用。方法：用巴豆油致炎液经角膜注入眼前房法制备兔眼部急性化学炎症模型;用重物击打眼睑法制备兔眼部急性外伤性炎症模型。将致炎后的动物随机分组给药,并参照眼部炎症评判标准进行评分统计。结果：各KTOS剂量组对外伤性和化学性眼部炎症作用的评分均低于生理盐水组;小剂量KTOS虽有作用,但无统计学意义（P＞0．05）,而中、大剂量KTOS均有明显改善外伤性和化学性眼部炎症的作用（P＜0．05,P＜0．01）;其中对化学性眼部炎症的作用与地塞米松作用相似,对外伤性眼部炎症的作用优于地塞米松。结论：KTOS对外伤性和化学性眼部炎症均有明显的抗炎作用,对外伤性眼部炎症的抗炎作用更强。     

卡前列素氨丁三醇防治产后出血的临床疗效观察

目的探讨卡前列素氨丁三醇防治产后出血的临床疗效情况。方法分析我院2012年2月至2014年5月收治的产妇1200例临床资料,依据治疗方式不同进行分组,对照组600例和观察组600例。结果观察组产妇剖宫产术中出血量、术后2 h出血量及总出血量、产后24 h Hb下降值和RBC下降值均优于对照组,观察组产妇临床治疗总有效率明显高于对照组,P<0.05,差异均有统计学意义。结论卡前列素氨丁三醇防治产后出血的临床疗效明显,值得临床推广应用。     

卡前列素氨丁三醇治疗产后出血的效果分析

目的：探讨卡前列素氨丁三醇治疗产后出血的临床疗效。方法：选取本院2011年3月-2014年1月收入院的61例产后出血患者，随机分为观察组31例和对照组30例，观察组患者采取卡前列素氨丁三醇治疗，对照组患者采取米索前列醇联合缩宫素治疗。对比两组患者治疗后2h出血量、止血时间、不良反应的发生率和临床疗效情况。结果：观察组患者治疗后2h出血量少于对照组，止血时间明显短于对照组，不良反应的发生率低于对照组，差异均有统计学意义（P〈0.05）；观察组治疗的总有效率（93.55%）显著高于对照组（83.33%），差异具有统计学上意义（P〈0.05）。结论：对于产后出血的孕妇使用卡前列素氨丁三醇治疗，止血快，出血少，效果显著。     

酮咯酸氨丁三醇联合骶管阻滞超前镇痛对小儿包皮环切术患者术后镇痛效果的影响

目的:观察酮咯酸氨丁三醇联合骶管阻滞超前镇痛对小儿包皮环切术患者术后镇痛效果的影响。方法:选择我院择期拟行包皮环切术的患儿60例,随机分为酮咯酸氨丁三醇组(K组)、骶管阻滞组(D组)、酮咯酸氨丁三醇联合骶管阻滞组(KD组),每组20例。K组和KD组患儿于麻醉诱导前15 min静脉注射酮咯酸氨丁三醇0.5 mg·kg^-1。D组和KD组患儿术前行骶管阻滞麻醉,并于穿刺成功后一次性注入局麻药物0.8%利多卡因+0.25%罗哌卡因混合液1 ml·kg^-1。观察3组患儿术中体动、芬太尼和丙泊酚的使用情况、术后麻醉苏醒和麻醉苏醒后在麻醉后监测治疗室(PACU)的停留时间、术后补救镇痛情况和不良反应发生情况。结果:与K组相比,D组和KD组患儿术中体动发生率和术后布洛芬混悬液的服用率明显降低,术中芬太尼和丙泊酚的总用量明显减少,术后麻醉苏醒以及麻醉苏醒后在PACU的停留时间明显缩短(P<0.05)。D组布洛芬混悬液服用率明显高于KD组(P<0.05)。3组患儿术后均未见呼吸抑制、恶心、呕吐、瘙痒和尿潴留等不良反应的发生。结论:对于小儿包皮环切术患者,酮咯酸氨丁三醇联合骶管阻滞的术后镇痛效果确切且提供了高质量的术后苏醒。     

卡前列素氨丁三醇预防高危妊娠剖宫产产后出血的临床疗效及安全性探讨

目的观察卡前列素氨丁三醇预防高危妊娠剖宫产产后出血的临床疗效及安全性。方法将本院83例高危妊娠产妇随机分为两组,均进行剖宫产手术分娩。对照组40例给予单纯缩宫素治疗,试验组43例给予卡前列素氨丁三醇和缩宫素治疗。观察两组产后出血量及出血率的差异,评价其不良反应的情况。结果试验组产后2、24h出血量低于对照组,差异有统计学意义（P〈0．05）;试验组产后出血率为11．6％,低于对照组的32．5％,差异有统计学意义（P〈0．05）;试验组不良反应发生率为16.3％,稍高于对照组的12．5％,差异无统计学意义（P〉0．05）。结论卡前列素氨丁三醇预防高危妊娠剖官产产后出血的疗效显著,能够显著降低产妇剖宫产后的出血量,降低患者产后出血的发生率,不良反应发生率较低,可促进产妇早日康复。     

卡前列素氨丁三醇注射液和缩宫素在剖宫产产后出血中的应用

目的观察卡前列素氨丁三醇注射液（欣母沛）和缩宫素在预防和减少剖宫产产后出血的疗效及其不良反应比较。方法选择2013年11月至2014年3月同济大学附属第一妇婴保健院足月妊娠并行子宫下段剖宫产术的40例产妇为研究对象,并按胎儿娩出后宫体注射药物的不同,将剖宫产术中使用卡前列素氨丁三醇注射液的20例产妇纳入Ⅰ组,将术中使用缩宫素的20例产妇纳入Ⅱ组。观察两组产妇的手术情况和生命体征变化情况。两组产妇年龄、孕龄、体质量等一般情况比较,差异无统计学意义（P〉0.05）。本研究遵循的程序符合同济大学附属第一妇婴保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。结果Ⅰ组产妇术中出血量显著少于Ⅱ组,两组比较,差异有统计学意义（P〈0.05）。两组产妇用药10min后生命体征变化情况比较,差异有统计学意义（P〈0.05）。Ⅰ组产妇恶心、呕吐、胸闷和颜面潮红等药物不良反应发生率显著高于Ⅱ组,两组比较,差异也有统计学意义（P〈0.01）。结论卡前列素氨丁三醇注射液用于剖宫产术能有效的减少产后出血,但该药物使用时应预防和避免其药物不良反应的发生。