咪达唑仑和丙泊酚镇静用于结肠镜检查的比较(前瞻性随机对照研究)

目的借助脑电双频指数（bispectral index，BIS）监测，随机前瞻性比较咪达唑仑和丙泊酚用于结肠镜检查的镇静深度、镇静效果和安全性。方法接受无痛结肠镜检查患者60例，用随机数字表分为3组，每组20例：Ⅰ组，咪达唑仑首次剂量0．06mg／kg；Ⅱ组，丙泊酚首次剂量1．0mg／kg；Ⅲ组，丙泊酚首次剂量1．5mg／kg。于丙泊酚给药后1min、眯达唑仑给药后2min进镜。病人出现不良反应且影响操作时追加丙泊酚20～30mg。监测血压、心率、血氧饱和度值（SpO，）、BIS值，以BIS值反映镇静深度。结果进镜时镇静深度由浅到深依次为Ⅰ、Ⅱ、Ⅲ组（F=25．40，P=0．000），检查中的BIS最低值无统计学差异。进镜时三组患者均无不良反应，丙泊酚追加剂量Ⅰ组明显少于Ⅱ、Ⅲ组，清醒时间Ⅰ组明显长于Ⅱ、Ⅲ组。Ⅰ组有1例心率〈60次／min，Ⅲ组有1例血压〈90／60inmHg，均为一过性，三组SpO2均大于90％。结论咪达唑仑0．06mg／kg和丙泊酚1．0mg／kg作为首次剂量用于结肠镜检查，检查中适时追加丙泊酚镇静深度，镇静效果满意且安全。     

“分步给药”在低氧易感患者无痛苦胃镜检查中安全性的探讨

目的 探讨在低氧易感患者无痛苦胃镜检查中采用分步给药的安全性和镇静/镇痛效果.方法 接受胃镜检查的180例患者,其中有鼾症、或咳嗽、咳痰症状的患者120例单双号随机入选Ⅰ组(分步给药组)和Ⅱ组(普通组),60例无鼾症、咳嗽、咳痰症状的患者为Ⅲ组(常规给药组),Ⅰ组采用分步给药法,Ⅲ组采用常规给药法对患者实施胃镜检查前的镇静/镇痛术,Ⅱ组则进行普通胃镜检查,分析2种镇静法对SBP、DBP、SpO2、HR、清醒时间、患者反应、患者对检查过程的感受以及是否愿意再次接受检查的影响,评价分步给药法在低氧易感患者无痛苦胃镜检查中的安全性和镇静/镇痛效果.结果 Ⅰ组、Ⅲ组检查中SBP、DBP变化无明显差异(均P＞0.05),Ⅰ组检查前、中SpO2的变化小于Ⅲ组(均P＜0.01);Ⅰ组进镜时咽部受刺激产生的恶心咽吐、流涎、咳嗽、躁动反应多于Ⅲ组(均P＜0.01),但较Ⅱ组少(均P＜0.01);Ⅰ组对胃镜检查的评价与Ⅲ组无明显差异(P＞0.05),与Ⅱ组相比有明显差异(P＜0.01).结论 分步给药法是一种适用于低氧易感患者无痛胃镜检查的安全、有效的镇静/镇痛方法.     

An investigation into the information obtained by patients undergoing gastroscopy investigations

? The benefits of informing patients before undergoing surgery or other investigative procedures are clearly demonstrated in the literature. ? This study aimed to determine the amount and type of information given to patients before, during and after undergoing gastroscopy investigations. ? A survey approach incorporating structured interviews and structured observation was utilized. ? There were statistically significant differences between the information acquired by younger and older patients prior to, but not during or after, the procedure. ? Nurses appear to be the most important source of information for older patients while the information leaflet was perceived as the most important source of information for younger patients.     

红景天镇静催眠作用的实验研究

目的探讨中药红景天(Rhodiola rosea)的镇静催眠作用。方法取雄性SD大鼠30只,设正常对照组(不灌服任何药物)、阴性对照组(灌服羧甲基纤维素钠溶液)、地西泮组(灌服地西泮溶液)、红景天低剂量组(灌服低剂量红景天)、红景天中剂量组(灌服中剂量红景天)和红景天高剂量组(灌服高剂量红景天),每组5只。灌服药物1h后,各组动物按照55mg/kg的剂量腹腔注射0.1%戊巴比妥钠溶液,记录每只大鼠从腹腔注射戊巴比妥钠到翻正反射消失的时间为睡眠潜伏期,翻正反射消失的到翻正反射开始出现的时间为睡眠时间,观察灌服不同剂量红景天对大鼠睡眠潜伏期及睡眠时间的影响。结果与正常对照组(3.24±0.22、93.96±2.25)相比,灌服中剂量及高剂量的红景天可以缩短大鼠的睡眠潜伏期(2.42±0.33,P<0.01;2.16±0.13,P<0.01),亦可延长大鼠的睡眠时间(102.54±3.15,P<0.05;107.10±7.75,P<0.05)。结论中剂量及高剂量的的红景天对大鼠具有镇静催眠作用。     

Eye Movements and Visually Active Dreams

There are a number of reports suggesting an association between profusion of eye movements and active dreaming. It has however been suggested that this relationship might only be evident in comparisons across the night and would not be evident in comparisons within one REM period. Data from 20 subjects taking placebo, amylobarbitone, and nitrazepam were used to test this. Dream reports were collected from REM awakenings and rated blind as visually active or passive. Eye movement profusion (number of 2 sec epochs) was assessed for each REM period. Correlation between dream content and eye movement was low but significant in comparisons including the whole night, and including data from drug, withdrawal, and placebo conditions. A significant correlation was not consistently obtained, however, when data from each REMP were considered separately. Correlations based on data from non-drug nights only were also small and could have been due to chance effects alone. The low correlations were not explicable solely by poor reliability of content ratings. It is concluded that the relationship between visually active dreaming and eye movement is slight, and may not hold when time of night is adequately controlled.     

肝癌患者肝动脉导管栓塞后消化系统病变的观察

应用B超对168例施行肝动脉导管栓塞(TAE)治疗的肝癌患者进行了胆囊、胰腺和脾脏的动态观察,并对其中有明显上腹部疼痛的34例进行了胃镜对照检查。结果发现TAE后胆囊病变最常见(123/168),占73.2％;其次为胃、十二指肠病变,占15.5％(26/168);胰腺病变为1.2％(2/168);未见脾脏病变。结果表明TAE后的消化系统并发症并非少见。     

胃镜直视下清创后服药治疗消化性溃疡125例观察

目的：观察胃镜直视下清创对消化性溃疡愈合的影响。方法：２４５例消化性溃疡中治疗组１２５例（胃溃疡５８例,十二指肠球部溃疡６７例）,对照组１２０例（胃溃疡５６例,十二指肠球溃６４例）。治疗组在胃镜直视下用细胞刷反复拉刷溃疡创面,直到创面坏死苔清除干净,其后服药治疗。对照组仅用药物治疗。结果：２周后治疗组消化性溃疡愈合率为７１％,其中胃溃疡为６８％,十二指肠球溃７５％,对照组愈合率５６％（胃溃疡４９％,十二指肠球溃５８％）。１个月后治疗组愈合率为９６％（胃溃疡９４％,十二指肠球溃９８．２％）,对照组为８５％（胃溃疡７２％,十二指肠球溃９１％）。治疗组的２周及１月愈合率明显高于对照组（Ｐ＜０．０５）。胃溃疡清创后愈合率明显优于十二指肠球溃。结论：胃镜直视下清创能加速溃疡愈合,对胃溃疡效果更优。     

住院精神病患者滥用镇静催眠药物倾向

目的:调查我院住院精神病患者镇静催眠药物使用情况.并对相关因素进行分析.方法:通过对591例住院精神病患者的病历进行回顾性调查,获取相关资料并进行分析.结果:住院精神病患者应用镇静催眠药物主要集中在40～49岁,住院时间≤5年,且女性相对用药率明显高于男性.结论:镇静催眠药物在住院精神病患者中的滥用倾向与患者的性别、年龄、住院时间及医师的工作情况有关.     

276例急性上消化道大量出血病因分析

目的:分析急性上消化道大量出血的病因及急诊诊断方法,以提高其急诊诊断水平.方法:回顾近十年来收治急性上消化道大量出血患者276例资料,分析急诊诊断方法及结果,并将入院诊断与最后诊断对比.结果:48小时内参与B超检查阳性率50.61%(83/164),胃镜检查阳性率95.24%(100/105),血管造影100%(5/5).入院诊断消化性溃疡、食管胃底静脉曲张破裂、肿瘤、出血性胃炎、贲门黏膜撕裂、血管畸形和Dieulafoy病构成比分别为38.77%、45.65%、8.70%、6.52%、0.36%、0,而最后诊断分别为35.14%、34.78%、21.74%、2.54%、1.45%、4.35%;诊断符合率分别为73.20%、86.46%、20.00%、71.43%、25.00%、0,其中最高是食管胃底静脉曲张破裂,最低是血管畸形和Dieulafoy病.结论:单凭病史作出急性上消化道大量出血的病因诊断可能存在一定误差,非创伤性B超检查有助于病因诊断,急诊胃镜及血管造影检查能作出病因诊断.     

咪唑安定复合芬太尼在硬膜外麻醉中的应用

目的探讨咪唑安定(力月西,Midazolam)与芬太尼(Fentanyl)联合在硬膜外麻醉中的镇静程度、遗忘及抑制内脏牵拉反应的作用。方法将择期腹部手术行硬膜外麻醉患者60例,随机分为2组(Ⅰ,Ⅱ组)各30例,Ⅰ组静注咪唑安定(力月西)0.04 mg/kg,2 min后静注芬太尼0.75μg/kg;Ⅱ组静注氟哌定0.05 mg/kg 芬太尼0.75μg/kg。两组术中酌情追加首次剂量的1/3~1/2。注药后不同时段记录镇静情况,以改良警觉/镇静观察评分法(OAA/S),观察HR、SBP、DBP和SPO2及术中牵拉反应情况。结果两组在术中的镇静效果无差异,术毕Ⅰ组较Ⅱ组苏醒快,能产生较深的遗忘作用,且能更好的抑制内脏牵拉反应。结论只要加强术中管理,咪唑安定(力月西)复合芬太尼在硬膜外麻醉中能够替代芬氟合剂。