围术期不同时间应用曲马多对术后镇痛和恶心呕吐的影响

Objective To investigate the analgesic effect and the influence on nausea and vomiting of tramadol during the different periods of perioperation. Methods Fifty-four patients undergoing gynecologic surgery under general anesthesia were randomly divided into three groups according to the time of using tramadol: after operation instantly group, before the end of surgery group and before induction of anesthesia group. All the patients received intravenous patient controlled analgesia(PCA) pump. The vital signs, pain scores and postoperative nausea and vomiting were observed 24 hours after operation. Results There was no significant difference of the vital signs and visual analogue scale (VAS) scores among the three groups( P ＞ 0.05 ). At 8 h after PCA, the number of PCA in before induction of anesthesia group was obviously reduced(P ＜0.05). At 1 h after PCA, the patients in before the end of surgery group experienced the severest nausea and vomiting( P ＜0. 05 ). At 4 h, 8 h and 12 h after PCIA, the patients in after operation instantly group experienced the severest nausea and vomiting ( P ＜ 0.05 ).Conclusion Using tramadol before induction of anesthesia not only has a good analgesic effect, but also decreases the incidence of nausea and vomiting after postoperative analgesia.     

人脑内不同机制参与视觉图形冲突的处理

目的：研究脑内对具有冲突信息的立体图形及平面图形处理的机制。方法：刺激对由觉的平面图形及立体图形随机组合而成,分为四种状态,a,刺激对由两个完全相同的立体图形组成;b.刺激对由两个完全相同的平面图形组成;c．刺激对由两个构型不同的立体图形组成;d.刺激对由两个构型不同的平面图形组成,受试者的任务;辨别前后呈现的两个刺激（第一个刺激S1,第二个刺激S2）形状是否相同。结果：在c,d两种状态下,已记录到冲突负波N270,该负波不出现于a,b状态,同时,N270的最大振幅在c状态下出现在右侧后头部,而d状态下则出现在前头部,结论;脑对具有冲突特征的立体及平面图形具有不同处理机制。     

肌张力障碍的发病机制

肌张力障碍 (ｄｙｓｔｏｎｉａ)是肌肉过度收缩导致身体一部分或全部出现持续性扭转或姿势异常为主要表现的一组综合征。其特点是主动肌和拮抗肌同时收缩 ,运动时症状加剧 ,严重的病人安静时也出现肌肉的异常活动[1,2 ] ;运动时肌肉活动选择性缺乏 ,在完成动作时远隔部位无关肌肉过度活动 ,影响动作完成[3 ] ,比如 ,从事简单的手指运动却表现出整个上肢甚至躯干部位的不协调运动。此外 ,执行动作时还可表现出动作的迟缓及不稳。临床上肌张力障碍可以表现为全身性或局灶性 ,后者包括眼睑痉挛、Ｍｅｉｇｅ综合征、口舌综合征、痉挛性斜颈、书…     

右美托咪定对老年前列腺电切术全麻患者导管相关膀胱刺激症和认知功能障碍的影响

目的研究右美托咪定对老年前列腺电切术全麻患者导管相关膀胱刺激症和认知功能障碍的影响。方法选取郑州大学第一附属医院2016年2月-2018年2月收治的110例老年前列腺电切术全麻患者。按照随机数字表法分为观察组与对照组,各55例。观察组在麻醉诱导前预注右美托咪定,对照组在麻醉诱导前预注等量生理盐水。比较两组入室后血流动力学指标,记录麻醉情况,检测术后12 h应激指标与血清S100β,评估术后3 d认知功能,统计术后认知功能障碍与导管相关膀胱刺激症发生率。结果观察组T1、T2、T3、T4的心率(HR)、平均动脉压(MAP)低于对照组(P0.05);丙泊酚与舒芬太尼用量低于对照组(P0.05);术后12 h血清去甲肾上腺素(NE)、S100β低于对照组(P0.05)。观察组术后认知功能障碍与导管相关膀胱刺激症发生率分别为5.5%、36.4%,低于对照组的18.2%、56.4%(P0.05)。结论全麻诱导前预注右美托咪定可以缓解导尿管引起的膀胱刺激症,有利于老年前列腺电切术全麻患者血流动力学稳定,对术后近期认知功能改善具有一定作用。     

围术期不同时间应用曲马多对术后镇痛和恶心呕吐的影响

Objective To investigate the analgesic effect and the influence on nausea and vomiting of tramadol during the different periods of perioperation. Methods Fifty-four patients undergoing gynecologic surgery under general anesthesia were randomly divided into three groups according to the time of using tramadol: after operation instantly group, before the end of surgery group and before induction of anesthesia group. All the patients received intravenous patient controlled analgesia(PCA) pump. The vital signs, pain scores and postoperative nausea and vomiting were observed 24 hours after operation. Results There was no significant difference of the vital signs and visual analogue scale (VAS) scores among the three groups( P ＞ 0.05 ). At 8 h after PCA, the number of PCA in before induction of anesthesia group was obviously reduced(P ＜0.05). At 1 h after PCA, the patients in before the end of surgery group experienced the severest nausea and vomiting( P ＜0. 05 ). At 4 h, 8 h and 12 h after PCIA, the patients in after operation instantly group experienced the severest nausea and vomiting ( P ＜ 0.05 ).Conclusion Using tramadol before induction of anesthesia not only has a good analgesic effect, but also decreases the incidence of nausea and vomiting after postoperative analgesia.     

中医《方剂学》教材编排改革之我见

现行《方剂学》教材,编排模式十分传统,不利于快速培养中医临床人才,改革势在必行。1《方剂学》教材编排改革的目的 首先,学习《方剂学》的目的,在于临床施药配方灵活准确,在于掌握它的配方原则。能够使药对病(或证)达到最有效的治疗效果。而现行教学中,即使讲完课,还不能有效开方     

C反应蛋白检测在急性脑血管病变中的临床应用

目的探讨脑血管病患者发病早期血液中C反应蛋白含量高低与病情程度及预后的关系.方法采用免疫透射比浊法测定214例急性脑血管病变患者血清C反应蛋白浓度,并分析病程及预后的关系.结果214例脑血管病变患者,有77例C反应蛋白浓度增高,阳性率为36.0%,脑出血患者阳性率(46/81)明显高于脑梗塞患者(31/133).C反应蛋白增高的死亡率明显增高(P＜0.01).结论脑血管病变者早期血液中的C反应蛋白含量增高提示病情严重而且预后不良.     

远洋渔民出航前后血脂与免疫球蛋白的变化

目的了解远洋渔民因作业区域、副食品供应、环境等因素发生改变,是否影响正常生理功能.方法检测32名远洋渔民,以航前、航后作自身对照的血脂和免疫球蛋白.结果航后与航前相比IgG、IgA结果升高,P＜0.05;HDL-C结果升高,P＜0.05;APoB-100结果下降,P＜0.05.结论由于环境因素影响,体力消耗多,食用多不饱和脂肪酸,可以降低胆固醇,从而避免因食用超标准脂肪引起的心血管疾病.     

Q-T间期延长综合征患者的全身麻醉

目的 总结QT间期延长综合征(LQTS)患者全身麻醉的经验.方法 LQTS患者36例,采用咪唑安定0.1 mg/kg、依托咪酯0.3 mg/kg、芬太尼5μg/kg、维库溴铵0.1 mg/kg麻醉诱导,插管后吸入60%N2O和1%～2%异氟醚,并间断追加芬太尼和维库溴铵维持麻醉.持续监测BP、HR、SpO2和PETCO2.记录麻醉前和术中FCG,测量Q-T值并计算出Q-Tc值.术后应用芬太尼、咪唑安定静脉镇痛镇静.结果 所有患者各时点BP、HR差异无统计学意义.与麻醉前相比,个别患者麻醉诱导后Q-Tc值有轻微下降,但Q-T间期无明显延长;术中无心律失常等心血管意外发生.结论 此种麻醉方式及用药对LQTS患者是安全有效的.