复方麝香注射液联合脑血肿引流术治疗中老年高血压脑出血疗效观察及费用对比

目的:探讨复方麝香注射液联合微创手术治疗中老年高血压脑出血的临床疗效.方法:将78例接受微创治疗的患者随机分组,两组均采用内科综合治疗.手术对照组在综合治疗基础上加用微创手术进行脑血肿引流;中西医结合组在微创手术治疗后加用复方麝香注射液(10～20 ml/d)静脉滴注1周.结果:中西医结合组显效率(66.67%)、有效率(82.05%)均明显高于手术对照组(46.15%和69.23%,P均<0.05),存活患者日常生活能力也明显优于手术对照组(P<0.05),意识恢复时间明显短于手术对照组(P<0.05),并发症的发生率(15.38%)明显低于手术对照组(38.46%,P<0.01),病死率(5.13%)明显低于手术对照组(10.26%,P<0.01),平均住院天数[(18.29±4.93)d]明显少于手术对照组[(26.23±5.82)d,P<0.05],平均住院费用[(5 916.23±826.39)元]明显少于手术对照组[(8 168.35±1 021.21)元,P<0.05].结论:脑血肿引流术后加用复方麝香注射液治疗中老年高血压脑出血,可降低病死率,减少并发症,降低病残程度,提高生存患者的生活质量,缩短住院时间,降低治疗费用.     

Intravenous drug abuse and Type 1 diabetes: financial and healthcare implications.

AIMS: To determine the morbidity, mortality and healthcare costs of intravenous drug-abusing patients with Type 1 diabetes (IVDA-DM), who are admitted to hospital. METHODS: Retrospective case note analysis of admissions, complications and cost estimation over a 6-year period. Each drug-abusing patient (IVDA-DM) (n = 9) was compared with two controls (n = 18) with Type 1 diabetes but without a history of intravenous drug abuse (DM-controls). Admissions were also analysed for patients with intravenous drug abuse, but without Type 1 diabetes (IVDA-controls) (n = 198). Admissions were at a University teaching hospital in Liverpool, UK. DM-controls were drawn from a population attending diabetes outpatient clinics between 1997 and 2002 at the same hospital. The main outcome measures were: the duration and healthcare costs of hospital admissions per year, outpatient attendances per year, glycated haemoglobin (HbA(1c)), weight, micro- and macrovascular complications and mortality. RESULTS: Multiple admissions, mainly related to ketoacidosis, led to marked differences in mean (95% CI) inpatient days per year per patient [IVDA-DM 28.1 (13.6-42.7) vs. DM-control 1.1 (0.2-1.9); P < 0.0001], mean inpatient days per year per patient in critical care bed (IVDA-DM 1.7 (-0.7-4.2) vs. DM-control 0; P < 0.02) and mean costs of admission, per patient per year (pound sterling 7320 vs. pound sterling 230). The IVDA-DM group frequently omitted insulin, were underweight, failed to attend as outpatients and five had died by the end of 2002. The IVDA-controls spent considerably less time in hospital [3.4 (2.8-3.9) days per patient per year]. CONCLUSION: IVDA-DM patients have higher rates of diabetes complications, are admitted more frequently and have a high mortality compared with DM and IVDA-controls. The cost of inpatient care of this small group of patients was considerable.     

听觉诱发电位指数指导全凭静脉麻醉期间病人输注异丙酚的效果

目的探讨听觉诱发电位指数(AAI)指导全凭静脉麻醉期间病人输注异丙酚的效果。方法择期全麻下行腹腔镜胆囊切除术病人60例,ASAⅠ或Ⅱ级,随机分为2组(n=30):试验组(Ⅰ组)和对照组(Ⅱ组)。静脉诱导气管插管后,持续输注0．2μg·kg-1·min-1瑞芬太尼以维持合适的麻醉深度。Ⅰ组通过监测AAI调节异丙酚输注速率,使AAI维持在30以下,Ⅱ组根据病人血压及心率调节异丙酚输注速率,每5分钟增减0．01 mg·kg-1·min-1异丙酚。记录气腹前(T1)、气腹后(T2)、分离胆囊(T3)、腹腔冲洗(T4)、手术结束(T5)时2组的血压、心率、AAI和输注异丙酚的速率,同时记录2组异丙酚、维库溴铵、瑞芬太尼用量、术毕睁眼时间、应答时间和拔管时间。结果2组各时间点AAI差异有统计学意义(P<0．05),与Ⅱ组相比,Ⅰ组输注异丙酚速率以及总用量减少(P<0．05)。术后24 h随访病人均无术中知晓。结论AAI指导全凭静脉麻醉输注异丙酚用于腹腔镜胆囊切除术病人,可较好的控制麻醉深度,指导合理用药,避免病人术中知晓。     

前列腺癌细胞株Du145裸鼠胫骨部骨肿瘤转移模型的建立

目的:建立一种裸鼠前列腺癌骨转移模型,观察肿瘤局部生长和远处转移情况,并进一步探讨其应用价值。方法:9只6周龄雄性BALB/C裸鼠麻醉后,将前肢及左后肢固定,以1 m l TB针筒-29G针头从胫骨头关节窝,刺入骨髓腔缓缓注入人前列腺癌Du145细胞悬液30μl(约5×106个细胞)至骨髓腔,以建立前列腺癌骨转移模型。观察裸鼠生命体征变化。于濒死状态下处死,取右后肢及其附近淋巴结、肺脏和肝脏等标本,用40 m l/L甲醛固定、石蜡包埋、苏木精-伊红染色后显微镜下观察。结果:9只裸鼠中有6只模型建立成功。接种后平均48 d裸鼠出现跛行现象,右后肢胫骨部可触及米粒大小的包块,质硬,进一步发展至小鼠行走障碍。55 d后出现恶病质,解剖后发现右后肢胫骨部骨质疏松,局部有“腐肉”样组织突出髓腔,填塞肌肉间隙,病理证实为肿瘤组织。肝脏泛黄、被膜皱缩,镜下呈急性重型肝炎的病理改变。结论:胫骨内注射细胞悬液制作裸鼠前列腺癌骨转移模型较好地模拟了人前列腺癌在骨骼微环境中的生长及转归情况,是研究前列腺肿瘤骨转移的适宜模型。     

顺铂腹腔注入治疗卵巢癌腹水的临床观察

晚期卵巢癌腹水的治疗相当困难,目前虽有一些治疗卵巢癌腹水的方法,但用顺铂腹腔内注入治疗卵巢癌腹水尚未见报道。我们在术前和术中用顺铂(各100mg)腹腔注入治疗20例晚期卵巢癌腹水患者。所有患者的全身状况在术前均得到明显改善,19例上皮性卵巢癌腹水患者一年内无腹水生长。该方法简单、安全,控制腹水生长效果明显,副作用少。     

Epidural block for obstetrics: Comparison of bolus injection of local anesthetic with gravity flow technique

Study Objective: To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection.

Design: Prospective, randomized study.

Setting: Teaching hospital.

Patients: 600 ASA physical status I and II parturients scheduled for labor and delivery or elective cesarean section.

Interventions: After identification of the epidural space with pulsations of an air-fluid column, parturients for vaginal delivery (n = 380) were randomized to receive a test dose of 3 ml 3% 2-chloroprocaine with epinephrine 20 μg, two doses of 7 ml bupivacaine 0.03 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow (Group 1) given over 30 seconds or by bolus injection (Group 2) given over 5 seconds through the epidural needle; parturients for Cesarean delivery (n = 220) were randomized to receive a test dose and two doses of 6 ml lidocaine 2 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow or by bolus injection through the epidural needle. Changes in maternal heart rate (HR) and blood pressure, signs of intravascular injection, and adverse effects of epidural bupivacaine-sufentanil were recorded after each dose.

Measurements and Main Results: Gravity flow administration (Group 1) was associated with a smaller increase in mean maternal HR (p < 0.001), less hypotension (p < 0.01), sedation (p < 0.01), nausea (p = 0.01), and segmental spread (p < 0.0001) than were corresponding doses given by traditional bolus injection (Group 1) for vaginal or Cesarean deliveries. The incidence of systemic toxicity was zero of 300 (0%) with gravity flow and 4 of 300 (1.3%) by bolus injection, p = 0.12, Fisher's exact test. No patient in either group had an accidental intrathecal injection.

Conclusion: Gravity flow administration of local anesthetic-opioid solution during epidural block for obstetrics was associated with fewer signs of systemic drug absorption and cardiovascular perturbations than was the traditional bolus injection. This study supports the current opinion that slow administration of local anesthetic during epidural black contributes to fewer adverse events.     

Insulinoma: Selective arterial calcium injection performed to confirm localization and complete resection

A case of insulinoma is reported in a patient in whom selective arterial calcium injection (SACI) tests were performed both to confirm tumor localization before surgery and to confirm complete tumor removal during surgery. An 18-year-old woman with hypoglycemic episodes was diagnosed with an insulinoma in the pancreatic body demonstrated by celiac arteriography. In a preoperative SACI test, calcium was injected into the splenic artery (SpA), gastroduodenal artery (GDA), and superior mesenteric artery (SMA). Serum immunoreactive insulin (IRI) and proinsulin levels were measured in hepatic venous samples. IRI was markedly increased after the injection of calcium into the GDA and SMA, while there was no response in IRI levels when calcium was injected into the SpA. Therefore, no occult insulinoma was revealed in the distal area fed by the SpA, although the presence of insulinoma was uncertain in the proximal pancreas. In the intraoperative SACI test, calcium was injected into the celiac artery. Insulin (determined by enzyme immunoassay) and proinsulin levels were measured in portal venous samples before and after resection of the tumor. After resection, these levels decreased in response to the calcium stimuli, confirming complete removal of the insulinoma. The SACI test was helpful to localize the insulinoma and was useful to confirm the complete removal of the tumor.     

The use of propofol and alfentanil by infusion in military anaesthesia

A total intravenous technique using propofol and alfentanil was used successfully in four battlefield casualties treated at a British Military Field Hospital during the recent Gulf conflict. All patients made a rapid recovery of adequate quality for prompt evacuation. We believe that the use of propofol and alfentanil as an induction and maintenance regimen for military anaesthesia merits further evaluation and comparison with established techniques.     

黄芪注射液对冠心病病人心电图的影响

目的：观察黄芪注射液对冠心病病人心电图的影响。方法：冠心病６０例（男性４５例，女性１５例，年龄５４±ｓ１３ａ），采用黄芪注射液２０ｍＬ＋５％葡萄糖氯化钠注射液２５０ｍＬ，静脉滴注，ｑｄ，连用２ｗｋ。结果：治疗后心电图Ｐｔｆ－Ｖ１绝对值减小，缺血型ＳＴ－Ｔ明显改善。结论：黄芪注射液能明显改善冠心病心肌缺血之ＳＴ－Ｔ改变及左心功能不全所致的Ｐｔｆ－Ｖ１负值增大。     

Influence of anaesthesia and muscle relaxation on intubating conditions and sympathoadrenal response to tracheal intubation

Background : The study aimed to assess the relative influence of anaesthesia and muscle relaxation on intubating conditions and the haemodynamic and catecholamine responses to tracheal intubation.
Methods : Sixty ASA 1 or 2 patients were randomly assigned to one of four groups (15 patients each) that differed in the depth of anaesthesia (thiopentone plus fentanyl 2.5 μg kg^-1 or thiopentone alone) and the degree of vecuronium–induced neuromuscular block (100% or _>: 65%) at intubation. Muscle relaxation was measured at 0.1 Hz by means of mechanomyography. Heart rate (HR) and mean arterial blood pressure (MAP) were measured before and after induction of anaesthesia, and 1 min and 5 min following intubation, while adrenaline (A) and noradrenaline concentrations (NA) were determined from arterial blood samples.
Results : Intubating conditions were improved primarily by providing complete muscle relaxation at the adductor pollicis muscle (P<0.001) and to a lesser extent by adding fentanyl to thiopentone (P=0.04). The response of HR and MAP to tracheal intubation was attenuated mainly by fentanyl (P<0.001). Complete muscle relaxation further diminished the response of MAP to intubation (P=0.03). Changes in A and NA were dependent on the depth of anaesthesia only (P =>0.01).
Conclusion : The results of the study demonstrate that the sympathoadrenal response to intubation is attenuated by adding fentanyl (2.5 kg^-1) to an induction regimen with thiopentone, whereas provision of complete muscle relaxation at the adductor pollicis muscle is necessary to attain smooth intubating conditions.