小剂量甲氧明维持剖宫产手术中循环稳定作用观察

摘 要 目的： 探讨小剂量甲氧明维持剖宫产手术中循环稳定的作用,以寻找甲氧明预防和治疗剖宫产术中低血压的最佳方案。方法: 择期剖宫产产妇200例随机分为试验组和对照组(每组100例),实验组于L_3-4腰 硬联合穿刺,注入麻醉药。麻醉完成后即刻开始输注甲氧明;对照组穿刺注入麻醉药后即刻不给予甲氧明,当产妇出现血压下降幅度超过15%时给予静注甲氧明2～3 mg,预先稀释至20 ml。比较两组产妇腰麻前(T₀)、腰麻后5 min(T₁)、腰麻后10 min(T₂)、腰麻后15 min(T₃)、手术结束(T₄)五个时间点的收缩压(SBP)、舒张压(DBP)、心率(HR)变化情况。记录两组产妇新生儿的脐动脉血气分析结果及1 min Apgar评分情况。比较两组产妇术中药品不良反应发生情况。结果: 两组T₁~T₃时的SBP、DBP均明显低于T₀时(P＜0.05);对照组SBP、DBP较试验组下降更明显(P＜0.05)。对照组T₁~T₄时的HR均明显低于T₀时;而试验组T₁~T₄时的HR较T₀时差异无统计学意义(P＞0.05)。对照组T₁~T₃时的HR值明显低于试验组(P＜0.05)。两组新生儿pH、PCO₂、PO₂、Apgar评分比较,差异均无统计学意义(P＞0.05)。试验组产妇术中不良反应发生率明显低于对照组(P＜0.05)。结论:应用微量泵预防性使用甲氧明维持剖宫产术中的循环稳定性较为可靠,且对新生儿无不良影响。     

硬膜外注射治疗急性腰椎间盘突出症的临床观察

目的：探讨硬膜外注射对急性腰椎间盘突出症的疗效。方法：60例急性腰椎间盘突出患者随机分为硬膜外注射组30例和常规治疗组30例，治疗前、治疗后1天、1周及出院前应用目测类比定级法（VAS）对疼痛进行评估，应用腰椎疾患治疗成绩评分表对治疗前后腰椎功能状态进行临床评定。结果：硬膜外注射即时止痛效果明显， 治疗优良率占83．4％，平均改善指数及改善率均高于常规组，并可明显缩短住院时间。结论：硬膜外注射对急性腰椎间盘突出症有较好的临床疗效。     

氯胺酮复合麻醉合并硬膜外阻滞在小儿腹部手术的应用

目的　比较氯胺酮复合麻醉合并硬膜外阻滞和单纯氯胺酮复合麻醉在小儿腹部手术中的应用效果。方法　对 40例随机分为复合组 (A组 ) 2 0例 ,单纯氯胺酮复合麻醉组 (B组 ) 2 0例。观察术中麻醉效果及并发症 ,并记录氯胺酮用量 ,术毕作清醒程度的判断。结果　麻醉效果满意率A组明显优于B组 (P <0 .0 5 )。术中氯胺酮用量A组 (80± 15 )mg比B组 (15 0± 10 )mg显著少 (P <0 .0 1)。与B组比较 ,A组术毕未醒例数极显著减少 ,完全清醒例数大大增多 (P <0 .0 1)。A组无呼吸抑制、恶心、呕吐 ,而B组肌颤 2例、呕吐 3例。结论　氯胺酮复合麻醉合并硬膜外阻滞 ,镇痛完善 ,肌肉松驰 ,用药量明显减少 ,术后并发症少 ,清醒快     

单纯全麻和全麻复合硬膜外对心血管反应的影响

[目的]观察全麻复合硬膜外麻醉的血液动力学变化。[方法]选60例下腹部手术的病例,随机分为单纯全麻(A组)和全麻复合硬膜外(B组)两组,每组30例,观察二组麻醉前、插管、切皮、探查、拔管时的SBP、DBP、MAP、HR的变化,记录呼吸恢复时间、拔管时间、恢复时间。[结果]两组中SBP、DBP、MAP、HR,A组变化较大,B组平稳,P<0.05或0.01,有显著性差异,各项苏醒时间A组长于B组。[结论]全麻复合硬膜外具有心血管反应较小、血液动力等平稳的优点,且苏醒迅速,无躁动。     

The peridural membrane of the spine has characteristics of synovium

The peridural membrane (PDM) is a well-defined structure between dura mater and the wall of the spinal canal. The spine may be viewed as a multi-segmented joint, with the epidural cavity and neural foramina as joint spaces and PDM as synovial lining. The objective of this investigation was to determine if PDM has histological characteristics of synovium. Samples of the PDM of the thoraco-lumbar spine were taken from 23 human cadavers and analyzed with conventional light microscopy and confocal microscopy. Results were compared to reports on similar analyses of synovium in the literature. Histological distribution of areolar, fibrous, and adipose connective tissue in PDM was similar to synovium. The PDM has an intima and sub-intima. No basement membrane was identified. CD68, a marker for macrophage-like-synoviocytes, and CD55, a marker for fibroblast-like synoviocytes, were seen in the lining and sub-lining of the PDM. Multifunctional hyaluronan receptor CD44 and hyaluronic acid synthetase 2 marker HAS2 were abundantly present throughout the membrane. Marked presence of CD44, CD55, and HAS2 in the well-developed tunica muscularis of blood vessels and in the body of the PDM suggests a role in the maintenance and lubrication of the epidural cavity and neural foramina. Presence of CD68, CD55, and CD44 suggests a scavenging function and a role in the inflammatory response to noxious stimuli. Thus, the human PDM has histological and immunohistochemical characteristics of synovium. This suggests that the PDM may be important for the homeostasis of the flexible spine and the neural structures it contains.     

高氧医用液在高位硬膜外麻醉中低张性缺氧的应用

目的　研究高氧医用液在高位硬膜外麻醉中治疗和预防低张性缺氧的效果和安全性。方法　将10 0例胸壁手术患者随机分成高氧液治疗组 (A组 )和同等量细胞外液治疗组 (B组 ) ,均在高位硬膜外麻醉下完成胸壁手术 ,入室后输液速度第 1小时为 10ml (Kg·h) ,以后 6ml (Kg·h) ;A组输入高氧液 ,B组输入林格氏液 ;两组患者出现SPO2 <95 %时面罩给氧 ,氧流量 3～ 5L min ;两组于麻醉前和麻醉后 30、6 0、90min及术毕麻醉平面消失后 5个时点各抽取动脉血 1ml进行血气分析 ,同时观察生命体征和术中不良反应。结果　两组各时点血气结果各项指标均在正常范围内波动 ,组间、组内比较均无显著性差异 (P >0 .0 5 ) ,术中A组无需面罩给氧治疗 ,B组全部需面罩给氧治疗 ;A组生命体征各指标在各时点无显著性差异 (P >0 .0 5 ) ,B组在麻醉后初期呼吸频率增快 ,较麻醉前和A组比较均有显著性差异 (P <0 .0 5 ) ;术中两组患者均无寒战、烦躁、头痛、过敏、气栓等不良反应发生。结论　高氧医用液为术中高位硬膜外麻醉所致的缺氧提供了全新的供氧方法 ,且有使用方便、安全性强、疗效确切等优点。     

Effect of peridural heart block on the threshold of ventricular fibrillation in dogs

The threshold of ventricular fibrillation in animals with an intact heart and myocardial infarction was determined by injection of trimecaine into the peridural space at the T₁-T₂ level. The threshold of fibrillation was shown to be increased under these circumstances on account both of the resorptive action of trimecaine and the blockade of the sympathetic nerves to the heart.Laboratory of Clinical and Experimental Cardiology, I. P. Pavlov Institute of Physiology, Academy of Sciences of the USSR, Leningrad. (Presented by Academician V. N. Chernigovskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 86, No. 9, pp. 277–279, September, 1978.     

分娩镇痛促进母乳喂养的临床护理研究

目的研究硬膜外阻滞分娩镇痛、母乳喂养的健康教育对母乳喂养的影响,以提高产科质量、促进母乳喂养。方法随机选择2001～2003年7月住院阴道分娩无产科并发症、合并症的健康孕妇170例,采用持续硬膜外阻滞分娩镇痛产妇96例为观察组,未采用分娩镇痛及产后镇痛产妇74例为对照组。观察两组产妇产后精神状态、泌乳始动时间、泌乳量,所得资料进行统计学处理。结果①观察组产后产妇精神状态明显优于对照组,差异有显著性(P<0.001);②观察组产后泌乳始动时间短于对照组,72小时内泌乳量多于对照组,差异有显著性(P<0.05)。结论①分娩镇痛及产后镇痛其镇痛效果确切,改善产妇的精神状态,促进母乳喂养。②实施一条龙的母乳喂养宣教服务、护理小组监督实施宣教和指导工作,可巩固和提高母乳喂养成功率。     

Effectiveness of the Biophysical Barriers to the Peridural Fibrosis in Rat Laminectomy Model

Purpose: Peridural fibrosis which could occur after the spinal surgery could adhere neural tissue closely and may cause to neural entrapment symptoms and require surgical reintervention. Aim of the study: Present study was designed to reduce occurrence of peridural fibrosis in rat laminectomy model by using biophysical barriers called hyaluronic acid (HAS) dural barrier, activated polyethylene glycol and polyethylene imine (PEG) dural barrier, and platelet-rich plasma (PRP). Materials and methods: In this study, 2 of 26 male Wistar albino rats (325–350 g body weight), which were not included into study groups were sacrificed by removing their total blood and their blood was used for preparation of PRP, and remaining rats were randomly delivered into four groups called SHAM, HAS, PEG, and PRP groups. Then L3-4-5 laminectomy was performed to all animals and experimental agents were administered to the selected groups mentioned above. Spinal colons of all animals were removed gross total after 6-week period and investigated histopathologically. Additionally, real-time-polymerase chain reaction was used to obtain collagen type I and type III, transforming growth factor-1β, and tumor necrosis factor-α gene expressions. Results: All results demonstrated that polyethylene glycol and polyethylene imine dural barrier and PRP could decrease peridural fibrosis formation efficiently in rat. Conclusion: Present study results suggested that to reduce or block formation of peridural fibrosis, either polyethylene glycol and polyethylene imine dural barrier or PRP could be used effectively in human subjects after they will be closely investigated in future studies.