常温不同贮存时间对国产顺阿曲库铵肌松效应的影响

目的 评价常温不同贮存时间对国产顺阿曲库铵肌松效应的影响.方法 择期全麻手术患者120例,年龄18～64岁,性别不限,ASA分级Ⅰ或Ⅱ级,BMI＜ 30 kg/m2,采用随机数字表法,将患者分为3组(n=40):低温60d组(LT组)、室温30 d组(RT30组)和室温60 d组(RT60组).顺阿曲库铵置于冰箱4～8 ℃贮存60 d(LT组)、室温21 ～ 24℃存放30 d(RT30组)或60 d(RT60组).采用TOF-Watch SX肌松监测仪,采用单次超强电刺激观察拇内收肌的肌松程度.待患者麻醉诱导意识消失时静脉注射顺阿曲库铵0.2 mg/kg,当肌颤搐达到最大抑制时行气管插管.记录顺阿曲库铵起效时间、肌颤搐最大抑制程度、临床作用时间、恢复指数和75％恢复时间.评价气管插管条件,记录低血压、心动过缓和皮肤过敏的发生情况.结果 与LT组比较,RT30组顺阿曲库铵起效时间、临床作用时间、恢复指数、75％恢复时间差异无统计学意义(P＞0.05),RT60组起效时间延长,临床作用时间和75％恢复时间缩短(P＜0.05),恢复指数差异无统计学意义(P＞0.05).与RT30组比较,RT60组起效时间延长,临床作用时间缩短(P＜0.05).3组气管插管条件均为优良,且差异无统计学意义,3组低血压和心动过缓发生率比较差异无统计学意义(P＞0.05),均未发生皮肤过敏.LT组和RT30组最大肌颤搐抑制均达到100％,RT60组除1例最大肌颤搐抑制程度为95％外,其余均达到100％.结论 室温贮存30 d对国产顺阿曲库铵肌松效应无明显影响,而贮存60 d可降低其肌松效应.     

手术病人麻醉后恢复的特点

分析１９９５年８月至１９９６年１１月麻醉恢复室接收４３３例病人的情况，以期了解手术后麻醉恢复期护理的特点。其中男性４０．６％，女性５９．４％，平均年龄５４．１±１４．７岁（６～８２岁），平均停留时间４４ｍｉｎ（５～２６５ｍｉｎ），９８．８％的病人平稳恢复后送回病房，１．２％的病人转入ＳＩＣＵ。实施麻醉方法除６例为连续硬膜外麻醉或腰麻外，余为全麻或强化麻醉。根据Ｒａｍｓａｙ评分法，入室时９５％以上病人５～６分，出室时９２％的病人是４分以下，所有病人血压、心率无显著变化，没有给予任何血管活性药物。入室时６３．３％的病人自主呼吸已经恢复。由于麻醉药和肌肉松弛药对中枢和呼吸肌的残留抑制作用，术后早期病人最易出现缺氧。因此全麻术后必须认真监测病人呼吸功能恢复情况，提高吸入氧浓度，根据病情需要保留气管导管，或短时间的机械通气，提高吸入氧浓度，以保证病人呼吸道通畅，避免ＣＯ２的潴留，特别是缺氧的发生。从观察病例可以看出，全麻术后未能立即清醒，平均约４５ｍｉｎ后意识方能满意恢复。     

中药治疗哮喘病临床应用举隅

哮喘为肺系疾病的常见病症，呼吸短促而急迫者谓之喘，气喘而喉中有吼鸣者谓之哮，喘者多以气息而言，哮者多以声响而言，如《医学入门》曰：“呼吸急促者谓之喘，喉中有响声谓之哮。”哮喘初发多属病有夙根，如《景岳全书》中所说：“喘有夙根，遇寒则发，或遇劳即发者，亦名哮喘。”《临证指南医案》中将其称为“宿哮”，     

氩离子凝固术治疗结直肠息肉的临床应用价值

目的探讨氩离子凝固术治疗结直肠息肉的疗效及临床应用价值。方法对160例患者共351枚结直肠息肉行氩离子凝固术（APC）治疗,其中214枚扁平和65枚亚蒂息肉仅行APC治疗,72枚有蒂息肉电切治疗后用APC处理息肉残端。结果本组病例全部临床治愈。2例患者出现无症状的局部黏膜下气肿,78例患者出现短暂腹痛,未行处理自行缓解。结论 APC是一种安全有效的结直肠息肉治疗方法,副反应少,操作简便,尤其是在扁平、广基息肉的治疗中可作为首选方法。     

顺阿曲库铵的药效学及其对组胺释放的影响

Objective To evaluate and compare the histamine-releasing,potencies of cis-atracurium and atracurium during induction of general anesthesia.Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=15 each):group Ⅰcis-atracurium (stored at 4-8℃)(group CIS1);groupⅡcis-atracurium (stored at room temperature)(group CIS2) and group Ⅲ atracurium (stored at 4-8℃)(group ATR).Anesthesia Was induced with TCI of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml).A bolus of cis-atracurium 0.15 mg/kg or atracurium 0.75 mg/kg Was given iv over 5-10 s as soon as the patients lost consciousness.Neuro-muscular block was monitored with TOF-Watch(R) SX(Organon,the Netherlands).Single stimulation (0.1 Hz) was apphed to the ulna nerve at wrist.The maximal degree of N-M block,onset time,duration of action and recovery index were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition Was evaluated.MAP and HR were continuously monitored.Changes in skin were scored (0=no change,Ⅰ=flushed>120 s,Ⅱ=erytbema,Ⅲ=urticaria).Blood samples were obtained before (T0,baseline),at 2 min after induction of anesthesia with TCI of propofol and remifentanil (T1) and 2 and 5 min after CIS/ATR administration (T2,T3) for determination of plasma histamine concentration using enzymatically amplified immunoassay.Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.     

改良阴式子宫切除术58例效果观察

目的：观察子宫脱垂阴式子宫切除术的术式效果。方法：对58例子宫脱垂或伴阴道壁膨出的病例行改良阴式子宫切除术及阴道前后壁修补术的方法、结局及并发症进行观察。结果：阴道顶端呈圆顶状,阴道黏膜伤口渗血少或无渗血,无阴道脱垂并发症。     

失眠的中医辨证治疗

失眠临床上也称"不寐",即无特殊病症而不能入眠的一种病患,本病在西医方面属神经衰弱的范畴[1].祖国医学文献中有"不寐""不得卧""不得眠""目不瞑"等皆失眠之谓也,究其病因多与思虑劳倦,内伤心脾,气血及脏腑功能失调,阴亏与内,阳浮于外,阴阳失交,使阳不入阴,心神不安,导致失眠.另外也有素体阳盛,突受惊吓,情绪不稳,导致肝郁痰阻[2,3].治疗以补虚泻实,调整阴阳为原则.     

中医辨证治疗高血压病

目的：探讨高血压病中医辨证分型的临床疗效。方法：运用中医辨证法，对常见高血压分为肝火上炎、阴虚阳元、肝阳化风、痰湿中阻型、肝气脾虚等4种症型，进行辨证治疗。结果：用中医辨证治疗高血压病，治愈率达85％以上，患者病情稳定，复发率低。结论：根据祖国医学辨证治疗高血压疗效可靠，副作用小，可有效预防高血压病并发症发生。     

马来酸左旋氨氯地平治疗原发性高血压的临床观察

目的 评价马来酸左旋氨氯地平(玄宁)治疗原发性高血压的效果.方法 临床确诊的高血压患者,口服马来酸左旋氨氯地平.30d后进行疗效评价,并跟踪3个月监测血压.结果 治疗后平均收缩压(126+10)mmHg,平均舒张压(72+12)mmHg.治疗30d,显效92例,占73 0%;有效31例,24 6%;无效2例,1 6%;1例服药2d后出现头痛、眩晕停药,总有效率97 6%.跟踪随访监测血压3个月,血压控制较稳定.结论 马来酸左旋氨氯地平是一种安全、有效的降压药物.     

氩离子凝固术治疗结直肠息肉的临床应用价值

目的探讨氩离子凝固术治疗结直肠息肉的疗效及临床应用价值。方法对160例患者共351枚结直肠息肉行氩离子凝固术(APC)治疗,其中214枚扁平和65枚亚蒂息肉仅行APC治疗,72枚有蒂息肉电切治疗后用APC处理息肉残端。结果本组病例全部临床治愈。2例患者出现无症状的局部黏膜下气肿,78例患者出现短暂腹痛,未行处理自行缓解。结论 APC是一种安全有效的结直肠息肉治疗方法,副反应少,操作简便,尤其是在扁平、广基息肉的治疗中可作为首选方法。