格拉司琼复合利多卡因减轻异丙酚注射痛的随机双盲对照研究

目的 观察格拉司琼复合利多卡因静脉预处理减轻异丙酚注射痛的临床效果. 方法 200例拟行妇科腹腔镜手术的患者,随机分为对照组(Ⅰ组)、利多卡因组(Ⅱ组)、格拉司琼组(Ⅲ组)和格拉司琼+利多卡因组(Ⅳ组),每组50例.所有患者在给药前均先以橡胶止血带阻断其局部静脉回流.对照组患者给予生理盐水3 mL,其它患者按其分组分别给予利多卡因20 mg、格拉司琼2 mg或2 mg格拉司琼和20 mg利多卡因混合液.1 min后松开止血带,并推注1/4预计量异丙酚,同时记录注射部位疼痛评分. 结果 4组患者术中异丙酚注射痛发生率分别为:对照组84%,利多卡因组46%,格拉司琼组52%,格拉司琼+利多卡因组24%.后3组注射痛发生率低于对照组(P<0.05),而格拉司琼复合利多卡因组异丙酚注射痛、术后恶心呕吐及寒战的发生率更低(P<0.05). 结论格拉司琼复合利多卡因静脉预处理可以有效减轻术中异丙酚注射痛,并且还能预防术后恶心呕吐及寒战.     

布托啡诺静脉预处理减轻异丙酚注射痛的随机双盲对照研究

目的观察布托啡诺静脉预处理减轻异丙酚注射痛的临床效果。方法 200例拟在静吸复合全身麻醉下行择期妇科手术的患者,随机分为Ⅰ组(0.5mg布托啡诺组)、Ⅱ组(1mg布托啡诺组)、Ⅲ组(利多卡因组)和Ⅳ组(生理盐水对照组),每组50例。所有患者在给药前均先以橡胶止血带阻断其局部静脉回流。Ⅰ组和Ⅱ组分别经静脉给予布托啡诺0.5mg和1mg;Ⅲ组给予利多卡因20mg;Ⅳ组给予生理盐水2ml。1min后松开止血带,并推注1/4预计量异丙酚,同时记录注射部位疼痛评分。结果 4组患者术中异丙酚注射痛发生率分别为:0.5mg布托啡诺组68%,1mg布托啡诺组46%,利多卡因组52%,生理盐水对照组88%。布托啡诺组和利多卡因组注射痛发生率均明显低于对照组(P0.05),其中1mg布托啡诺组注射痛发生率低于0.5mg布托啡诺组(P0.05)。结论布托啡诺静脉预处理可以有效减轻异丙酚注射痛。     

利多卡因和输液部位对丙泊酚注射痛的影响

目的 观察利多卡因和不同输液部位对丙泊酚注射痛的影响.方法 120例妇产科日间手术患者随机分为二组,每组60例,每组内再根据患者的输液部位分成手背静脉和桡静脉两组.1组推注2ml乳酸林格液后和2组推注40mg利多卡因后缓慢推注丙泊酚.观察推注丙泊酚时患者的疼痛情况.结果 1组的桡静脉的注射痛优于手背静脉(P<0.05),2组的桡静脉和手背静脉的注射痛没有明显区别(P>0.05);2组注射痛的发生率45%,1组注射痛的发生率是78%(P<0.05),药物对注射痛的影响因子大于输液部位对静脉痛的影响因子.结论 利多卡因可以缓解丙泊酚的注射痛,在不复合利多卡因的情况下,选择桡静脉要优于选择手背静脉.     

两种方法使用利多卡因缓解异丙酚注射痛的效果观察及护理

目的：探讨2种方法使用利多卡因缓解异丙酚注射痛的效果及护理措施。方法：选择150例自愿接受无痛人工流产的患者,随机分3组,每组50例,Ⅰ组静注生理盐水2ml60s后静脉推注异丙酚;Ⅱ组静脉注射2％利多卡因2ml 60s后静脉推注异丙酚;Ⅲ组前臂扎止血带后静脉注射2％利多卡因2ml且维持止血带60s后静脉推注异丙酚。各组均进行心理护理、选择肘部静脉、选择留置针及局部按摩护理措施,采用4分评分法对异丙酚注射痛进行评价。结果：Ⅰ、Ⅱ、Ⅲ组异丙酚用药后注射部位无痛发生率分别为30％（15例）、66％（33例）、84％（42例）,3组阍比较有统计学意义（P〈0．001）。绪论：扎止血带后静脉注射2％利多卡因2ml且维持止血带60s缓解异丙酚注射痛效果更好,同时配合有效的护理措施是减轻注射痛的保证。     

利多卡因与芬太尼用于预防丙泊酚注射痛的比较性研究

目的:比较两种剂量利多卡因和芬太尼预防丙泊酚注射痛的效果。方法:将200例择期行手术的女性病人随机分成4个组,每组50例。前臂扎止血带后分别静脉注A组:利多卡因0.5 mg/kg,B组:利多卡因40 mg,C组:芬太尼50μg,D组:生理盐水2 ml。60 s后松止血带,静脉注射丙泊酚。注射期间使用4分法对注射痛评分。麻醉清醒后使用VAS评分法对注射痛再次评分。结果:4组注射痛发生率分别是38%(19例)、50%(25例)、64%(32例)、80%(40例)。VAS评价4组注射痛发生率分别是32%(16例)、44%(22例)、60%(30例)、74%(3例)。结论:扎止血带后静脉注射利多卡因0.5 mg/kg或40 mg并保留止血带1 min,均可降低丙泊酚注射痛的发生率和严重程度。     

氟比洛芬酯注射液不同方式预处理对异丙酚注射痛防治效果的临床观察

目的比较氟比洛芬酯注射液3种不同预处理方式对防治异丙酚注射痛的临床效果,从而找到一种更为有效的方法,提高患者麻醉诱导期的舒适性。方法将120例ASAⅠ～Ⅱ级择期手术患者随机分为6组:A～C组为实验组,A组静脉注射氟比洛芬酯50mg,2min后注射异丙酚1.5mg/kg;B组在注射静脉近心端距穿刺点10cm处用止血带结扎阻断后注射氟比洛芬酯50mg,2min后开放静脉,注射异丙酚1.5mg/kg;C组注射氟比洛芬酯50mg和异丙酚1.5mg/kg的混合液。D～F组为对照组,D组注射生理盐水5ml,2min后注射异丙酚1.5mg/kg;E组在注射静脉近心端距穿刺点10cm处用止血带结扎阻断后注射生理盐水5ml,2min后开放静脉,注射异丙酚1.5mg/kg;F组注射生理盐水5ml和异丙酚1.5mg/kg的混合液。选择左手头静脉平第一腕横纹上3cm处,用20G静脉留置针穿刺。采用口述描述疼痛评分法(VRS)进行注射痛强度评估。手术后24h内观察注射部位的不良反应,如疼痛、水肿、水疱、炎症反应等。结果异丙酚注射痛的发生率如下:A组:60%(12/20);B组:30%(6/20);C组:80%(16/20);D组:90%(18/20);E组:85%(17/20);F组:90%(18/20)。疼痛评分的中位数:A组为1,D组为2,A组与D组相比,差异有统计学意义(P<0.01);B组为0,E组为2,B组与E组相比,差异有统计学意义(P<0.01);C组为2,F组为2,C组与F组相比,差异无统计学意义,(P>0.05)。B组与A组相比,异丙酚注射痛的发生率和严重程度,差异有统计学意义,(P<0.05)。注射部位未观察到不良反应。结论预先给予氟比洛芬酯50mg,继而用止血带在穿刺静脉近心端距穿刺点10cm处结扎2min,与其他的氟比洛芬酯预处理方法相比,可更有效地减少异丙酚注射痛。     

预防异丙酚注射痛的效果和方法学的评价

目的:比较芬太尼、利多卡因、咪唑安定3种药物预防异丙酚注射痛的效果,同时比较口述描绘(VRS)评分和疼痛视觉模拟(VAS)评分对异丙酚注射痛评价的差异,探求其中最优的方案供临床参考使用。方法:静脉麻醉患者140例,随机分为对照组(静脉注射生理盐水2ml)、芬太尼组(静脉注射25μg/ml芬太尼2ml)、咪唑安定组(静脉注射0.1%咪唑安定2ml)、利多卡因组(静脉注射2%利多卡因2ml)4组,各组从静脉给予实验药物120s后,5mg/s恒速推注异丙酚,应用注射异丙酚时的VRS评分和苏醒后VAS评分法分别对各组预防异丙酚注射痛的效果进行评价。结果:(1)VRS评分:芬太尼组、咪唑安定组、利多卡因组用药后无痛发生率分别为49%、57%、46%,均明显高于对照组(P<0.05),而3个实验组间差异无统计学意义(P>0.05);(2)VAS评分:利多卡因组和咪唑安定组疼痛评分明显低于对照组(P<0.01)。结论:(1)预先注射咪唑安定或利多卡因均能减轻异丙酚注射痛;(2)VAS和VRS评分法联合应用于异丙酚注射痛的评价,结果更准确、客观、全面。     

恩丹西酮合用地塞米松预防腹腔镜胆囊切除术后恶心呕吐临床应用

目的 探讨预防性应用5-羟色胺受体拮抗剂恩丹西酮合用地塞米松预防腹腔镜胆囊切除术后恶心呕吐(postoperativenausea and vomiting,PONV)的效果.方法 择期行腹腔镜胆囊切除术的患者100例,随机分为4组,每组25例.在手术结束麻醉苏醒拔管前,对照组(C组)静脉推注0.9%氯化钠溶液6m l;恩丹西酮组(O组)静脉推注恩丹西酮8m g;地塞米松(D组)静脉推注地塞米松10m g;恩西丹酮合用地塞米松(O+D组)静脉推注恩丹西酮8m g+地塞米松10m g.观察术后24h的恶心、呕吐发生频率.结果 术后24h恶心、呕吐发生率恩丹西酮组、地塞米松组明显低于对照组(P<0.01),但高于恩丹西酮合用地塞米松组(P<0.01).结论 恩丹西酮和地塞米松均能有效预防腹腔镜胆囊切除术后恶心呕吐,且两者合用效果更佳.     

小儿无痛胃镜小剂量芬太尼减轻异丙酚静脉注射痛的观察

目的观察芬太尼、利多卡因单独应用或复合应用对消除异丙酚静脉注射痛的效果。方法将3~14岁自愿接受无痛电子胃镜检查的患儿100例,ASA~级,随机分为相等的四组(L、F、F L、D),试验采用双盲对照的方法。根据疼痛严重程度划分为不痛、轻度疼痛、中度疼痛、严重疼痛。结果L组注射痛发生率48%;F组注射痛发生率56%;F L组注射痛发生率12%。D组注射痛发生率96%。L组和F组之间差异无显著性;F L组的疼痛发生率最少。结论复合用药使单一药物的用量明显减少,使用安全、副作用少,可作为一种减轻异丙酚注射痛的有效方法。     

舒芬太尼预处理对丙泊酚注射痛的影响

目的 观察舒芬太尼预处理减轻1%丙泊酚注射痛的效果.方法 择期全麻下腹腔镜胆囊切除术患者150例,随机分为舒芬太尼组(S,n=50),利多卡因组(L,n=50)和生理盐水组(C,n=50).s组静脉推注10μg 舒芬太尼1min后,注射丙泊酚5ml;L组静脉推注等量生理盐水后,注射丙泊酚与利多卡因混合液;C组静脉推注生理盐水后,注射丙泊酚5ml.在推注丙泊酚过程中用视觉模拟评分法(VAS)评估患者肢体的疼痛程度并记录患者上肢退缩的发生情况.结果 S、L组患者VAS评分明显低于C组(P<0.01),而VAS评分在S、L组之间比较无统计学意义,(P>0.05).S、L组患者上肢退缩的发生率明显低于C组(P<0.05),而上肢退缩的发生率在S组、L组之间比较无统计学意义(P>0.05).结论 舒芬太尼预处理可以有效地减轻丙泊酚注射痛,其效果与利多卡因混合丙泊酚注射相当.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.