曲马多治疗硬膜外麻醉中寒战反应的临床观察

目的探讨曲马多治疗硬膜外麻醉中寒战反应的疗效。方法选择下腹部手术硬膜外麻醉中发生寒战反应的病人80例,随机分为两组,治疗组于寒战出现后2 min内静脉注射曲马多50 mg,对照组于寒战出现后2 min内静脉注射生理盐水5 mg,于用药后10 min观察病人寒战情况。结果治疗组病人寒战反应在观察时间内能有效地控制。结论曲马多可有效控制硬膜外麻醉中的寒战反应。     

一次性升温毯用于硬膜外麻醉手术患者术中及术后复苏期的观察

目的：探讨一次性升温毯用于硬膜外麻醉手术患者术中及术后复苏期保暖的效果。方法：选择硬膜外麻醉的骨科、妇科、泌尿科手术患者各150例,随机分为观察组和对照组各225例。对照组以术中升温毯保温,观察组以术中及术后复苏期升温毯保温。观察记录术后寒战发生的情况。结果：观察组寒战发生率、隐性寒战发生率低于对照组,有统计学差异。结论：术中及术后复苏期给予患者保温可有效减少患者术后寒战发生率。     

加温系统对麻醉剖宫产产妇术后寒战的效果

[目的]观察充气式病人加温系统对腰硬联合麻醉剖宫产产妇术后寒战的作用。[方法]将腰硬联合麻醉下行剖宫产且在术后恢复室发生寒战的产妇48例随机分为加温组和曲马多组，分别给予充气式加温系统保暖和曲马多（1．5mg／kg）静脉注射。观察两组产妇干预前及干预后5min、15min、30min体温、寒战发生率、寒战强度及恶心、呕吐发生率。[结果]干预后30min加温组产妇体温高于曲马多组（P〈0．05）；两组产妇干预后15min、30min寒战发生率和强度与干预前比较均下降（P〈0．05）；加温组在干预后5min的寒战发生率和强度较曲马多组高（P〈0．05）；加温组产妇干预后恶心、呕吐发生率低于曲马多组（P〈0．05）。[结论]充气式病人加温系统可以有效缓解产妇腰硬联合麻醉后寒战的发生，且无明显副反应。     

不同处理方法对经尿道前列腺电切术患者寒战反应的预防效果分析

目的比较不同的处理方法对减少经尿道前列腺电切术中患者寒战的效果。方法收集320例择期行经尿道前列腺电切术患者，随机分成Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组各80例，全部采用蛛网膜下隙阻滞硬膜外联合麻醉，经尿道行前列腺电切术，对4组患者分别采用不同的预防和护理方法，观察4组患者寒战发生情况。结果寒战的发生率Ⅰ组和Ⅲ组较Ⅳ组显著降低，差异有统计学意义。结论物理升温及曲马多静脉注射可降低经尿道前列腺电切术中患者寒战的发生率。     

不同处理方法对经尿道前列腺电切术患者寒战反应的预防效果分析

目的 比较不同的处理方法对减少经尿道前列腺电切术中患者寒战的效果.方法 收集320例择期行经尿道前列腺电切术患者,随机分成Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组各80例,全部采用蛛网膜下隙阻滞硬膜外联合麻醉,经尿道行前列腺电切术,对4组患者分别采用不同的预防和护理方法,观察4组患者寒战发生情况.结果 寒战的发生率Ⅰ组和Ⅲ组较Ⅳ组显著降低,差异有统计学意义.结论 物理升温及曲马多静脉注射可降低经尿道前列腺电切术中患者寒战的发生率.     

充气式保温毯预防腹部手术病人术中低体温的效果观察

[目的]观察充气式保温毯预防腹部手术病人术中低体温的效果。[方法]将80例择期腹部手术病人随机分为观察组和对照组各40例,对照组给予常规保暖措施,观察组使用充气式保温毯保暖。监测两组病人全身麻醉前、全身麻醉后10 min、30 min、60 min、90 min、120 min、术毕食管温度,观察病人术中低体温(<36℃)及寒战发生情况。[结果]观察组病人术中低体温、寒战发生率低于对照组(P <0.05);观察组病人全身麻醉后30 min、60min、90 min、120 min、术毕食管温度均高于对照组(P <0.05)。[结论]充气式保温毯能有效保持腹部手术病人术中体温稳定、预防术中低体温的发生。     

保暖贴提高剖宫产术中产妇舒适度的效果观察

[目的]探讨剖宫产术中产妇使用保暖贴保暖的效果。[方法]将200例进行剖宫产术的产妇随机分为观察组、对照组各100例,对照组给予常规保暖,观察组在常规保暖的基础上增加保暖贴保暖,观察两组产妇的寒战发生率、舒适度、满意度。[结果]观察组产妇寒战发生率明显低于对照组(P0.05);观察组产妇自感舒适度和对手术室工作满意度均高于对照组(P0.05)。[结论]对剖宫产术中产妇使用保暖贴能明显增加产妇的舒适度,减少寒战的发生,提高产妇满意度。     

术中温度控制对肺叶切除术病人麻醉恢复期的影响

[目的]探讨肺叶切除术中实施温度控制对手术病人麻醉恢复期的影响。[方法]将156例择期行肺叶切除手术病人随机分为对照组(78例)和观察组(78例),对照组采用调节室温常规盖被等保暖措施,术中输入室温22.0℃~24.0℃液体及库存血;观察组采用常规保暖措施外,还使用温毯仪保暖,术中输入36.7℃~37.2℃液体和库存血补充血容量。比较两组手术结束至完全清醒时间、寒战及躁动发生率。[结果]观察组手术结束至完全清醒时间明显比对照组缩短,寒战及躁动的发生率明显低于对照组(P0.01)。[结论]为病人保暖及输注温热液体可缩短手术结束至完全清醒时间及减少寒战及躁动的发生率。     

曲马多治疗剖宫产病人寒战的临床观察

目的：观察曲马多用于治疗剖宫产病人麻醉期间寒战反应的效果。方法：选择剖宫产麻醉期内发生寒战反应的病人100例，在寒战发生后静脉注射曲马多1．0mg／kg十咪唑安定2，5mg，用药后密切观察寒战反应的变化，以用药后5分钟的效果判定疗效，对于寒战完全消失的病人，记录用药后30分钟内寒战复发的次数。对于寒战复发的病人静脉追加1／2首次剂量药物后观察30分钟，记录用药前，用药后5分钟SBP，HR、RR、SPO2等，结果：病人用药5分钟后寒战消失率为95％，用药后SBP、RR、HR、SPO2变化轻微。结论：曲马多对寒战反应的抑制效果良好，对呼吸、循环无明显抑制，值得临床推广。     

实施严谨的保暖措施对剖宫产产妇术中寒战的影响及护理对策

[目的]探讨实施严谨的保暖措施对剖宫产产妇术中寒战的影响及护理对策。[方法]将2009年3月—2010年3月本院270例剖宫产产妇随机分成研究组和对照组各135例。研究组根据气候和产妇个体情况,术前、术中、术毕实施严谨的保暖措施。对照组给予常规手术护理,输入体内的液体、腹腔冲洗液及术中用的湿纱布垫等均为当时室温下的温度。[结果]研究组发生寒战的15例,发生率11.11%;其中Ⅰ级寒战7例;Ⅱ级寒战8例。对照组发生寒战的48例,发生率35.55%。其中Ⅰ级寒战24例;Ⅱ级寒战24例。[结论]对剖宫产产妇术中实施严谨的保暖措施,可有效地降低术中寒战的发生率及发生的强度,明显减轻了产妇的痛苦。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.