持续输注依托咪酯对腹腔镜胆囊切除术患者细胞因子和肾上腺皮质功能的影响

目的 观察依托咪酯对腹腔镜胆囊切除术患者细胞因子和肾上腺皮质功能的影响.方法 将40例择期行腹腔镜胆囊切除术患者(ASAⅠ～Ⅱ级)随机分为依托咪酯组(E组)和异丙酚组(P组),每组20例.麻醉诱导给予芬太尼0.005 mg/kg,维库溴胺0.1 mg/kg,E组用依托咪酯0.3 mg/kg, P组用异丙酚2 mg/kg.术中麻醉维持:E组给予依托咪酯20～25 μg/(kg·min), P组给予异丙酚6～10 mg/(kg·h).分别在麻醉前(T1)、气腹即刻(T2)、术后即刻(T3)、术后12 h(T4)、术后24 h(T5)、术后48 h(T6)抽静脉血,测定血皮质醇、白细胞介素(IL)-6及IL-10水平.结果 T2～T5时刻P组皮质醇浓度高于E组(P<0.05),两组皮质醇浓度于T6时点均恢复至术前水平.IL-6:两组术中T2时点开始升高,至术后T4(与T1相比,P>0.05)时点达到高峰,术后48 h恢复至正常水平;P组IL-6在T3、T4时点高于E组(P<0.05).IL-10组间比较差异无统计学意义.结论 在腹腔镜胆囊切除术中,应用依托咪酯静脉持续输注安全有效. Abstract： Objective To observe the infuence of etomidate on adrenocortical function and cellular factor in patients undergoing laparoscopic cholecystectomy. Methods Forty patients scheduled for elective laparoscopic cholecystectomy (ASAⅠ- Ⅱ) were randomized into the etomidate group (group E) and the propofol group (group P) with 20 cases in each group. Patients were induced with fentanyl 0.005 mg/kg, vecuronium 0.1 mg/kg, and etomidate 0.3 mg/kg (group E) or propofol 2 mg/kg(group P). Anesthesia as maintained with etomidate 20-25 μg/(kg·min) in group E or propofol 6-10 mg/(kg·h) in group P. Blood sample were taken before induction (T1), immediately after pneumoperitonieum (T2),immediately after operation(T3),12 h(T4) 24 h(T5) and 48 h(T6) after operation to measure plasma concentration of cortisol, IL-6 and IL-10. Results The concentration of cortisol were significantly higher in group P than group E at T2-T5, and restored to preoperative level in both groups at T6. The concentration of IL-6 increased from T2, peaked at T4 and restored to baseline at T6 in both groups. Significant differences were detected only at T3 and T4 between groups with a higher level in group P. No significant difference were detected in the concentration of IL-10 between groups at any time point. Conclusions continuous infusion of etomidate is effective and safe for laparoscopic cholecystectomy.     

布托啡诺复合小剂量氯氨酮用于剖宫产术后镇痛

目的 观察术后硬膜外持续泵入布托啡诺复合小剂量氯胺酮用于剖宫产术后镇痛的效果和对初乳及不良反应的影响. 方法选择40例Ⅰ～Ⅱ级择期或急症孕足月行剖宫产手术后的产妇,年龄23～35岁,随机分为两组.A组为观察组(n=20),用布托啡诺0.1 mg/kg+氯胺酮1 mg/kg+生理盐水至 100 ml持续泵入;B组为对照组(n=20),用0.15%罗哌卡因+0.004%芬太尼+0.1%地塞米松+生理盐水总量100 ml持续泵入.观察产妇术后各时间段的视觉模拟镇痛评分(VAS)、镇静评分、泌乳时间,并对术后产妇的总体感觉满意度进行评分.结果 A、B两组在泵药后4、12、24、48 h的VAS评分、镇静评分差异无统计学意义(P>0.05).A组产妇的总体感觉满意度高于B组(P<0.05),两组的初乳时间差异无统计学意义(P>0.05).结论 布托啡诺复合小剂量氯胺酮硬膜外持续泵入用于剖宫产术后镇痛可以提供满意的镇痛效果,而且也有利于术后产妇的恢复,并且不影响泌乳. Abstract： Objective To observe the analgesia effects of buprenorphine hydrochloride combined with low ketamine that continued to pump into epidural space,which were used to treat postoperative analgesia of cesarean section and to study their on colostrums and side reactions. Methods Forty patients were at age of 23-35 years and term pregnancy, who were 1-2 grade or emergency.These cases were randomly divided into two groups: group A(study group,n=20) and group B(control group,n=20),group A were treated with buprenorphine hydrochloride(0.1 mg/kg)+ ketamine(1 mg/kg)+NS(coming to 100 ml),which continued to pump into epidural space. Group B were treated with ropivacaine(0.15%)+febtanyl citrate(0.004%)+dexame thasone(0.1%)(coming to 100 ml), which continued to pump into epidural space.We observe postoperative parturients mimic analgesia VAS of visual sense,sedation VAS,lactigenous time and the total degree of satisfaction. Results There were no significant difference between group A and group B about mimic analgesia VAS of visual sense(P>0.05) and lactigenous time(P>0.05),the total degree of satisfaction in group A was higher than that in group B (P<0.05). Conclusions Buprenorphine hydrochloride combined with low ketamine continued to pump into epidural space,which are used to treat postoperative analgesia of cesarean section, show satisfactory analgesia effect, and it is propitious to recovery of posteroprative parturients and did not influence lactation.     

瑞芬太尼静脉自控式分娩镇痛的临床研究

The study intended to evaluate the efficacy and safety of patient-controlled intravenous analgesia with remifentanil for labor. Three hundred and two parturients at 37 -42 week of gestation received remifentanil (0. 1μg · kg-1 ·min-1 ) as patient-controlled intravenous analgesia for labor (analgesia group) and their clinical results were compared with those of 221 parturients in labor without intravenous analgesia (control group). Maternal monitoring, including pain scores(VAS), delivery mode, side effects, laboring time was performed for both groups. There was a significant decrease (P ＜0. 01) of pain scores in analgesia group compared with those in control group. Parturients in analgesia group experienced a significantly shorter first stage, than those in the control group ( P ＜ 0. 01). There were no differences between two groups in the rate of cesarean section and instrumental delivery. And there were no significant differences for newborns with Apgar scores less than 7 at the point of one minute. Patient-controlled intravenous analgesia with remifentanil for labor is an effective and safe procedure, which can significantly relieve pain, shorten first stage of labor and has no effect on the delivery mode and Apgar scores of neonates.     

瑞芬太尼静脉自控式分娩镇痛的临床研究

The study intended to evaluate the efficacy and safety of patient-controlled intravenous analgesia with remifentanil for labor. Three hundred and two parturients at 37 -42 week of gestation received remifentanil (0. 1μg · kg-1 ·min-1 ) as patient-controlled intravenous analgesia for labor (analgesia group) and their clinical results were compared with those of 221 parturients in labor without intravenous analgesia (control group). Maternal monitoring, including pain scores(VAS), delivery mode, side effects, laboring time was performed for both groups. There was a significant decrease (P ＜0. 01) of pain scores in analgesia group compared with those in control group. Parturients in analgesia group experienced a significantly shorter first stage, than those in the control group ( P ＜ 0. 01). There were no differences between two groups in the rate of cesarean section and instrumental delivery. And there were no significant differences for newborns with Apgar scores less than 7 at the point of one minute. Patient-controlled intravenous analgesia with remifentanil for labor is an effective and safe procedure, which can significantly relieve pain, shorten first stage of labor and has no effect on the delivery mode and Apgar scores of neonates.     

Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement

Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared wit     

加贝酯、奥曲肽和奥美拉唑联合应用对内镜下逆行胰胆管造影术术后胰腺炎的预防作用

目的 探讨加贝酯、奥曲肽和奥美拉唑联合应用在预防内镜下逆行胰胆管造影术(ERCP)术后胰腺炎(PEP)中的作用.方法 将235例ERCP术后患者随机分为治疗组(125例)和对照组(110例).治疗组ERCP术后应用加贝酯1 mg/(kg·h)持续静脉滴注12 h;奥曲肽0.1 mg皮下注射,每12小时1次,12 h内应用;奥美拉唑40 mg静脉滴注,每12小时1次,24 h内应用.对照组ERCP术后静脉滴注生理盐水500 ml.ERCP术前、术后3、12、24 h检测血清淀粉酶并观察PEP的发生率.结果 治疗组和对照组ERCP术后PEP的发生率分别3.20%和11.82%(P<0.01),高淀粉酶血症的发生率分别为18.40%和39.09%(P<0.05).结论 加贝酯、奥曲肽和奥美拉唑联合应用可减少PEP和高淀粉酶血症的发生率. Abstract： Objective To investigate the prophylactic effect of gabexate mesilate, octreotide and omeprazole on post - ERCP pancreatitis. Methods Two hundred and thirty - five post ERCP patients were randomized into therapeutic group (125 cases) and control group (110 cases). After the operation of ERCP, patients in the therdpeutic group were treated with gabexate mesilate 1 mg/(kg·h) by contin-ous intravenous infusion for 12 hours, Octreotide 0. 1 mg by subcutaneous injection per 12 hours for 12 hours, Omeprazole 40 mg by intravenous infusion per 12 hours for 24 hours. The patients in the control group were applied with intravenous infusion of nermal saline 500 ml. The levels of serum amylase were detected and the incidence of PEP were observed at pre - ERCP and 5 h, 12 h ,24 h post - ERCP, respectively. Results The incidences of post - ERCP pancreatitis in the therapeatic group and control group were 3. 2% and 11. 82% , respectively ( P < 0. 01 ) , and the percentages of hyperamylasemia were 18.4% and 39.09% Respectively ( P <0. 05). Conclusions The combined use of gabexate, meilate, octreotide and omeprazole can reduce the incidences of PEP and hyperamylasemia.     

Protective Effect of Norcantharidin on Collagen-Induced Arthritis Rats

Objective: To observe the effect of norcantharidin(NCTD) on collagen-induced arthritis(CIA) rats. Methods: Sixty Sprague-Dawley(SD) rats were randomly divided into 6 groups(n=10): normal group, CIA model group(model group), NCTD low-dose group [1.35 mg/(kg·d)], NCTD middle-dose group [2.7 mg/(kg·d)], NCTD high-dose group [5.4 mg/(kg·d)] and methotrexate(MTX) group [1.8 mg/(kg/w)]. Anesthetized rats were sacrificed by luxation of cervical vertebra after 4 weeks of administration. The arthritis scores were evaluated twice a week. The pathological changes in the ankle joints of rats were observed by hematoxylin-eosin(HE) staining. The serum levels of interleukin(IL) 1β, IL-6, tumor necrosis factor(TNF)-α, vascular endothelial growth factor(VEGF), IL-17 and transform growth factor(TGF) β were detected by enzyme linked immunosorbent assay(ELISA). The mRNA expression of retinoid-related orphan nuclear receptor γ t(ROR γ t) and forkhead box P3(Foxp3) in peripheral blood lymphocytes were confirmed by real-time polymerase chain reaction. Results: MTX and high-dose NCTD not only decreased the arthritis scores but also alleviated the pathological changes in CIA rats' ankle joints compared with the model group(P0.05 or P0.01). All doses of NCTD significantly inhibited the serum levels of IL-6, IL-17 and TNF-α in CIA rats(P0.05). Only middle-and high-dose of NCTD prominently decreased serum IL-1β and TGF-β levels of CIA rats(P0.05). However, NCTD has no effect on vascular endothelial growth factor(VEGF) level in CIA rats. The Foxp3 mRNA expression in all NCTD groups were increased significantly than in the model group(P0.05). The mRNA expression of RORγt in NCTD high-dose group was decreased apparently in comparison with the model group(P0.05). Conclusion: NCTD showed therapeutic effect on CIA rats by inhibition of cytokines and regulation of Th17/Treg cells.     

Preemptive analgesic effects of flurbiprofen axetil in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach

Background  Systemic non-steroidal anti-inflammatory drugs have been evaluated for their possible preemptive analgesic effects. The efficacy of flurbiprofen axetil for preemptive analgesia in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach needs further investigation. The aim of this study was to research the preemptive analgesic effects of flurbiprofen axetil in thoracic surgery, and the influence of preoperative administration on postoperative respiratory function.

Methods  This randomized, double-blind, controlled trial enrolled 60 patients undergoing radical resection of esophageal carcinoma via the left thoracic approach. Anesthesia management was standardized. Each patient was randomly assigned to receive either 100 mg flurbiprofen axetil intravenously 15 minutes before incision (PA group) or intravenous normal saline as a control (C group). Postoperative analgesia was with sufentanil delivered by patient-controlled analgesia pump. Postoperative sufentanil consumption, visual analog scale pain scores, plasma levels of interleukin-8, and oxygenation index were measured.

Results  Compared with the preoperative baseline, postoperative patients in the PA group had no obvious increase in pain scores (P >0.05), but patients in the C group had significantly increased pain scores (P <0.05). Pain scores in the C group were significantly higher at 24 hours postoperatively than preoperatively. Intergroup comparisons showed lower visual analog scale scores at 2–24 hours postoperatively in the PA group than the C group (P <0.05). Sufentanil consumption and plasma interleukin-8 levels at 2 and 12 hours postoperatively were significantly lower in the PA group than the C group (P <0.05). The oxygenation index at 2 and 12 hours postoperatively was significantly higher in the PA group than the C group (P <0.05).

Conclusions  Intravenous flurbiprofen axetil appears to have a preemptive analgesic effect in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach, and appears to contribute to recovery of respiratory function and to reduction of the postoperative inflammatory reaction.

     

硬膜外布托啡诺用于老年患者髋关节置换术后镇痛

目的 观察布托啡诺持续硬膜外输注镇痛用于老年病人髋关节置换术后的临床效应及安全性.方法 60例年龄60～103岁,ASAⅠ～Ⅱ级的择期髋关节置换术患者,术毕随机分为两组,使用一次性镇痛泵分别用布托啡诺(B组,n=30例)和吗啡(M组,n=30例)持续输注镇痛.观察术后4、8、12、24、48h患者的疼痛程度,患者对镇痛治疗总体印象评分以及不良反应.结果 B组与M组术后不同时间点镇痛效果比较差异无显著性(P>0.05),但是术后48h内B组不良反应(呼吸抑制、恶心、呕吐、瘙痒、腹胀等)比M组少(P<0.01).结论 布托啡诺持续硬膜外输注镇痛用于髋关节置换手术后老年病人的镇痛是安全的,效果确切,不良反应轻.

Abstract：

Objective To evaluate the efficaey and safety of continuous epidural analgesia(CEA) with butorphanol in elderly patients undergoing hip replacement.Methods Sixty patients scheduled for selective hip replacement were randomized into group B (n=30) to receive patient-controlled epidural analgesia(PCEA) with butorphanol and group M (n=30) to receive PCEA with morphine.Their pain distribution at 5 time points,postoperative global score and the adverse effects in 48 h were observed.Results The pain distribution at the 5 time points or the global score for postoperative PCEA in 48 h showed no statistically significant difference between the two groups (P>0.05).Analgesia with butorphanol caused less adverse effects (respiratory depression,nausea and vomiting,itching and abdominal distension)than that with morphme(P<0.05).Conclusion CEA with butorphanol is safe and effective for the treatment of postoperative pain in elderly patients and causes less adverse effects than morphine.     

Patient controlled intravenous analgesia with tramadol for labor pain relief

Objective To evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA)+ patient controlled epidural analgesia (PCEA). Methods Eighty American Society of Anesthesiologist (ASA) Ⅰ-Ⅱ at term parturients in active labor were randomly divided into 3 groups: the control group (n=30) received no analgesia; group A (n=30) received spinal administration with ropivacaine 2.5 mg and fentanyl 5 μg, then with PCEA; group B (n=20) received 1 mg/kg tramadol loading dose i.v.. PCIA with 0.75% tramadol and it included: PCA dose 2 ml, lockout time 10 minutes, background infusion 2 ml/h, total dose no more than 400 mg. The intensity of pain was evaluated using Visual Analogue Scale (VAS). Results Both group A and B showed good pain relief. VAS pain scores were significantly decreased in group A and B compared with those in the control group (P&lt;0.01). In comparison with group B, the VAS pain scores decreased in group A (P&lt;0.05). The onset times of analgesia in group A were shorter than those in group B (P&lt;0.05). Apgar scores in group B were lower than those in group A (P&lt;0.05). The periods of second stage of labor in group A were longer than those in the control group and group B (P&lt;0.05). The cesarean delivery rate was significantly higher in the control group (16.7%) than in group A (3.3%) and group B (5.0%), but it did not differ between group A and B. There were no significant differences in vital signs, fetal heart rate, degree of motor block, and uterine contractions among the 3 groups. Conclusions PCIA with tramadol is now a useful alternative when patients are not candidates for CSEA for labor, or do not want to have a neuraxial block anesthesia. However, sometimes it may not provide satisfactory analgesic effect.     

低分子量肝素在胸部肿瘤合并高凝血状态病人围术期的临床应用

目的 使用低分子量肝素(LMWH)预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生.方法 对2006年1月至2007年10月我科收治的合并高凝血状态的食管癌、贲门癌、肺癌病人,在围术期皮下注射低分子量肝素,每日1次,从术前3～5 d开始直至病人下床,观察术中出血量及术后胸液量,并统计血栓性疾病发生率.结果 该组病人围术期血栓性疾病发生率得到了明显控制.结论 低分子量肝素对预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生有明显效果,安全可靠. Abstract： Objective To evaluate the efficacy of low molecular weight heparin for preventing thromboembolism disease in perioperative of thoracic tumor with blood hypercoagulabale state. Methods From January 2006 to October 2007, we diagnosed and treated 72 patients with lung cancer and carcinoma of esophagus and cardia. All the patients were treated with LMWH qd from the 3 -5 days before operation until ambulation after operation. To observe the postoperative total amount effusion and to statistic of incidence of thromboembolism disease. Results Incidence of thromboembolism disease decreased more significantly of this group than usual. Conclusions Application of LMWH for preventing thromboembolism disease in periopetive of thoracic tumor with blood hypercoagulabale state is an effective, safe and reliable treatment.     

骨科术后硬膜外自控镇痛的观察与护理

目的 探讨骨科术后硬膜外自控镇痛(PCEA)的护理. 方法应用一次性自控镇痛泵,并妥善固定.镇痛配方:生理盐水100 ml,氟哌啶5 mg+吗啡5 mg+0.75%布比卡因10 ml,给药速度2 ml/h,持续48～72 h.重点放在对呼吸和血压的观察,做好心理护理,加强巡视. 结果骨科术后采用PCEA止痛效果好,避免了术后疼痛的发生,提高了患者休息的质量,减少了患者的痛苦. 结论骨科术后应用PCEA安全有效,及时适当的护理可改善PCEA的疗效,减少和缓解不良反应. Abstract： Objective To explore the care of orthopedic postoperative epidural analgesia (PCEA). Methods Application of disposable controlled analgesia pumps, and properly fixed. Analgesic formula:normal saline 100 ml, droperidol 5 mg + morphine 5 mg +0.75% bupivacaine 10 ml, delivery speed of 2 ml/h, continuous 48-72 h. Focus on the respiration and blood pressure observation, good psychological care, to step up inspection. Results PCEA analgesic effect was good, to avoid the occurrence of postoperative pain and improve the quality of the patient rest, reducing the postoperative pain. Conclusions PCEA is safe, effective and appropriate care, would improve the efficacy of PCEA, reduce and mitigate side effects.     

全髋关节置换术后脱位原因及防治

目的 探讨全髋关节置换术后脱位原因及防治措施.方法 选择350例全髋关节置换术患者,进行侧卧外展试验和放射学测量,分析术后脱位的原因.结果 350例全髋关节置换术后6个月共发生脱位15例.首次置换与翻修手术脱位率比较差异有统计学意义(P＜0.01);侧卧外展试验阳性患者与试验阴性患者脱位率比较差异有统计学意义(P＜0.05);测量术后X线臼杯安放位置在安全区内与在安全区外脱位率比较,两者差异有统计学意义(P＜0.01);使用具有防脱位高边的髋臼假体患者与使用普通髋臼假体患者脱位率比较,两者差异有统计学意义(P＜0.05);使用直径为28 mm的股骨头假体患者与直径＜28 mm的股骨头假体患者脱位率比较,两者差异有统计学意义(P＜0.05);经后外侧入路手术患者与经后外侧入路并保留关节囊患者脱位率比较,两者差异有统计学意义(P＜0.05);不同年龄、体重、性别的患者术后脱位率差异无统计学意义.结论 全髋关节置换术后脱位与假体的放置位置、组织肌力平衡、手术是否保留关节囊、假体设计、是否翻修等因素有关,而与年龄、性别、体重等因素无关.精确的假体置入,术后完善的护理可有效降低脱位发生率.一旦发生早期脱位,应及早复位,对于反复出现的脱位,明确病因,积极手术治疗. Abstract： Objective To investigate the cause and prevention of postoperative dislocation after total hip replacement. Methods Radiographic measurement and side lying abduction test were used in 350 patients to determine the influence of patient-related and operative factors and the position of the acetabular component on the rate of dislocation. Results Dislocation occurred in 15 of 350 after total hip arthroplasties: 12 of 255 primary procedures and 3 of 26 revisions and the defference was statistically significant( P ＜ 0. 01 ). The dislocation rate of patients, with a positiven side lying abduction test was 6. 15% ,otherwise the rate was 3.18%, and the difference was statistically significant( P ＜ 0. 05 ). The dislocation rate for cup orientation with anteversion of 15 ± 10 degrees and lateral opening of 40 ± 10 degrees was 2. 41% ,while outside this safe range of the dislocation rate was 13.3%. This defference was statistically significant ( P ＜ 0. 01 ). The dislocation rate of patients using high-side prosthesis acetabu-lum preventing dislocation was 3.08 % compared with 7.78% in those without such prosthesis acetabu-lum( P ＜0.05). The dislocation rate of patients using 28 mm in diameter femoral head prostheses was 3.17%, the dislocation rate of patients using less than 28 mm in diameter femoral head prostheses was 7.14%. This defference was statisticall significant ( P ＜ 0. 05 ). The difference of dislocation rate between patients with a posterolateral approach(5.14 % )and those with a reserving and reconstructing articular capsule( 3.43 % )apart from this approach was also statistically significant( P ＜ 0. 05 ). There was no relationship between the variables of age, weight and gender. Conclusions The causes of postoperative dislocation after total hip replacement are correlated with the position of prostheses, the balance of muscle force, reserving and reconstructing articular capsule, design of prostheses and revision arthroplasties. Precise implantation of prosthesis and good nursing care can decrease the mobidity of dislocation. Reduction should be in time when the dislocation occurred. The causes should be carefully analyzed for the recurrent cases and aggressive operation should be considered.     

雷莫司琼不同给药时机预防甲状腺手术后恶心呕吐的效果

目的 观察雷莫司琼不同给药时机预防患者甲状腺术后恶心、呕吐(PONV)的效果.方法 将60例在气管插管全身麻醉下行甲状腺次全切除术的患者随机分为三组,每组20例.雷莫司琼术前用药组(Ⅰ组),于麻醉诱导前给予雷莫司琼0.3 mg;雷莫司琼术后给药组(Ⅱ组),于手术结束时给予雷莫司琼0.3 mg;对照组(Ⅲ组),给予生理盐水5 ml作对照.观察记录患者术后24 h内恶心、呕吐发生情况.结果 Ⅰ组术后0～6 h和7～24 h两时段内恶心、呕吐发生率为30%和15%,Ⅱ组为35%和20%,Ⅰ组与Ⅱ组比较差异无统计学意义(P＞0.05),但均随时间推移PONV有显著降低(P < 0.05);Ⅲ组两时段内恶心、呕吐发生率为65%和50%,Ⅰ组、Ⅱ组与Ⅲ组同时段比较差异均有统计学意义(P＜0.05).结论 雷莫司琼在剂量相同的条件下,术前和术后两种不同时机给药均能有效地减少术后恶心、呕吐的发生,术前给药似乎效果更优. Abstract： Objective To study the effects of ramosetron on postoperative nausea and vomiting (PONV) after thyroid gland surgery.Methods Sixty patients, ASA score Ⅰ-Ⅱ, scheduled for elective thyroid gland surgery were randomly allocated into three groups: preoperative group (group I,n=20),ramosetron was given prior to the inductional anesthesia; postoperative group (group Ⅱ,n=20),ramosetron was given at the end of the surgery; control group (group Ⅲ,n=20), no ramosetron was given. The accidence of PONV was obversed, the numbers of patients with PONV and side effects were recorded during 24 h after surgery respectively. Results The frequency of PONV was 30% and 15% on 0-6 h and 7-24 h respcetively in gloup I,35% and 20% in group Ⅱ and 65%and 50% in group Ⅲ.There was no significantly difference between group Ⅰ and group Ⅱ(P>0.05), and were significantly differences between group Ⅲ and group Ⅰ or group Ⅱ(P<0.05).Conclusions Under the same dose,ramosetron given either before surgery or after surgery can effectively reduce the occurence of PONV,it seems that the former is better.     

诺维本联合顺铂二线治疗晚期乳腺癌

目的 探讨诺维本(长春瑞滨)联合顺铂方案治疗蒽环类和(或)紫杉类耐药晚期乳腺癌的疗效与安全性.方法 73例蒽环类和(或)紫杉类耐药晚期乳腺癌患者接受诺维本联合顺铂方案化疗.诺维本(法国Pierre Fabre公司产品)25 mg/m2,第1天和第8天,静脉滴注;顺铂75～80 mg/m2,静脉滴注, 分割为2～5 d.3周为1个周期,每2个周期治疗结束2周后评价疗效.结果 71例均可评价近期疗效和不良反应,总有效率为63.4%(45/71),完全缓解4.2%(3/71),部分缓解59.2%(42/71),稳定32.4%(23/71),进展4.2%(3/71).既往放疗者疗效优于未放疗者(P=0.029),转移部位为单个者疗效优于多个者(P=0.005).主要不良反应为骨髓抑制和胃肠道反应.结论 诺维本联合顺铂方案是治疗蒽环类和(或)紫杉类耐药晚期乳腺癌安全有效的方案. Abstract： Objective To investigate the efficacy and security of vinorelbine combined with cisplatin in the treatment of advanced breast cancer patients resistant to antracyclines and/or taxanes.Methods Seventy-three patients with advanced breast cancer resistant to anthracyclines and/or taxanes received NP regimen:Vinorelbine(NVB 25 mg/m2,intravenous infusion, day 1,8) plus cisplatin(DDP 75-85 mg/m2,intravenous infusion in 2-5 days).Three weeks as one period of treatment.The evaluation was performed two weeks after every two periods of treatment. Results Seventy-one patients were evaluated for efficacy and toxicity of the therapy, the overall response was 63.4%(45/71),3 cases (4.2%) had complete response,42 cases(59.2%)had partial response,while 23 cases(32.4%) had stable disease and progressive disease were 3 cases(4.2%).The efficacy in patients who had received radiotherapy were more effective than those without radiotherapy(P=0.029).The efficacy in patients with single metastatic organ were more effective than those with multiple organs(P=0.005). The common toxicities were myelosuppression and gastrointestinal reactions.Conclusions Vinorelbine combined with cisplatin are tolerable and effective in the treatment of advanced breast cancer with anthracycine and/or taxanes resistance.     

FOLFIRI一线治疗晚期结直肠癌近期疗效观察

目的 观察FOLFIRI方案即伊立替康联合5-氟尿嘧啶(5-FU)及亚叶酸钙(LV)作为一线治疗晚期结直肠癌的近期疗效及毒性反应.方法 2007年6月至2009年7月,共32例晚期结直肠癌患者接受FOLFIRI方案化疗.FOLFIRI方案具体用法:伊立替康180 mg/m2静脉滴注90 min,第1天:LV 200 mg/m2与伊立替康同时滴入,持续时间相同,在5-FU之前,第1天和第2天;5-FU 400 mg/m2静脉推注,然后600 mg/m2持续静脉滴注22 h,第1天和第2天.14 d为1个周期.结果 32例可评价疗效患者平均治疗6个周期,总有效率为40.6%,中位缓解期7个月,无死亡病例.骨髓抑制为主要毒性反应,Ⅰ～Ⅳ度骨髓抑制发生率为71.9%;Ⅰ～Ⅱ度迟发型腹泻发生率56.2%.结论 FOLFIRI方案治疗晚期结直肠癌有效率高,毒性反应可以耐受,可作为治疗晚期结直肠癌的一线方案. Abstract： Objective To evaluate the short-term efficacy and toxicity of FOLFIRI as first-line treatment in advanced colorectal cancer. Methods From June 2007 to July 2009, 32 patients with advanced colorectal cancer received FOLFIRI chemotherapy.Regimen: irinotecan 180 mg/m2 iv drop in 90 minutes d1;LV 200 mg/m2 with irinotecan and the same time,before 5-FU,d1-2;5-FU 400 mg/m2 iv in blous, 600 mg/m2 iv drop in 22 hours, d1-2.14 day as a cycle. Results 32 cases can be appraised received 6 cycles of average therapy,the total response rate was 40.6%,the median overall survival was 7 months.The main toxic reaction was myelosuppression,Ⅰ～Ⅳ Grade myelosuppression 71.9%.Ⅰ-Ⅱ grade delayed diarrhea 56.2%. Conclusions FLOFIRI is effective for advanced colorectal cancer and the toxicreaction is tolerable.     

国产长春瑞滨联合卡铂治疗晚期非小细胞肺癌的临床研究

目的 观察国产长春瑞滨(NVB)联合卡铂(CBP)治疗非小细胞肺癌(NSCLC)的疗效和毒性反应.方法 NVB 25mg/m2 静脉滴注第1、8天, CBP 300 mg/m2第1天,21～28 d为1个周期,完成2～6个周期.结果 45例患者中完全缓解(CR)5例,部分缓解(PR)119例,稳定(SD)10例,进展(PD)11例,总有效率(CR+PR)为53.3%.NVB主要不良反应为白细胞下降,其中Ⅲ、Ⅳ度为60%.结论 NVB加CBP方案可以作为NSCLC患者较理想的治疗方案,NVB加CBP方案具有较好的疗效和耐受性,可提高患者的生活质量. Abstract： Objective To observe the efficacy and toxicity combined chemotherapy of NVB and CBP in treatment of non-small cell lung cancer(NSCLC).Methods NVB 25 mg/m2 iv. for day 1and 8,CBP 300 mg/m2 for day 1,the treatment was recycled every 21-28 days and finished 2-6 recycles. Results Complete response was achieved in 5 cases, partial response in 19 cases,stable in 10 cases,progression in 11 cases.The overall response rate was 53.3%.Leukopenia which was the most frequent toxicity were present in 73.3%, and the grades 3,grade 4 leukopnia were present in 60%.Conclusions Combination chemotherapy of NVB and CBP is well tolerated and effective in the treatment of NSCLC and can improve quality of life(QOL).