舒芬太尼联合氟比洛芬酯用于膝关节置换术后静脉自控镇痛临床观察

目的 观察舒芬太尼联合氟比洛芬酯用于骨科膝关节置换术后持续静脉镇痛的临床效果.方法 选择骨科单侧膝关节置换手术术后患者72例,随机分为舒芬太尼组(A组)和舒芬太尼加用氟比洛芬酯组(B组).A组:舒芬太尼2.5μg/kg、托烷司琼3 mg加入生理盐水共100 mL;B组:舒芬太尼2.0μg/kg、氟比洛芬酯125 mg、托烷司琼3 mg加入生理盐水共100 mL,行静脉自控镇痛(PCIA)治疗.观察并记录2组术后2 h、4 h、8 h、12 h、24 h、48 h疼痛评分及不良反应情况.结果2组各时间点疼痛VSA评分基本相同,差异无统计学意义(P>0.05);与B组相比,A组不良反应发生率高,镇痛治疗满意率低,差异有统计学意义(P<0.05).结论 氟比洛芬酯联合舒芬太尼用于膝关节置换术后镇痛能减少舒芬太尼用量,安全有效,且副作用较少.     

两种麻醉方式对老年髋关节置换术后认知功能及镇痛效果的影响

目的:探讨氟比洛芬酯联合舒芬太尼与单用舒芬太尼对老年髋关节置换术患者术后认知功能及镇痛效果的影响.方法:选取120例行髋关节置换术的患者为研究对象,按照随机数字表法将患者分为氟比洛芬酯联合舒芬太尼镇痛组(A组)和舒芬太尼镇痛组(B组)各60例.A组患者麻醉诱导后给予氟比洛芬酯100 mg+舒芬太尼2.0 mg,稀释至200 ml,自控镇痛(PCIA)为2 ml/30 min,B组麻醉诱导后给予舒芬太尼2.0 mg,稀释至200 ml,PCIA为2 ml/30 min.分别于术后3 h、6 h、12 h、24 h和48 h采用视觉模拟评分法对2组患者镇痛效果进行评分.分别于术前、术后1 d、3 d和5 d采用简易智力状态检查法对2组认知功能进行评定.记录2组患者术后1 h、24 h、48 h舒芬太尼用量、PCIA次数及患者并发症情况.结果:A组术后3 h、6 h、12 h和24 h视觉模拟评分均明显低于B组(P<0.01).A组术后1 d、3 d和5 d简易智力状态检查法评分均高于B组(P<0.05~P<0.01).A组术后1 h与24 h舒芬太尼用量和PCIA次数均少于B组(P<0.01).A组患者恶心呕吐、躁动、呼吸抑制和认知功能障碍发生率均低于B组(P<0.05).结论:氟比洛芬酯镇痛能有效降低患者认知功能障碍的发生,提高患者镇静镇痛效果,减少术后舒芬太尼PCIA使用量.     

氟比洛芬酯复合舒芬太尼用于开胸术后镇痛的研究

目的 评价氟比洛芬酯(凯纷)复合舒芬太尼在开胸术后镇痛的效果.方法 择期开胸术患者165例,随机分为 3 组,术前用药及麻醉方法 3 组相同,术后分别给予不同剂量镇痛药物.A组:舒芬太尼5μg/kg+0.9%生理盐水至200ml;B组:舒芬太尼3μg/kg+氟比洛芬酯3mg/kg+0.9%生理盐水至200ml;C组:舒芬太尼1.5μg/kg+氟比洛芬酯4.5 mg/kg+0.9%生理盐水至200ml.分别记录各组患者术后6、12、24、36、48 小时视觉模拟(VAS) 评分.结果 3组患者术前的一般情况、手术方式、术中情况、麻醉时间、手术时间、术中芬太尼用量、术后清醒时间、拔管时间以及 ICU 停留时间均无统计学差异.C 组患者术后 24 小时静息 VAS 评分低于 A 组,差异有统计学意义.B组患者术后 24、36、48 小时咳嗽时VAS评分低于 A组,差异有统计学意义;B组患者术后 48 小时咳嗽时 VAS评分低于 C组,差异有统计学意义.结论 氟比洛芬酯复合舒芬太尼可以安全有效地用于开胸术后镇痛,在减少舒芬太尼用量的同时,可以取得与单纯舒芬太尼相似的镇痛效果.     

舒芬太尼联合氟比洛芬酯在静脉自控镇痛中的应用

目的 比较妇科手术患者静脉自控镇痛中应用舒芬太尼联合氟比洛芬酯的镇痛效果与不良反应.方法 选择妇科手术术后行静脉自控镇痛患者60例,随机分为两组:舒芬太尼氟比洛芬酯组(S-F组)手术结束前30min给予氟比洛芬酯50mg.术后镇痛给予(舒芬太尼2ug/kg+氟比洛芬酯100mg+托烷司琼5mg加盐水至100ml);舒芬太尼组(S组)给予(舒芬太2ug/kg+托烷司琼5mg加盐水至100ml).两组静脉镇痛泵的设置,维持量2ml/h.单次负荷剂量0.5ml.锁定时间12min.观察两组术后2h、6h、12h、24h的镇痛、镇静评分和不良反应发生率.结果 S-F组术后镇痛及镇静评分好于S组.S-F组恶心呕吐发生率低于S组.结论 舒芬太尼联合氟比洛芬酯用于妇科手术静脉镇痛效果优于单纯用舒芬太尼,而且不良反应明显降低.     

不同剂量氟比洛芬酯复合舒芬太尼用于妇科手术患者术后镇痛疗效观察

目的 观察不同剂量氟比洛芬酯复合舒芬太尼用于妇科手术患者术后静脉镇痛的临床效果及不良反应.方法 择期妇科于术患者80例ASA Ⅰ～Ⅱ级,随机分为4组,每组20例.F1+S组、F2+S组、F3+S组分别为氟比洛芬酯50 mg+舒芬太尼60 μg、氟比洛芬酯150 mg+舒芬太尼60μg、氟比洛芬酯250 mg+舒芬太尼60 μg;舒芬太尼组(S组)为舒芬太尼120μg.四组均以生理盐水稀释到100 ml,按2.0 ml/h速度使用一次性镇痛泵经静脉持续镇痛48 h.比较各组镇痛、镇静效果,以及小良反应的发生率.结果 F2+S组、F3+S组、S组患者术后4、8、12、24、48 h镇痛效果优于F1+S组,但F3+S组,S组术后恶心、呕叶的发生率明显高于F1+S组和F2+S组(P<0.05或P<0.01).结论 氟比洛芬酯150 mg复合舒芬太尼60 μg用于妇科手术术后静脉镇痛安全有效,小良反应较少.     

丙帕他莫联合氟比洛芬酯、舒芬太尼对烧伤切痂植皮术后镇痛的效果观察

目的观察丙帕他莫联合氟比洛芬酯、舒芬太尼对烧伤切痂植皮术后镇痛的效果。方法将60例烧伤切痂植皮术后患者按随机数字表法随机分为A、B及C组,各20例。A组负荷剂量为舒芬太尼5 g,镇痛泵用药为舒芬太尼150 g+0.9%氯化钠注射液稀释至100 ml;B组负荷剂量为氟比洛芬酯50 mg,镇痛泵用药为氟比洛芬酯100 mg+舒芬太尼100 g+0.9%氯化钠注射液稀释至100 ml;C组术毕前15 min静脉滴注盐酸丙帕他莫2 g(加入100 ml0.9%氯化钠注射液中,15 min内滴完),负荷剂量为氟比洛芬酯50 mg,镇痛泵用药为氟比洛芬酯100 mg+舒芬太尼100 g+0.9%氯化钠注射液稀释至100 ml。3组镇痛泵均设置维持量2ml/h,单次负荷剂量0.5 ml,锁定时间15 min。记录3组术后2、6、12、24及48 h患者安静和活动时的疼痛视觉模拟评分(VAS)及不良反应情况。结果 3组患者安静和活动时均获得满意的镇痛效果,术后2及6 h安静与活动时VSA C组均要小于A、B组,差异均有统计学意义(均<0.05)。3组不良反应发生率差异有统计学意义(<0.05),A组不良反应的发生率显著高于B、C组(均<0.05)。结论在烧伤切痂植皮术后,丙帕他莫联合氟比洛芬酯、舒芬太尼在镇痛效果上更优,且安全有效,不良反应少。     

舒芬太尼和氟比洛芬酯联合用药在乳腺癌根治术术后镇痛中的应用

目的分析舒芬太尼和氟比洛芬酯联合用药在乳腺癌根治术术后镇痛中的应用效果。方法选择郑州大学附属郑州中心医院2014年5月至2016年5月收治的123例乳腺癌根治术术后行自控静脉镇痛患者为研究对象,随机分为A、B、C组,各41例。A组患者术后使用150μg舒芬太尼、5 mg氟哌利多+100 ml质量分数为0.9%的Na Cl进行镇痛;B组患者给予200 mg氟比洛芬酯、5 mg氟哌利多+100 ml质量分数为0.9%的Na Cl进行镇痛;C组患者给予75μg舒芬太尼、100 mg氟比洛芬酯、5 mg氟哌利多+100 ml质量分数为0.9%的Na Cl进行镇痛。对比观察3组患者术后镇痛、镇静评分与不良反应发生情况。结果 3组患者术后各时间点镇静镇痛评分比较,差异无统计学意义(P>0.05)。A组各种不良反应发生率均显著高于B组和C组,差异有统计学意义(P<0.05)。结论舒芬太尼、氟比洛芬酯单用和联合用药对于乳腺癌根治术术后镇痛的效果相当,但两者连用可以显著减少舒芬太尼单用时产生的不良反应,同时降低舒芬太尼和氟比洛芬酯的用量,临床用药安全性更高。     

氟比洛芬酯联合舒芬太尼用于剖宫产手术后静脉镇痛的研究

目的:比较剖宫产手术后患者自控静脉镇痛(PCIA)中氟比洛芬酯联合舒芬太尼与单纯舒芬太尼的镇痛效果及不良反应。方法:选择剖宫产手术术后行PCIA患者58例,随机均分为两组。舒芬太尼组(A组)术后镇痛给予舒芬太尼250μg/250ml;氟舒芬组(B组)术后镇痛给予舒芬太尼125μg+氟比洛芬酯150 mg/250 ml。两组PCIA泵的设置维持量0.4 ml/h,单次负荷剂量1.6ml,锁定时间10 min。观察两组镇痛开始时及开始后2、4、8、24、48 h的疼痛评分、生命体征和不良反应发生率。结果:两组术后镇痛评分差异无统计学意义。B组药物不良反应发生率低于A组(P<0.05)。结论:氟比洛芬酯联合舒芬太尼用于剖宫产手术后PCIA的镇痛效果与单纯舒芬太尼组相似,但不良反应明显降低。     

舒芬太尼复合氢溴酸高乌甲素在子宫切除术患者术后静脉自控镇痛中的应用

目的 观察舒芬太尼复合高乌钾素用于子宫切除术患者术后静脉自控镇痛的效果.方法 择期行子宫切除术患者60例,随机分为三组,每组20例.A组术后静脉自控镇痛采用舒芬太尼150μg+雷默司琼0.6mg+0.9%氯化钠稀释至100ml(舒芬太尼1.5μg/ml);B组采用氢溴酸高乌钾素24mg+舒芬太尼100μg+雷默司琼0.6mg+0.9%氯化钠稀释至100ml(舒芬太尼1μg/ml+氢溴酸高乌钾素0.24mg/ml);C组采用氢溴酸高乌钾素24mg+舒芬太尼150μg +雷默司琼0.6mg+0.9%氯化钠稀释至100ml(舒芬太尼1.5μg/ml+氢溴酸高乌钾素0.24mg/ml).观察并记录患者术后6h(T1)、12h(T2)、24h(T3)、48h(T4)疼痛、镇静评分以及术后24h内PCIA泵按压次数.结果 与A组比较,B组和C组T2、 T3 、T4时疼痛评分降低(P<0.05),24h内PCIA泵按压次数减少(P<0.05),B组T1、T2、T3 时镇静评分降低(P<0.05);与C组比较,B组T1、T2、T3时镇静评分降低(P<0.05).结论 舒芬太尼1μg/ml复合氢溴酸高乌钾素0.24mg/ml可为子宫切除术患者提供良好的镇痛效果,不良反应发生少.     

氟比洛芬酯在肛肠术后镇痛中的应用效果观察

目的观察氟比洛芬酯在肛肠术后镇痛中的应用效果。方法选择2013年7月至2015年6月洛阳市第二中医院行手术治疗的84例肛肠病患者,随机分为对照组和观察组,各42例。对照组术后给予舒芬太尼100μg+生理盐水100 ml镇痛,观察组给予氟比洛芬酯200 mg+舒芬太尼50μg+生理盐水100 ml镇痛。结果观察组术后6、12、24 h的VAS评分均低于对照组(P<0.05),两组术后48 h的VAS评分比较,差异无统计学意义(P>0.05)。观察组头晕和嗜睡发生率低于对照组(P<0.05),两组瘙痒和恶心呕吐发生率差异无统计学意义(P>0.05)。结论肛肠术后应用氟比洛芬酯镇痛效果较好,安全性高,值得推广应用。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.