小剂量纳洛酮对吗啡镇痛效能的影响

目的 研究能够增强吗啡镇痛效能的纳洛酮剂量范围.方法 84只雄性SD大鼠,取42只随机分为7组(n=6),即生理盐水组对照组(NS)、吗啡对照组(M组,皮下注射吗啡6mg/kg),吗啡复合纳洛酮组(MN组,皮下注射吗啡6mg/kg及纳洛酮),根据纳洛酮剂量的不同(分别为1μg/kg、100、10、1和0.1ng/kg),MN组又分为MN1、MN2、MN3、MN4和MN5组.测定各组大鼠在注药前及注药后不同时间点的痛阈.另外42只大鼠分组方法 同上,仅将M组和各MN组吗啡剂量改为2mg/kg,在大鼠后爪建立急性疼痛模型后,分别皮下注射生理盐水或相应药物,观察各组大鼠在1h内的累积疼痛评分.结果 与NS组比较,M组和各MN组大鼠的痛阈在5～120min显著增高(P＜0.01);累积疼痛评分显著降低(P＜0.01).与M组比较,MN1组大鼠在30、40、50min的疼痛阈值显著降低(P＜0.01),累积疼痛评分升高(P＜0.01);MN2、MN3、MN4组大鼠的疼痛阈值在注药后20～120min内显著升高(P＜0.01),累积疼痛评分降低(P＜0.05);MN5组疼痛阈值、累积疼痛评分与M组比较无统计学差异(P＞0.05).结论 1～100ng/kg的纳洛酮能够增强吗啡对大鼠的镇痛效能,1μg/kg的纳洛酮可拮抗吗啡的镇痛效能,而剂量在0.1ng/kg时则不增强吗啡的镇痛效能.     

氯诺昔康复合吗啡应用于肺叶切除术后持续镇痛的临床研究

目的:观察氯诺昔康持续静脉镇痛复合吗啡硬膜外镇痛用于肺叶切除术后患者的镇痛效果及安全性。方法:开胸行肺叶切除术的患者40例,随机分为A组(20例)和B组(20例)。在手术结束前30 min,A、B两组均于硬膜外腔注入含吗啡2 mg的0.25%布比卡因6 ml,并接PCA镇痛泵。A组为静脉镇痛,含氯诺昔康0.8 mg/kg;B组为硬膜外镇痛,含0.5%布比卡因20 ml,吗啡0.1 mg/kg。记录各组的疼痛强度值(VAS评分)、术后36 h患者对镇痛效果满意程度及不良反应。结果:A组术后疼痛VAS评分显著低于B组,且镇痛效果的满意度高。两组的不良反应发生率无显著性差异。结论:开胸肺叶切除术后应用氯诺昔康静脉持续镇痛复合吗啡硬膜外镇痛,其镇痛效果更强,且安全可靠。     

氯诺昔康联合吗啡或曲马多肌注对术后镇痛的影响

目的观察氯诺昔康联合吗啡或曲马多肌注对术后镇痛的影响。方法选择ASAⅠ～Ⅱ级择期全麻下行妇科剖腹手术的患者36例,随机分为氯诺昔康+吗啡组(LM组)、氯诺昔康+曲马多组(LT组)及对照组(C组),每组12例。手术结束麻醉苏醒前三组分别肌注氯诺昔康8 mg﹢吗啡5 mg、氯诺昔康8 mg﹢曲马多50 mg、等容量的生理盐水。观察术后1、2、4、8、24 h时的视觉模拟评分(VAS)和Ramsay镇静评分,8 h内的PCA有效按压次数及不良反应发生率。结果 LM组和LT组患者术后1、2、4 h的VSA评分明显优于C组(P<0.01),8 h的VSA评分仍优于C组(P<0.05),8 h内PCA按压次数明显少于C组(P<0.01)。LM组术后2 h的Ramsay评分高于C组(P<0.01)和LT组(P<0.05),LT组高于C组(P<0.05)。LM组和LT组术后8 h内恶心发生率均为66.7%、明显高于C组的25%(P<0.01),但LT组呕吐发生率为50%、明显高于C组的16.7%(P<0.01)和LM组的33.3%(P<0.05),均未见呼吸抑制及SpO2下降。结论氯诺昔康联合吗啡或曲马多肌注可有效抑制手术后4 h内的疼痛,减少术后8h内PCA的按压次数及不良反应发生率。     

氯诺昔康联合地佐辛肌注用于犬创伤后镇痛疗效观察

目的观察肌注氯诺昔康、地佐辛及两者联合用药对犬创伤后院前镇痛的影响。方法中华田园犬16只,雌雄不限,体质量7~10 kg,按三因素4×4拉丁方设计随机分成4组:A组:肌注氯诺昔康0.4 mg/kg;B组:肌注地佐辛0.5 mg/kg;C组:肌注氯诺昔康0.2 mg/kg+地佐辛0.25 mg/kg;D组:肌注氯诺昔康0.4 mg/kg+地佐辛0.5 mg/kg,每组4只。各组模拟脾切除术建立模型,之后即刻单次肌注药物,分别于术前1 h(T_0)和给药后2 h(T_1)、4 h(T_2)、6 h(T_3)、8 h(T_4)和24 h(T_6)测定疼痛评分、心率(HR)和呼吸频率(RR),并检测血气、血糖(GLU)、血清皮质醇(S)、肾上腺素(E)、白细胞介素-10(IL-10)和α肿瘤坏死因子(TNF-α)。结果 (1)疼痛评分:T_1时点,B组墨尔本大学疼痛总评分(MPS)和客观疼痛评分高于其余3组(P<0.05)。T_2时点,A组客观疼痛评分中动作项目评分高于其余3组(P<0.05)。T_2和T_3时点,B组MPS高于C、D两组(P<0.05)。T_4时点,A组客观疼痛评分中动作项目评分高于C、D两组(P<0.05)。T_6时点,B组MPS中吠叫项目评分高于其余3组(P<0.05)。(2)其他指标:T_4时点,B组血糖值高于C、D两组(P<0.05)。T_6时点,A组血糖值高于C、D两组(P<0.05);B组TNF-α值高于其T_0时的起始值(P<0.05)。结论 4组镇痛方案中,D组评价最好。氯诺昔康和地佐辛联合用药具有相加的镇痛效果及较好的协同效应。     

氯诺昔康和芬太尼用于术后镇痛效果比较观察

目的：观察比较氯诺昔康和芬太尼用于术后自控镇痛（PCIA）效果。方法：将中等以上疼痛60例随机分为观察组（氯诺昔康）和对照组（芬太尼），每组各30例。采用VAS评分、舒适度评分和镇静评分测定术后12、24和48h镇痛、舒适度和镇静效果，记录用药量、PCIA次数、镇痛泵持续时间、术后第1次肛门排气时间和不良反应。结果：观察组术后48h疼痛评分和舒适度评分与对照组比较，差异显著（P〈0．05）。两组在用药量、PCIA次数、镇痛泵持续时间、术后第1次肛门排气时间和不良反应差异不显著（P〉0．05）。结论：氯诺昔康具有与芬太尼相似的镇痛效果，而无呼吸抑制，可作为芬太尼的替代药。     

氯诺昔康在普通外科腹腔镜手术后镇痛效果观察

目的评价氯诺昔康在外科微创手术术后镇痛的有效性和安全性。方法对氯诺昔康组(L组)和芬太尼组(F组)患者分别连续泵注氯诺昔康和芬太尼,观察48 h镇痛药物用量、镇痛效果及不良反应发生情况。结果 L组术后2、4、8、12、24、48 h的VAS评分略低于F组。PC IA期间恶心、呕吐、头晕、嗜睡发生率F组显著高于L组(P<0.05)。结论氯诺昔康用于腹腔镜手术术后PC IA镇痛效果接近芬太尼,不良反应发生率低,氯诺昔康是普通外科腹腔镜手术后PC IA治疗的一种安全有效的药物。     

氯诺昔康复合舒芬太尼用于妇科术后镇痛的临床观察

目的观察氯诺昔康联合舒芬太尼用于妇科术后的镇痛效果及不良反应。方法 90例择期妇科手术的患者,随机分为3组,分别以氯诺昔康（A组）、氯诺昔康加舒芬太尼70μg（B组）、舒芬太尼120μg（C组）作为术后静脉自控镇痛（PCA）。以视觉模拟评分法（VAS）和警觉与镇静评分法（OAA/S）来记录术后镇痛期间的疼痛评分和镇静程度,并观察3组的不良反应。结果 B、C组在术后4、8、12h的VAS评分明显低于A组（P〈0.01,P〈0.05）,C组在术后4h的镇静评分中达到3级的病例数要明显高于A组与B组（P〈0.05）。3组不良反应发生率无统计学差异（P〉0.05）。结论氯诺昔康复合小剂量舒芬太尼作为术后静脉镇痛的效果满意,并且优于单纯使用氯诺昔康,不良反应发生率未增加。     

氯诺昔康用于术后镇痛的临床观察

目的比较静脉持续输注氯诺昔康复合小剂量芬太尼及单纯芬太尼的术后镇痛效果。方法选择择期手术ASAⅠ~Ⅱ级行上腹部手术的患者80例,行静吸复合全麻,随机分为单纯芬太尼组(A组)和氯诺昔康复合芬太尼组(B组)。镇痛开始后4、8、12、24和48h记录疼痛VAS评分、镇静程度评分、PCA按压次数、药物用量和不良反应发生次数。结果两组镇痛VAS评分、镇静评分、按压次数无统计学意义(P>0.05)。但不良反应,两组间差异有统计学意义。结论氯诺昔康复合小剂量芬太尼用于术后镇痛更安全有效。     

氟比洛芬酯和氯诺昔康对踝关节微骨折术超前镇痛的比较研究

目的比较氟比洛芬酯、氯诺昔康用于局麻踝关节微骨折术超前镇痛的疗效。方法收集2009年9月～2011年8月于解放军总医院骨科收治的踝关节距骨软骨损伤患者的临床资料,随机分为3组,氟比洛芬酯组、氯诺昔康组和对照组。分别于术中和术后观察疼痛视觉模拟评分（VAS）。结果关节镜清理时3组之间的VAS差别无显著性意义（P〉0.05）;微骨折术时氟比洛芬酯组和氯诺昔康组的评分低于对照组,其差别有显著性意义（P〈0.05）,而氟比洛芬酯组和氯诺昔康组之间的VAS差别无显著性意义（P〉0.05）。术后1 h、4 h被动屈伸踝关节VAS氟比洛芬酯组〈氯诺昔康组〈对照组,其差别有显著性意义（P〈0.05）。结论在局麻踝关节微骨折术的超前镇痛中,氟比洛芬酯、氯诺昔康均能达到满意的术中镇痛效果,而氟比洛芬酯术后镇痛效果更为显著。     

新的非甾体抗炎药物氯诺昔康

氯诺昔康是新的非甾体抗炎药。临床试验显示氯诺昔康可替代盐酸吗啡、盐酸呱替啶和盐酸曲吗多等止痛药，减轻外科病人术后疼痛。氯诺昔康可有效地减轻骨关节炎、类风湿性关节炎、强直性脊椎炎等疾病的疼痛。象其它的非甾体抗炎药一样，氯诺昔康最主要的不良反应是胃肠道症状。与其它昔康类药物相比，其特点是半衰期较短（3-5h），临床用药剂量较小（4-8mg），因此不良反应较轻。它具有很好的镇痛、抗炎作用，有口服和非肠道剂型，是很有市场前景的镇痛、抗炎新药。     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

新疆石河子地区奶牛隐性乳房炎的调查与分析

采用LMT法对新疆石河子地区三个规模化奶牛场泌乳牛群进行了隐性乳房炎检测,共检测994头泌乳牛3976个乳区.结果表明:奶牛隐性乳房炎阳性率为81.9%,乳区阳性率为49.1%.数据分析表明,不同年龄、胎次以及有无卧床奶牛的隐性乳房炎阳性率差异显著(P<0.05),后乳区的隐性乳房炎感染率显著高于前乳区感染率(P<0.05),隐性乳房炎乳区发生数也明显影响当日产奶量(P<0.05).     

Sex differences in neuromuscular fatigability in response to load carriage in the field in British Army recruits

Objectives

Women are resistant to neuromuscular fatigue compared to men in response to a range of exercise tasks. The sex differences in the neuromuscular responses to load carriage have yet to be investigated.

Decrease in eccentric hamstring strength in runners in the Tirol Speed Marathon

Background

The local muscular endurance of knee flexors, during eccentric work in particular, is important in preventing or delaying kinematic changes associated with fatigue during treadmill running. This result, however, may not be transferable to overground running.

Objective

To test the hypothesis that overground running is associated with eccentric hamstring fatigue.

Methods

Thirteen runners (12 male and one female) performed an isokinetic muscle test three to four days before and 18 hours after a marathon. Both legs were tested. The testing protocol consisted of concentric and eccentric quadriceps and hamstring contractions.

Results

There were no significant differences between peak torque before and after the race, except that eccentric peak hamstring torque (both thighs) was reduced.

Conclusion

Overground running (running a marathon) is associated with eccentric hamstring fatigue. Eccentric hamstring fatigue may be a potential risk factor for knee and soft tissue injuries during running. Eccentric hamstring training should therefore be introduced as an integral part of the training programme of runners.     

肺心病慢性呼吸性酸中毒合并代谢性酸碱失衡判断方法探讨(附80例次血气分析)

目的：对42例肺心病慢性呼吸性酸中毒患者的80例次血气测定结果。方法：用不同的酸碱图（卡）及代偿公式进行酸碱类型的初步差别分析。结果：结合临床表现、各种影响因素与治疗反应等作出综合判定。结论：比较二种判定的差异，并提出较为实用、可靠的判断建议，以助于复合型呼吸性酸碱失衡的临床诊断与处理。     

Oxalosis in primary hyperoxaluria in infancy

Primary hyperoxaluria (PH1) is a rare inborn autosomal recessive metabolic disorder due to the deficiency of hepatic alanine-glyoxylate-aminotransferase. This deficiency results in excessive synthesis and urinary excretion of oxalate, inducing renal stone formation and deposition of calcium oxalate in the kidney, bone, myocardium, and vessels (systemic oxalosis, SO) in the most severely affected individuals. We report renal and skeletal changes in a 3-month-old girl with PH1 and SO. Intense cortico-medullary hyperechogenicity and increased homogeneous radiopacity of normal-sized kidneys suggested the diagnosis of SO. Skeletal survey showed osteopenia and characteristic symmetrical metaphyseal transverse bands in long bones, progressively becoming more dense and migrating towards the diaphysis. Multiple pathological and slowly healing fractures of the limbs occurred at the dense band level. A radiopaque rim was then observed in flat bones, epiphyseal nuclei, and vertebral bodies. Inflammatory granulomatous reaction, induced by the presence of oxalate crystals in the marrow spaces, coexisted with progressively evident radiological signs of secondary hyperparathyroidism, with partially overlapping features. The patient was treated by peritoneal dialysis and hemodialysis until combined liver–kidney transplantation. There are no previous reports of infants treated with hemodialysis for more than 2 years.     

Interventional radiology in oncology in private practice

Interventional oncology in private practice requires expert training and can be performed in a stand-alone facility for type 1 procedures in a hospital setting for type 2 and 3 procedures where subspecialized radiologists, state-of-the-art equipment, and postprocedure hospital monitoring are available. A multidisciplinary effort with oncologists, internal medicine physicians and anesthesiologists is necessary. The practice of interventional oncology requires around the clock availability, meticulous and established protocols and procedures and a financial investment. On the other hand, it is professionally gratifying because of constant technical advances and the impact on patients.