腹部手术患者吸入七氟醚与异氟醚麻醉恢复的比较

目的比较腹部手术患者吸入七氟醚与异氟醚麻醉恢复的情况。方法全麻下行开腹手术患者40例,随机分为2组（n=20）：七氟醚组（S组）及异氟醚组（Ⅰ组）。麻醉诱导后行气管插管,机械通气。诱导后吸入纯氧,氧流量2 L/min,30min后调整为1 L/min。手术开始前,调整吸入麻醉药的呼气末浓度为1.0 MAC。麻醉维持：吸入七氟醚或异氟醚,间断静脉注射罗库溴铵和芬太尼,维持血压和心率波动幅度不超过基础值30%。缝皮结束时,停止吸入七氟醚或异氟醚,纯氧流量调整为5 L/min。记录睁眼时间（停止吸入麻醉药到睁眼的时间）、拔除气管导管时间（停止吸入麻醉药到拔除气管导管的时间）、Aldrete评分达到9分时间（从停止吸入麻醉药计时）及麻醉后恢复室（PACU）停留时间。记录吸入麻醉药用量。结果与Ⅰ组比较,S组睁眼时间、拔除气管导管时间、Aldrete评分达到9分时间及PACU停留时间缩短（P〈0.05）,吸入麻醉药的总用量和单位时间用量差异无统计学意义（P〉0.05）。结论与异氟醚比较,吸入七氟醚患者麻醉恢复较快,且麻醉恢复质量较好。     

静吸复合麻醉下七氟醚与异氟醚对颅内压的影响

目的:在颅内顺应性正常神经外科病人,观察1.0 MAC七氟醚与异氟醚对颅内压的影响。方法:垂体瘤或颅咽管瘤手术病人16例,随机分为两组:A组为咪唑安定 芬太尼 1.0 MAC异氟醚;B组为咪唑安定 芬太尼 1.0 MAC七氟醚。选择L_(3～4)行蛛网膜下腔穿刺。麻醉诱导采用芬太尼-咪唑安定-阿曲库铵。插管后维持稳定30分开始吸入七氟醚(或异氟醚)。分别于麻醉前、吸入麻醉药前、达预定呼气末浓度30分内观察监测指标。结果:1.0 MAC七氟醚和异氟醚均可显著降低脑灌注压,异氟醚作用较强。吸入1.0 MAC七氟醚后颅内压首先呈显著性下降,15分后回复至基础水平。吸入1.0 MAC异氟醚后颅内压无显著性变化。结论:在颅内顺应性正常患者,1.0 MAC七氟醚和异氟醚均可安全用于神经外科麻醉。     

七氟醚与异氟醚麻醉用于支撑喉镜下声带息肉摘除术的比较

目的探讨七氟醚与异氟醚麻醉在支撑喉镜下声带息肉摘除术的临床效果。方法支撑喉镜下声带息肉摘除术患者40例,ASAⅠ～Ⅱ级,随机分为七氟醚组（S组）与异氟醚组（Ⅰ组）,每组20例。两组静注异丙酚2mg／kg、维库溴胺0．05mg／kg,随即S组吸入8％七氟醚或Ⅰ组吸入4．5％异氟醚2min后行气管插管术,术中分别以七氟醚或异氟醚维持麻醉。监测围术期血压、心率、心电图及脉搏氧饱和度等生命体征,记录术毕自主呼吸恢复、拔管及认知恢复的时间。结果麻醉诱导后,S组与Ⅰ组平均动脉压均明显降低,心率加快（P〈0．01）;气管插管后MAP、HR均升高（P〈0．05或P〈0．01）。七氟醚或异氟醚维持麻醉均满足手术要求,两组麻醉苏醒顺利,不良反应少,但S组自主呼吸恢复、拔管及认知恢复的时间均快于Ⅰ组（P〈0．01）。结论七氟醚或异氟醚全麻均适用于支撑喉镜下声带息肉摘除术,七氟醚的麻醉苏醒比异氟醚快。     

地氟醚对内皮素、前列腺素和血栓素的影响

目的：观察地氟醚对上腹手术患者血浆中内皮素（ET）、6酮－前列腺素1a(6-keto-PGF1a）和血栓素B2（TXB2）的影响。方法:随机选取ASAI－II级择期上腹部手术患者10例,全麻诱导气管插管后吸入1MAC的地氟醚维持麻醉。于麻醉前、诱导后、吸入地氟醚10分钟、吸入地氟醚50分钟及手术结束时抽取静脉血,采用放免法测定血浆中ET、6-keto-PGF1a和TXB2的含量。结论：术中ET虽有升高,但无统计学意义。6-keto-PGF1a在诱导后显著降低（P＜0.01）,吸入地氟醚后开始升高（P＜0.01）直至术毕。TXB2在诱导后显著降低（P＜0.01）,吸和地氟醚后逐渐恢复,但仍显著低于术前水平（P＜0.05）。6-keto-PGF1a与TXB2的比值在诱导后及吸入地氟醚后显著增大（P＜0.05及P＜0.01）。结论：吸入1MAC地氟醚时,血浆前列腺素水平增加,血栓素降低,二者比值增加有助于保护心血管功能。     

地氟醚与异氟醚麻醉对小儿循环功能的影响

目的：比较地氟醚和异氟醚麻醉对小儿血液动力学的影响。方法：28例1－5岁小儿，ASAI－Ⅱ级，快速诱导气管插管后随机分为地氟醚（D）帮异氟醚（I）两组，每组14例。分别测量呼气末麻醉药浓度为0、0．5、1．0和1．5MAC稳定5分钟后的SI、CI、SVR、HR及MAP。结果：与0MAC比较，0．5MAC时两组MAP和SVR均略有降低（P＜0．05），其他指标均无明显变化（P＞0．05）。1．0MAC时，SVR和MAP进一步降低，其幅度两组间无显著差异；HR和SI均略有升高，但无显著差异；CI值D组显著高于I组。达1．5MAC时，D组的HR显著高于I组，而SI下降与0MAC近似；SVR和MAP两组无进一步降低。结论：地氟醚和异氟醚麻醉对小儿心肌收缩功能均有一定抑制作用,但地氟醚使小儿HR增快的作用大于异氟醚。     

患者低流量吸入地氟醚或异氟醚的药代动力学

目的比较腹部手术患者低流量吸入地氟醚或异氟醚的药代动力学。方法腹部手术患者40例,ASAⅠ级或Ⅱ级,年龄18～64岁,BMI＜35kg/m^2。随机分为2组（n=20）：地氟醚组（D组）和异氟醚组（Ⅰ组）。麻醉诱导后调节纯氧流量3L/min,术中调整挥发罐刻度,维持肺泡浓度（FA）0．8 MAC,稳定5min后纯氧流量改为1L/min。调节瑞芬太尼静脉输注速率,维持HR和BP波动幅度不超过基础值20%。手术结束时,停止吸入地氟醚或异氟醚,同时吸入纯氧3L/min。记录设定的吸入麻醉药浓度（FD）、吸入麻醉药浓度（FI）、FA/FI=1/2时间、FA/FAO=1/2时间（FAO为关闭挥发罐即时的肺泡浓度）,并计算各时点FA/FI、FA/FD。结果D组FA/FI=1/2时间及FA/FAO=1/2时间均较Ⅰ组缩短（P＜0．05）。低流量麻醉下,D组FD稳定,Ⅰ组FD波动较大。D组FA/FI、FA/FD上升速率较Ⅰ组快,且同一时点各比值D组均高于Ⅰ组。结论与异氟醚比较,腹部手术患者低流量吸入地氟醚时达到预定的肺泡浓度更迅速,可控性好,停止吸入时排泄较快。     

七氟醚、异氟醚不同呼气末浓度对熵和脑电双频指数的影响

目的 观察不同呼气末浓度的七氟醚和异氟醚对熵、脑电双频指数(BIS)及血流动力学的影响.方法 40例ASA Ⅰ或Ⅱ级全麻手术患者随机均分为七氟醚组(Ⅰ组)和异氟醚组(Ⅱ组).麻醉诱导用丙泊酚1 mg/kg,1 min后吸入七氟醚或异氟醚;维持反应熵(RE)、状态熵(SE)、BIS45～55,6 min后置入喉罩.调节吸入浓度使两组患者呼气末浓度分别为0.4、0.6、0.8、1.0和1.3MAC时各维持10 min,记录RE、SE、BIS、HR和MAP.结果 两组患者不同呼气末浓度七氟醚和异氟醚RE、SE、BIS随浓度增加而逐渐下降(P<0.05),HR逐渐减慢、MAP逐渐降低(P<0.05).两组间各指标差异均无统计学意义.RE、SE、BIS间直线相关性随呼气末浓度增大相关系数有增加趋势.结论 熵和BIS均能有效监测七氟醚、异氟醚麻醉深度.     

不同靶浓度异丙酚对腹部手术病人异氟醚呼气末浓度的影响

目的以脑电双频指数(BIS)值45～55作为麻醉深度监测指标,观察不同靶浓度异丙酚对腹部手术病人异氟醚呼气末有效浓度的影响,并初步探讨额肌电(EMG)作为麻醉深度监测指标的意义.方法选择60例ASAⅠ～Ⅱ级择期行腹部手术的病人,随机分为三组Ⅰ组(n=20)麻醉诱导后单纯吸入异氟醚;Ⅱ组(n=20)吸入异氟醚的同时输注靶浓度为1μg/ml的异丙酚;Ⅲ组(n=20)吸入异氟醚的同时输注靶浓度为2μg/ml的异丙酚.全麻诱导采用咪达唑仑、芬太尼、维库溴铵,气管插管后启动靶控输注异丙酚.根据BIS值的变化调节异氟醚吸入浓度,维持BIS值在45～55范围.麻醉中连续观察平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)、BIS及EMG的变化,并持续监测异氟醚的吸入和呼气末浓度.结果三组病人年龄、性别、体重、麻醉时间、术中芬太尼用量、MAP、HR及SpO2的变化组间比较差异无显著性(P＞0.05);Ⅱ组、Ⅲ组插管后和切皮后异氟醚呼气末浓度均低于Ⅰ组(P＜0.01),Ⅱ组、Ⅲ组呼气末异氟醚有效浓度分别为0.43%±0.08%、0.21%±0.06%,较Ⅰ组分别降低43.4%、72.3%(P＜0.05).入室后麻醉用药前EMG为46～53(BIS值91～96).麻醉诱导后及术中EMG维持在26～29(BIS值45～55),麻醉恢复期EMG逐渐升高,当大于40时(相应BIS值80～85),大部分病人能够呼之睁眼.结论随异丙酚靶浓度的增加,维持BIS值为45～55时的异氟醚的呼气末浓度随之降低.EMG作为麻醉深度的监测指标有一定意义.     

丙泊酚对异氟醚心肌预处理效应的影响

目的 评价在心脏直视手术中异氟醚是否具有处理效应及丙泊酚对异氟醚预处理效应的影响。方法 将30例择期行心脏直视手术的室间隔缺损（VSD）患者分为三组：异氟醚吸入组（Ⅰ组）、异氟醚吸入加丙泊酚输注组（Ⅱ组）和对照组（Ⅲ组）。分别于麻醉诱导平稳后（T1）、主动脉阻断时（T2）、主动脉阻断开放后30min（T3）采血检测超氧化物歧化酶（SOD）、丙二醛（MDA）;分别于T2、T3、再灌注后3h（T4）及12h（T5）采血检测肌酸激酶同功酶（CK-MB）和乳酸脱氢酶（LDH）。结果 在T2时,与同期Ⅲ组比较,Ⅰ组SOD活性降低（P〈0．05）,MDA含量升高（P〈0．05）,Ⅱ组SOD活性升高（P〈0．05）。T3时Ⅰ组SOD活性和MDA含量均低于Ⅱ组和Ⅲ组（P〈0．05）。主动脉开放后的各个时点（T3、T4、T5）,三组的血清LDH活性和CK-MB活性均较T2时显著升高（P〈0．05）;Ⅰ组的LDH活性和CK-MB活性在T3、T4、T5时较Ⅱ组和Ⅲ组低（P〈0．05）。结论 心脏直视手术中缺血前吸入异氟醚对再灌注心肌具有一定保护作用。缺血前吸入异氟醚同时输注丙泊酚可能会减弱异氟醚对心肌的保护作用。     

择期手术病人七氟醚全麻诱导的效果

目的 比较七氟醚和异丙酚全麻诱导的效果。方法 择期手术病人60例,ASAⅠ级或Ⅱ级,年龄18～64岁,行全身麻醉。随机分为2组（n=30）：七氟醚组（S组）,吸入1MAC七氟醚麻醉诱导;异丙酚组（P组）,靶控输注血浆靶浓度3 mg/L异丙酚麻醉诱导,2组均靶控输注血浆靶浓度4μg/L瑞芬太尼。病人入室静卧5min后记录血压（BP）、心率（HR）作为基础值。记录插管前即刻、插管后1、2、3min的BP和HR以及病人意识消失的时间。结果 与基础值比较,插管前即刻2组BP下降,S组HR减慢（P＜0．01）;插管后1min P组BP下降（P＜0．01）;插管后3min S组BP下降（P＜0．05）。插管后3 min,P组HR较S组快（P＜0．05）。S组意识消失时间短于P组（P＜0．01）。结论 七氟醚用于全麻诱导,是一种安全有效、方便快捷的技术。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果,提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件,并用于临床教学。结果:该课件在本校园网上运行半年余,2000余人次对其进行访问,受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法,实现护理教学的直观性和交互性,对护理教学和临床带教指导有一定的借鉴作用。     

Physiology and pharmacology of nausea and vomiting

The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D₂, 5-HT₃, histamine H₁ and neurokinin NK₁ receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV).