不同剂量瑞马唑仑在气管插管全麻老年手术患者中的应用

目的：探讨不同剂量瑞马唑仑在气管插管全麻老年手术患者中的应用效果。方法：选取2021年1月至2022年12月治疗的150例老年手术患者，按随机数字表法分为A组、B组与C组各50例。A组在全麻诱导时静脉注射0.2 mg/kg瑞马唑仑，B组在全麻诱导时静脉注射0.3 mg/kg瑞马唑仑，C组在全麻诱导时静脉注射0.4 mg/kg瑞马唑仑。比较三组血流动力学指标、脑电双频指数（BIS）值、瑞马唑仑补救治疗率和不良反应发生情况。结果： 诱导开始时（T0）、BIS值≤60时（T1）、气管插管后（T2），三组平均动脉压、心率比较，差异无统计学意义（P＞0.05）；T0时，三组BIS值比较，差异无统计学意义（P＞0.05）；T2时，B组、C组BIS值均低于A组，差异有统计学意义（P＜0.05）；T2时，B组与C组的BIS值比较，差异无统计学意义（P＞0.05）；B组、C组瑞马唑仑补救治疗率低于A组，B组不良反应发生率低于C组，差异有统计学意义（P＜0.05）；B组与C组的瑞马唑仑补救治疗率比较，差异无统计学意义，A组与C组的不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：全麻诱导时给予0.3 mg/kg瑞马唑仑对气管插管全麻老年手术患者血流动力学影响小，镇痛效果良好，能够降低瑞马唑仑补救治疗率及不良反应发生率。     

不同剂量右美托咪定对瑞马唑仑致患者意识消失ED95及应激反应的影响

目的 探讨不同剂量右美托咪定对瑞马唑仑致患者意识消失ED95及全麻诱导期间气管插管应激反应的影响。方法 选择气管插管全麻患者87例，随机分为瑞马唑仑组（R组）、0.5μg/kg右美托咪定复合瑞马唑仑组（RD1组）和1.0μg/kg右美托咪定复合瑞马唑仑组（RD2组）。3组分别输注生理盐水、右美托咪定0.5μg/kg和1.0μg/kg，其后按序贯法泵注瑞马唑仑，计算瑞马唑仑致患者意识消失ED95及95%CI。结果R组、RD1组和RD2组瑞马唑仑ED95及95%CI分别为0.250(0.234～0.397)、0.199(0.190～0.258)和0.184(0.172～0.282)mg/kg。结论 预注右美托咪定0.5μg/kg和1.0μg/kg均可降低瑞马唑仑致患者意识消失的ED95，减轻插管应激反应。但应用右美托咪定1.0μg/kg有导致心率减慢的风险。     

不同性别对日间关节镜手术患者瑞马唑仑使用剂量及术后恢复质量的影响

目的 探讨性别对日间关节镜手术患者瑞马唑仑使用剂量以及术后24 h恢复质量（QoR）的影响。方法 选择预约在日间手术中心进行关节镜半月板修复术的患者50例,按照性别分为两组,其中男25例（M组）,女25例（F组）。本研究主要观察两组在麻醉诱导失去意识和术中维持瑞马唑仑剂量的区别,以及采用QoR-15量表、阿森斯失眠（AIS）量表观察性别对术后睡眠和24 h恢复质量的影响。结果M组患者失去意识时瑞马唑仑剂量为0.14(0.13,0.15) mg/kg,麻醉维持剂量为0.80(0.60,0.96)mg/（kg·h）;F组患者失去意识时瑞马唑仑剂量为0.14(0.12,0.16) mg/kg,麻醉维持剂量为0.90(0.79,1.12)mg/（kg·h）,两组患者失去意识与麻醉维持的瑞马唑仑剂量差异均无统计学意义（P> 0.05）。两组对术后第1天睡眠的AIS总分影响差异无统计学意义（P> 0.05）,但女性患者较男性患者更易发生低血压和PONV,术后比期望中更早醒及QoR-15总分、生理舒适度分数降低,差异有统计学意义（P <0.05）。结论 性别对日间关节镜患者瑞马唑仑...     

脑电双频指数监测下瑞马唑仑在老年患者无痛胃肠镜检查中的剂量

目的 探讨在老年患者无痛胃肠镜检查中,脑电双频指数(BIS)监测下应用瑞马唑仑的适宜初始剂量。方法 选取2022年8月至11月于临沂市中医医院行无痛胃肠检查的165例老年患者,按照随机数字表法分为A、B、C三组,各55例。所有患者先静脉注射瑞芬太尼0.30μg/kg, A、B、C三组瑞马唑仑的初始剂量分别为0.15 mg/kg、0.20 mg/kg、0.25 mg/kg。当BIS<75或改良警觉/镇静评分(MOAA/S)<3分时,开始置入胃镜,肠镜开始前追加瑞芬太尼0.20μg/kg。记录三组入镜时间、首次追加瑞马唑仑间隔时间、胃肠镜检查总时间、胃肠镜检查瑞马唑仑总剂量、苏醒时间、离开复苏室(离室)时间,记录患者给药前(T0)、胃镜置入即刻(T1)、首次追加瑞马唑仑时(T2)、胃镜结束时(T3)、肠镜结束时(T4)时的脉搏血氧饱和度(SpO₂)、心率(HR)、平均动脉压(MAP)、BIS值,观察麻醉期间及术后不良反应。结果 与A组比较,B组、C组入镜时间缩短(P<0.05),首次追加间隔时间延长(P<0.05),胃肠镜检查瑞马唑仑总剂量增加...     

瑞马唑仑联合氟马西尼在老年患者胃镜检查中的应用

目的比较老年患者胃镜检查中丙泊酚、瑞马唑仑联合氟马西尼对检查安全性及效益的影响。方法选择80例进行无痛胃镜检查老年患者,随机数字法分为丙泊酚组(C组)及瑞马唑仑联合氟马西尼组(R组)各40例。C组以丙泊酚+瑞芬太尼诱导维持,R组以甲苯磺酸瑞马唑仑配合瑞芬太尼诱导维持,维持BIS 45～55。检查结束后,两组均静脉注射氟马西尼5 mg。比较两组术中血压、心率及呼吸抑制次数、注射痛等不良反应次数,术后1小时对患者术后认知功能进行评价,记录手术因麻醉因素暂停时间、清醒时间及术后并发症情况,同时评估患者满意度。结果两组认知评分及术后满意度比较,差异无统计学意义(P0.05)。与C组比较,R组低血压、心动过缓、呼吸抑制、注射痛次数较低;术中暂停时间、术后苏醒时间较少,差异均有统计学意义(P0.05)。两组术后均无并发症发生。结论丙泊酚与瑞马唑仑用于老年患者无痛胃镜检查均有满意效果。相较丙泊酚+氟马西尼,瑞马唑仑+氟马西尼心血管安全性明显较高,不良反应更少,在临床中具有推广价值。     

胸阻抗法监测危重病患者血流动力学变化的影响因素及咪达唑仑的作用

目的：探讨咪达唑仑对危重病患者血流动力学变化的影响。方法危重病患者在应用咪达唑仑后,应用无创血流动力学监测仪分别于给药前、用药后20 min、用药后1 h监测心率（HR）、平均动脉压（MAP）、心脏指数（CI）、心排血量（CO）、胸液水平（TFC）、左心作功指数（LCWI）的变化并进行统计分析。结果30例危重病患者中,用药及干预后MAP上升33.3%、HR下降9.4%、CO上升56.7%,差异有统计学意义（P＜0.05）,TFC变化不明显（P＞0.05）。结论咪达唑仑对患者血流动力学的影响应引起临床重视,应用BioZ胸电生物阻抗法无创血流动力学监测仪可以起到很好地预防其不良反应的作用。     

不同剂量瑞马唑仑在老年患者无痛胃镜检查中的应用效果

目的 探讨不同剂量瑞马唑仑在老年患者无痛胃镜检查中的应用效果。方法 根据随机抽签法将2021年7月至2022年7月接受无痛胃镜检查的138例老年患者分为A、B、C三组,各46例。A组给予丙泊酚麻醉,B组给予0.1 mg/kg瑞马唑仑麻醉,C组给予0.3 mg/kg瑞马唑仑麻醉。比较三组的麻醉效果。结果 B组与C组的各生命体征指标变化较A组更为稳定（P<0.05）,但两组之间不同时间点无显著差异（P>0.05）。C组的麻醉起效时间、入睡时间、苏醒时间、定向力恢复时间及离室时间短于A、B组,镇静成功率高于A、B组（P<0.05）。B组与C组的各类不良反应发生率均显著低于A组（P<0.05）。麻醉苏醒后10、30 min,B组与C组的蒙特利尔认知评估量表（MoCA）评分均显著高于A组（P<0.05）。结论 与丙泊酚相比,瑞马唑仑更有利于降低不良反应发生率,且对认知功能影响小;另外,0.3 mg/kg较0.1 mg/kg的瑞马唑仑更有利于提高镇静成功率,促进麻醉恢复。     

甲苯磺酸瑞马唑仑在面部微整形手术麻醉中的应用及安全性评价

目的探讨甲苯磺酸瑞马唑仑在面部微整形手术麻醉中的安全性。方法选取我院2020年7～12月需行面部微整形手术患者80例,随机分为丙泊酚组(P组,n=20)、瑞马唑仑低剂量组(M1组,n=20)、瑞马唑仑中剂量组(M2组,n=20))和瑞马唑仑高剂量组(M3组,n=20)。P组:(丙泊酚1.50 mg/kg+瑞芬太尼0.10μg/kg静注诱导)+丙泊酚3～5 mg/(kg·h)静脉泵注;M1组:(甲苯磺酸瑞马唑仑0.10 mg/kg+瑞芬太尼0.10μg/kg静注诱导)+甲苯磺酸瑞马唑仑0.25 mg/(kg·h)静脉泵注;M2组:(甲苯磺酸瑞马唑仑0.15 mg/kg+瑞芬太尼0.10μg/kg静注诱导)+甲苯磺酸瑞马唑仑0.25 mg/(kg·h)静脉泵注;M3组:(甲苯磺酸瑞马唑仑0.20 mg/kg+瑞芬太尼0.10μg/kg静注诱导)+甲苯磺酸瑞马唑仑0.25 mg/(kg·h)静脉泵注。待MOAA/S评分≤2分时置入鼻咽通气管给氧后开始手术,MOAA/S评分3分时追加丙泊酚0.25 mg/kg或甲苯磺酸瑞马唑仑2.5 mg/次。于麻醉诱导前(T_1)、手术开始后5 min(T_2)、手术结束苏醒后(T_3)监测平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO_2)及手指末梢血糖(Glu)变化。记录追加药物次数、定向力恢复时间及Steward苏醒评分,心动过缓、血压下降、呼吸抑制、呼吸道梗阻的发生情况。结果 T_2时M1组MAP、 HR、 RR、 SpO_2, M2组MAP、 SpO_2变化较P组明显(P0.05); M3组HR、 RR、 SpO_2变化与M2组有差异(P0.05)。M1组药品追加例数明显增加;但M1、 M2、 M3各组较P组苏醒质量更高有统计学意义(P0.05)。M1组心动过缓、呼吸道梗阻及呼吸抑制发生例数,M2、 M3组心动过缓、血压下降、呼吸道梗阻及呼吸抑制发生例数较P组明显降低(P0.05);甲苯磺酸瑞马唑仑剂量降低时呼吸道梗阻、呼吸抑制发生率降低(P0.05)。结论甲苯磺酸瑞马唑仑可以安全的用于面部微整形手术静脉麻醉,其中(甲苯磺酸瑞马唑仑0.15 mg/kg+瑞芬太尼0.1μg/kg静注诱导)+甲苯磺酸瑞马唑仑0.25 mg/(kg·h)静脉泵注的方案拥有患者循环呼吸抑制轻、机体应激反应弱、苏醒质量高、并发症少的特点。     

咪达唑仑应用于小儿术前镇静的研究进展

咪达唑仑是一种苯二氮类药物,具有抗焦虑、镇静、催眠、中枢性肌肉松弛及顺行性遗忘作用。由于其起效快,安全性好,被广泛地应用于小儿术前镇静。通过概括咪达唑仑药物代谢动力学特点以及有关镇静-躁动双向反应,镇静成功率,与术后烦躁、术后认知功能改变的关系等,旨在了解咪达唑仑在小儿术前镇静中的应用进展及药物特性,为临床用药提供参考。     

苯磺酸瑞马唑仑抑制老年患者喉罩置入心血管反应有效剂量的测定

目的 研究苯磺酸瑞马唑仑抑制老年患者对喉罩置入心血管反应的有效剂量。方法 选取2023年3月—6月接受喉罩全身麻醉的老年患者,采用苯磺酸瑞马唑仑与0.2μg/kg舒芬太尼诱导,首例给予苯磺酸瑞马唑仑0.16 mg/kg静脉泵注1 min,根据患者对喉罩置入时的反应,通过抛偏倚硬币法来确定下一位患者的瑞马唑仑剂量。记录诱导期间改良警觉/镇静评分、生命体征和麻醉深度指数(anesthesia depth index, AI)。采用Probit分析计算半数有效剂量(half effective dose, ED₅₀)、95%有效剂量(95%effective dose, ED₉₅)和半数有效AI(half effective AI, AI₅₀)。根据统计学的要求,至少需要45例阴性反应患者。结果 至试验终止共纳入53例老年患者参与研究,苯磺酸瑞马唑仑抑制喉罩插入心血管反应的ED₅₀和ED₉₅分别为0.154 mg/kg[95%置信区间(confidence interval, CI)...     

中风病急性期综合治疗方案研究与评价--附522例临床研究报告

目的研究中风病急性期综合治疗方案的临床疗效。方法在前期研究基础上,开展了通治、辨治、针灸方案与西医治疗方案的多中心、随机对照研究,建立以辨证论治为特点的综合治疗方案,并进行验证和评价,共观察522例中风病急性期患者。结果缺血性中风综合治疗方案临床疗效优于西医组;通治方案、辨治方案和针灸方案在不同时间点对患者的神经功能、日常生活能力和认知功能都有不同程度的改善作用。结论以辨证论治为核心的综合治疗方案有其自身的优势与特点,对中风病具有积极的综合治疗作用,贴近临床实际,便于推广应用,各种评价量表在中风病不同时点具有不同的评价作用。     

Biological Aspects and Clinical Importance of Ultrasound Therapy in Bone Healing

Objectives. The purpose of this study was to review past and recent literature findings regarding the effects of ultrasound therapy on bone healing and its clinical efficacy in medical and dental interventions. Methods. A literature review was conducted on the effects of ultrasound therapy on bone healing. The studies regarding clinical applications in long bones and maxillofacial bones were evaluated separately from each other. Results. The effects of therapeutic ultrasound on bone healing have been studied for half a century. Numerous clinical and experimental studies have addressed this relationship, and many of them have shown positive correlations. Although several theories have been proposed to explain the mechanism of action, the exact mechanism has not been fully understood. Conclusions. Therapeutic ultrasound therapy in clinical settings is a noninvasive application and has no serious complications or side effects. It may be an acceptable treatment of choice in many types of clinical procedures involving maxillofacial bones.     

基于fMRI任务态与静息态对头针疗法的研究进展

头针疗法是针灸体系的重要组成部分且广泛应用于临床,但是有关其作用原理研究的文献却不足以完全阐明头针机理,并指导其发展方向.功能磁共振成像技术因其独特优势,成为穴位针刺脑部中枢效应机制研究的首选方法.通过阅读分析相关文献及该领域整体研究趋势,发现应用功能磁共振成像技术对头针疗法进行研究主要集中在特异性脑区激活、针刺作用机...     

Local therapy with capsaicin or ASS in chronic pain

OBJECTIVE: To provide a brief review of the current state of topical treatment with capsaicin or acetylsalicylic acid (ASA) for therapy of chronic pain syndromes. DATA SOURCES: A MEDLINE search was used to find the pertinent literature on "capsaicin" or "ASA" and "chronic pain"; further publications found in these articles were added. CONCLUSIONS: Capsaicin is a white crystalline parent compound of a group of vanillyl fatty acid amines. Because of its highly specific action in neurons it has become an important tool in neuroscience. Because of its effects, it is obvious to try for the therapy of circumscribed neuropathic pain. Capsaicin acts by depleting stores of substance P and other neurotransmitters, resulting in a blockade of a specific group of sensory afferents. The corresponding clinical findings are initial burning and a desensitization of specific C fiber nociceptors after repeated application. The pain relieving potency was observed in various clinical investigations and even in a few controlled, double-blind studies about neuropathic pain syndromes and (osteo)arthritis. In contrast to these findings, a recent study found no significant benefit of capsaicin, probably because this study was the first to use an active placebo. Therefore, and because clinical efficacy and advantages over other therapies have not been demonstrated up to now, capsaicin cannot be classified as standard therapy. It may be a therapeutic option as an alternative or as an adjuvant treatment. Pain reduction was also observed after topical application of ASA/ether mixture in the one and only controlled double-blind study on this issue. Therefore, topical ASA therapy for (post)herpetic neuralgia is mainly based on a few enthusiastic case reports rather than on well founded investigations. Furthermore, the discrimination of local from systemic effects, the toxicological profile of longterm topical treatment, and the mechanism of action has not been evaluated. In conclusion, topical ASA cannot be recommended for routine clinical use at present.     

Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature

There are an increasing number of reports espousing the clinically beneficial effects of Mulligan's mobilization-with-movement (MWM) treatment techniques. The most frequent reported effect is that of an immediate and substantial pain reduction accompanied by improved function. Prompted by these dramatic effects are questions regarding the mechanism(s) of action that underpins MWM. It appears timely that a review of the current literature is performed to synthesize and evaluate claims of the effectiveness of MWM and speculation about the proposed mechanisms of action. This article provides an overview of the literature concerning the clinical efficacy, effects and putative mechanisms of action of the MWM approach in the treatment of musculoskeletal conditions. The literature regarding the mechanisms of action in both the biomechanical and pain science paradigms is covered herein by reviewing all available scientific evidence from laboratory-based studies. Limitations of reported studies and directions for further research are also considered.     

Comparative assessment of the effect of nitroglycerin, sodium nitroprusside and isoket on hemodynamics in patients with ischemic heart disease

The effects of glycerol trinitrate (GTN), sodium nitroprusside and isoket on central hemodynamics, myocardial contractility and myocardial function have been compared. 65 patients with ischemic heart disease have been examined. All the patients were divided into 3 groups depending on the drug studied. GTN was administered sublingually at a dose of 0.5 mg, while sodium nitroprusside and isoket were infused at doses of 1.5 micrograms (kg min) and 400 micrograms/min, respectively. It has been shown that GTN and isoket effects on central hemodynamics were mainly mediated by their venodilating action and preload reduction, thus promoting to the improvement of the myocardial function. Hemodynamic effects of sodium nitroprusside on the cardiovascular system are mediated by its dilating action on the arterial bed and afterload reduction.     

Amiodaron: decades of administration

The review of long-term international clinical experience with amiodaron covers pharmacological properties of the drug, mechanisms of development of its pharmacodynamic effects basing on its action on ionic channels, receptors, impact on thyroid function. Unique pharmacokinetics of amiodaron, high antiarrhythmic efficacy of the drug in supraventricular and ventricular arrhythmia, positive experience in primary and secondary prevention of sudden death are characterized. Amiodaron is effective in patients with atrial fibrillation including those with organic heart disease and chronic cardiac failure. It is safe in relation to different cardiac side effects which are minimal but has some non-cardiac side effects which require control during long-term treatment.     

Insights into defibrotide: an updated review

Defibrotide is a polydisperse oligonucleotide with antiatherosclerotic, anti-inflammatory, anti-ischaemic, pro-fibrinolytic and antithrombotic actions without significant systemic anticoagulant effects. It has been used in the treatment of various cardiovascular disorders, and especially in endothelial complications of allogeneic stem-cell transplantation. We reviewed the published work for the mechanism of action and clinical use of defibrotide to consolidate data and to describe new applications of this drug. We reviewed the most relevant papers on defibrotide published from November 1982 to January 2008. (selected through PubMed), and used recent meeting abstracts as sources for this review. Reports have suggested that defibrotide has clinical efficacy for treatment and prophylaxis of hepatic sinusoidal obstruction syndrome occurring after stem-cell transplantation. Animal models have clearly shown the potential antineoplastic effect of this drug. Further clinical investigations are needed to clarify this new application.     

Exenatide in type 2 diabetes: treatment effects in clinical studies and animal study data

The therapeutic options for treating type 2 diabetes have been widened by the introduction of exenatide as the first incretin mimetic. Incretins are gut hormones that contribute to the stimulation of insulin secretion after a carbohydrate rich meal. The incretin hormone glucagon-like peptide-1 (GLP-1) not only stimulates insulin secretion under hyperglycaemic conditions, but also suppresses glucagon secretion, slows gastric emptying, induces satiety and improves beta cell function in type 2 diabetes. These beneficial effects have awakened the interest to use GLP-1 for the treatment of type 2 diabetes. Because of its short biological half-life, GLP-1 itself is not practical for type 2 diabetes therapy. Exenatide is a peptide found in the lizard Heloderma suspectum and has a high similarity to GLP-1. Exenatide belongs to the novel class of incretin mimetics because of its incretin-like action. It has a much longer biological half life than GLP-1 and is a GLP-1 receptor agonist that can be used for therapeutic purposes by twice daily injection. Clinical studies and clinical experience with exenatide have shown a significant reduction in HbA1c, fasting- and postprandial glucose and a marked reduction in body weight in type 2 diabetic patients. Animal studies reveal an improvement of beta cell function and an increase in beta cell mass after exenatide treatment. This review gives an overview on exenatide, its pharmacological profile and its role and potential in the therapeutic setting of type 2 diabetes. Furthermore, future developments concerning exenatide application are highlighted.     

间充质干细胞在免疫治疗中的应用

近年来对间充质干细胞的研究越来越多，对于间充质干细胞的自我更新和体外扩增的能力及其多向分化的潜能已经被广泛认识。同时，间充质干细胞还具备低免疫原性以及免疫调节活性，使其非常适合用于细胞治疗。目前对间充质干细胞发挥免疫调节的作用机制还不完全了解。本文综述了间充质干细胞免疫调节机制的研究现状及其在免疫治疗中的应用前景。