硬膜外小剂量吗啡四种配方术后止痛的比较研究

２００例ＡＳＡⅠ－Ⅱ级，年龄１８－４４岁，４５－６８ｋｇ的子宫或卵巢全部或部分切除的患者，以单盲法分为四组，每组４０例，分别于术后自硬膜外腔注入（１）吗啡２．５ｍｇ；（２）吗啡２．５ｍｇ＋保分子右旋糖酐６ｍｌ；（３）吗啡２．５ｍｇ＋纳洛酮０４ｍｇ；（４）吗啡２ｍｇ＋５％Ｎａ Ｃｌ６ｍｌ，比较了注药前及注药后１、３、６、９、１２ｈ的ＣＯ２通气反应、止痛效应及副作用。     

硬膜外吗啡复合氟哌啶术后镇痛

１００例妇产科术后病人随机分为四组，观察组为妇科和产科病人各３０例，镇痛药物用吗啡３ｍｇ＋氟哌啶２．５ｍｇ，对照组为妇科和产科病人各２０例，镇痛药物用吗啡３ｍｇ。结果：（１）术后镇痛效应，各观察组与对照组比无明显差异，妇科病作产科比也无明显差异；（２）各组病人药后２４ｈ呼吸循环均有轻度抑制；（３）除寒战反应外，各观察组吗啡不良反应有降低趋势，恶心，呕吐发生率明显减少，在这方面复合应用哌啶比单用吗啡     

小剂量氯胺酮吗啡及氯胺酮-吗啡配伍用于硬膜外腔术后镇痛作用的比较小剂量氯胺酮吗啡及氯胺酮-吗啡配伍用于硬膜外腔术后镇痛作用的比较

目的：探讨氯胺酮、吗啡硬膜外腔术后镇痛效应和伍用后是否可提高镇痛效果并减少副作用。方法：５０例硬膜外腔麻醉下行骨科手术的患者，随机分为５组，每组１０例。Ａ组：吗啡０．０１ｍｇ／ｋｇ；Ｂ组：氯胺酮０．４ｍｇ／ｋｇ；Ｃ组氯胺酮０．６ｍｇ／ｋｇ；Ｄ组：Ａ＋Ｂ；Ｅ组：Ａ＋Ｃ。于术后４、８、１２、２４、４８、７２ｈ记录疼痛评分（ＶＡＰＳ）及副作用的发生情况。结果：Ａ组ＶＡＰＳ评分平均为２．９５，有效镇痛７例，平均持续时间为５２．０ｈ；Ｂ组镇痛效果差，ＶＡＰＳ评分平均为７．２６，有效镇痛３例，与Ａ组比较有统计学显著差异（Ｐ＜０．０１）；Ｃ组ＶＡＰＳ评分平均为３．６０，与Ａ组比较无统计学差异，有效镇痛７例，平均持续时间为４４．４ｈ；Ｄ组ＶＡＰＳ平均评分为２．７３，与Ａ组比较无统计学差异，平均持续时间为５０．８ｈ；Ｅ组平均ＶＡＰＳ评分为１．５８，与Ａ组比较有统计学显著差异（Ｐ＜０．０１），持续时间为５８．１ｈ。结论：１．氯胺酮０．４ｍｇ／ｋｇ硬膜外腔术后镇痛效果差，剂量增至０．６ｍｇ／ｋｇ镇痛效果与吗啡０．０１ｍｇ／ｋｇ相近，恶心、呕吐发生较少，无精神方面的副作用；２．氯胺酮与吗啡配伍，随着氯胺酮剂量增加到０．６ｍｇ／ｋｇ     

麻黄碱增强吗啡镇痛效应的临床观察

麻黄碱增强吗啡镇痛效应的临床观察徐中东＊赵莹＊陈高梅＊靳志群＊蒋玲＊杜娟＊选择应用硬膜外麻醉的ＡＳＡⅠ～Ⅱ组的下腹部及下肢手术９０例，随机分为三组，每组３０例。Ⅰ组吗啡２ｍｇ，Ⅱ组吗啡２ｍｇ＋布比卡因２５ｍｇ，Ⅲ组吗啡２ｍｇ＋麻黄碱２０ｍｇ，均用ＮＳ...     

硬膜外小剂量氯胺酮与芬太尼超前镇痛作用的比较

目的 比较切皮前硬膜外小剂量氯胺酮与芬太尼的超前镇痛效应。方法 ４８例择期下肢手术病人随机分为３且，每组１６例，分别在切皮前硬膜外注入芬太尼２５μ（Ⅰ组），氯胺酮３０ｍｇ（Ⅱ组）０．９％生理盐水０．５ｍｌ（Ⅲ组）。术后均采用硬膜外病人自控镇痛（ＰＣＥＡ）。观察术中硬膜外用药量，术后感觉疼痛时间、镇痛药用量、术后ＶＡＳ评分和副作用。结果 ３组病人，在手术时间上无统计学差异，术中麻醉药用量，与Ⅲ组比较     

酚苄明用于预防硬膜外吗啡所致尿潴留的初步观察

４３例在硬膜外阻滞下行择期腹部手术病人接受硬膜外２ｍｇ吗啡止痛，其中１８例分别于术前晚，术前１ｈ，术后５ｈ和次日晨口服酚苄明１０－２０ｍｇ。结果表明，加用酚苄明不能明显降低硬膜外吗啡止痛病人术后尿潴留的发生率。     

硬膜外注射吗啡术后镇痛最佳剂量探讨

本文报告腹部手术１１７９例硬膜外注药镇痛，根据吗啡用量随机分为四组：Ａ组０．５ｍｇ；Ｂ组１．０ｍｇ；Ｃ组１．５ｍｇ；Ｄ组２．０ｍｇ，观察各组的镇痛效果与并发症。结果：１～１．５ｍｇ剂量的吗啡不仅镇痛效果佳，且并发症少（２．６％～４．７％）；超过此剂量（如用２ｍｇ），镇痛效果未见明显增加，而并发症却明显上升（３０．９％）；相反剂量太小（０．５ｍｇ）镇痛效果欠佳。结论：使用吗啡１～１．５ｍｇ可能是硬膜外注射吗啡术后镇痛的最佳剂量     

麻醉和手术对肾小球和肾小管功能的影响

目的 了解麻醉与手术对肾小球和肾小管功能的影响。方法 病人分为４组；１、全身麻醉＋较大手术组（Ｇ＋Ｂ）；２、全身麻醉＋较小手术组（Ｇ＋Ｓ）；３、硬膜外阻滞＋较大手术组（Ｅ＋Ｂ）；４、硬膜外阻滞＋较小手术组（Ｅ＋Ｓ）。每组１０例。检测术前、术中１ｈ和术后２４ｈ尿中β２－微球蛋白（β２－ＭＧ）、白蛋白Ａｌｂ）和免疫球蛋白Ｇ（ＩｇＧ）浓度。结果 在不同麻醉方法下行较小手术时，术中及术后尿中β２－ＭＧ、Ａ     

老年人围手术期低氧血症防治的研究

目的 观察老年病人围手术期低氧血症的发生率及硬膜外镇痛或加用穴位电刺激等对低氧血症的治疗效果。方法 １２３例ＡＳＡⅠ～Ⅱ级择期腹部手术老年病人,分为５组：Ⅰ组为上腹部手术全麻组,Ⅱ组为下腹部手术全麻组,Ⅲ组为上腹部手术全麻＋连续硬膜外（连硬）,Ⅳ组为上腹部手术全麻＋连硬＋电刺激,Ⅴ组为下腹部手术全麻＋连硬。监测２４小时ＳｐＯ２,术前及术后１、２、５天作动脉血气分析。结果 ５组中２４小时内发生一次或     

剖宫产及硬膜外吗啡术后镇痛对产妇泌乳的影响

目的：观察剖宫产及硬膜外吗啡术后镇痛产妇的泌乳状况及血清泌乳素（ＰＲＬ）变化。方法：足月初产妇１２０例均分为四组：Ⅰ组术毕行硬膜外吗啡镇痛;Ⅱ组术毕硬膜外吗啡镇痛,２４小时后追加１次;Ⅲ组未行术后镇痛;阴道自然分娩３０例为Ⅳ组。结果：产后５分钟、２４值变化各组间无显著性差异。Ⅳ组产后２４小时内开发泌乳发生率（４０％）,高于同期所有剖宫产组（２０％）;但４８小时内开始泌乳及７２小时乳汁分泌不足发生率     

Epidural lipomatosis

ONSET: Epidural lipomatosis is a rare disorder defined as a pathological overgrowth of normal epidural fat. It is more often associated with administration of exogenous steroid with variable duration and doses. Furthermore, it may occur in some patients in the absence of exposure to steroids but generally associated with obesity. Whatever the predisposing factor, the majority of these patients are men. The causal effect of epidural lipomatosis in the development of spinal cord or radicular compression is generally well accepted. DIAGNOSIS: The diagnosis of epidural lipomatosis can be established by melography, computed tomography (CT) and magnetic resonance imaging (MRI). MRI is considered the imaging procedure of choice, allowing an assessment of the extent of lipomatosis and, as well as CT, an identification of the lipomatous tissue. Most cases of epidural lipomatosis with corticosteroid use occur in the thoracic region, while most idiopathic cases occur in the lumbar region. TREATMENT: Management of treatment depends on the severity of the neurological signs and the patient's background. The most common treatment for epidural lipomatosis with corticosteroid use consists in surgical decompression but with a high risk of postoperative mortality. In some cases however, medical treatment includes corticosteroid withdrawal or reduction and calorie restriction, leading to clinical improvement. Treatment for idiopathic epidural lipomatosis is more often medical, based on weight loss and physical therapy with generally successful outcome. The pathogenesis of epidural lipomatosis remains unknown but different suggested hypotheses may lead to a metabolic disorder as the underlying cause.