盐酸羟考酮注射液用于无痛人流术临床麻醉观察

目的观察盐酸羟考酮注射液复合丙泊酚用于无痛人流术的麻醉效果和安全性。方法将要求行无痛人流术患者100例随机分为A组和B组,每组各50例。A组:盐酸羟考酮注射液复合丙泊酚;B组:单纯使用丙泊酚;记录不同时段两组患者的MAP、HR、Sp O2,TFS、TFW、丙泊酚总用药量,术中体动、呼吸抑制(Sp O2<90%)、血压下降、不良反应例数以及术毕清醒后10、30、60、120、180分钟视觉模拟评分(VAS);观察术后镇痛效果。结果 T2时,两组患者MAP较T1时均出现了明显的下降(P<0.05),但A组和B组比较,差异无显著性(P>0.05);T3和T4时,B组的MAP、HR升高较A组明显(P<0.05);A组术后意识恢复时间、丙泊酚用量、术中体动、术后10、30、60分钟疼痛发生率均低于B组(P<0.05),差异有显著性。结论盐酸羟考酮注射液联合丙泊酚在无痛人流术中麻醉镇痛效果好,可减少丙泊酚用量,术中MAP和HR波动较小、体动发生率较低,患者术后意识恢复时间较短,术后镇痛效果好、维持时间长,是一种较为安全有效的配伍方法。     

不同剂量氨酚羟考酮对膝关节置换术后镇痛效果的研究

目的观察口服氨酚羟考酮片在膝关节置换术后患者中的镇痛疗效和安全性,选择最佳的给药剂量。方法选择行单侧全膝关节置换患者50例,随机分为氨酚羟考酮10mg组和5mg组,均为Q8H给药,同时使用股神经阻滞（0.2%罗哌卡因）,两组患者均维持镇痛5 d。术后记录静息痛、康复锻炼疼痛最重时、康复锻炼结束时疼痛评分、膝关节被动活动度、膝关节主动活动度,记录功能活动时疼痛：下床、行走、即刻松拐疼痛评分,以及药物相关的并发症。结果氨酚羟考酮10mg组患者在术后1 d、3 d的静息痛VAS评分及膝关节主动活动优于5mg组,不良反应发生率10mg组为26.7%,5mg组为10%。结论氨酚羟考酮用于全膝关节置换术后康复镇痛效果良好,建议在术后早期（1～3天）使用10mg,Q8H给药,以缓解患者的静息痛、锻炼痛,之后可以减药量为5mg,Q8H,也可以达到满意的功能表现,同时减少药物的副作用。     

羟考酮超前镇痛在无痛宫腔镜手术中的应用

目的评价羟考酮超前镇痛对无痛宫腔镜手术镇痛效果的影响。方法选取无痛宫腔镜术的患者60例。ASAⅠ～Ⅱ级,所有患者随机数字表法分为两组,羟考酮组和生理盐水对照组。术前30分钟对照组静注生理盐水0.1ml/kg,试验组静注羟考酮0.1mg/kg(羟考酮稀释至1mg/kg)。手术开始两组均静注丙泊酚2.5mg/kg,术中出现体动反应追加丙泊酚1mg/kg。结果两组患者一般资料差异无统计学意义。两组手术时间、苏醒时间差异无统计学意义。试验组丙泊酚用量少于对照组(P0.05),术后宫缩痛实验组明显低于对照组(P0.05)。结论盐酸羟考酮用于宫腔镜手术超前镇痛,安全有效、简单易行且不良反应少     

盐酸羟考酮注射液与地佐辛用于无痛人流手术的效果比较

目的比较盐酸羟考酮与地佐辛用于无痛人流术的麻醉效果。方法随机将100例接受人流术的孕妇分为2组,各50例。A组静脉注射盐酸羟考酮,B组静脉注射地佐辛。随后均静注丙泊酚。记录麻醉开始诱导前(T0)、意识消失时(T1)、扩宫颈时(T2)、术毕苏醒时(T3)、苏醒后10 min(T4)的SBP、Sp O2、HR。记录苏醒时间、丙泊酚总用量、不良反应发生率及患者清醒后5 min、10 min、20 min及离院时的VAS评分。结果 T1、T2、T3、T4时点BP、HR较T0低(P0.05)。T1、T2时点SPO2较T0低(P0.05)。A组丙泊酚总用量、不良反应发生率及清醒后5 min、10 min、20 min和离院时的VAS评分均低于B组,差异有统计学意义(P0.05),见表3。结论盐酸羟考酮复合异丙酚用于人流术镇痛效果确切。     

腰硬联合麻醉剖宫产术后应用盐酸羟考酮联合超声引导罗哌卡因腹横肌平面阻滞的镇痛效果

目的探讨腰硬联合麻醉剖宫产术后应用盐酸羟考酮联合超声引导罗哌卡因腹横肌平面阻滞(TAPB)的镇痛效果。方法选取2018-12-2019-12间在兰考县中心医院接受腰硬联合麻醉剖宫产术的96例产妇。依据术后镇痛方法不同分为2组,各48例。对照组术毕时通过硬外导管注射盐酸羟考酮镇痛,观察组在对照组基础上联合罗哌卡因TAPB镇痛。比较2组的镇痛效果和舒适度。结果 2组不良反应发生率差异无统计学意义(P>0.05)。但各时点的NRS疼痛评分和舒适度BCS评分均显著优于对照组,差异有统计学意义(P<0.05)。结论对接受腰硬联合麻醉剖宫产的产妇,术后应用盐酸羟考酮联合罗哌卡因TAPB镇痛,未增加不良反应,有利于提升镇痛效果和产妇的舒适度。     

不同剂量羟考酮对腹部手术后急性疼痛的抑制作用

目的探讨不同剂量羟考酮对腹部手术后急性疼痛的抑制作用。方法择期全麻下行腹部手术患者60例,ASAⅠ或Ⅱ级,年龄30~70岁,随机均分为四组:羟考酮0.05mg/kg组(OL组)、羟考酮0.1mg/kg组(OM组)、羟考酮0.2mg/kg组(OH组)和对照组(C组)。两组麻醉诱导采用静脉注射咪达唑仑0.03mg/kg、丙泊酚2.0~2.5μg/kg、顺阿曲库铵0.2mg/kg、舒芬太尼0.6μg/kg;麻醉维持采用瑞芬太尼5~10μg·kg-1·h-1、丙泊酚4~6mg·kg-1·h-1、顺阿曲库铵0.1mg·kg-1·h-1。关腹时羟考酮组给予相应剂量的羟考酮抑制术后疼痛。于患者清醒后行NRS评分(对所有NRS大于4分者给予羟考酮镇痛),记录患者苏醒时间、清醒后的疼痛数字评分、镇痛持续时间、以及恶心、呕吐、瘙痒等不良反应的发生情况。结果与C组比较,OH组患者苏醒时间明显延长,OL、OM和OH组患者的NRS评分均明显降低,镇痛持续时间明显延长(P<0.05或P<0.01);与OL组比较,OM和OH组NRS评分明显降低,镇痛持续时间明显延长(P<0.05)。结论在关腹前给予羟考酮具有抑制腹部手术后疼痛的作用,但0.1mg/kg的羟考酮最适宜,既能达到良好的镇痛效果,同时又不影响患者的苏醒。     

羟考酮与吗啡在腹部大、中型手术中的镇痛效果对比研究

目的 :比较羟考酮与吗啡用于腹部大、中型手术病人的镇痛效果。方法 :选取200例择期行腹部大、中型手术病人,包括胆囊切除术、胃癌根治术、结肠直肠手术和妇科肿瘤手术,ASA分级Ⅰ/Ⅱ级。分为羟考酮组(O组,n=100)和吗啡组(M组,n=100)。在停用瑞芬太尼前10 min静脉注射0.08 mg/kg羟考酮或吗啡,观察血流动力学指标、苏醒时间、拔管时间、疼痛视觉模拟评分(visual analogue scale,VAS)、自控镇痛按压次数、补救镇痛例数、警觉/镇痛评分(OAA/S),同时观察药物不良反应,并记录病人镇痛满意度。结果:O组和M组各时间点的心率和平均动脉压、苏醒时间、拔管时间无统计学差异(P0.05)。O组VAS评分低于M组(P0.05)。O组自控镇痛按压次数少于M组(P0.05)。O组补救镇痛例数少于M组(P0.05)。O组OAA/S评分和恶心、呕吐发生率低于M组(P0.05)。两组均未出现呼吸抑制。结论:羟考酮在腹部大、中型手术后苏醒期镇痛的效果与安全性优于吗啡。既能对病人苏醒期起到镇痛作用,又为病人提供更舒适的术后镇痛,且无严重不良反应。     

罗哌卡因切口浸润联合羟考酮静脉输注对剖宫产术后宫缩痛和早期恢复的影响

目的观察罗哌卡因切口浸润联合羟考酮静脉术后镇痛对剖宫产术后宫缩痛和产妇早期恢复的影响。方法择期行剖宫产手术产妇60例,年龄22～35岁,ASAⅠ或Ⅱ级,随机均分为三组:羟考酮组(O组),罗哌卡因组(R组)和羟考酮联合罗哌卡因组(OR组)。O组患者于手术缝皮前静脉注射羟考酮0.1 mg/kg,R组患者于手术缝皮前皮下注射0.5%罗哌卡因15 ml浸润麻醉,OR组患者于手术缝皮前静脉注射羟考酮0.1 mg/kg联合皮下给予0.5%罗哌卡因15 ml浸润麻醉。术后VAS评分4分者静脉注射曲马多50 mg作为补救镇痛。比较三组产妇术后4、8、16、24、48 h的切口痛和宫缩痛的VAS评分和Ramsay镇静评分、术后48 h曲马多补救镇痛例次、术后恢复情况、术后皮肤瘙痒和恶心呕吐等不良反应发生情况。结果术后16、24 h O组和OR组宫缩痛VAS评分明显低于R组(P0.05),O组和R组切口痛VAS评分明显高于OR组(P0.05),术后曲马多补救镇痛例次明显大于OR组(P0.05)。O组和R组恶心呕吐发生率明显高于OR组(P0.05)。三组其他不良反应和术后恢复情况差异无统计学意义。结论剖宫产手术应用羟考酮静脉术后镇痛联合罗哌卡因切口浸润为基础的多模式镇痛,能对产妇的切口痛和宫缩痛达到良好的镇痛效果,其中羟考酮在减轻宫缩痛方面作用明显,且不增加术后不良反应。     

剖宫产术后羟考酮复合酮咯酸氨丁三醇静脉自控镇痛对血泌乳素的影响

目的探讨剖宫产术后羟考酮复合酮咯酸氨丁三醇静脉自控镇痛对血泌乳素的影响。方法随机将200例择期行剖宫产术的患者分为2组,各100例。术后均使用静脉自控镇痛泵镇痛,观察组予以羟考酮+酮咯酸氨丁三醇,对照组予以舒芬太尼+酮咯酸氨丁三醇+托烷司琼。比较2组血泌乳素水平及术后疼痛评分。结果术后2组血泌乳素水平均高于术前,差异有统计学意义(P 0. 05)。观察组术后疼痛评分低于对照组,差异有统计学意义(P 0. 05)。结论剖宫产术后羟考酮复合酮咯酸氨丁三醇静脉自控镇痛,可提高血泌乳素水平,缓解术后疼痛效果好。     

舒芬太尼或羟考酮自控静脉镇痛联合腰方肌阻滞用于剖宫产术后镇痛的效果

目的评价超声引导下腰方肌阻滞(quadratus lumborum block,QLB)联合舒芬太尼或羟考酮PCIA用于剖宫产术后镇痛的效果。方法择期在腰-硬联合阻滞下行剖宫产术的产妇120例,年龄22~38岁,体重50~80 kg,ASAⅠ或Ⅱ级,采用随机数字表法分为四组,每组30例:舒芬太尼组(S组)、羟考酮组(Q组)、QLB联合舒芬太尼组(BS组)和QLB联合羟考酮组(BQ组)。BS组和BQ组术毕行超声引导下双侧QLB,每侧注射0.25%罗哌卡因20 ml。四组术后均行PCIA,S组和BS组镇痛泵药物为舒芬太尼100μg加生理盐水至100 ml,Q组和BQ组镇痛泵药物为羟考酮50 mg加生理盐水至100 ml。设置镇痛泵背景输注速率2 ml/h,单次剂量2 ml,锁定时间10 min。记录术后24 h内PCIA给药总量、有效按压次数、补救镇痛情况和镇痛满意度评分。记录镇痛期间恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应的发生情况。结果与S组比较,Q组、BS组和BQ组PCIA给药总量、有效按压次数明显减少,镇痛满意度评分明显升高(P<0.05),Q组术后恶心呕吐发生率明显降低(P<0.05),BS组和BQ组补救镇痛率明显降低(P<0.05)。与Q组比较,BS组和BQ组PCIA给药总量、有效按压次数明显减少,补救镇痛率明显降低,镇痛满意度评分明显升高(P<0.05)。与BS组比较,BQ组PCIA给药总量、有效按压次数明显减少,镇痛满意度评分明显升高,术后恶心呕吐发生率明显降低(P<0.05)。结论超声引导下QLB可增强剖宫产术后镇痛效果,减少术后镇痛药物用量,提高产妇满意度,联合羟考酮PCIA可更有效抑制术后宫缩痛,并降低术后恶心呕吐的发生率。     

Midazolam-sufentanilvs sufentanil-enflurane for induction of anaesthesia for CABG surgery

PURPOSE: To compare the effects of midazolam-sufentanil (Group I) and sufentanil-enflurane (Group II) anaesthesia on myocardial oxygenation and metabolism in patients with preserved ventricular function undergoing CABG surgery. METHODS: Patients randomized to Group I (n = 16) received midazolam 0.3 mg.kg-1 at induction of anaesthesia, 0.15 mg.kg-1 after tracheal intubation, followed by an infusion of 2.5-10.0 micrograms.kg-1.min-1. Supplemental sufentanil (cumulative maximum of 5 micrograms.kg-1) was given for adverse haemodynamic responses. Group II (n = 16) received 5 micrograms.kg-1 sufentanil at induction. Additional sufentanil (maximum 5 micrograms.kg-1), and enflurane (0-3% inspired concentration) were administered for adverse haemodynamic responses. Haemodynamics, myocardial oxygen consumption (MVO2), and lactate extraction were determined at the following times: I) awake (AWA), 2) after induction (IND), and 3) after tracheal intubation (ETT). RESULTS: Systemic haemodynamics and myocardial metabolism were similar at AWA. Heart rate response was attenuated and MVO2 reduced in Group I at IND (P < 0.05). Following AWA, myocardial lactate production (MLP) occurred more frequently in Group II vs Group I patients (9/16 vs 2/16) and at more individual measurement points (Group II: 10/64 vs Group I: 3/64). Myocardial lactate flux demonstrated a deleterious trend in Group II at ETT. CONCLUSIONS: Compared with sufentanil-enflurane, midazolam-sufentanil anaesthesia resulted in comparable and acceptable haemodynamics and myocardial oxygenation in CABG patients.     

A novel fully human anti-CD40 monoclonal antibody, 4D11, for kidney transplantation in cynomolgus monkeys

BACKGROUND: CD40-CD154 pathway blockade by anti-CD154 monoclonal antibodies (mAbs) significantly prolongs allograft survival in nonhuman primates. However, thromboembolic complications have prevented clinical application. Thus, blockade of the counter molecule by a novel fully human anti-CD40 mAb, 4D11, is an attractive alternative. METHODS: Kidney transplantations were performed between outbred cynomolgus monkeys (stimulation index >3 in a mixed lymphocyte reaction). The animals were divided into five groups: nontreatment control (Group 1, n=3), 10-week treatment with either 10 mg/kg (Group 2, n=3), 20 mg/kg (Group 3, n=3), or 40 mg/kg (Group 4, n=1), and 4-week treatment (Group 5, n=1 each) with 10 mg/kg, 20 mg/kg, or 40 mg/kg followed by monthly administration. Graft survival, biochemistry, complete blood counts, lymphocyte phenotypes, blood drug levels, antidonor and antidrug antibodies, and renal histology were examined. RESULTS: Survival (days) was as follows: Group 1 (5, 6, 7), Group 2 (150, 108, 108), Group 3 (84, 108, 379), Group 4 (147), and Group 5 (147, 102, 112). Two animals in Group 3 with normal graft function were killed upon development of hydronephrosis and cerebral infarction. B lymphocytes fell to one-third of the preoperative value at 4 weeks after transplantation in all animals. Antidonor antibodies developed in most of the animals after stopping drug treatment or at the time of death. No animals except for one formed anti-4D11 antibody. CONCLUSION: 4D11 appears to be a promising agent for antirejection treatment in clinical organ transplantation.     

Advantages of intrathecal nalbuphine, compared with intrathecal morphine, after cesarean delivery: an evaluation of postoperative analgesia and adverse effects

We performed a prospective, randomized, double-blinded, multicenter study to compare the analgesic efficacy and adverse effects of intrathecal nalbuphine, at three different doses, and intrathecal morphine for postoperative pain relief after cesarean deliveries. Ninety healthy patients at full term who were scheduled for elective cesarean delivery with spinal anesthesia were enrolled in the study. They received 10 mg of hyperbaric bupivacaine 0.5% with either morphine 0.2 mg (Group 1), nalbuphine 0.2 mg (Group 2), nalbuphine 0. 8 mg (Group 3), or nalbuphine 1.6 mg (Group 4). Only patients in Groups 1 and 2 reported pain during surgery. Postoperative analgesia lasted significantly longer in the morphine group, compared with the nalbuphine groups (P: < 0.0001). In the nalbuphine groups, postoperative analgesia lasted longest with the 0.8-mg dose. The additional increase to 1.6 mg did not increase efficacy. The incidence of pruritus was significantly higher in Group 1 (11 of 22), compared with Group 2 (0 of 22, P: < 0.0002), Group 3 (0 of 23, P: < 0.0001), and Group 4 (3 of 20, P: < 0.02). Postoperative nausea and vomiting were more frequent in Group 1 (5 of 22), compared with Group 2 (0 of 22, P: < 0.05), Group 3 (0 of 23, P: < 0.05), and Group 4 (3 of 23, not significant). There was no maternal or newborn respiratory depression. Neonatal conditions (Apgar scores and umbilical vein and artery blood gas values) were similar for all groups. This study suggests that intrathecal nalbuphine 0.8 mg provides good intraoperative and early postoperative analgesia without side effects. However, only morphine provides long-lasting analgesia. IMPLICATIONS: Small doses of intrathecal nalbuphine produce fewer adverse effects, such as pruritus and postoperative nausea and vomiting, compared with intrathecal morphine. This may allow earlier discharge of patients from the recovery room.     

The effect of adding nitrous oxide on MAC of sevoflurane combined with two target-controlled concentrations of remifentanil in women

BACKGROUND AND OBJECTIVE: The aim of this prospective, randomized, double-blind study was to determine the effects of adding nitrous oxide on sevoflurane requirement for blunting sympathetic responses after surgical incision combined with two different target-controlled concentrations of remifentanil (1 and 3 ng mL(-1)) in female. METHODS: 102 female patients, aged 20-50 yr, ASA I, undergoing general anaesthesia for elective abdominal surgery were enrolled and randomly allocated to receive sevoflurane anaesthesia alone (Group A, n=53), or with the addition of 60% nitrous oxide (Group N, n=49). Patients of both groups were further assigned to receive a target-controlled remifentanil infusion with an effect-site concentration of either 1 ng mL(-1) (Group N1, n=27; Group A1, n=30), or 3 ng mL(-1) (Group N3, n=22; Group A3, n=23). Sympathetic responses to surgical incision were determined after a 20-min period of stable end-tidal sevoflurane and target-controlled remifentanil concentrations. Predetermined end-tidal sevoflurane concentrations and minimum alveolar concentration (MAC) for each group were determined using an up-and-down sequential allocation technique. RESULTS: The MAC of sevoflurane was 3.96% (95% confidence interval, CI95: 3.69-4.23%) in Group A1 and 1.2% (CI95: 0.9-1.3%) in Group N1 (P < 0.01), while in Groups A3 and N3 the MAC of sevoflurane was 0.36% (CI95: 0.24-0.47%) and 0.18% (CI95: 0.1-0.3%), respectively (P < 0.05). CONCLUSION: Adding 60% nitrous oxide reduces the MAC of sevoflurane by 70% when using a remifentanil concentration of 1 ng mL(-1) and 50% when using a remifentanil concentration of 3 ng mL(-1).     

舒芬太尼对心脏瓣膜置换术患者血浆炎性细胞因子及丙二醛的影响

目的 探讨不同剂量舒芬太尼对心脏瓣膜置换术患者围术期血浆炎性细胞因子和丙二醛(malonic dialdehyde,MDA)的影响.方法 30例心脏瓣膜置换术患者,随机分为3 组即 S1组(舒芬太尼总量3μg/kg),S2组(舒芬太尼总量5μg/kg)和S3组(舒芬太尼总量10 μg/kg).分别于麻醉前(T0)、开胸后5 min(T1)、阻断后30 min(T2)、开主动脉后2 h(T3)和术后24 h(T4)各时间点测定动脉血中肿瘤坏死因子α(TNF-α),白细胞介素-6(IL-6)以及血浆MDA浓度,并记录3组患者在ICU的滞留时间和拔管时间.结果 与麻醉前(T0)比较,3组TNF-α(ng/L)、IL-6(ng/L)和MDA(mmol/L)在体外循环(cardiopul monary bypass,CPB)后明显升高(P<0.01或P<0.05),S2组在T2(TNF-α15.7±4.1、IL-6 116.5±18.2和MDA 8.5±0.8)、T3(TNF-α22.8±3.6、IL-6 158.9±13.7和MDA 10.2±1.3)时均明显低于S1组T2(TNF-α20.3±4.5、IL-6 141.8±21.3和MDA 10.6±0.9)和T3(TNF-α28.1±3.7、IL-6 175.6±15.1和MDA 12.5±1.4)时(P<0.05),S3组在T2(TNF-α14.4±3.2、IL-6 115.3±19.8和MDA 8.3±0.8)、T3(TNF-α21.0±3.7、IL-6 156.7±14.3和MDA 9.8±1.4)时均明显低于S1组(P<0.05),但S2、S3,组比较差异无统计学意义.S3组患者ICU滞留时间(3.5±0.5)d和术后拔管时间(29.3±3.0)h较S1(2.2±0.5)d,(18.2±2.5)h和S2组(2.4±0.4)d,(19.3±2.8)h明显延长(P<0.05).结论 CPB可促发促炎细胞因子及氧自由基的释放,较大剂量舒芬太尼能抑制心脏手术所致的全身性炎性反应,减少氧自由基的产生,从而减轻再灌注损伤,但达到一定剂量后这种效应并不存在剂量依赖性,且延长患者在ICU的滞留时间.     

Phrenic nerve paralysis following pediatric cardiac surgery. Role of diaphragmatic plication

Eighteen children sustained unilateral phrenic nerve paralysis (PNP) after cardiac surgical procedures. Ten (Group I), under 7 months (mean: 2.9 +/- 2.2), required long-term ventilatory assistance (mean: 23.9 +/- 13.0 days); they failed to be weaned from the ventilator. All underwent diaphragmatic plication (DP). DP was performed late in 7 cases (Group Ia) with a mean time of 30.8 days between surgery and DP, and early in 3 others (Group Ib) with a mean time of 10.2 days. Eight children (Group II), older than 1 year, tolerated PNP better and could be extubated early without diaphragmatic plication. In Group Ia severe lung infections were recorded in 5 before or/and after DP, and two died at 3 and 30 days after plication. Five children from Group Ia and all 3 from Group Ib were late survivors. They could be weaned from ventilatory support in a mean time of 3 days after DP, although those with severe lung infection (Group Ia) took the longest time. All from Group II were late survivors. We conclude: PNP is well tolerated without plication in children older than 1 year. However early DP offers excellent and immediate results in infants with PNP. Early DP in these children avoids or reduces severe lung infections and death.     

FK506对大鼠阴茎海绵体神经再生影响的研究

目的:探讨FK506对大鼠阴茎海绵体神经损伤后再生的影响,并讨论其作用的可能机制。　方法:54只 SD雄性大鼠随机分成3组,即假手术对照组(简称对照组,n=24)、单侧阴茎海绵体神经切断组(简称单切组,n= 24)、单侧阴茎海绵体神经切断+FK506组(简称FK506组,n=6)。术后1、3个月电刺激阴茎海绵体神经并连续监 测阴茎海绵体内压变化及阴茎勃起情况,同时取阴茎海绵体组织采用NADPH d法观察一氧化氮合酶(nNOS)阳性 神经纤维的再生情况。　结果:术后1个月单切组nNOS阳性神经纤维数量明显减少,与对照组相比差异有极显 著性(P<0.01),术后3个月在电刺激未切断侧阴茎海绵体神经时,FK506组比单切组产生更大的最大海绵体内压 (P<0.01),且单切组阴茎海绵体组织中nNOS阳性神经纤维比术后1个月无明显增加(P>0.05),而FK506组 nNOS阳性神经纤维显著增加(P<0.01)。　结论:FK506皮下注射能促进大鼠损伤的阴茎海绵体神经再生,促进 勃起功能恢复。     

Late antinociception and lower untoward effects of concomitant intrathecal morphine and intravenous buprenorphine in humans

STUDY OBJECTIVE: To evaluate the perioperative antinociceptive effect of intrathecal morphine (a pure mu agonist), intravenous (IV) buprenorphine (a partial mu agonist) or their combination. DESIGN: Randomized, double-blind, placebo-controlled study. SETTINGS: Anesthesiology department of a university-affiliated public hospital. PATIENTS: 45 ASA physical status I, II, and III patients undergoing hysterectomy with general anesthesia. INTERVENTIONS: Preoperative and postoperative regimens consisted of intrathecal morphine 4.3 microg.kg(-1) plus IV 0.9% saline (Group 1), IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline (Group 2), and intrathecal morphine 4.3 microg.kg(-1) plus IV buprenorphine 1.3 microg.kg(-1) (Group 3; postoperative supplements consisting of IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline). MEASUREMENTS AND MAIN RESULTS: Group 2 and 3 patients were given three analgesic dosings compared with two dosings in Group 1 (p < 0.001). The duration of action in Group 2 was significantly shorter (p = 0.001) than in the other two groups. The 12-hour postoperative pain intensity and sedation in Group 3 was significantly lower (p < 0.05) than in the other groups. Side effects (mainly pruritus and nausea and vomiting) were significantly fewer (p < 0.05) in Groups 2 and 3 (26% and 28%, respectively) than in Group 1 (46%). CONCLUSIONS: The concomitant administration of intrathecal morphine and IV buprenorphine alleviates pain sensation and minimizes sedation more effectively than when given after the administration of either drug separately. In addition, IV buprenorphine affords a reduction in side effects.     

Mechanical characteristics of cross-stitch epitenon suture in association with various two-strand core sutures: a biomechanical study using canine cadaver tendons

The purpose of this study was to investigate the ultimate tensile strength and stiffness of the cross-stitch epitenon suture technique in association with three different two-strand core suture techniques (the modified Kessler, Tsuge, and two-strand Savage). Twenty-four canine cadaver flexor profundus tendons were lacerated and repaired by one of the following techniques: the cross-stitch (Group 1), the modified Kessler with cross-stitch (Group 2), the Tsuge with cross-stitch (Group 3), and the two-strand Savage with cross-stitch (Group 4). Ultimate strength was determined with a tensile testing machine and stiffness was recorded by a video dimension analyser system. The ultimate strength of Group 2 (5.704 kgf) was significantly greater than that of the other techniques, followed by Group 4 (4.608 kgf), Group 3 (3.568 kgf), and Group 1 (2.935 kgf). The stiffness of Group 2 (495.8 kgf/m) was significantly greater than that of the other techniques, followed by Group 4 (369.7 kgf/m), Group 3 (225.7 kgf/m), and Group 1 (200.1 kgf/m). These results may be helpful to surgeons in deciding which core suture technique to use in association with the cross-stitch epitenon suture.     

Postoperative analgesia after total hip arthroplasty: i.v. PCA with morphine, patient-controlled epidural analgesia, or continuous "3-in-1" block?: a prospective evaluation by our acute pain service in more than 1,300 patients

STUDY OBJECTIVE: To assess the most appropriate postoperative analgesic technique after hip surgery. DESIGN: Prospective, nonrandomized study. SETTING: University hospital. PATIENTS: 1,338 ASA physical status I, II, and III patients scheduled for elective unilateral total hip arthroplasty (THA). INTERVENTIONS: During the first 48 postoperative hours, pain relief was provided by intravenous (i.v.) patient-controlled analgesia (PCA) with morphine (Group 1), continuous "3-in-1" block (Group 2), or patient-controlled epidural analgesia (PCEA) (Group 3). MEASUREMENTS AND MAIN RESULTS: During a 7.5-year period, pain scores, supplemental analgesia, satisfaction score, technical problems, and side effects were collected by our acute pain service. Postoperative pain relief was comparable in the three groups. More paracetamol was required in Group 2 (1.0 +/- 1.2 g/48 h) and Group 3 (0.9 +/- 1.3 g/48 h) than in Group 1 (0.5 +/- 1.1 g/48 h) (p < 0.01). However, only 8% of patients in Group 2 and 12% of patients in Group 3 needed an opioid. A higher incidence of technical problems was noted in Group 3 (23.4%) than in Group 1 (2.3%) or Group 2 (5.5%) (p < 0.001). A lower incidence of side effects was observed in Group 2 (23.5%) when compared with Group 1 (58.8%) and Group 3 (71.9%) (p < 0.001). Satisfaction score was significantly higher in Group 2 than in the other two groups [80 +/- 16 vs. 87 +/- 14 vs. 81 +/- 14 in Groups 1, 2, and 3 respectively (p = 0.003)]. CONCLUSION: After THA, i.v. PCA with morphine, continuous "3-in-1" block, and PCEA provided comparable pain relief. Because it induces the fewest technical problems and side effects, continuous "3-in-1" block is the preferred technique.