碳酸利多卡因硬膜外持续输注给药麻醉方案的临床研究

通过临床手术麻醉 ,评价碳酸利多卡因在硬膜外麻醉中持续输注给药方案的安全性和有效性。采用利多卡因硬膜外麻醉常规剂量加持续输注给药方案 ,对 5 1例下腹部或下肢手术病人 ,观察其临床麻醉效果、血压、心律、心率及连续监测利多卡因血药浓度。结果 5 1例病人麻醉效果基本满意 ,除 1例出现心律失常外 ,余病人的血压、心律、心率均正常 ,无明显不良反应发生。 5 1例病人手术过程中共取标本 146份 ,平均 (2 9± 0 5 )份。利多卡因血药浓度为 (3 2 2± 1 48) μg /ml,范围 0 92～ 9 90 μg/ml。其中 5 0 7%标本血药浓度在理论计算值范围内 ,81 5 %在安全有效浓度内。结果表明 ,用此方法给药 ,可获得临床满意的麻醉效果 ,且无明显不良反应发生 ,大部分标本的血药浓度是在安全有效浓度范围内。证明该方案适于临床应用     

盐酸二氢埃托啡对F1小鼠生长发育的影响

设盐酸二氢埃托啡１、２、４μｇ／ｋｇ３个剂量组，在小鼠预产期前１２ｈ、临产时和分娩开始后２ｈ共肌注给药３次。１和２μｇ／ｋｇ组（累积给药相当于人用剂量的４．５和９倍）对子一代Ｆ１小鼠的生长发育、神经行为发育及生殖能力等无明显影响。４μｇ／ｋｇ组（累积给药相当于人用剂量１８倍）仔鼠１日龄时体重减轻，２１日龄雄鼠的脾脏和胸腺绝对重量下降，显示出一定的毒性作用。盐酸吗啡２００μｇ／ｋｇ（累积给药相当于人用剂量的３．６倍）皮下注射，新生鼠触须定位反射及视觉定位反射完成时间延迟。盐酸普鲁卡因１０００μｇ／ｋｇ组（累积给药相当于人用剂量的３倍）仔鼠平面翻正反射完成时间延长，提示对Ｆ１小鼠的生长发育有不良影响。结果表明，在临床治疗剂量范围内，盐酸二氢埃托啡的安全性明显高于盐酸吗啡和盐酸普鲁卡因     

G-CSF减轻大鼠下肢缺血再灌注致肺功能损伤的实验研究

目的：研究重组粒细胞集落刺激因子（Ｇ－ＣＳＦ）对大鼠下肢缺血再灌注所致肺功能损伤的治疗作用。方法：雄性ＳＤ大鼠随机分３组,手术组及给药组麻醉后开腹解剖口主动脉．在肾动脉水平远端阻断１２０ｍｉｎ,开放、再灌注 １２０ ｍｉｎ;假手术组不阻断腹主动脉,余同手术组。３组均于术前经舌静脉注入伊文氏蓝（Ｅｖａｎ’ｓ ｂｌｕｅ ｄｇｅ） ３０ ｍｇ／ｋｇ;给药组术前经尾赢脉注入Ｇ－ＣＳＦ ２０μｇ／ｋｇ．余二组给予生理盐水１ｍｌ。术后取肺组织测定丙二醛（ｍａｌｏｎｒｌｄｉａｄｅｈｙｄｅ,ＭＤＡ）及伊文氏蓝含量。结果：给药组ＭＤＡ含量为（１．７１±０．３４）ｎｍｏｌ／ｍｇ,假手术组为（ｌ．７３±０．６５）ｎｍｏｌ／ｍｇ,均显著低于手术组〔（２．５４±０．３９）ｎｍｏｌ／ｍｇ］。 给药组伊文氏蓝含量为（１．５０±０．２９）μｇ／ｍｇ．假手术组为（０．１３±０．０７）μｇ／ｍｇ,均显著低于手术组［（（３．０７±１．１８）μｇ／ｍｇ］．结论：Ｇ－ＣＳＦ有减轻大鼠下肢缺血再灌注所致肺功能损伤的作用。     

老年患者硬膜外麻醉不同给药方式的临床研究

目的：比较硬膜外不同给药方式在老年患者手术中的临床效果分析。方法96例择期行手术的老年患者,按照不同的给药方式将患者均为两组（ n＝48）。持续给药组患者实施连续硬膜外穿刺成功后注入2％利多卡因试验量3 mL,调节麻醉平面达T10且固定后根据患者情况硬膜外连续输注2％利多卡因3～5 mL／h,至手术结束。分次给药组患者同样行硬膜外麻醉,调节麻醉平面达T10且固定后硬膜外分次注入2％利多卡因3～5 mL／h,每半小时注射1次。观察两组麻醉阻滞情况及不同时间点血流动力学变化。结果两组患者感觉阻滞起效时间基本相同,均能阻滞到最高平面T10,但持续给药组阻滞完善时间和用药总量均少于分次给药组,差异有显著性意义（ P＜0.05）。给药后两组血压均有明显下降,分次给药组术中追加药物后血压较持续给药组下降明显（P＜0.05）,波动较大,不如持续给药组稳定。结论硬膜外麻醉持续给药比传统的间断分次给药对老年患者血流动力学的影响小,有利于维持循环稳定,提高围术期安全性。     

光动力治癌药血啉甲醚的药代动力学研究

目的 探讨血啉甲醚在动物体内的药代动力学规律。方法 将１５只家兔分成３组，每组５只，分别静脉注射血啉甲醚１０、２０、４０ｍｇ／ｋｇ后，以荧光分光光度法测定血药浓度，并根据血药浓度－时间数据计算药代动力学参数。结果 血啉甲醚血浆浓度为１０、２０、４０μｇ／ｍｌ时，重复测定５次，方法回收率的均值和变异系数分别为９７．１０％、２．１９％，９７．３０％、２．２６％，９８．６０％、２．０３％。静脉给药后，血     

持续泵注与多次注药法用于硬膜外麻醉比较性研究

目的：观察微量泵持续输注法与分次注药法用于硬膜外麻醉的麻醉效果比较。方法：60例骨科下肢手术患者随机分为两组,微量泵持续输注组（A组）和常规分次注药组（B组）,每组30例,硬膜外用药均为2％利多卡因先注入实验量3ml,观察5min,无全脊麻征象后,A组以0．13—0．15ml·kg^-1·h^-1速度持续输注药物至手术结束;B组10—12ml,2—3min内分次注完,术中未再追加药物。观察镇痛起效时间、麻醉平面、镇痛效果、运动阻滞程度、BP、HR、SPO2和用药总量。结果：麻醉平面、镇痛效果、运动阻滞程度、SPO2两组间差异无显著性（P〉0．05）。A组用药总量显著减少（P〈0．01）BP波动显著降低（P〈0．01）。结论：微量泵持续输注法与分次注药法用于硬膜外麻醉比较麻醉效果可靠,BP平稳,用药量少。     

利多卡因喉上神经阻滞＋环甲膜穿刺气管内给药时的药代动力学

喉上神经阻滞和／或环甲膜穿刺气管内给药表面麻醉降低气管插管的应激反应是临床常用的方法［１～４］。但两者结合的药代动力学研究未见报道。本文拟就此加以研究。１　资料与方法择期全麻手术的病人８例，ＡＳＡＩ～ＩＩ级，无心、肺、脑、肝、肾功能障碍，呼吸道无炎症。男５例、女３例。平均年龄５３．２２±１２．２２（３５～６９）岁，平均体重６１．４９±８．５８（５１～７０）ｋｇ。术前常规肌注苯巴比妥钠０．１ｇ，阿托品０．５ｍｇ。入室后接无创血压心电监护仪。用简易法行颈内静脉穿刺置管建立静脉通道并作取血标本用。方法…     

头孢克罗颗粒剂相对生物利用度研究

１０名男性健康志愿者随机交叉口服单剂量的头孢克罗颗粒剂和胶囊剂，采用ＨＰＬＣ法测定血浆中的药物浓度，实验数据经３Ｐ８７程序处理，结果表明：血药浓度－时间曲线符合一室模型，达峰时间分别为（０．３９±０．０９）ｈ及（０．５２±０．０４）ｈ，峰浓度分别为（１７．４５±３．７６）μｇ／ｍｌ，（１４．６３±１．７７）μｇ／ｍｌ，曲线下面积分别为２０．９０μｇ／（ｍｌｈ），２０．９７μｇ／（ｍｌｈ），头孢克罗颗粒剂的相对生物利用度为９９．７６％。     

重组人IL-11对照射小鼠造血系统的影响

目的：观察重组人白细胞介素－１１（ｒｅｃｏｍｂｉｎａｎｔ ｈｕｍａｎ ＩＬ－１１,ｒｈＩＬ－１１）对照射小鼠血恢复的影响。方法：给５．５Ｇｈ＾６０Ｃｏγ射照射小鼠连续１０ｄ皮下注射ｒｈＩＬ－１１ ２００,４０００μｇ／（ｋｇ．ｄ）或溶剂,观察体重、外周血象和髓髓造血祖细胞的变化。结果：各种给药组小鼠体重明显增加（Ｐ〈０．０１）。照后第１１天ｒｈＩＬ－１１ ２００μｇ／（ｋｇ．ｄ）组血小板计数检查值     

烟碱诱发大鼠体温下降形成耐受的时间与剂量依赖性

烟碱急性给药（２．０，３．５和５．０ｍｇ／ｋｇ，ｉｐ）诱发大鼠体温下降具有剂量依赖性。美加明（１．０和５．０ｍｇ／ｋｇ，ｉｐ）可部分拮抗烟碱的体温下降作用，而六甲溴胺（５ｍｇ／ｋｇ，ｉｐ）不表现拮抗活性。烟碱（２．０，３．５和５．０ｍｇ／ｋｇ，ｉｐ）每日一次，连续１２ｄ给药，随着时间。     

Epidural steroid injections

Epidural steroid injections have a significant role in the treatment of patients with low back, neck, and radicular pain. Although these procedures may not address the causative lesions, they often shorten the clinical course of the disease process, keep patients out of the hospital, and provide symptomatic relief that improves quality of life. These procedures are most accurately performed with fluoroscopic guidance and major complications are rare. Although support for cervical epidural steroid injection is less uniform than that for lumbar and caudal injections, a growing body of experience is beginning to support its efficacy and safety.     

Epidural placement of Pantopaque after myelography

Summary A review of Pantopaque myelograms followed by plain radiographs revealed that an accidental extraarachnoid injection of the contrast medium had been made in 10% and epidural leakage of the contrast medium had occurred after the examination in 27% of the patients. The possibility of direct communication between the sub-and extraarachnoid spaces via the root pouches is discussed on the basis of a review of the literature. A personal view is expressed, however, that the epidural leakage of contrast medium takes place through the needle defect in the meninges. Contrast leakage occurs more often if larger amounts of contrast medium are left in the spinal canal, and in younger patients.

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Epidurale Ablagerung von Pantopaque nach der Myelographie

Zusammenfassung Die Durchsicht von Patopaque Myelogrammen zeigte, daß in 10% der Fälle eine extraarachnoideale Injektion des Kontrastmittels vorlag und in 27% der Fälle ein epiduraler Austritt des Kontrastmittels nach der Untersuchung beobachtet werden konnte. Es wird die Möglichkeit einer direkten Verbindung zwischen den Sub-und Extraarachnoideal-Räumen über die Wurzeltaschen diskutiert. Der epidurale Austritt des Kontrastmittels geht wahrscheinlich durch den Nadel-Defekt der Meningen. Dieser Kontrastmittel-Austritt erscheint öfter, wenn größere Mengen Kontrastmittel im Spinalkanal zurückbleiben.

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Présence de pantopaque dans espace épidural après myélographie

Résumé Les myélographies au Pantopaque entraînent dans 10% des cas la présence par injection accidentelle de produit de contraste dans l'espace sous-dural et dans 27% des cas une fuite de produit de contraste dans l'espace épidural après l'examen. Après revue de la littérature, l'auteur discute la possibilité d'une communication directe entre les espaces arachnoïdiens et extraarachnoïdiens à travers les poches radiculaires. Il pense cependant que la fuite dans l'espace épidural du produit de contraste se fait à travers la blessure des méninges par l'aiguille. La fuite est plus fréquente lorsqu'une grande quantité de produit de contraste est laissée dans le canal rachidien et lorsqu'il s'agit de sujets jeunes.

     

Epidural Metastasis in Nasopharyngeal Carcinoma

BACKGROUND: In nasopharyngeal carcinoma, both, a short metastasis-free interval after primary treatment and the occurrence of epidural metastasis have been associated with poor prognosis. We present the clinical course of a young patient with these two conditions and review the literature. PATIENT: A 26-year-old male with stage T2N3M0 non-keratinizing carcinoma (WHO type 2) of the nasopharynx was treated with induction chemotherapy and radical radiotherapy, 6 months after documentation of a clinical complete remission, the patient experienced metastatic disease to the C7-D1 vertebral bodies associated with an epidural soft tissue mass. Since no further metastatic lesions were detectable, the patient was treated with radiotherapy alone (3 960 cGy/22 fractions). RESULTS: Treatment resulted in compete resolution of neurological and radiological signs of the disease and the patient continues to be disease-free, 32 months after salvage treatment. In a literature search, we identified 54 reported cases with long-term survival after treatment for metastatic nasopharyngeal cancer. The vast majority of them had primary tumors with undifferentiated histology and was treated with combination chemotherapy. In 25 of them, radiotherapy was given as consolidation therapy (in 19 cases for bone and in six cases for mediastinal lymph node metastases). CONCLUSIONS: Epidural metastatic disease from a nasopharyngeal carcinoma is highly sensitive to moderate doses of fractionated radiotherapy. MR imaging is essential for the detection of relevant soft tissue disease extensions within the epidural space and proper selection of the radiation target volume in vertebral metastases. In patients with nasopharyngeal carcinoma, the occurrence of a solitary epidural metastasis after a short metastasis-free interval is not incompatible with long-term survival.     

Epidural hematomas of the posterior fossa

BACKGROUND: Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. METHODS: Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course, neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. RESULTS: Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT) and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. CONCLUSION: Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition, early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.     

Epidural extramedullary haemopoiesis in thalassaemia

Intrathoracic extramedullary haematopoiesis is a rare condition. Involvement of the spinal epidural space with haematopoietic tissue is rather unusual. A 31-year-old-man with a known diagnosis of beta-thalassaemia was referred with focal back pain. Magnetic resonance imaging revealed diffuse bone-marrow changes, thoracic paraspinal masses and lobulated epidural masses, suggesting extramedullary haemopoiesis. The patient was treated with radiotherapy and blood transfusions. Follow-up MRI was performed for evaluation efficacy of the treatment.     

椎管硬膜外原发肿瘤的MRI诊断

目的：探讨MRI对椎管硬膜外原发肿瘤的诊断价值。资料与方法：分析经手术病理证实的16例硬膜外原发肿瘤的MRI表现，结果：MR定位正确率为100％，5例血管脂肪瘤中4例以脂肪信号为主，瘤体内血管成分表现为条带状T2WI低信号，T2WI高信号，3例海绵状血管瘤呈椭圆形，T1WI呈低信号，T2WI呈高信号，注射对比剂后可明显均匀强化，1例血管瘤MR表现与海绵状血管瘤相似。4例恶性淋巴瘤T1WI呈等低信号，T2WI呈等或稍高信号，可中度或显著强化，有2例通过椎间孔向椎旁生长，1例破坏邻近椎体形成巨大软组织肿块，3例脊膜瘤呈宽基底附着于硬膜，T1WI呈中等信号，T2WI呈等信号，瘤体明显的均匀强化，邻近硬膜增厚，结论：根据椎管硬膜外原发肿瘤的MR表现，可准确定位并可推测其病理类型。