Epidural Morphine for Postoperative Pain: Experience with 1085 Patients

A prospective study of the effect and side-effects of epidural morphine for pain relief in 1085 patients after thoracic, abdominal, urologic, or orthopaedic surgery was performed. Morphine chloride was diluted in saline or bupivacaine and administered through an epidural catheter placed at a segmental level appropriate for the type of surgery. The initial dose was 4 or 6 mg morphine and supplementary doses were given when needed to obtain complete freedom from pain during deep breathing or nursing care. The total dose of epidural morphine from end of surgery until the next morning varied from 4 to 18 mg. 97% of hip arthroplasty patients, 91% of prostatectomy patients and thoracotomy patients, 90% of patients after major lower extremity surgery and 88% of patients after laparotomy were completely satisfied with the postoperative course. For hip arthroplasty and major extremity surgery, an initial dose of 4 mg of epidural morphine was as effective as 6 mg. After prostatectomy, laparotomy, and thoracotomy, an initial dose of 6 mg gave significantly better effect than 4 mg. Pruritus occurred in 11%, nausea or vomiting in 34%, and respiratory depression in 0.9% of the total patient population. Urinary retention occurred in 42% of patients not having urinary catheters in place. Postoperative nausea or vomiting was more frequent in women than in men (P less than 0.001). There was a higher incidence of nausea or vomiting in men experiencing pain than in men who were completely pain-free after abdominal surgery (P less than 0.001). Respiratory depression was rare and occurred as a gradually decreasing respiratory rate.(ABSTRACT TRUNCATED AT 250 WORDS)     

EFFECT OF DOSE AND PREMEDICATION ON INDUCTION COMPLICATIONS WITH ETOMIDATE

The induction characteristics of etomidate, a new i.v. hypnoticagent, were studied in 400 patients. Two hundred were premedicatedwith atropine and anaesthesia was induced with 0.2, 0.25, 0.3or 0.35 mg/kg of etomidate. The remainder received one of fourstandard premedications and anaesthesia was induced with etomidate0.3 mg/kg. Involuntary muscle movements occurred in more than60% of patients receiving atropine alone. The frequency wasreduced in the second group, but remained unacceptable in over8% of patients. The incidence of other excitatory phenomena,such as cough and hiccup, was 10% approximately. Cardiovascularchanges were minimal and no serious allergic phenomena wereobserved. Nausea and vomiting occurred after surgery in up to30% of patients and was unrelated to the dose of etomidate orto premedication. Pain on injection occurred in up to 80% ofpatients when the drug was injected into small peripheral veinsand occurred in more than % when using more proximal veins     

A study to determine the optimum dose of metaraminol required to increase blood pressure by 25% during subarachnoid anaesthesia

We studied dosage optimization for metaraminol when managing hypotension during subarachnoid anaesthesia. Twenty patients aged 53 to 84 years, were recruited. Non-invasive blood pressure (BP) and heart rate were recorded one-minutely. A series of four i.v. metaraminol boluses (0.25 to 1.0 mg per 50 kg adult) were administered. From individual patient time plots of BP predicted dosages for a 25% elevation in BP were estimated. Dose-related elevations in systolic BP [mean (SD)] occurred following dosages of 0.5 mg [25 (11)%] and 1.0 mg [50 (23)%]. Similar elevations occurred in mean and diastolic BP. Overall estimated dosage (median) to produce a 25% elevation in systolic BP was 0.5 mg (per 50 kg adult). However, individual patient responses varied (10-90th centiles = 0.23 to 0.80 mg). Thus, we now recommend a starting dose of 0.25 mg, increasing to 0.5 mg if necessary, to treat hypotension (25% decrease in systolic BP) during subarachnoid anaesthesia.     

Prolongation of QT Interval During Induction of Anaesthesia

QT interval was studied in 156 adults and in 127 children during the induction of anaesthesia. Both in adults and in children, QT interval was prolonged statistically significantly after thiopentone 5 mg/kg and the most marked prolongation occurred after suxamethonium 1 to 1.5 mg/kg. In adults, d-tubocurarine 0.06 mg/kg, but not alcuronium 0.03 mg/kg or pancuronium 0.01 mg/kg, prevented statistically significantly the prolongation of the QT interval after suxamethonium 1.5 mg/kg. In children, all three muscle relaxants prevented statistically significantly the effect of suxamethonium 2 mg/kg and pancuronium also prevented the effect of thiopentone. The most common ECG changes were ventricular ectopic beats (VEB) which occurred in 26% of the adults and in 22% of the children who were not pretreated with the muscle relaxants. After pretreatment with d-tubocurarine, the incidence of VEB was 3% in both groups. In adults, alcuronium was as effective as d-tubocurarine in the prevention of VEB but in the alcuronium group supraventricular ectopic beats and junctional rhythm occurred in 6% and 9% of the patients, respectively. Pancuronium did not significantly prevent the incidence of VEB. On the basis of the present results, d-tubocurarine is the relaxant of choice for the prevention of the prolongation of QT interval as well as ECG changes during the induction of anaesthesia.     

Avoidance of cyclosporine in renal transplantation: effects of daclizumab, mycophenolate mofetil, and steroids

Cyclosporine (CsA) has been implicated in both acute and chronic graft dysfunction. The addition of humanized IL-2 receptor antibody daclizumab (DZB) to CsA-based immunosuppression decreases the rate of acute renal transplant rejection. Therefore, 45 patients were evaluated in an immunosuppressive protocol that included DZB, mycophenolate mofetil (MMF), and steroids without CsA. This was a prospective, nonrandomized, open-label trial of the efficacy and safety of the treatment. DZB was given intravenously at 2 mg/kg before transplantation and then at 1 mg/kg every 2 wk for four doses, MMF was given orally at 3 g/d, and methylprednisolone/prednisone was given at 7 mg/kg per day and tapered to 15 mg/d at 6 mo. CsA was added to the regimen when patients developed acute rejection episodes or adverse effects to steroids or MMF; 49% of patients were spared CsA maintenance. Patients without CsA had lower serum creatinine at 6 mo and needed fewer medications to control BP. Incidence of biopsyproven rejections was 31% and occurred early (median, 10 d). These rejection episodes occurred earlier in cadaver transplants (median, 7 d) and later in living donor transplants (median, 62 days). Acute rejections occurred at a higher frequency (46% versus 34%) and earlier (6.5 versus 15 d) in patients with delayed graft function compared with patients without delayed graft function. Most of the rejections were moderate and easily reversible. The actuarial 1-yr graft survival was 95% with 100% patient survival.     

Intraarterial 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and systemic chemotherapy for malignant gliomas: a follow-up study

Twenty-five adults who harbored malignant gliomas received 72 courses of intraarterial 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) (100 mg/m2) and 67 courses of systemic vincristine (1.0 mg/m2) and procarbazine (100 mg/m2) as induction therapy (BVP) followed by 106 courses of systemic 1-(2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (methyl-CCNU) (130 mg/m2), vincristine, and procarbazine as maintenance therapy (MVP). With a 6-week interval between each treatment, the median and range for the number of courses of BVP were 3 and 1 to 4 and those for MVP were 3 and 0 to 14, respectively. Fifteen patients (60%) responded to both BVP and MVP, and 10 (40%) did not. The overall median survival time was 12.7 months (range, 1.8 to 48.5+ months). Two of 3 patients who had recurrent gliomas responded and survived for 37+ to 45+ months. Seven of 10 who had nonirradiated glioblastomas responded and survived for 9 to 22 months. Four who had nonirradiated anaplastic astrocytomas all responded and survived for 38+ to 48.5+ months. Two who also received radiotherapy (1 glioblastoma and 1 primitive neuroectodermal tumor) benefited and survived for 16.9 and 28.5+ months. All who did not respond favorably died within 8 months. During the infusion of BCNU, complications included transient orbital and head pain, periorbital and scleral erythema in all patients, and a focal seizure in 1 (4%). During the 6-month induction periods, leukopenia and thrombocytopenia occurred in 1 (4%), deep vein thrombosis occurred in 9 (36%), pulmonary emboli occurred in 8 (32%), upper respiratory infections occurred in 6 (24%), pneumonia occurred in 9 (36%), and herpes zoster occurred in 1 (4%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Solifenacin is effective for the treatment of OAB dry patients: a pooled analysis

OBJECTIVE: The aim of this analysis was to determine the effects of solifenacin in patients considered overactive bladder (OAB) dry at baseline. METHODS: This was a pooled analysis of 4 randomized, placebo-controlled 12-week, phase 3 studies. Patients received placebo or solifenacin 10 mg once daily (2 studies), or placebo or solifenacin 5 mg or 10 mg once daily (2 studies). A subgroup of patients without incontinence at baseline was identified from a 3-day diary. Mean changes from baseline to endpoint for urgency episodes, micturition, frequency and nocturia episodes per 24 hours, and volume voided/micturition were evaluated. The proportion of patients with normalization of micturition frequency (<8 micturitions), resolution of urgency, or resolution of nocturia at endpoint was also determined. RESULTS: Of 2848 evaluable patients treated with placebo or solifenacin, 975 (34%) were OAB dry at baseline. Solifenacin 5 mg and 10 mg were significantly (p < 0.001) more effective than placebo for improving urgency, micturition frequency, and volume voided. In addition, solifenacin 10mg was significantly (p < 0.01) more effective than placebo for improving nocturia. Resolution of urgency occurred significantly (p < 0.05) more often with solifenacin 5 mg (37%) and 10 mg (33%) than with placebo (25%). Significantly (p < 0.01) more OAB dry patients had normalization of micturition frequency with solifenacin 5 mg (29%) and 10 mg (35%) compared with placebo (19%). Resolution of nocturia occurred in 14%, 21%, and 13% of patients treated with solifenacin 5mg, solifenacin 10 mg, and placebo, respectively (p < 0.01 for solifenacin 10 mg versus placebo). CONCLUSION: Solifenacin significantly improved urgency, frequency, and nocturia symptoms and increased volume voided in OAB dry patients.     

Femoro-popliteal artery thrombolysis with intra-arterial infusion of recombinant tissue-type plasminogen activator--report of a pilot trial

Recombinant tissue-type plasminogen activator (rt-PA) was infused at a rate of 10 mg/h into 50 thrombosed femoral and popliteal arteries. Patency was restored in 43 but a secondary angioplasty led to 2 reocclusions and in 3 patients early rethrombosis occurred. A favourable clinical result was thus obtained in 38 patients (76%). Thirteen bleeding complications occurred in 10 patients, mainly haematomas at puncture sites. One patient required blood transfusion for gastro-intestinal bleeding from a previously unknown ulcer. The angiographic recanalisation rate in 16 patients who received a slower infusion of rt-PA (5 or 3 mg/h) was 94% and the clinical success rate in this series was 81%. However, the incidence of bleeding complications was not decreased by the slower infusion rate. The data obtained confirm the feasibility of rt-PA thrombolysis in peripheral arterial thrombosis and warrant a comparative study with streptokinase.     

Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients

Thirty ASA physical status I or II outpatients scheduled to undergo short procedures (less than 1 hr in duration) requiring tracheal intubation received either 1.0 mg/kg succinylcholine or 0.20 mg/kg (2.5 x ED95) or 0.25 mg/kg (3 x ED95) mivacurium. A N2O/O2/narcotic anesthetic technique was utilized and the ulnar nerve was stimulated with subcutaneous electrodes placed at the wrist. Tracheal intubation was attempted in all patients either 2 min after mivacurium or 1 min after succinylcholine. Intubation conditions were not different between the succinylcholine and mivacurium groups or between the two mivacurium groups. The onset and duration of neuromuscular blockade were shorter with succinylcholine than with mivacurium. Suppression of the T1 response to 90% of baseline occurred in 0.9 min with 1.0 mg/kg succinylcholine and at 2.2 and 1.5 min respectively, with 0.20 mg/kg and 0.25 mg/kg mivacurium. Initial recovery of the T1 response occurred at 6.4 min after 1.0 mg/kg succinylcholine and 12.7 and 13.6 min respectively after 0.20 mg/kg and 0.25 mg/kg mivacurium. Subsequent to initial recovery from the intubating dose of relaxant, infusions of mivacurium or succinylcholine were administered to maintain approximately 95% block. The mean infusion rates were 6.6 micrograms.kg-1.min-1 mivacurium and 41.2 micrograms.kg-1.min-1 for succinylcholine. Spontaneous recovery from neuromuscular blockade occurred more quickly after succinylcholine than after mivacurium: the time from cessation of infusion to recovery of T1 to 95% of baseline was 6.5 min in patients given succinylcholine and 16.7 min in patients given mivacurium. When reversal was in order, residual mivacurium-induced blockade was readily antagonized by 0.045 mg/kg neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prophylaxis of heterotopic ossification after total hip arthroplasty: a prospective randomized study comparing indomethacin and meloxicam

We performed a randomized, prospective study on the prophylaxis of heterotopic ossification (HO) after total hip arthroplasty (THR), comparing indomethacin and the selective COX-2 inhibitor meloxicam. From the day after surgery, 272 patients were treated with 7.5 mg meloxicam, 15 mg meloxicam, or 2 x 50 mg indomethacin a day, for 14 days. After 6 months, radiographs of patients treated with 7.5 mg meloxicam showed that HO had occurred in one third. This treatment was therefore stopped after 26 patients have been assigned to this group. According to the intention-to-treat principle, patients given 15 mg meloxicam developed HO in 25% (20% Brooker grade I, 4% grade II and 1% grade III) and those given indomethacin in 10% (7% Brooker grade I, 1% grade II and 2% grade III), a statistically significant difference.     

Prophylaxis of heterotopic ossification after total hip arthroplasty

We performed a randomized, prospective study on the prophylaxis of heterotopic ossification (HO) after total hip arthroplasty (THR), comparing indomethacin and the selective COX-2 inhibitor meloxicam. From the day after surgery, 272 patients were treated with 7.5 mg meloxicam, 15 mg meloxicam, or 2 × 50 mg indomethacin a day, for 14 days. After 6 months, radiographs of patients treated with 7.5 mg meloxicam showed that HO had occurred in one third. This treatment was therefore stopped after 26 patients have been assigned to this group. According to the intention-to-treat principle, patients given 15 mg meloxicam developed HO in 25% (20% Brooker grade I,4% grade II and 1 % grade III) and those given indomethacin in 10% (7% Brooker grade I,1% grade II and 2% grade III), a statistically significant difference.     

Efficacy of 0.1 mg of subarachnoid morphine combined with bupivacaine on postoperative analgesia in total hip arthroplasty

OBJECTIVES: To analyze the analgesic efficacy, safety and side effects of subarachnoid morphine (0.1 mg) with bupivacaine in patients undergoing total hip arthroplasty. PATIENTS AND METHODS: Thirty patients scheduled for total hip replacement under spinal anesthesia with bupivacaine were randomly assigned to two groups according to whether local anesthetic with 0.1 mg subarachnoid morphine was also provided or not (group M [n = 15] and group S ? = 15[, respectively). Top-up analgesia with morphine was available through a patient-controlled device. Postoperative pain was assessed on a visual analogue scale (VAS) and consumption of intravenous morphine in the first 48 hours after surgery was recorded. RESULTS: VAS scores (mean +/- SD) were significantly lower in the first six hours in group M, but no differences between the two groups were observed thereafter. Total consumption of morphine at 48 hours was much lower in group M (6.80 +/- 7.74 mg) than in group S (31.38 +/- 13.17 mg). The incidence of nausea was high in both groups (46%). Slight pruritus affected 26.6% of patients in group M. Urinary retention necessitating temporary placement of a catheter was observed only in group M, where the incidence was 35.7%. No cases of respiratory depression occurred. Drowsiness was observed in 26.6% of patients in group S in comparison with 6.6% in group M. CONCLUSIONS: Combining 0.1 mg morphine and bupivacaine for total spinal anesthesia during hip arthroplasty significantly decreased the consumption of intravenous morphine during the first 48 hours after surgery. No respiratory depression occurred and the only side effects were urinary retention and mild pruritus and drowsiness.     

Prophylaxis of heterotopic ossification after total hip arthroplasty: A prospective randomized study comparing indomethacin and meloxicam

We performed a randomized, prospective study on the prophylaxis of heterotopic ossification (HO) after total hip arthroplasty (THR), comparing indomethacin and the selective COX-2 inhibitor meloxicam. From the day after surgery, 272 patients were treated with 7.5 mg meloxicam, 15 mg meloxicam, or 2 ×50 mg indomethacin a day, for 14 days. After 6 months, radiographs of patients treated with 7.5 mg meloxicam showed that HO had occurred in one third. This treatment was therefore stopped after 26 patients have been assigned to this group. According to the intention-to-treat principle, patients given 15 mg meloxicam developed HO in 25% (20% Brooker grade I, 4% grade II and 1% grade III) and those given indomethacin in 10% (7% Brooker grade I, 1% grade II and 2% grade III), a statistically significant difference.     

A concurrent chemoirradiation with cisplatin followed by adjuvant chemotherapy with ifosfamide, 5-fluorouracil, and leucovorin for stage IV nasopharyngeal carcinoma

BACKGROUND: To evaluate the toxicity and efficacy of concurrent chemoirradiation with cisplatin followed by adjuvant ifosfamide, 5-fluorouracil and leucovorin in patients with stage IVb nasopharyngeal carcinoma (NPC) PATIENTS AND METHODS: Between October 1998 and August 2001, 35 Chinese patients with stage IVb NPC (N3a:12, N3b:23) were treated with by concurrent chemoirradiation using cisplatin 100 mg/m2 on days 1, 22, and 43 of radiotherapy, followed by adjuvant chemotherapy with 1.4 g/m2, ifosfamide, 450 mg/m2 5-fluorouracil, and 20 mg/m2 leucovorin daily for 5 days and repeated every 3 weeks for three cycles. Radiotherapy was given using standard fractionation at 2 Gy/day to a total of 68 Gy to the nasopharynx and 66 Gy to the neck. RESULTS: All patients completed the prescribed radiotherapy. Twenty-three patients (66%) completed all scheduled cycles of chemotherapy. The compliance rate for concurrent and adjuvant chemotherapy was 71% and 80%, respectively. Grade 3 mucositis occurred in 37%, and grade 3 dermatitis occurred in 11.5% during radiotherapy. Grade 3 neutropenia occurred in 17% during concurrent chemotherapy, and grade 3-4 neutropenia occurred in 48.5% during adjuvant chemotherapy. There were no treatment-related deaths. With a median follow-up of 31 months, the 3-year relapse-free rate was 60%, and the 3-year overall survival rate was 74%. Locoregional control was excellent, with a 3-year local and nodal relapse-free rate of 91% and 83%, respectively. Eleven patients (31%) had developed distant metastases, and the 3-year distant metastasis-free rate was 66%. CONCLUSIONS: The chemotherapy regimen tested is practical with an acceptable compliance rate. Despite having a more advanced stage disease, the observed outcome of our patients seems to be comparable with other series using platinum-based adjuvant chemotherapy. Further investigation to confirm the benefit of using the study regimen in advanced stage NPC is warranted.     

Intracavernous self-injection for erectile failure

Thirty-three patients with erectile failure were taught to self-inject papaverine intracavernosally. The dose was from 15 to 80 mg. Phentolamine was added if 80 mg was not sufficient. The patients kept a diary on the effects of the regimen, and also filled out a questionnaire after a follow-up of 4-16 months. The results showed that 55% were satisfied with the method. However, technical difficulties were common. Sexual stimulation turned out to be very important resulting in varying erections on consecutive occasions with the same papaverine dose. Prolonged erection occurred once in 5 patients and was easily handled conservatively in all. Fibrous plaques developed in 2 patients. Twelve patients (36%) stopped the injections for various reasons. When failure occurred the disappointment was usually severe. Thus, the selection of patients for self-injection is important.     

Clinical evaluation of ofloxacin in the treatment of chronic complicated urinary tract infection

Ofloxacin was administered orally at a daily dosage of 300 mg and 600 mg in three divided doses for 14 days to 24 and 60 patients with chronic complicated urinary infections, respectively, in order to evaluate the therapeutic efficacy. The clinical efficacy was evaluated according to the criterion proposed by the UTI Committee in Japan and its efficacy was evaluated in 84 cases. In the group of 24 patients receiving a daily dosage of 300 mg, the clinical effectiveness after a 5-day treatment was excellent in 13 cases and moderate in 7 cases. The overall clinical efficacy was 83.8%. In the group of 60 patients receiving a daily dosage of 600 mg, the rate of overall clinical efficacy after a 5-day treatment was 83.3%, being excellent in 23 cases and moderate in 27 cases. The eradication rate was 85.3% and 92.5% by 300 mg and 600 mg dosages of ofloxacin, respectively. As adverse reactions, anorexia and nausea occurred in 2 cases. Laboratory anomalies consisted of 1 case of slight and transient elevation of transaminase, and 1 case of elevated serum creatinine.     

Pregnancy outcome after renal transplantation

AIMS: The aim of our study was to evaluate the frequency and the outcome of pregnancies in renal transplant recipients at our center. METHODS: This study involved the retrospective analysis of 405 childbearing female renal recipients for presence of risk factors, the outcome of pregnancy, and maternal and fetal complications. RESULTS: Fourty-four pregnancies occurred in 41 patients (10.8%). Mean age at transplantation was 23.6 +/- 6.3 years (range, 12-38 years). Only in 5 pregnancies were there no risk factors. In 13 (29.5%) pregnancies, the previous creatinine level was >1.5 mg/dL, in 16 (36.45%), proteinuria was >500 mg/24 hours; 29 (65.9%) were hypertensive; 14 (31.8%) had a time between transplantation and pregnancy less than 2 years (mean time, 35.5 +/- 30.9 months; range, 3-120 months). The outcomes were 27 (61.4%; 11 term and 16 premature delivery) successful pregnancies, 6 (13.6%) spontaneous abortions, 10 (22.7%) therapeutic abortions, and 1 (3.2%) fetal death. Pre-eclampsia occurred in 9 (20.4%) pregnancies and eclampsia in 1 (2.2%). The mean weight of the offspring was 2195 +/- 490 g (range, 1300- 2980 g). There were 2 cases of acute fetal distress and 1 oligodramnios. Median creatinine level was 1.0 (range, 0.4-3.0) mg/dL before conception and 1.2 (range, 0.7-9.0) mg/dL 6 month after pregnancy (P <.001). The long-term patient and graft survival rates were similar for pregnant versus nonpregnant recipients in the childbearing age. CONCLUSION: Most pregnancies were successful, although the premature delivery rate was high (36.4%). Only 5 conceptions occurred in the absence of risk factors. Pregnancy did not impair the patient and graft survival during long-term follow-up.     

孕三烯酮用于紧急避孕120例临床观察

目的 :对孕三烯酮 ( R2 3 2 3 )的紧急避孕效果、副反应及对下次月经的影响进行前瞻性临床观察。方法 :1 2 0名要求紧急避孕的妇女 ,单次口服 5mg R2 3 2 3后进行随访 ,观察用药后的副反应和月经情况 ,按 Dixon法推算其避孕有效率。结果 :1 2 0名受试者的总预期妊娠数为 9.0 1 4,实际妊娠 1例 ,避孕有效率为 88.9% ,失败率为 0 .83 %。 1 0 %的受试妇女有轻微头痛、腹痛、恶心、呕吐等副反应 ,无需特殊处理。对下次月经无明显影响。结论 :5mg R2 3 2 3用于紧急避孕时安全有效 ,剂量小 ,副反应少 ,对月经周期无明显干扰。尚有待于大样本多中心研究证实     

Comparison of ondansetron and prochlorperazine for the prevention of nausea and vomiting after adenotonsillectomy

This study has compared the incidences of nausea, vomiting and headache after ondansetron 0.06 mg kg-1 i.v., prochlorperazine 0.2 mg kg-1 i.m. and prochlorperazine 0.1 mg kg-1 i.v. given during induction of general anaesthesia to 282 patients undergoing adenotonsillectomy. The cardiovascular effects of the drugs were similar. After operation, nausea per se and vomiting per se occurred with similar frequency, in between 6% and 11% and 11% and 19%, respectively, in each test group. Nausea and vomiting in the same patient was reduced from 29% to 2% by i.v. ondansetron (P < 0.0005) and to 3% by i.m. prochlorperazine (P < 0.0005), and appeared to be less severe in these groups. Headache was most frequent after i.v. ondansetron (35%: P < 0.05), but occurred with similar frequency after i.m. prochlorperazine (32%) and i.v. prochlorperazine (29%).      

小剂量兔抗人胸腺细胞免疫球蛋白和赛尼哌在肾移植诱导治疗中的应用效果

目的比较小剂量兔抗人胸腺细胞免疫球蛋白（ATG，即复宁）和赛尼哌在肾移植诱导治疗中的应用效果。方法150例尸体肾移植患者分3组，小剂量即复宁组72例（总剂量2．1～3．0mg／kg），赛尼哌组15例（50mg第1、14天各1次），未接受诱导治疗的肾移植受者63例作为对照组。随访6个门，比较3组患者急性排斥反应、DGF发生率和并发肺部感染率。结果即复宁组、赛尼哌组和对照组6个月内发生急性排斥反应分别为4例（5．5％）、1例（6．7％）、10例（15．9％），发生DGF分别为3例（4．2％）．0例、8例（12．7％），并发肺部感染分别为4例（5．1％）、1例（6．7％）、3例（4．8％），发生白细胞减少分别3例（4．2％）、1例（6．7％）、5例（7．9％），发生血小板减少分别2例（2．8％）、1例（6．7％）、5例（7．9％）。结论早期应用小剂最即复宁和赛尼哌是肾移植诱导治疗的合适选择。