硬膜外吗啡术后镇痛对老年患者血气的影响

本文观察老年患者手术术后硬膜外吗啡镇痛对血气的影响,为老年手术硬膜外吗啡术后镇痛对呼吸系统的安全性提供依据。资料与方法一般资料选择同期70岁以上老年患者前列腺手术24例(排除严重心肺疾病患者)。随机分为两组。麻醉方法连续硬膜外阻滞麻醉,穿刺部位L2～3间隙,头向置管4     

抑肽酶对体外循环中血小板膜糖蛋白的影响

本研究拟利用流式细胞技术观察体外循环中抑肽酶对血小板膜糖蛋白Ⅱb、Ⅲa(GPⅡb、Ⅲa)表达的影响,以探讨抑肽酶作用的分子生物学机制。资料及方法选择30例先天性房缺或/并室缺患儿,年龄在3～15岁,体重12～28 kg,心功能Ⅰ～Ⅱ级,男14例,女16例,随机分为两组:对照组和抑肽酶组。术前用药均为肌注哌替啶1mg/kg、氟哌利多0.1 mg/kg、东莨菪碱0.01 mg/kg,入室后静脉     

患者自控硬膜外镇痛对老年患者上腹部手术后镇痛效果及循环应激反应的影响

本研究旨在探讨罗比卡因伍用芬太尼患者自控硬膜外镇痛(PCEA)对老年人上腹部手术后镇痛效果及循环应激反应的影响。     

采用流式细胞术检测体外循环对血小板膜糖蛋白Ⅱb—Ⅲa的影响

体外循环是一种非生理性灌注。各种因素的综合影响可导致血小板结构和功能的变化，引起血小板的激活及聚集功能的严重伤。本文综述运用流式细胞术检测体外循环对血小板膜糖蛋白Ⅱｂ－Ⅲａ的影响。     

静脉和硬膜外患者自控镇痛术用于术后镇痛的效果比较

术后患者自控镇痛（PCA）技术的应用日趋普遍，确能减轻患者应激反应，改善手术区血运。本文拟比较术后患者静脉自控镇痛（PCIA）与术后患者硬膜外自控镇痛（PCEA）的临床效果与安全性。     

采用流式细胞术检测体外循环对血小板膜糖蛋白Ⅱb-Ⅲa的影响

体外循环是一种非生理性灌注。各种因素的综合影响可导致血小板结构和功能的变化,引起血小板的激活及聚集功能的严重损伤。血小板膜糖蛋白Ⅱb—Ⅲa(GPⅡb—Ⅲa)与血小板聚集功能密切相关。流式细胞术是近年来发展起来的一种自动分析细胞的高新技术。本文综述运用流式细胞术检测体外循环对血小板膜糖蛋白Ⅱb-Ⅲa(GPⅡb-Ⅲa)的影响。     

术后硬膜外镇痛和静脉镇痛对老年高血压患者全髋置换术后应激反应的影响

目的比较硬膜外镇痛与静脉镇痛对老年高血压患者全髋置换术后应激反应的影响。方法 30例择期全髋置换术后的高龄患者随机均分为三组:对照组(A组)、术后静脉镇痛(PCIA)组(B组)、术后硬膜外镇痛(PCEA)组(C组)。观察患者术后8、12、24及48h的镇痛效果,记录术前(T1)、术毕(T2)、术后24h(T3)及术后48h(T4)的血流动力学和应激激素的变化。结果 T2～T4时A组的SBP、DBP明显高于、HR明显快于T1时(P<0.05或P<0.01)。T3时B、C组内皮素(ET)、心房利钠肽(ANP)显著低于A组(P<0.05或P<0.01),T4时C组ET明显低于A组,B、C组ANP仍明显低于A组(P<0.05或P<0.01);T3、T4时C组皮质醇(Cor)、促肾上腺皮质激素(ACTH)明显低于A组(P<0.05或P<0.01)。结论 PCEA及PCIA均能有效控制术后疼痛,维持血流动力学稳定,降低术后应激激素水平,而硬膜外镇痛较静脉镇痛对高龄高血压患者镇痛效果更平稳。     

腰椎胶原酶溶核术后患者硬膜外镇痛对疗效的影响

我们于1999～2003年间对CT或MRI确诊的腰椎间盘突出症患者进行胶原酶溶核术加术后硬膜外镇痛治疗,并与单纯施行胶原酶溶核术治疗比较,观察其对术后康复的影响。     

胸科手术患者硬膜外自控镇痛对术后呼吸功能影响的临床研究

术后疼痛是机体对手术造成的组织损伤所产生的一种复杂的生理反应,术后患者肺功能均有不同程度的抑制,术后疼痛刺激所致不良神经反射及麻醉药物残余作用等均可导致肺功能下降,根据不同的手术部位选择相应的脊神经节段术后行硬膜外患者自控镇痛(PCEA),能减轻患者的切口疼痛,降低应激反应,改善呼吸功能.本文对开胸术后患者使用硬膜外自控镇痛泵与未用自控镇痛泵对潮气量(VT)、肺活量(VC)、RR和SpO2的影响、镇痛效果及术后肺部并发症进行了比较研究,现报道如下.     

不同取代级羟乙基淀粉对血小板膜糖蛋白表达的影响

目的探讨不同取代级羟乙基淀粉对血小板凝血功能的影响。方法择期行外科小手术患者60例,ASAⅠ级,年龄25～45岁,体重51～70 kg,随机分为乳酸钠林格氏液组(LR组)、HES 200／0．5组(H组)和HES 130／0．4组(V组),每组20例。麻醉诱导后,3组患者分别静脉输注乳酸钠林格氏液、HES 200／0．5和HES 130／0．4 20 ml·k-1,30-60 min内输注完毕。采用流式细胞术测定3组患者在术前(T1,基础值)、输注完毕后15 min(T2)、输注完毕后6 h(T3)各时点静脉血中静息态血小板与活化态血小板CD42b、CD61／41、CD62p的表达。结果3组患者输注前后静息态血小板膜糖蛋白表达差异无统计学意义(P>0．05)。与基础值比较,H组和V组T1时ADP活化血小板CD42b、CD61/41、CD62p表达降低(P<0．05或0．01),H组T3时以上指标表达降低(P<0．01),V组T3时以上指标表达差异无统计学意义(P>0．05)。结论HES 130／0．4抑制血小板凝血功能的程度较HES 200／0．5低。HES 130／0．4液体治疗有助于降低术后出血的发生。     

Continuous epidural administration of midazolam and bupivacaine for postoperative analgesia

BACKGROUND: Midazolam has been reported to have a spinally mediated analgesic effect. Clinically, single-shot epidural or spinal administration of midazolam has been shown to have an analgesic effect on perioperative pain. In this study, we investigated the analgesic effect of continuous epidural administration of midazolam with bupivacaine on postoperative pain. METHODS: Four groups of 20 patients who underwent gastrectomy or cholecystectomy were studied. Continuous epidural infusion of bupivacaine 100 mg (Group C), bupivacaine 100 mg + midazolam 10 mg (Group M10), or bupivacaine 100 mg + midazolam 20 mg (Group M20) in 40 ml per 12 h was started after surgery using the balloon infuser. Group I received intermittent epidural bupivacaine (2.5 mg.ml-1) 6 ml every 2 h. When necessary, an indomethacin suppository and then a single epidural shot of bupivacaine (2.5 mg.ml-1) 6 ml was administered. Blood pressure, heart rate, respiratory rate, analgesic area, analgesia score, and sedation score were monitored for 12 h postoperatively. Memory and frequencies of supplemental analgesia (indomethacin suppositories and epidural bupivacaine) were also checked. RESULTS: Group M20 showed a significantly wider area of pinprick analgesia and better analgesia scores than other groups. The need for rescue analgesics were significantly less in Group M20. Sedation and amnesia were more pronounced in Group M20 than the other groups. CONCLUSION: Adding midazolam (10 to 20 mg per 12 h) to continuous epidural infusion of bupivacaine for postoperative pain can provide a better analgesia, amnesia and sedation than bupivacaine alone.     

Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection

Background  Thoracic epidural analgesia (TEA) provides superior analgesia with a lower incidence of postoperative ileus when compared with systemic opiate analgesia in open colorectal surgery. However, in laparoscopic colorectal surgery the role of TEA is not well defined. This prospective observational study investigates the influence of TEA in laparoscopic colorectal resections. Methods  All patients undergoing colorectal resection between November 2004 and February 2007 were assessed for inclusion into a prospective randomized trial investigating the influence of bisacodyl on postoperative ileus. All patients treated by laparoscopic resection from this collective were eligible for the present study. Primary endpoints were use of analgesics and visual analogue scale (VAS) pain scores. Secondary endpoint concerned full gastrointestinal recovery, defined as the mean time to the occurrence of the following three events (GI-3): first flatus passed, first defecation, and first solid food tolerated. Results  75 patients underwent laparoscopic colorectal resection, 39 in the TEA group and 36 in the non-TEA group. Patients with TEA required significantly less analgesics (metamizol median 3.0 g [0–32 g] versus 13.8 g [0–28 g] (p < 0.001); opioids mean 12 mg [±2.8 mg standard error of mean, SEM] versus 103 mg [±18.2 mg SEM] (p < 0.001). VAS scores were significantly lower in the TEA group (overall mean 1.67 [± 0.2 SEM] versus 2.58 [±0.2 SEM]; p = 0.004). Mean time to gastrointestinal recovery (GI-3) was significantly shorter (2.96 [±0.2 SEM] days versus 3.81 [±0.3 SEM] days; p = 0.025). Analysis of the subgroup of patients with laparoscopically completed resections showed corresponding results. Conclusion  TEA provides a significant benefit in terms of less analgesic consumption, better postoperative pain relief, and faster recovery of gastrointestinal function in patients undergoing laparoscopic colorectal resection.     

麻醉方式对老年创伤患者术后早期认知功能的影响

目的研究麻醉方法对老年创伤患者术后早期认知功能的影响。方法50例年龄≥65岁的股骨手术老年患者随机分成全身麻醉组(G组,28例)和单侧腰-硬联合麻醉组(E组,22例)。采用神经心理学测试技术简易智力状态检查(MMSE)术前1d及术后第1天进行评定认知功能。术后认知功能障碍(POCD)的诊断是首先计算所有患者麻醉前MMSE评分,患者以麻醉前测试值为对照,等于或超过1个标准差判断患者出现POCD。结果G组术后早期MMSE值低于E组(P0.05);G组术后早期POCD的发生率为42.9%,明显高于E组的13.6%(P0.05)。结论与腰-硬联合麻醉相比,全身麻醉可增加老年创伤患者术后早期第1天POCD的发生率。     

Epidural abscess following epidural analgesia in pediatric patients

Epidural abscess following epidural analgesia is an unusual event especially in pediatric patients. Two patients presented with fever and local signs of infection without neurological deficit on day 4 after the initiation of epidural analgesia. Neuro-imaging studies revealed epidural abscess. Both pediatric patients were treated successfully with intravenous antibiotics. One of the patients' initial MRI was normal. However, the symptoms persisted and a followed-up scan revealed epidural abscess. The other patient presented with worsening local indurations over the epidural insertion site and positive blood culture with Hemolytic streptococcus. Our experience suggests that neuro-imaging study should be strongly considered to evaluate pediatric patients with suspicion of epidural abscess.     

酒石酸布托啡诺在硬膜外术后镇痛中的应用

目的通过与吗啡作对比研究酒石酸布托啡诺在术后硬膜外镇痛中的效能和副作用。方法56例择期行在腰硬联合麻醉下行下腹部手术患者,男36例,女20例,年龄21岁～63岁,ASAⅠ～Ⅱ,随机分成二组：M组（吗啡组n=28）：0．004％吗啡＋0．12％布比卡因,B组（酒石酸布托啡诺n=28）：0．004％酒石酸布托啡诺＋0．12％布比卡因,进行硬膜外术后镇痛。手术缝皮时分别向两组病人硬膜外腔注射吗啡或酒石酸布托啡诺1mg做为负荷剂量,然后接硬膜外PCA泵,参数设定如下背景输入速度2ml／h,自控镇痛剂量0．5ml／次,锁定时间15min。用VAS评分评价镇痛效果,同时观察硬膜外术后镇痛的并发症。结果两组镇痛效果都较为满意;酒石酸布托啡诺组的VAS评分低于吗啡组,但无统计学意义。酒石酸布托啡诺组瘙痒、恶心、呕吐的发生率低于吗啡组。结论酒石酸布托啡诺硬膜外术后镇痛效果可靠,副作用少,值得在临床中推广使用。     

术后镇痛对老年人上腹部手术后肺功能的影响

３２例 ＡＳＡ Ⅱ～Ⅲ级择期行上腹部手术（ＵＡＳ）的老年患者随机分成两组：对照组（ｎ＝１６）和术后每６小时用 ０． １２５％丁听卡因十芬太尼０．０２５ｍｇ １０ｍｌ行硬膜外镇痛（ＰＥＡ）组（ｎ＝１６），分析两组患者术前，拔管时，术后４、８和２４小时的呼吸频率（ＲＲ）、潮气量（ＶＴ）、分钟通气量（ＭＶ）和动脉血ｐＨＰａＯ２、ＰａＣＯ２、ＮＣＯ０－３、ＢＥ－Ｂ、Ｏ２Ｓａｔ。结果表明：虽术后持续鼻导管吸氧，对照组仍出现严重的呼吸抑制和酸碱平衡紊乱，尤以术后８小时内，特别是４小时内最严重；而镇痛组则程度轻微且无明显缺氧、二氧化碳蓄积和酸碱平衡失调。可见用０．１２５％丁哌卡因十芬太尼０．０２５ｍｇ １０ｍｌ行ＰＥＡ能改善老年患者的术后肺功能。但在ＰＥＡ期间仍应继续进行呼吸监测，并常规给予吸氧至少８小时。//     

The effect of epidural analgesia on postoperative outcome after colorectal surgery

OBJECTIVE: The aim of this review was to determine the effects of epidural analgesia as it relates to outcome after colorectal surgery. METHOD: We searched and reviewed studies that included colorectal surgery and epidural method of analgesia listed on the Pubmed, Medline, Embase and the Cochrane library database. RESULTS: The majority of data demonstrate a superior effect of epidural analgesia on pain control after colorectal surgery. Well designed randomized controlled trials (RCT's) have also shown that epidural analgesia reduces the duration of ileus after colorectal surgery. Limited data suggest the additional benefit may be minimal after laparoscopic surgery or when epidural analgesia is used as part of a multimodal regime. Data does not convincingly show either a clear harmful or beneficial effect of epidural analgesia on rates of anastomotic leakage. Epidural analgesia may have beneficial effects on postoperative lung function, however due to low numbers, the effects on cardiovascular and thromboembolic complications are indeterminate. Length of hospital stay has not been shown to be shortened by sole use of an epidural and, although epidural analgesia may be apparently more costly, alternatives may incur higher indirect costs and decreased patient satisfaction. CONCLUSION: Randomized controlled trials have shown a benefit for epidurals on postoperative pain relief, and ileus, and possibly respiratory complications. There is no proven benefit with regard to length of stay. There are a number of unresolved issues which further focussed RCT's may help clarify such as effects of epidural on complication rates after colorectal surgery.     

The dose of caudal epidural analgesia and duration of postoperative analgesia

BACKGROUND: Single dose caudal epidural is commonly utilized for postoperative analgesia in children. Previous studies have determined the optimal concentration of local anaesthetic, and the minimal volume to produce a desired dermatomal distribution. However, none has sought the optimal volume to administer. The specific aim of this study was to determine whether the volume of caudal epidural local anaesthetic influenced the duration of postoperative analgesia. METHODS: Fifty-four children aged 1-6 years and ASAPS I-II scheduled for elective inguinal herniorraphy were enrolled in this randomized and blinded clinical trial. They received a standardized general anaesthetic with one of three possible doses of caudal epidural analgesic: 0.7, 1.0, or 1.3 ml.kg-1 of 0.175% bupivacaine with 1 : 200 000 epinephrine. The patients were assessed by blinded observers during in-hospital recovery and by parents at home. RESULTS: The principal outcome measure of time until first postoperative analgesic requirement was similar between the groups (4.2, 3.6, and 4.8 h respectively). Other effects which might be altered by epidural analgesia, including time until first void, ambulation, and discharge readiness did not differ between groups. CONCLUSIONS: Increasing local anaesthetic dose and volume do not increase the duration of postoperative analgesia of caudal epidural in children undergoing inguinal herniorraphy.     

硬膜外分娩镇痛的研究进展

硬膜外分娩镇痛对分娩的影响一直存在争议.新近资料不仅提供了硬膜外分娩镇痛对产程、剖宫产率、阴道器械助产率、及新生儿影响的进展,而且它与持续性枕后位和产妇发烧的关系也受到关注.改进硬膜外分娩镇痛技术的关键是减小对分娩不利影响并保证产妇满意镇痛的重要手段.研究表明采用低浓度局麻药复合阿片类药硬膜外镇痛,设置大容量PCEA和长锁定时间的输注模式对分娩的影响最小.