右美托咪定静脉或局部用药对腰丛联合坐骨神经阻滞效果的影响

目的:比较右美托咪定静脉或局部用药对腰丛联合坐骨神经阻滞效果的影响。方法:拟行髋部骨折手术的老年患者90例,美国麻醉医师学会(American Society of Anesthesiologists,ASA)分级Ⅱ或Ⅲ级,随机分为三组。A组给予0.4%罗哌卡因溶液50 mL行腰丛联合坐骨神经阻滞,静脉给予0.9%氯化钠注射液50 mL;B组给予0.4%罗哌卡因溶液50 mL行腰丛联合坐骨神经阻滞,静脉给予含0.5μg/kg右美托咪定的0.9%氯化钠注射液50 mL;C组给予含0.5μg/kg右美托咪定的0.4%罗哌卡因混合溶液50 mL行腰丛联合坐骨神经阻滞;静脉给予0.9%氯化钠注射液50 mL。记录三组患者感觉和运动阻滞起效时间、感觉和运动阻滞持续时间、镇痛时间,以及低血压、低氧血症、心动过缓及过度镇静等不良反应发生情况。结果:C组感觉、运动持续时间明显长于A、B组(P0.05);C组镇痛时间显著长于A、B组(P0.05);A、B两组感觉、运动持续时间及镇痛时间差异无统计学意义(P0.05);三组感觉、运动起效时间差异无统计学意义(P0.05)。B组较A、C组心动过缓、过度镇静发生率高(P0.05);A、C两组心动过缓及过度镇静发生率差异无统计学意义(P0.05);三组低血压及低氧血症发生率差异无统计学意义(P0.05)。结论:右美托咪定局部用药可改善腰丛联合坐骨神经阻滞效果,避免心动过缓、过度镇静等不良反应的发生,效果优于静脉途径用药。     

右美托咪定对臂丛阻滞的影响

目的观察右美托咪定对臂丛阻滞的影响。方法选择陕西省凤翔县医院2012-05—2014-05骨科收治的单侧上肢手术患者100例,分为右美托咪定组(D组)和生理盐水组(N组),各50例,D组术后采用右美托咪定输注,N组用生理盐水,观察两组感觉运动阻滞时间及评价麻醉手术过程舒适度。结果 D组患者感觉、运动阻滞时间明显长于N组(P0.05),D组术中舒适度评分明显高于N组(P0.05),D组心动过缓发生率明显高于N组。结论静脉输注右美托咪定可以延长等比重罗哌卡因的臂丛腔阻滞的时间,患者舒适度高,但易发生心动过缓。     

右美托咪定联合罗哌卡因用于超声引导颈臂丛神经阻滞下锁骨骨折手术中的效果观察

目的：观察右美托咪定联合罗哌卡因在超声引导颈臂丛神经阻滞下锁骨骨折术中的应用效果,旨在提高锁骨骨折患者手术安全性。方法：采用随机数字表法将2020年3月至2022年6月收治的64例锁骨骨折患者随机分为对照组(给予罗哌卡因进行颈臂丛神经阻滞)和研究组(给予罗哌卡因联合右美托咪定进行颈臂丛神经阻滞),各32例。对比两组麻醉情况、麻醉质量、呼吸循环指标[平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO₂)]、镇静状态(采用镇静状态Ramsay评分评估)及不良反应发生情况。结果：与对照组相比,研究组运动阻滞维持、感觉阻滞维持时间较长,运动阻滞奏效、感觉阻滞奏效时间较短,差异有统计学意义(P<0.05);研究组疼痛程度及牵拉反应缓解效果均优于对照组,差异有统计学意义(P<0.05);入室时(T1)时点,两组HR、MAP、SpO₂、Ramsay评分对比,差异无统计学意义(P>0.05);麻醉后10 min(T2)、手术即刻(T3)时点,两组HR、MAP均下降,且研究组低于对照组,差异有统计学意义(P<0.05);T2、T3、...     

右美托咪定联合罗哌卡因在小儿腹股沟疝修补术后镇痛的效果观察

目的探讨右美托咪定联合罗哌卡因在小儿腹股沟疝修补术后镇痛的效果。方法选取腹股沟疝修补术患儿80例,随机分为对照组和观察组。对照组患儿给予单纯的罗哌卡因阻滞,观察组给予右美托咪定联合罗哌卡因阻滞。比较2组术后4、8、12、24、48 h的疼痛视觉模拟评分法(VAS)评分、镇静(Ramsay)评分。比较2组术后不良反应发生率及患儿的镇痛满意度。结果 2组术后8、12、24、48 h的VAS评分均显著高于同组术后4 h的VAS评分,对照组术后8、12、24、48 h的Ramsay评分均显著低于术后4 h的Ramsay评分,且观察组术后8、12、24、48 h的VAS评分、Ramsay评分均显著优于对照组(P 0.05)。观察组不良反应发生率为10.00%,与对照组的15.00%比较无显著差异(P 0.05)。观察组镇痛总满意度为97.50%,显著高于对照组的80.00%(P 0.05)。结论相比于单纯罗哌卡因阻滞,右美托咪定联合罗哌卡因阻滞的镇痛、镇静效果更好,安全性也较高。     

不同剂量右美托咪定复合罗哌卡因行肌间沟臂丛神经阻滞的阻滞效果和不良反应

目的探讨两种不同剂量的右美托咪定复合罗哌卡因行肌间沟臂丛神经阻滞的效果和不良反应。方法 40例行单侧上肢/手部手术的患者随机分为两组,即0.5μg/kg右美托咪定复合罗哌卡因组(DR1组)和1μg/kg右美托咪定复合罗哌卡因组(DR2组)。比较2组患者阻滞起效时间,阻滞后4、6、8、10、12和14 h的静息和运动阻滞效果,术后血流动力学改变和镇静等不良反应。结果 DR1组患者感觉和运动阻滞开始恢复和完全恢复的时间均显著早于DR2组患者(P0.01);DR2组在6 h活动疼痛评分和术后8、10、12和14 h的静息和活动疼痛评分均显著优于DR1组(P0.05)。结论 1μg/kg右美托咪定复合罗哌卡因较0.5μg/kg右美托咪定复合罗哌卡因用于肌间沟臂丛神经阻滞,可以增强臂丛神经阻滞效果且不增加不良反应。     

右美托咪定复合重比重罗哌卡因蛛网膜下腔阻滞麻醉效果研究

选择择期行下肢手术的病人80例,ASA I~III级,随机分为两组。对照组(n=40)0.5%的重比重罗哌卡因(罗哌卡因1.5ml1%+10%葡萄糖1.5ml)+0.5ml的生理盐水,右美托咪定组(n=40)0.5%的重比重罗哌卡因(罗哌卡因1.5ml1%+10%葡萄糖1.5ml)+5μg右美托咪定(0.5ml)行蛛网膜下腔阻滞。观察记录麻醉效果、不良反应以及术后镇静评分和VAS评分的差异。结果与对照组相比,右美托咪定组阻滞平面消退时间显著延长,术后VAS最高评分显著下降,差异具有统计学意义。(P<0.05)。两组间最高阻滞平面、平面固定时间、不良反应以及镇静评分无显著差异。5μg右美托咪定可以显著延长重比重罗哌卡因的痛觉神经阻滞时间,有利于延长患者术后镇痛时间并且不增加不良反应。     

全髋关节置换术患者应用罗哌卡因复合不同剂量右美托咪定超声引导下髂筋膜间隙阻滞的效果

目的观察全髋关节置换术(THA)患者应用罗哌卡因复合不同剂量右美托咪定超声引导下髂筋膜间隙阻滞(FICB)的效果。方法选取在超声引导下FICB联合全身麻醉下行THA患者142例并分为4组,A组30例采用0.3%罗哌卡因治疗,B组37例采用0.3%罗哌卡因联合0.5μg/kg右美托咪定治疗,C组41例采用0.3%罗哌卡因联合1.0μg/kg右美托咪定治疗,D组34例采用0.3%罗哌卡因联合1.5μg/kg右美托咪定治疗,比较4组的治疗效果。结果 B组、C组、D组的阻滞起效时间、首次下床时间、住院时间短于A组,阻滞消退时间长于A组,差异均有统计学意义(P 0.05),C组、D组以上指标与B组比较,差异有统计学意义(P 0.05),C组、D组以上指标比较,差异无统计学意义(P 0.05); D组拔管时间显著长于A组、B组、C组(P 0.05),A组、B组、C组拔管时间比较,差异无统计学意义(P 0.05);各组不同时点心率(HR)、平均动脉压(MAP)比较,差异无统计学意义(P 0.05); C组、D组术后不同时点的视觉模拟评分法(VAS)评分显著低于A组、B组(P 0.05),A组、B组VAS评分差异无统计学意义(P 0.05);各组术后不同时点RAMSAY镇静评分比较,差异无统计学意义(P 0.05); C组、D组丙泊酚使用量显著少于A组、B组(P 0.05),B组、C组、D组瑞芬太尼使用量显著少于A组(P 0.05); D组PACU停留时间显著长于A组、B组、C组(P 0.05),A组、B组、C组PACU停留时间比较,差异无统计学意义(P 0.05); D组心动过缓发生率高于A组、B组、C组,B组、C组、D组恶心呕吐、追加镇痛的发生率低于A组,差异均有统计学意义(P 0.05)。结论 THA患者应用罗哌卡因复合右美托咪定超声引导下FICB效果显著,1.0μg/kg右美托咪定作用最佳。     

罗哌卡因加右美托咪定腹横肌平面阻滞用于腹腔镜术后镇痛的效果研究

目的观察罗哌卡因复合右美托咪定腹横肌平面阻滞(TAP)用于腹腔镜疝修补手术患者术后镇痛的效果。方法择期行腹腔镜疝修补手术患者60例,常规气管插管全麻下行手术,手术结束行超声引导下双侧TAP,随机分为两组:罗哌卡因+右美托咪定组(Rpd组):腹横肌平面内注射右美托咪定1.0μg/kg+0.4%罗哌卡因30 ml;罗哌卡因组(R组):腹横肌平面内注射生理盐水1 ml+0.4%罗哌卡因30 ml。观察两组患者手术切皮、术中1 h、出手术室时的血压、心率(HR);术后即刻、4、6、8、12和24 h视觉模拟疼痛评分(VAS);记录两组患者腹部感觉阻滞时间,及术后恶心、呕吐不良反应发生率。结果两组患者术中及术后各时间点的血流动力学指标无差异(P0.05),Rpd组术后6、8和12 h Rpd组的VAS评分低于R组(P0.05),术后即刻、4和24 h VAS评分无差异(P0.05),腹部感觉阻滞时间Rpd组明显长于R组(P0.05),术后恶心呕吐发生率两组患者无差异(P0.05)。结论罗哌卡因复合右美托咪定TAP用于腹腔镜疝修补手术患者,可以显著延长术后镇痛时间。     

右美托咪定复合罗哌卡因腰麻-硬膜外麻醉用于剖宫产术的效果分析

目的:观察右美托咪定静脉给药应用于罗哌卡因腰麻-硬膜外麻醉下行剖宫产术的效果。方法:将择期行剖宫产手术、美国麻醉师协会(ASA)I或II级的136例产妇随机分为右美托咪定复合罗哌卡因组(Dex组)和罗哌卡因组(Rop组),每组68例。Dex组蛛网膜下腔给予0.75%罗哌卡因12 mg并静脉注射负荷剂量0.2μg/kg、维持剂量0.5μg/(kg·h)的右美托咪定至手术结束;Rop组蛛网膜下腔给予0.75%罗哌卡因12 mg并持续静脉注射与Dex组右美托咪定等量的0.9%氯化钠液至手术结束。观察两组麻醉效果、对新生儿的影响及不良反应率。结果:Dex组麻醉起效时间、达到完全运动阻滞时间、BIS分值及Ramsay改良评分均明显短于Rop组(P0.05),而Dex组最平面恢复时间则明显长于Rop组(P0.05)。Dex组和Rop组胎儿娩后1 min、5 min、10 min的新生儿Apgar评分均无统计学差异(P0.05)。Dex组产妇寒战和焦虑的发生率均明显低于Rop组,而其他不良反应差异无统计学意义。结论:右美托咪定静脉注射联合罗哌卡因腰麻-硬膜外麻醉可明显缩短麻醉起效时间、延长麻醉时间,具有更好的镇静效果。     

右美托咪定联合罗哌卡因股神经阻滞用于膝关节镜术后镇痛的临床研究

目的对比观察右美托咪定联合罗哌卡因用于膝关节镜术后镇痛的临床效果。方法拟行膝关节镜手术的患者60例,随机分为罗哌卡因组(A组,n=30)和右美托咪定联合罗哌卡因组(B组,n=30)。两组患者在喉罩全麻后,分别在超声引导下行单次股神经阻滞,A组注入0.25%罗哌卡因注射液30 ml,B组注入0.25%罗哌卡因及100μg右美托咪定混合液30 ml。观察两组患者术后4 h(T0),8 h(T1),12 h(T2)及24 h(T3)的视觉模拟评分(VAS),当VAS评分大于5分时,静脉注射氟比洛芬酯50 mg。结果两组间在T0、T1、T2时间点的VAS评分分布无统计学差异(P0.05)。B组在T3时间点的VAS评分分布优于A组,两者比较差异有统计学意义(P0.05)。A组氟比洛芬酯的用量(68.33±35.92 mg)明显高于B组(18.33±30.75 mg),差异有统计学意义(P0.05)。结论右美托咪定联合罗哌卡因较单纯罗哌卡因行单次股神经阻滞镇痛时间长,术后辅助氟比洛芬酯镇痛剂量小。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.