小剂量氯胺酮对芬太尼术后静脉自控镇痛的影响

目的 观察添加小剂量氯胺酮对芬太尼术后病人静脉自控镇痛(IPCA)的影响。方法 选50例腹部手术病人随机分为2组 ,F组选芬太尼1mg加生理盐水至100ML,KF组在F组基础上添加100mg氯胺酮 ,分别给两组病人术后静脉镇痛。结果 两组病人术后静脉镇痛芬太尼用量及镇痛效果无显著差异(p>0.05) ,但KF组能明显增加病人IPCA期间睡眠时梦境及幻觉(p<0.05)。结论 添加小剂量氯胺酮只能增加芬太尼术后静脉镇痛期间梦境及幻觉发生比例 ,对镇痛效果无明显改善作用。     

右美沙芬对术后镇痛芬太尼用量的影响

目的：观察骨科手术病人应用右美沙芬术后镇痛的临床效果。方法：择期骨科手术病人40例。ASAⅠ～Ⅱ，随机分为2组：对照组20例术前30min肌注生理盐水3mL；实验组20例术前30min肌注右美沙芬3mL（15mg），术后用止痛泵2h、6h、24h及36h观察及记录平均动脉压、心率、脉搏血氧饱和度，VSA评分、OAA／S评分。结果：实验组的术后镇痛效果明显优于对照组，其芬太尼的用量明显少于对照组。结论：术前30min肌注右美沙芬对术后芬太尼静脉镇痛能取得良好的镇痛效果，并减少了术后镇痛药物的用量，减少了镇痛带来的不良反应的发生。     

SCN9A基因多态性与肺癌疼痛发生及阿片镇痛剂量的相关性

目的:探讨SCN9A基因多态性与肺癌病人疼痛发生之间的相关性,同时分析其与阿片类药物镇痛剂量间的关系。方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)的方法检测246例肺癌病人和106例对照者的SCN9A-rs6746030位点基因分型。对影响肺癌疼痛发生的混杂因素进行单因素分析及多因素logistic回归分析。采用Mann-Whitney检验比较不同基因型间阿片类药物用量的差异。结果:(1)疼痛组、无痛组和对照组的rs6746030等位基因(G/A)频率分别为0.83/0.17、0.94/0.06和0.95/0.05,无痛组和对照组基因分型无统计学差异;(2)疼痛组与无痛组相比,基因型GA/AA为肺癌疼痛发生的独立危险因素(P <0.001, OR=3.695, 95%CI=1.883-7.253);Ⅲ-Ⅳ期肺癌病人的疼痛发生风险显著增高(P=0.009, OR=2.339, 95%CI=1.235-4.431);(3)中、重度疼痛组病人不同基因型间24 h阿片类药物用量无统计学差异。结论:尚不认为SCN9A-rs6746030多态性影响肺癌疼痛病人阿片类药物的镇痛剂量,但基因型GA/AA可能是影响肺癌病人疼痛发生的独立危险因素之一。     

术后芬太尼皮下镇痛及对胃肠功能影响的研究

目的 比较术后芬太尼皮下镇痛(PCSA)与硬膜外镇痛(PCEA)的临床效果,以及对胃肠功能的影响.方法 2009年1-6月间观察择期硬膜外麻醉下经腹子宫切除术患者120例,术后分别实施PCSA与PCEA,观察术后第4、8、12、24、48 h的镇痛、镇静情况,呼吸循环、恶心呕吐及其他不良事件,记录术后首次肛门排气时间,...     

雷米芬太尼麻醉对胃癌病人术后镇痛的影响

目的评价雷米芬太尼麻醉对胃癌病人术后镇痛的影响。方法选择拟全身麻醉下胃癌根治手术病人60例,随机分为七氟烷静吸复合全麻（S组）和雷米芬太尼、丙泊酚全凭静脉麻醉（R组）两组,每组30例。病人在麻醉恢复室停留1h,并进行术后镇痛,采用视觉模拟评分法WAS）评价疼痛程度．当VAS评分i〉3分时开始静脉注射舒芬太尼0．1ug／kg,10min后可重复,直至VAS评分≤2分,接静脉镇痛泵。记录患者术后48h的VAS评分;计算术后1h舒芬太尼用量、术后镇痛1～48h内有效按压次数和镇痛药消耗总量：同时观察恶心、呕吐和术后烦躁的发生情况。结果与S组比较,R组在术后0．25h、0．5hVAS评分升高,术后1h舒芬太尼用量增加,差异均有统计学意义（t分别=8．16、7．09、8．89,P均〈0．05）,R组在术后1h内舒芬太尼用量明显高于增加S组,差异有统计学意义（t=8．89,P〈0．05）;而术后1-48h内有效按压次数和镇痛药消耗总量比较,差异均无统计学意义（t分别=0．66、0．50,P均〉0．05）。结论雷米芬太尼、丙泊酚全凭静脉麻醉进行手术患者在术后1h内存在痛觉过敏现象,术后应及时、足量的应用阿片类药物或其它方法来预防和处理。     

剖宫产术后芬太尼、吗啡硬膜外镇痛的临床观察

手术后疼痛对产科手术病人造成极大的痛苦，常规肌注止痛药物不能达到理想需要，现将我院剖宫产手术后病人实施硬膜外除痛病例总结如下，以评价镇痛效果及副作用。     

CYP1A2基因单核苷酸多态性与前列腺增生术后尿路感染风险的关系

目的 探讨细胞色素P450酶1A2(CYP1A2)单核苷酸多态性(SNP)与前列腺增生术后尿路感染易感性的关系.方法 将2017年1月至2020年12月于该院就诊和治疗的行经尿道前列腺等离子双极电切术(TUPKRP)的前列腺增生患者82例纳入研究,根据是否发生尿路感染分为感染组(n=19)和非感染组(n=63).提取2...     

术后罗哌卡因芬太尼硬膜外镇痛和对肺功能的影响

目的 :评估开胸术后罗哌卡因芬太尼硬膜外镇痛效果和对肺功能的影响。方法 :4 0例择期行肺叶切除术病人 (ASAI～II)随机分为两组 :罗哌组 (n =2 0 )给予 0 .2 %罗哌卡因 (复合 2 μg/ml芬太尼 )胸椎硬膜外连续输注 ,4ml/h ;吗啡组 (n =2 0 )给予静脉吗啡自控镇痛。采用 10cm视觉模拟评分尺评估术后 1日、2日静息和咳嗽疼痛评分 ,测量术前和术后 1日、2日肺功能 (用力肺活量FVC、1秒用力呼出量FEV1、呼气峰流速PEF)和血气 ,记录副作用、肺部并发症和术后住院日。结果 :(1)术后 1日、2日静息和咳嗽疼痛评分罗哌组显著低于吗啡组 (P <0 .0 1) ;(2 )术后 1日、2日罗哌组肺功能显著优于吗啡组 (P <0 .0 5 ) ,罗哌组氧分压显著高于吗啡组 (P <0 .0 1) ;(3)吗啡组术后恶心发生率显著高于罗哌组 (P <0 .0 5 ) ,其它副作用无显著差异 ;(4)均无肺部合并症发生 ,术后住院日无显著差异。结论 :0 .2 %罗哌卡因 (复合 2 μg/ml芬太尼 )可安全有效用于开胸术后硬膜外镇痛 ,并改善肺功能。     

OPRM1 A118G基因多态性与艾森克人格类型和疼痛敏感性相关性研究

目的 探讨OPRM1 A118G基因多态性与艾森克人格类型和疼痛敏感性的相关性。方法 选择2018年1月—2020年12月泸州市人民医院由急诊医学部转普外科住院的手术患者。术前采用艾森克人格问卷调查患者人格类型并使用电刺激仪测定痛阈和耐痛阈,利用聚合酶链反应-限制性片段长度多态性分析技术检测患者外周静脉血OPRM1 A118G基因型。根据分型结果将患者分为野生纯合子（A/A）组、突变杂合子（A/G）组、突变纯合子（G/G）组。分析3组患者的一般情况、疼痛敏感性、艾森克人格问卷评分、艾森克人格类型的差异性和艾森克人格类型与疼痛敏感性的相关性。结果 共纳入患者356例。其中,A/A组174例,A/G组136例,G/G组46例。OPRM1 A118G基因突变率为32.00%。3组患者的疼痛敏感性（痛阈、耐痛阈）及内外向、神经质、掩饰性人格类型评分比较,差异均有统计学意义（P<0.05）。3组患者内外向和精神质型人格类型比较,差异均有统计学意义（P<0.05）。不同内外向和精神质人格类型中的痛阈及耐痛阈比较,差异均有统计学意义（P<0.05）。结论 OPRM1 A118G基因...     

Cytochrome P450 3A4 genetic polymorphisms and post-operative fentanyl requirements

What is known and Objective: Interindividual variability in drug responses may be attributable to genetically determined alteration in enzyme activity. In this study, we investigated the association between cytochrome P450 3A4 (CYP3A4) genetic polymorphisms and post‐operative fentanyl requirements. Methods: Patients (n = 94) scheduled for gynaecological laparotomy received i.v. fentanyl infusion (3 μg/kg/h) after induction of general anaesthesia. Post‐operative fentanyl requirements were quantified by using a patient‐controlled analgesia and the number of i.v. fentanyl rescue analgesia required were recorded. Pain control was assessed using visual analogue scores (VAS) and fentanyl’s adverse effects were documented. CYP3A4*4, CYP3A4*5 and CYP3A4*18 alleles of cytochrome P450 3A4 were identified by polymerase chain reaction–restriction fragment length polymorphism. Differences in fentanyl requirements, VAS scores and adverse effects among the various genotypes were compared. Results and Discussion: No CYP3A4*4 and CYP3A4*5 alleles were detected. Eighty‐nine patients (94·7%) were wild‐type, five (5·3%) were heterozygous and none was homozygous. No significant difference was demonstrated between the genotype groups in terms of fentanyl consumption, pain control and adverse effects. What is new and Conclusion: CYP3A4*4 and CYP3A4*5 are rare in the Malaysian Malay population. Genetic polymorphism of CYP3A4*18 may not play an important role in influencing postoperative fentanyl requirements.     

Intranasal fentanyl in 1–3‐year‐olds: A prospective study of the effectiveness of intranasal fentanyl as acute analgesia

The primary objective of the present study was to determine the effectiveness of intranasal fentanyl analgesia in children aged 1–3 years with acute moderate to severe pain presenting to the ED. We also aimed to gather information on the safety and acceptability of intranasal fentanyl in this age group. Two paediatric ED enrolled children aged 1–3 years, with acute moderate or severe pain. Intranasal fentanyl was administered (1.5 µg/kg) via a mucosal atomiser device using a 50 µg/mL solution of fentanyl. Physiological parameters (heart rate, respiratory rate, oxygen saturations and level of consciousness) were measured at regular intervals. Objective pain assessment was completed using the Faces, Legs, Arms, Cry, Consolability (FLACC) score. Forty‐six children presenting with acute moderate to severe pain were included. The median FLACC score before intranasal fentanyl administration was 8 (interquartile range [IQR] 5–10), decreasing to 2 (IQR 0–4) 10 min post fentanyl (P < 0.0001) and 0 (IQR 0–2) 30 min post fentanyl (P < 0.0001). A clinically significant decrease in FLACC scores was seen in 93% of children 10 min post fentanyl administration and 98% of children 30 min post fentanyl. Intranasal fentanyl delivery using a mucosal atomiser was well tolerated by all children. There were no adverse drug reactions or adverse events detected. Intranasal fentanyl is an effective, safe and well‐tolerated mode of analgesia for children aged 1–3 years with moderate to severe pain.     

等位基因特异性PCR检测CYP3A5和MDR-1基因多态性方法的建立及临床应用

目的用等位基因特异性PCR(ARMS-PCR)检测细胞色素P450酶CYP3A5(A6986G)和多药耐药基因MDR-1(C3435T)基因多态性,探讨其与肾移植受者他克莫司(Tac)血药浓度和剂量比的相关性。方法根据CYP3A5(A6986G)和MDR-1(C3435T)基因多态性位点分别设计ARMS-PCR引物,分析72例肾移植受者外周血基因组DNA中该2个基因位点的多态性,同时以DNA测序法为金标准进行验证。化学发光微粒子免疫分析法测定肾移植受者血Tac浓度,并比较术后1个月时不同基因型受者之间血Tac浓度、Tac剂量/Tac用量的差异。结果建立的ARMS-PCR法与DNA测序法检测符合率为100%。72例肾移植受者中,CYP3A5*1/*1、*1/*3和*3/*3基因型的发生频率分别为18.1%、31.9%和50.0%,MDR-1 C/C、C/T和T/T基因型的发生频率分别为27.8%、58.3%和13.9%。此外,不同CYP3A5基因型肾移植受者的血Tac浓度(P=0.014)和Tac浓度/Tac用量(P=0.019)均存在明显差异,进一步两两比较发现,CYP3A5*3/*3基因型受者血Tac浓度/Tac用量明显高于*1/*1和*1/*3基因型(P均0.05)。结论成功建立检测CYP3A5和MDR-1基因多态性的ARMS-PCR法,肾移植受者CYP3A5*3基因多态性与Tac的药代动力学明显相关。     

Pharmacogenetics of acenocoumarol: CYP2C9, CYP2C19, CYP1A2, CYP3A4, CYP3A5 and ABCB1 gene polymorphisms and dose requirements

BACKGROUND AND OBJECTIVE: Acenocoumarol (AC) is a coumarin derivative, vitamin K antagonist anticoagulant drug. It has a narrow therapeutic index and shows large pharmacokinetic and pharmacodynamic interindividual variability. Our objective was to investigate the association between AC dose requirements to achieve a target level of anticoagulation and genetic polymorphisms of genes possibly associated with its metabolism (CYP1A2, CYP2C9, CYP2C19, CYP3A4, CYP3A5) and transport (ABCB1). METHODS: Ninety-six Bulgarian patients treated orally with AC for at least 3 months were included. They were separated into three groups according to their AC dose requirement, i.e. low, medium and high. RESULTS AND DISCUSSION: CYP2C9*1/*3 (associated with an intermediate CYP2C9 activity), CYP2C9*2/*2, and CYP2C9*2/*3 genotypes (associated with a low CYP2C9 activity) were more prevalent in the group with low dose requirement of AC compared with the other two groups (P = 0.003). The frequency of CYP2C9*1/*1 genotype, which is associated with an extensive CYP2C9 activity, was higher in the group of patients with high dose requirements (79%), compared with the groups of the medium and low dose requirements (67% and 21% respectively). In addition, the ABCB1 2677GG/3435CC haplotype was associated with use of lower AC dose, whereas the 2677TT/3435TT and 2677GT/3435TT haplotypes were associated with use of higher AC dose (P = 0.03). The distribution of polymorphisms of other genes did not show significant differences between the three groups. CONCLUSION: In vivo, cytochromes P450 isoforms other than CYP2C9 [corrected] were not significantly associated with dose requirement of AC. In our Bulgarian patients, the presence of CYP2C9*2 or/and CYP2C9*3 alleles, as well as the ABCB1 2677GG/3435CC haplotype were associated with low dose requirement of AC.     

Effect of CYP3A4*1G on the fentanyl consumption for intravenous patient-controlled analgesia after total abdominal hysterectomy in Chinese Han population

What is known and Objective: Clinical investigations into postoperative intravenous patient‐controlled analgesia (PCA) have indicated interindividual differences in fentanyl consumption. Cytochrome P450 3A4 (CYP3A4) is the main metabolism enzyme of fentanyl, and single nucleotide polymorphisms within the CYP3A4 gene may contribute to the variability of fentanyl analgesic efficacy. The aim of this study was to investigate whether the most common genetic variation in Chinese, CYP3A4*1G, has an impact on the fentanyl consumption for intravenous PCA in Chinese Han women undergone abdominal total hysterectomy. Methods: A total of 79 female patients (American Society of Anesthesiologist physical status I or II) scheduled to undergo elective abdominal total hysterectomy were enrolled. All patients received combined spinal–epidural anaesthesia with bupivacaine. Intravenous fentanyl PCA was provided postoperatively for satisfactory analgesia. The doses of fentanyl consumption were recorded 2, 4, 24 and 48 h after the initiation of PCA postoperatively. Pain at rest and adverse effects were measured with rating scales. CYP3A4*1G was screened by means of direct sequencing and further confirmed by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP). Results and Discussion: Forty‐six patients were GG homozygotes, 27 patients were GA heterozygotes, and six patients were AA homozygotes, respectively. The distribution of the CYP3A4*1G allele was consistent with Hardy–Weinberg equilibrium (P > 0·05). At 2 and 4 h, the doses of fentanyl required for patients with GA/AA genotypes were 80·0 (45·0, 112·5) μg and 120·0 (80, 173·8) μg, respectively, and significantly lower than those for GG homozygotes [91·3 (80·0, 125·0) μg and 169·0 (112·5, 226·3) μg, respectively, P < 0·05]. There was trend of decreasing fentanyl consumption at 24 and 48 h in patients with GA/AA genotypes, relative to GG homozygotes, but the difference was not statistical significant (P > 0·05). What is new and Conclusions: CYP3A4*1G has an impact on the analgesic effect of fentanyl in Chinese Han subjects. Further validation of our results in a well‐powered study would be helpful.     

Haemodynamic, endocrine and nociceptive response to gynaecological procedures under epidural local anaesthesia during continuous epidural infusion or bolus epidural fentanyl dosing

This study aimed to evaluate the analgesic effects and hormonal responses of a single epidural bolus compared to continuous epidural infusion of fentanyl as supplements to intraoperative local epidural anaesthesia for major gynaecological surgery. Forty patients undergoing total vaginal hysterectomy were randomised to receive in a double blind fashion either 1.5 μg kg⁻¹ fentanyl epidurally (group A) or saline (group B) as bolus injections followed by epidural infusion of saline or fentanyl (0.7 μg kg⁻¹h⁻¹) respectively at a rate of 10 ml h⁻¹. Postoperative pain intensity was assessed by visual analogue scale (VAS). Prolactin and cortisol plasma levels were used as stress markers. The onset of anaesthesia was significantly shorter in group A (p<0.05) but the duration of T₁₀ blockade was significantly longer in group B (p<0.01). Pain intensity was significantly higher in group A at 90, 105 and 120 minutes after skin incision (p<0.001). There was no intraoperative difference in heart rate or mean arterial pressure between the two groups nor was there any difference in the incidence of adverse effects such as nausea, vomiting or shivering. Both groups had a progressive decrease in serum cortisol and prolactin concentrations 30 and 60 min after skin incision, but cortisol and prolactin concentrations were higher in group A (p<0.05) 120 minutes after skin incision.Our observations suggest that perioperative continuous epidural infusion of fentanyl begun intraoperatively attenuates the endocrine stress response, but a bolus dose of fentanyl given along with bupivacaine lacks this protective effect. A possible explanation for these findings is that an infusion begun intraoperatively, just after administration of epidural bupivacaine, prolongs the duration of sensory blockade and provides a better quality of analgesia, and thereby attenuates the endocrine response triggered by regression of the intraoperative level of anaesthesia.     

溃疡性结肠炎伴抑郁患者5-羟色胺转运体基因多态性相关研究

目的探讨溃疡性结肠炎伴抑郁患者5-羟色胺转运体启动区基因多态性的变化。方法将15例溃疡性结肠炎伴抑郁患者设为研究组,15例溃疡性结肠炎不伴抑郁患者设为对照组,应用聚合酶链反应技术检测两组5-羟色胺转运体启动区基因多态性的分布频率,并进行对比分析。结果研究组5-羟色胺转运体启动区的s／s基因频率显著高于对照组（P〈0．05）,L／S及L／L基因频率均低于对照组,但两组比较差异无显著性（P〉0．05）。结论5-羟色胺转运体启动区基因的S／S基因型可能是溃疡性结肠炎伴抑郁患者的易感基因之一。     

CYP17A1基因多态性与原发性高血压的相关性研究

目的探讨CYP17A1基因rs11191548位点多态性与原发性高血压关系。方法选取原发性高血压患者143例和健康体检者199例。应用Taq Man探针分析CYP17A1基因rs11191548位点多态性的基因型,并探讨其相关性,采用逐步Logistic回归分析,分析获得性因素对高血压的影响。结果经χ~2检验,2组间基因型分布差异有统计学意义(P0.05),2组间等位基因频率分布差异有统计学意义(P0.05)。TT和CT基因型较CC基因型对于患病具有较高风险,CC基因型的个体患高血压的风险分别是携带TT基因型的0.370倍,携带T等位基因的个体患高血压的风险是携带C等位基因的1.776倍。获得性因素中,空腹血糖、甘油三酯及年龄较高的人群具有更高的患病风险。结论 CYP17A1基因rs11191548多态性与原发性高血压发病可能相关,其中TT基因型及T等位基因的个体患高血压的风险升高,获得性因素对高血压的发病有显著影响。     

白介素13基因+1923C/T 及+2044G/A 多态性与支气管哮喘的相关性研究

目的：探讨白细胞介素13(IL-13)基因第3内含子+1923C/T 及第4外显子+2044G/A 多态性与哮喘的关系。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)方法,检测100例哮喘患者和100例健康人群 IL-13基因+1923C/T 及+2044G/A 位点单核苷酸多态性,分析其基因型和等位基因分布频率。结果 IL-13+1923C/T 位点基因型 CC、CT 和 TT 在哮喘组分布频率为21.0%、41.0%和38.0%,对照组为41.0%、44.0%和15.0%。IL-13+2044G/A 位点基因型 GG、GA 和 AA 在哮喘组分布频率为51.0%、39.0%和10.0%,对照组为70.0%、25.0%和5.0%。IL-13+1923C/T 和+2044G/A 位点各基因型分布在两组间差异有统计学意义(χ2=16.54,P <0.01;χ2=7.71,P <0.05)。结论 IL-13基因+1923C/T 和+2044G/A 多态性与哮喘易感性相关,携带+1923T 或+2044A 等位基因的个体患哮喘的风险更大。     

Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received.