芬太尼与吗啡用于小儿术后镇痛对比观察

择期手术患儿40例，随机分为两组。M组20例，术后采用吗啡3μg／（kg．h）镇痛；F组20例，术后采用芬太尼0．2μg／（kg．h）镇痛。F组镇痛效果显著优于M组（P〈0．05），F组副作用显著少于M组（P〈0．05）。表明芬太尼镇痛效果优于吗啡。     

心血管手术术后三种静脉镇痛方法疗效与安全性研究

目的探讨氟比洛芬酯与曲马多分别复合芬太尼用于心血管手术围术期的镇痛效果及副作用,及对细胞因子的影响。方法150例择期行正中开胸心血管手术的患者,随机双盲对照法分为3组：氟比洛芬酯组（FF）,曲马多组（QF）,芬太尼组（F）。分别于深静脉通路建立后和缝心包时给予研究药物,FF组为氟比洛芬酯1mg／kg,QF组为曲马多2mg／kg,F组为空白脂肪乳5ml;手术结束时连接静脉恒速镇痛泵,内装研究药物与脂肪乳混合液100ml,流速2ml／h,FF组为氟比洛芬酯200mg和芬太尼1．0mg,QF组为曲马多700mg和芬太尼1．0mg,F组为芬太尼2．5mg。分别于围术期各观察点记录患者的VAS评分、恶心评分,镇静评分,胸液量,初醒时间,拔除气管插管时间,镇痛效果与副作用,是否追加镇痛药物,ICU停留时间,出院时间。其中每组随机抽取30例病例,分别于深静脉通路建立后（T0）,缝心包时（给与研究药物之前,T1）,术后4h（T2）,20h（T3）,24h（T4）抽取静脉血,检测细胞因子IL-1,IL-10,TNF-,PGE2。结果（1）VAS评分三组间相似,但术后追加镇痛药物F组明显高于其余两组（P〈0．05）;（2）F组恶心评分较高（P〈0．05）,镇静评分,呕吐、皮肤瘙痒、排尿困难等副作用的发生率三组患者无明显差异（P〉0．05）;（3）T1-T4,F组IL-1较哟升高明显,且明显高于FF,QF组（P〈0．05）;术后各组各时间点IL-10,PGE2较哟升高明显,F组升高持续时间较长（P〈0．05）;F组TNF-在T2,T4较T0明显升高（P〈0．05）,T2时明显高于FF,QF组;（4）初醒时间,拔出气管插管时间,ICU停留时间,24h胸液量,肝肾功能等三组患者无明显差异。结论静脉给予氟比洛芬酯或曲马多复合芬太尼的镇痛方法可安全、有效的应用于心血管手术术后镇痛,减少阿片类药物的用量,减轻术后炎症反应。     

高血压患者术后舒芬太尼静脉镇痛的疗效观察

目的:观察舒芬太尼用于高血压患者术后静脉镇痛的效应。方法:合并轻中度高血压病择期手术患者30例,全麻手术后随机分为对照(C)组、舒芬太尼镇痛(S)组和芬太尼镇痛(F)组,各10例。分别记录三组手术前(T0)、术毕气管拔管后10 min(T1)、术后1 h(T2)6、h(T3)2、4 h(T4)4、8 h(T5)各时点的HR、BP、SpO2的变化以及视觉模糊评分(VAS)和镇静评分。观察三组术后追加镇痛药的次数,术后降压药应用的情况,以及恶心、呕吐和呼吸抑制的发生率。结果:S和F组各时段VAS评分均低于C组,S组评分<3分多于F组;镇静评分达2分者S组>F组>C组。T2、T3时点S组HR、BP低于F组和C组,有显著性差异P<0.05。术后S组血流动力学稳定,C组术后应用佩尔地平降压者超过60%,F组应用降压药者占30%。C组全部(10例)需要间断注射哌替啶镇痛,F组需要追加镇痛药有2例,S组无追加镇痛药者。结论:舒芬太尼和芬太尼均能有效控制高血压患者术后疼痛,而舒芬太尼镇痛、镇静效果优于芬太尼,能有效地保持其术后血流动力学的稳定,故为高血压患者术后安全、有效的镇痛剂。     

不同剂量芬太尼静脉自控镇痛在小儿胸外科术后中的应用

目的比较不同剂量芬太尼用于小儿胸外科术后静脉自控镇痛（PCIA）的效果和安全性。方法将90例胸外科手术患儿（ASAⅠ-Ⅱ级）于术后随机分为F1、F2、F3三组各30例,均采用芬太尼行PCIA,芬太尼持续剂量分别为0．1、0．15、0．2μg/（kg&#183;h）,单次追加剂量0．25μg/kg,锁定时间20min,1h最大量1μg／kg。观察两组不同时间点镇痛、镇静评分,芬太尼用量、按压次数（D1）、有效按压次数（D2）,D1／D2,总体满意度及不良反应。结果疼痛及镇静评分：F1组在0．5、2、8、12h高于F3组（P〈0．05）;F2组在0．5、2h高于F3组（P〈0．05）;芬太尼总用量、D1、D1／D2、总体满意度及不良反应发生率F1组〈F2组〈F3组（P〈0．05）。结论认为芬太尼行PCIA用于儿童术后镇痛安全、有效,持续输注剂量以0．2μg/（kg&#183;h）为宜。     

舒芬太尼对心房颤动射频消融术患者的镇静和镇痛效果更优于芬太尼

摘要 目的：评价舒芬太尼对心房颤动(简称房颤)患者行射频消融术中的镇静、镇痛效果及安全性。方法：收集2020年10月 2021年4月华中科技大学同济医学院附属同济医院心内科行房颤射频消融术患者60例为研究对象,分为舒芬太尼组和芬太尼组,各30例。舒芬太尼组：将50μg/mL舒芬太尼稀释至10μg/mL负荷量按0.3μg/kg计算,加入莫非氏滴管,手术开始时5min缓慢滴入。芬太尼组：取0.3mg芬太尼用0.9%生理盐水稀释至50mL,由消融开始时给药持续静脉泵入芬太尼1μg/(kg?h),术中疼痛明显时,增加芬太尼至2μg/(kg?h),直至消融结束。比较2组各时间点的平均动脉压（MAP）、血氧饱和度（SpO2）变化,镇静评分（RASS评分）、镇痛评分（NRS评分）、总手术时间及不良反应发生情况。结果：在用药后1h(T1h)、T2h、手术结束时,芬太尼组MAP明显低于舒芬太尼组,而SpO2高于舒芬太尼组(P均＜0.05);在T1h、T2h时间点RASS评分比较,舒芬太尼组镇静效果更优于芬太尼组(P＜0.05);舒芬太尼组各部位点的NRS评分低于芬太尼组（P均＜0.05）。舒芬太尼组手术时间短于芬太尼组(P＜0.05)。结论：通过对平均压、镇静和镇痛效果等比较,舒芬太尼组患者镇静和镇痛效果更优于芬太尼组患者,手术时间更短,安全性更高。     

高龄髋关节术后镇痛与全身炎症反应综合征相关性研究

目的观察高龄髋关节手术后镇痛与全身炎症反应综合征（SIRS）间的相关性。方法将32例65～90岁髋关节手术患者随机分为M组和E组,术后分别采取肌注镇痛和硬膜外自控镇痛,观察肿瘤坏死因子（TNF-α）、白介素6（IL-6）水平变化,并行视觉模拟评分（VAS）与SIRS评分。结果两组TNF-α和IL-6术后均较术前升高,M组持续到术后24h达峰值,E组术后24h水平明显低于M组（P〈0.05）;E组术后各时间点VAS与SIRS评分均明显低于M组。结论高龄髋关节术后应用硬膜外自控镇痛有效降低疼痛强度同时,显著抑制TNF-α、IL-6等释放,有效防治术后SIRS的发生与发展。     

开胸术后舒芬太尼、芬太尼联合氟比洛芬酯静脉镇痛效果观察

目的观察并比较芬太尼、舒芬太尼单独或联合氟比洛芬酯用于开胸术后的静脉镇痛效果。方法选择60例ASAⅠ～Ⅱ级行开胸手术患者,随机分为芬太尼组（F组）、芬太尼联合氟比洛芬酯组（FK组）、舒芬太尼组（S组）、舒芬太尼联合氟比洛芬酯组（SK组）,每组15例。观察并记录术后2、6、12、24、48h镇痛、镇静评分和不良反应发生率。结果SK和FK组的2、6、12h的VAS评分显著低于F组（P均〈0．05）,SK和FK组的12h的VAS评分显著低于S组（P均〈0．05）,且SK组的12h的VAS评分也显著低于FK组（P〈0．05）;SK组12h的Ramsay评分显著低于FK和F组（P均〈0．05）,SK和FK组的不良反应发生率均显著低于S和F组（P均〈0．05）。结论芬太尼、舒芬太尼联合氟比洛芬酯对于开胸术后镇痛的效果优于单独芬太尼或舒芬太尼,且舒芬太尼联合氟比洛芬酯的效果更佳。     

舒芬太尼复合氯诺昔康用于老年开胸患者术后镇痛的效果观察

目的观察不同剂量的舒芬太尼复合氯诺昔康在老年患者开胸术后静脉自控镇痛（PCIA）的效果和不良反应。方法 60例ASAⅠ~Ⅱ级行开胸手术的老年患者随机分为两组,A组舒芬太尼1.0μg/kg,B组舒芬太尼1.5μg/kg,两组均复合氯诺昔康0.4 mg/kg稀释至100 ml行PCIA。分别记录两组术后4、8、12、24、48 h时间点的镇痛VAS评分、镇静RSS评分,并于48 h后记录不良反应和镇痛总体满意度。结果 B组镇静RSS评分4、12、24h点低于A组（P均〈0.05）,恶心呕吐和嗜睡的发生率高于A组。两组对镇痛治疗的总体满意度比较无统计学意义（P〉0.05）。结论舒芬太尼1.0μg/kg与1.5μg/kg两种剂量均可取得满意的镇痛效果,但前者不良反应少,过度镇静风险小。     

地佐辛复合芬太尼用于老年心脏病患者非心脏手术后镇痛效果的观察

目的:观察地佐辛复合芬太尼用于老年心脏病患者非心脏手术后镇痛效果及不良反应。方法:60例美国麻醉学家协会(ASA)II或III级择期行全麻手术合并高血压及缺血性心脏病老年患者,随机分为两组:芬太尼组(F组),芬太尼16μg/kg+盐酸托烷司琼10 mg+0.9%氯化钠液至总量100mL;芬太尼复合地佐辛组(FD组),芬太尼8μg/kg+地佐辛0.4 mg/kg+盐酸托烷司琼10 mg+0.9%氯化钠液至总量100 mL。两组患者镇痛液负荷量为5 mL,经静脉注射自控镇痛(PCIA)镇痛泵维持量2mL/h,追加量0.5 mL,锁定时间15 min。记录术后4 h、8 h、12 h、24 h、36 h及48h的视觉模拟评分(VAS)及Ramsay镇静评分、生命体征、术后各时段镇痛效果与镇痛泵按压次数及不良反应。结果:F组与FD组术后各时点VAS评分均<3分,两组间差异无统计学意义(P>0.05);F组术后8 h、12 h及24 h的Ramsay镇静评分明显高于FD组(P<0.05);镇痛期间不良反应发生率FD组低于F组(P<0.05)。结论:地佐辛复合芬太尼用于老年心脏病患者非心脏手术后镇痛治疗,其镇痛效果良好,不良反应发生率低。     

舒芬太尼在无痛胃镜术中的应用

目的探讨舒芬太尼应用于无痛胃镜术中的安全性和有效性。方法将80例ASA评分Ⅰ～Ⅱ级,拟行无痛胃镜检查术的患者随机分为舒芬太尼组(S组)和芬太尼组(F组),每组40例。分别采用舒芬太尼0.15μg/kg或芬太尼1.0μg/kg复合丙泊酚2mg/kg行静脉全麻。观察麻醉前、术中、手术结束、苏醒时、术后30min各时点病人的血压、心率、呼吸及镇静镇痛分级,记录手术时间、苏醒时间、手术室滞留时间以及恶心呕吐等副作用,随访术后24h腹痛及副反应。结果术后30min及4h的VAS评分两组差异有统计学意义(P0.05)。丙泊酚用量两组差异无统计学意义(P0.05)。术中、术毕、苏醒时镇静分级差异无统计学意义(P0.05),血压、心率及副反应方面差异无统计学意义(P0.05)。结论舒芬太尼0.15μg/kg复合丙泊酚2μg/kg可安全用于无痛胃镜术,其更长的镇痛时间在病人术后的舒适度方面较芬太尼有更大的优越性。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.