咪唑安定-布比卡因术后硬膜外连续输注镇痛和镇静

目前临床上硬膜外自控镇痛术 (PCEA)和患者自控镇静术 (PCS)联合用药尚存在一些副作用。本文观察布比卡因、咪唑安定用于PCEA和PCS的作用效果。1　资料和方法1 1　一般资料　 6 0例ASA分级Ⅰ～Ⅱ级的妇产科手术患者 ,年龄 2 2～ 4 7岁。随机分成 3组 ,每组 2 0例 ,Ⅰ组 :吗啡 2mg+布比卡因 10 0mg ;Ⅱ组 :布比卡因 10 0mg;Ⅲ组 :咪唑安定 10mg +布比卡因 10 0mg。 3组均配成 5 0ml镇痛液 ,术毕镇痛泵硬膜外连续输注 2ml/h。各组一般资料相近 (P >0 .0 5 ) ,有可比性。1 2　观察指标　术后观察呼吸、心率、血压、肠蠕动恢复情况、遗…     

罗哌卡因与布比卡因舒芬太尼用于老年患者PCEA的比较分析

目的：研究罗哌卡因与布比卡因用于老年患者PCEA的比较分析。方法：108例病人随机分为3组,A组0．15％布比卡因组;B组0．12％罗哌卡因组;C组0．2％罗哌卡因组。麻醉为连续硬膜外麻醉,手术接近结束时连接PCEA泵。记录术后4．8、12、24、48h的镇痛效果。结果：VAS评分三组无显著性差异（P〉0．05）,Bmmage评分A组高于B,C组（P〈0．05）,差异有显著性。结论：罗哌卡因较布比卡因组的患者术后活动能力恢复早,B组（0．12％罗哌卡因）用于老年术后患者为有效安全剂量。     

罗哌卡因与布比卡因术后病人硬膜外自控镇痛的疗效观察

目的：观察罗哌卡因与布比卡因术后病人硬膜外自控镇痛（PCEA）的各自疗效并进行评估。方法：60例择期经膀胱前列腺摘除病人。随机分R、B两组各30例。术中均采取L2-3硬膜外阻滞麻醉，给0．75％罗哌卡因和2％利多卡因对半混合液，术后保留硬膜外导管。术毕两组均给负荷量罗利对半混合液5ml。背景输入2ml／h，PCA量0．5ml，锁定时间15min。PCA药液R组0．15％罗哌卡因＋芬太尼3ug/ml＋地塞米松0．1mg/ml＋Ns共100ml，B组0．15％布比卡因＋芬太尼3ug/ml＋地塞米松0．1mg/ml＋NS共100ml。术后6、12、24、48h分别观察BP、HR、RR、SpO2、疼痛评分（VAS）、恶心、呕吐及下肢麻木。结果：两组病人镇痛效果无统计学差异（P〉0．05），恶心、呕吐的发生率也无差异（P〉0．05），下肢麻木的发生两组间差异有显著性（P〈0．05）。结论：罗哌卡因用于PCEA不但与布比卡因有相同的疗效，而且优于布比卡因。     

甲磺酸罗哌卡因与布比卡因用于剖宫产术后镇痛的临床观察

目的:探讨甲磺酸罗哌卡因与布比卡因用于剖宫产术后镇痛的临床效果.方法:将120例行剖宫产的患者随机分为A、B两组,A组采用0.25％甲磺酸罗哌卡因+芬太尼5 ug/mL自控硬膜外镇痛,B组采用0.15％布比卡因+芬太尼5 ug/mL镇痛,比较两组患者镇痛效果、运动阻滞程度、通气时间及并发症.结果:A组镇痛效果强于B组(P＜0.05),运动阻滞程度、通气时间及并发症A组均低于B组(P＜0.05).结论:甲磺酸罗哌卡因复合芬太尼可以安全有效的用于剖宫产术后镇痛.     

3组不同镇痛法用于分娩镇痛的效果评估

目的：比较不同镇痛方法用于分娩镇痛的效果。方法：分别对比芬太尼和曲马多以及曲马多复合氟哌利多分别用于分娩镇痛、镇静及不良反应情况。结果：Ⅰ组（0.75%罗哌卡因20mL加芬太尼0.2mg加生理盐水至100mL）的镇痛、镇静效果明显优于Ⅱ组（0.75%罗哌卡因20mL加曲马多200mg加生理盐水至100mL）和Ⅲ组（0.75%罗哌卡因20mL加曲马多200mg加氟哌利多50mg加生理盐水至100mL）。结论：采用罗哌卡因和芬太尼的CSEA技术具有明显的镇痛作用,是目前分娩镇痛的理想方法。二者对产妇及新生儿均无不良影响。     

硬膜外吗啡配伍罗哌卡因和氟哌利多用于术后镇痛的临床研究

目的　探讨不同剂量的吗啡配伍罗哌卡因和氟哌利多用于术后硬膜外镇痛的效果、不良反应,为临床用药提供指导。方法　将患者随机分成4组,每组各25例。A组:吗啡1mg+0.15％罗哌卡因10ml;B组吗啡1mg+0.15％罗哌卡因10ml+氟哌利多1mg;C组吗啡2mg+0.15％罗哌卡因10ml;D组吗啡2mg+0.15％罗哌卡因10ml+氟哌利多1mg。观察术后当天和术后1d恶心、呕吐、瘙痒,皮疹、嗜睡及呼吸抑制等情况,观察注药前及注药后20min血压、心率和氧饱和度的变化。结果4组注入镇痛药后,镇痛效果均满意,B组不良反应率最低,C组最多,B组与A,C,D三组相比差异显著。血压、脉搏,氧饱和度的变化,4组间无明显的差异。结论　吗啡、罗哌卡因、氟哌利多三药在硬膜外镇痛中有协同作用,小剂量的吗啡和氟哌利多可降低硬膜外镇痛的不良反应发生率;1mg的吗啡加0.15％罗哌卡因10ml和1mg氟哌利多的混合液作用时间长、副作用少,是硬膜外镇痛较合理的联合用药。     

硬膜外镇痛防治前列腺切除术后膀胱痉挛效果观察

目的：观察硬膜外镇痛对前列腺切除术后膀胱痉挛的防治效果。方法：选择耻骨上经膀胱切除前列腺者112例，随机分为3组，Ⅰ组为注射镇痛组（32例），均应用哌替啶镇痛。Ⅱ、Ⅲ组为硬膜外用药组（各40例）。Ⅱ组应用生理盐水100ml加吗啡5mg、氟哌利多5mg的混合液进行镇痛，Ⅲ组应用0．125％布比卡因100ml加吗啡5mg、氟哌利多5mg的混合液进行镇痛。结果：Ⅱ、Ⅲ组膀胱痉挛发生率、持续时间及停止膀胱冲洗时间与瑚比较，差异显著（P〈0.05）；Ⅲ组膀胱痉挛持续时间与Ⅱ组比较，差异显著（P〈0.05）。结论：硬膜外隙持续注入吗啡、布比卡因及氟哌利多混合液，可明显缓解前列腺切除术后膀胱痉挛。     

罗哌卡因与布比卡因复合芬太尼用于老年食管癌根治术后镇痛

目的：比较低浓度罗哌卡因与布比卡因用于硬膜外病人自控镇痛（patient—controlled epidural analgesia，PCEA）对食管癌根治术病人的镇痛效果及其对内分泌功能的影响。方法：66例择期行食管癌根治术的老年患者，ASAⅠ-Ⅱ级，随机分2组，各33例：A组（0．125％罗哌卡因100ml，内含芬太尼4μg/ml、昂丹司琼5mg），B组（0．125％布比卡因100ml，内含芬太尼4μg/ml、昂丹司琼5mg）。对比术后镇痛效果并分别于麻醉前、切皮后90rain、术后1、2、3天分别抽血测定血糖、胰岛素、皮质醇、肾上腺素浓度。结果：A、B组镇痛效果均满意。综合镇痛质量A组优于B组，两组于切皮后90min血皮质醇、血糖浓度均升高，但A组低于B组（P〈0．05），术毕60min均达高峰，术后24～48h虽有下降，但仍明显高于麻醉前水平（P〈0．05）；血胰岛素及肾上腺素水平两组术后无明显升高。结论：低浓度罗哌卡因复合芬太尼用于老年食管癌根治术后PCEA可良好镇痛，能有效抑制术后机体应激反应，不良反应小，有利于术后病人的恢复。     

舒芬太尼复合罗哌卡因用于下肢手术术后镇痛的观察

目的研究不同剂量舒芬太尼复合罗哌卡因用于下肢手术病人的术后镇痛效果。方法选择择期在硬腰联合麻醉下下肢手术病人100例,术后随机分为4组,每组25例均行硬膜外自控镇痛(PCEA)。A组:250 mg罗哌卡因;B组:250 mg罗哌卡因+50μg舒芬太尼;C组:250 mg罗哌卡因+75μg舒芬太尼;D组:250 mg罗哌卡因+100μg舒芬太尼。每组均加入托烷司琼4 mg且用生理盐水稀释至100m l。记录4组患者术后8、24、36、48 h各时相点的疼痛视觉模拟(VAS)评分和镇痛泵按压次数,观察并发症(恶心、呕吐、嗜睡、呼吸抑制)的发生情况。结果 A组、B组术后8、24、36、48 h的VAS评分显著高于C组和D组(P<0.01),但其中A组VAS评分又显著高于B组(P<0.05);D组恶心、呕吐、嗜睡等不良反应明显高于A组、B组、C组。而A组、B组、C组的不良反应呈逐渐增加的趋势,但每两组之间无统计学意义(P<0.05)。结论硬膜外腔较好术后的镇痛且不良反应较少的混合液为:250 mg罗哌卡因+75μg舒芬太尼。     

小剂量硫酸镁复合芬太尼术后静脉镇痛

目的比较小剂量硫酸镁联合芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法选择行上腹部手术后患者90例,随机均分为三组,每组30例,以一次性静脉镇痛泵(2m l/h)分别行静脉术后镇痛,F组:单纯芬太尼镇痛,0.2μg/(kg.h)芬太尼+5 mg氟哌利多,MF1组:硫酸镁联合芬太尼镇痛,0.2μg/(kg.h)芬太尼+0.5 mg/(kg.h)硫酸镁+5 mg氟哌利多,MF2组:硫酸镁联合芬太尼镇痛,0.2μg/(kg.h)芬太尼+1 mg/(kg.h)硫酸镁+5 mg氟哌利多,各组镇痛泵中药物均用医用盐水稀释至100 m l,观察各组患者镇痛48 h内的静息镇痛评分(VAS方法),恶心呕吐,皮肤瘙痒和尿潴留的发生情况。结果三组患者的静息镇痛评分在12 h内MF1组和MF2组明显低于F组(P<0.05),而在12 h后没有明显差别(P>0.05);恶心呕吐,皮肤瘙痒和尿潴留发生率MF1组和MF2组显著低于F组(P<0.01)。MF1组和MF2组之间在静息镇痛评分和并发症发生方面没有明显差别。结论小剂量硫酸镁用于术后静脉镇痛可明显减少芬太尼的剂量,使恶心呕吐,皮肤瘙痒和尿潴留发生率降低,镇痛效果明显优于单纯芬太尼术后静脉镇痛。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.