盐酸纳布啡复合丙泊酚在成人无痛胃镜检查术中的应用

目的探讨盐酸纳布啡复合丙泊酚在成人无痛胃镜检查中的麻醉效果和安全性。方法选取中科大附属第一医院西区18～65岁之间拟行无痛胃镜检查患者120例。采用随机数字表法分为3组,即低、高剂量纳布啡复合丙泊酚麻醉组(N1组,40例; N2组,40例)及芬太尼复合丙泊酚麻醉组(F组,40例)。N1、N2组患者静脉分别注射纳布啡0. 05 mg/kg、0. 10 mg/kg,F组患者静脉注射芬太尼1. 0 ug/kg,三组都复合丙泊酚1. 5mg/kg。三组患者均根据术中出现吞咽反射、呛咳、体动等静脉追加丙泊酚注射液以维持一定的麻醉深度。记录三组患者麻醉诱导前(T0)、睫毛反射消失时(T1)、胃镜刚入食管时(T2)、苏醒时(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_2),以及三组患者胃镜检查时间、苏醒时间、丙泊酚用量、围术期并发症发生率。结果N1、N2组患者术中低氧血症(T1-T3)的发生率低于F组,差异有统计学意义(P 0. 05);组内比较,三组术中(T1-T3) MAP、HR皆较T0下降,差异有统计学意义; N1、N2组患者苏醒时间显著缩短,差异有统计学意义(P 0. 05); N1、N2组患者围手术期并发症发生率显著低于F组,差异有统计学意义(P 0. 05)。N1丙泊酚用量高于N2组,差异有统计学意义。三组胃镜检查时间差异无统计学意义。结论盐酸纳布啡复合丙泊酚用于成人无痛胃镜检查术具有良好的麻醉效果和安全性。     

无痛胃镜中采用盐酸纳布啡复合丙泊酚麻醉的效果观察

目的探讨对无痛胃镜患者采用盐酸纳布啡复合丙泊酚中进行麻醉的效果。方法选择2017年5月～2018年12月在我院做无痛胃镜检查的82例患者,按随机数字法分为对照组和观察组41例。对照组患者采用丙泊酚麻醉,观察组患者采用丙泊酚联合盐酸纳布啡麻醉,麻醉完毕后对患者麻醉效果进行评估,比较两组麻醉效果、患者生命体征变化及不良反应发生率。结果观察组麻醉诱导、麻醉苏醒、麻醉清醒时间及丙泊酚用药剂量,均少于对照组(P0.05);两组T1、T2、T3时收缩压、舒张压及心率水平,均高于T0(P0.05);观察组T1、T2、T3时收缩压、舒张压及心率水平,均低于对照组(P0.05);观察组与对照组麻醉后低血压、呼吸抑制、恶心呕吐、呛咳及头晕嗜睡的发生率比较,无显著性差异(P0.05)。结论在无痛胃镜检查中采用盐酸纳布啡复合丙泊酚麻醉能取得良好的麻醉效果,患者收缩压、舒张压及心率水平波动较小,患者产生应激反应的情况较少,且不良反应发生风险低,值得临床推广应用。     

盐酸纳布啡复合丙泊酚静脉麻醉在无痛胃镜检查中的应用效果观察

目的盐酸纳布啡复合丙泊酚静脉麻醉在无痛胃镜检查中的应用效果观察。方法选取2017年9月至2018年12月某院行无痛胃镜检查的患者122例,采用随机数表法将其分为实验组和对照组,每组各61例患者。对照组采取舒芬太尼复合丙泊酚麻醉,实验组则采取纳布啡复合丙泊酚麻醉。比较两组患者心率(HR)、平均动脉压(MAP)、舒张压(SBP)、收缩压(DBP)等血流动力学指标变化情况。观察记录两组患者的丙泊酚用量、术后疼痛评分、麻醉唤醒时间、完全苏醒时间以及麻醉的不良反应情况。结果两组的T0～T4时HR、SBP、DBP比较,差异无统计学意义(P0.05),但实验组T_1～T_3时的血氧饱和度(SpO_2)高于对照组(P0.05)。两组患者的丙泊酚用量、麻醉唤醒时间以及完全苏醒时间比较,差异无统计学意义(P0.05)。实验组患者呛咳、呼吸抑制及术后恶心呕吐的发生率低于对照组(P0.05)。结论在行无痛胃镜检查时应用纳布啡复合丙泊酚静脉麻醉,麻醉效果良好,对血流动力学的影响较小,不良反应少,是一种相对有效安全的麻醉配伍方法。     

探究纳布啡+丙泊酚+依托咪酯麻醉用于老年患者无痛胃肠镜检查的麻醉效果

目的 探讨纳布啡+丙泊酚+依托咪酯麻醉用于老年患者无痛胃肠镜检查的麻醉效果。方法 选取2021年10月—2022年10月宁阳县第一人民医院收治的120例老年患者无痛胃肠镜检查者作为研究对象,用随机数表法将其分对照组和观察组,各60例,对照组接受丙泊酚+依托咪酯麻醉,观察组接受纳布啡+丙泊酚+依托咪酯麻醉,比较两组患者麻醉效果、血流动力学指标、关怀行为评价量表(Caring Behavior Evaluation Scale,CBA)评分、简易精神状态检查量表(Mini-mental State Examination, MMSE)评分、不良反应发生率等。结果 观察组麻醉效果优于对照组,CBA评分高于对照组,麻醉后15、30 min时MMSE评分高于对照组,差异有统计学意义(P均<0.05);观察组不良反应发生率(5.00%)比对照组(6.67%)低,但差异无统计学意义(χ²=0.000,P>0.05)。结论 老年患者接受无痛胃肠镜检查时,可采用纳布啡+丙泊酚+依托咪酯麻醉,其麻醉效果理想,并对其认知功能的影响较小,血流动力学指标处于稳定状态,疗效更理想...     

无痛胃镜检查时布托啡诺抑制吞咽反射ED50和ED95的测定

目的 测定不同剂量丙泊酚复合布托啡诺无痛胃镜检查时,布托啡诺抑制吞咽反射的ED50和ED95值.方法 将76例无痛胃镜检查患者随机分为P1组和P2组,P1组给予丙泊酚2.0 mg/kg复合布托啡诺静脉麻醉,P2组给予2.5 mg/kg丙泊酚复合布托啡诺静脉麻醉.布托啡诺初始剂量为5.0μg/kg,根据吞咽反射抑制情况,...     

纳布啡和舒芬太尼分别复合丙泊酚用于门诊无痛胃肠镜检查的临床观察

目的比较丙泊酚分别复合舒芬太尼和两种剂量的纳布啡用于无痛胃肠镜检查的临床效果,并探讨纳布啡用于胃肠镜检查的最适剂量。方法选2016年1~3月于北京友谊医院行无痛胃肠镜的患者90例进行前瞻性研究,随机数法分为3组:舒芬太尼组(S组)、低剂量纳布啡组(N1组)、高剂量纳布啡组(N2组),每组各30例。S组静脉注射舒芬太尼0.1μg/kg,N1组静脉注射盐酸纳布啡0.1 mg/kg,N2组静脉注射盐酸纳布啡0.2 mg/kg。各组均静脉注射丙泊酚1.5~2.0 mg/kg,行胃镜加肠镜检查,术中酌情追加丙泊酚0.5~1.0 mg/kg,观察3组患者术中呼吸及生命体征变化程度、苏醒时间、视觉模拟评分(VAS)及术中体动情况。结果与N1组和N2组比较,S组术中呼吸频率减少最明显(P0.05),3组在VAS评分和苏醒时间上差异无统计学意义(P0.05)。结论盐酸纳布啡适宜在无痛胃肠镜检查中使用,0.1 mg/kg的剂量能够满足胃肠镜检查的要求且具有良好的安全性。     

纳布啡联合瑞马唑仑用于老年患者无痛胃镜检查术的临床研究

目的 探讨纳布啡联合瑞马唑仑用于老年患者无痛胃镜检查术的效果。方法 按照随机数字表法将我院2021年2月至2022年2月期间收治的120例行无痛胃镜检查术的老年患者分为对照组和观察组各60例。对照组给予舒芬太尼联合丙泊酚镇痛，观察组给予纳布啡联合瑞马唑仑镇痛，观察两组患者入室前、胃镜检查结束后5 min镇静效果、生命体征变化、认知功能及不良反应发生情况。结果 胃镜检查结束后5 min，观察组麻醉脑电意识监测系统(Narcotrend,NT)评分较对照组低，差异有统计学意义（P<0.05）；观察组脉博氧饱和度(SpO2)、心率(HR)、呼吸频率(RR)均较对照组高，差异有统计学意义（P<0.05）；观察组简易精神状态检查量表（MMSE）评分较对照组高，差异有统计学意义（P<0.05）；观察组不良反应发生率为13.33%，低于对照组的29.98%，差异有统计学意义（P<0.05）。结论 纳布啡联合瑞马唑仑可以增强无痛胃镜检查术中老年患者的镇静效果，维持生命体征平稳，降低对认知功能的损伤，降低不良反应的发生。     

盐酸丁卡因与盐酸纳布啡、丙泊酚联合麻醉在无痛胃镜诊疗中的临床研究

目的:针对盐酸丁卡因与盐酸纳布啡、丙泊酚联合麻醉在无痛胃镜诊疗中的临床效果进行研究.方法:选择2020年1月至2020年12月天水市中西医结合医院内镜中心行无痛胃镜诊疗的患者100例,作为本次研究的对象,将其平均分为两组,各50例.对照组实施舒芬太尼+丙泊酚麻醉,观察组实施盐酸丁卡因+盐酸纳布啡+丙泊酚麻醉.针对两组患...     

布托啡诺联合丙泊酚改良法在无痛胃肠镜检查中应用研究

目的 探讨布托啡诺复合丙泊酚改良法在无痛胃镜检查中的应用效果.方法 选取2020年1—9月收治的180例行胃镜检查的老年急性上消化道疾病患者为研究对象.采用随机数字表法将患者随机分为A、B两组,每组各90例,其中,A组患者接受布托啡诺复合丙泊酚麻醉,B组患者接受芬太尼复合丙泊酚麻醉.分别记录两组推注麻醉药物前5 min...     

盐酸纳布啡复合丙泊酚在老年内镜下逆行胰胆管造影术中的应用分析

目的探讨丙泊酚联合盐酸纳布啡应用于老年内镜下逆行胰胆管造影术(ERCP)术中的临床价值。方法将2017年2月至2018年6月河南大学第一附属医院收治的78例老年ERCP患者经随机数字表法分为两组,每组39例。研究组予以纳布啡复合丙泊酚麻醉,对照组予以芬太尼复合丙泊酚麻醉。比较两组患者的生命体征及用药安全性。结果研究组各时间点心率、平均动脉压变化幅度小于对照组,组间、组内数据比较,差异均有统计学意义(P均0.05);研究组麻醉药物相关不良反应发生率为7.69%(3/39),小于对照组[25.64%(10/39)],差异有统计学意义(P0.05)。结论丙泊酚、纳布啡联合应用于老年ERCP患者中有效性及安全性均较优。     

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.