复合麻醉在门诊无痛人流手术中应用

目的探讨异丙酚、芬太尼复合麻醉应用于门诊无痛人流手术的可行性,安全性和不良反应。方法90例门诊无痛人流手术受术者为Ⅰ组,90例常规人流手术受术者为Ⅱ组,Ⅰ组经静脉缓慢推注芬太尼20μg和异丙酚1.5~2.0 mg/kg直至睫毛反射消失后,即开始手术操作;Ⅱ组进行常规人流手术。结果Ⅰ组受术者均顺利完成手术,术中心率和血压有下降趋势(P<0.05),90例受术者(100%)愿意再次接受无痛人流手术,明显高于Ⅱ组的18例(20%),所有受术者的SPO2均维持在95%以上;Ⅱ组有11例(12%)由于无法忍受而放弃手术,72例受术者(80%)拒绝再次接受常规人流手术。结论异丙酚复合小剂量芬太尼用于门诊无痛人流手术镇静效果好、恢复快、受术者满意度高的特点且未见明显不良反应。     

胃镜检查前联合应用镇静镇痛药物的研究

目的 :研究联合应用芬太尼和异丙酚或咪唑安定在胃镜检查中的镇静镇痛效果和安全性。方法 :将 132例胃镜检查患者随机分为Ⅰ组 (48例 ,给予芬太尼和异丙酚 )、Ⅱ组 (44例 ,给予芬太尼和咪唑安定 )和Ⅲ组 (对照组 ,40例 ,常规操作 ,不给镇静镇痛药 ) ,观察各组检查反应、操作时间、清醒时间及检查前、中、后血压、心率和SpO2 变化。结果 :Ⅰ、Ⅱ组的检查反应、操作时间明显优于Ⅲ组 (均为P <0 .0 0 5 ) ,Ⅰ组病人的清醒时间短于Ⅱ组 (P <0 .0 0 1)。Ⅰ、Ⅱ组病人检查中均有血压下降和心率减慢 ,但检查结束后恢复至检查前水平。结论 :胃镜检查前联合应用芬太尼和异丙酚或咪唑安定镇静镇痛是安全有效的 ,异丙酚 芬太尼的清醒时间短于咪唑安定 芬太尼     

异丙酚复合芬太尼在胃镜检查中的应用

目的研究异丙酚复合芬太尼在纤维胃镜检查患者中的镇痛作用。方法60例拟行纤维胃镜检查的门诊病人(ASAⅠ~Ⅱ级)随机均分为3给(n=20)。所有病人均首先应用1~1.5 mg/kg异丙酚至意识消失,然后Ⅰ、Ⅱ病人再分别缓慢静脉滴注芬太尼100 ug/2 ml与50 ug/2 ml。检查中连续检测病人生命体征和肢体反应度,检查前、后患者镇痛、焦虑水平采用视觉模拟评分(VAS)评价,镇静水平采用OAA/S法评价。结果检查恢复后Ⅰ、Ⅱ病人VAS评分明显低于对照组(P<0.01),而镇静、肢体评分、生命体征等三者无明显差异。结论应用异丙酚复合小剂量芬太尼对门诊纤维胃镜检查中的镇痛效果优于单纯应用异丙酚。     

异丙酚复合芬太尼、咪唑安定在胃镜检查治疗中的应用分析

目的分析和探讨异丙酚复合芬太尼、咪唑安定用于胃镜检查的效果、安全性及可行性。方法回顾性分析本院3300例胃镜检查,尤其对近2年来无痛胃镜检查的临床资料。选择ASAⅠ—Ⅱ胃镜检查者120例,其中男85例,女55例,年龄30～50岁,体质量46～75kg,随机分三组,每组40例,异丙酚组（A组）,芬太尼＋异丙酚（B组）,咪唑安定＋芬太尼＋异丙酚（C组）,分别观察插管情况,有无呕吐,呛咳,流泪,肢体活动,镇静及镇痛效果。结果与A组、B组比较,C组入睡时间缩短,苏醒时间及定向力恢复时间延长（P〈0．01）,C组流泪,呛咳,肢体活动,入镜有阻力及需追加异丙酚的发生率也低于A组和B组。结论异丙酚复合芬太尼、咪唑安定用于胃镜检查术时可以增强镇静及镇痛作用,降低术中焦虑,极大的减轻了异丙酚对血流动力学的影响,同时并不增加其不良反应,深受患者及医务人员的欢迎。     

芬太尼和咪唑安定分别与异丙酚联合用药与胃镜检查

目的：讨论胃镜检查中更加舒适的一种镇静镇痛方法。方法：芬太尼-异丙酚为Ⅰ组,咪唑安定一异丙酚组为Ⅱ组。观察记录各组术中的反应、胃镜操作时间、麻醉药物起效时间、苏醒时间和清醒时间,检查前中后BP、HR和SpO2的变化,及术后问卷调查。结果：Ⅰ组药物的起效快,受检者苏醒及清醒时间短,术中不适反应少,与Ⅱ组比较有统计学意义（P〈0．01）。结论：镇静无痛苦胃镜检查中芬太尼一异丙酚联合用药更舒适。     

异丙酚用于冠心病人胃镜检查术的临床观察

目的 :观察不同剂量的异丙酚静脉麻醉在胃镜检查中对冠心病人的影响。方法 :选择经内科确诊需行胃镜检查术的 36例门诊冠心病病人 ,随机分为三组 (n =12 ) ,分别静脉注射异丙酚Ⅰ组 1mg/kg ,Ⅱ组 1.5mg/kg ,Ⅲ组 2mg/kg。观察评定麻醉效果 ,不良反应 ,记录用药前后及病人清醒后SBP、DBP、HR、SpO2 和ECG变化。结果 :麻醉效果优良率Ⅰ组 91.4 % ;Ⅱ、Ⅲ组均为 10 0 % ,明显优于Ⅰ组 (P <0 .0 5 )。不良反应发生率Ⅰ组明显多于Ⅱ、Ⅲ组 (P <0 .0 5 )。三组用药后与用药前相比 ,BP、SpO2 均见下降 (P <0 .0 5或 0 .0 1)。Ⅱ组较Ⅰ组用药后下降明显 (P <0 .0 5 ) ,Ⅲ组与I组比较差异显著 (P <0 .0 1) ,ECG显示 :Ⅰ、Ⅱ组与术前比较未见明显变化 ,Ⅲ组有 3例S -T段下移 >0 .0 5mv ,2例出现室性早搏。病人清醒后离院时间Ⅲ组明显长于前两组(P <0 .0 5 )。结论 :异丙酚对冠心病人胃镜检查术也是非常适用的。对心肺功能的影响与剂量、注射速度有关。剂量应控制在 1.5mg/kg为宜。     

无痛胃镜技术在保健门诊中的应用

目的探讨单用普鲁泊福或伍用小剂量芬太尼在胃镜检查中的麻醉效果。方法选择保健门诊胃镜检查100例,随机分为A组(n=50):普鲁泊福异丙酚1~2mg/kg静注;B组(n=50):芬太尼0.05mg、异丙酚1~2mg/kg静注。观察BP、HR、RR、SpO2值,记录胃镜检查时间、苏醒时间和异丙酚的用量,待苏醒后询问检查中有无知晓、有无痛苦记忆,随访检查后恶心、呕吐情况。结果麻醉诱导后A、B两组SBP分别下降19.2%和20.1%,插胃镜时SpO2轻度下降,检查中呼吸循环平稳;两组检查中均无知晓、苏醒后无痛苦记忆;两组胃镜检查时间、苏醒时间、异丙酚用量差异无统计学意义(P>0.05);B组检查后恶心发生率高于A组(20%VS2%,P<0.01),检查后B组5例(10%)呕吐,A组无一例呕吐。结论单用异丙酚静脉麻醉安全、无痛、舒适,适用于保健门诊胃镜检查。     

不同镇静条件对ARDS机械通气的影响

目的:回顾性分析异丙酚或复合芬太尼在急性呼吸窘迫综合征(ARDS)机械通气中的镇静效果。方法:深圳市龙华人民医院ICU 2005-10/2009-05收治ARDS机械通气患者50例,分两组持续泵注镇静剂,P组异丙酚1.5~3.0mg/kg,F组异丙酚1.5~3.0 mg/kg+芬太尼5~10μg/kg,观察镇静效果及呼吸循环指标的变化。结果:F组镇静效果及镇静剂用量与P组比较有统计学差异(P0.05)。结论:异丙酚复合芬太尼对ARDS机械通气患者有良好的镇静作用。     

异丙酚复合芬太尼在无痛人流术中应用

目的探讨异丙酚复合芬太尼在无痛人流术中的应用效果及安全性。方法将接受无痛人流的120例病人分为2组,每组60例,开放静脉,Ⅰ组：给予异丙酚2～2．5mg／kg;Ⅱ组：先给予芬太尼1μg／kg,1min后给予异丙酚1．5-2mg／kg,至病人意识消失后开始手术。结果2组病人术后均未诉人流过程中有疼痛及其它明显不适,亦无不良回忆,均表示满意。麻醉后2minⅠ组MAP、HR与Ⅱ组比明显下降（P〈0．05）,Ⅰ组异丙酚总用量明显多于Ⅱ组（P〈0．05）。结论2种方法在无痛人流术中都是方便可行的,但异丙酚复合芬太尼更为安全可靠。     

异丙酚联合芬太尼佳苏仑用于老年人无痛肠镜的临床观察

目的　观察比较异丙酚联合芬太尼佳苏仑和异丙酚复合芬太尼用于老年人无痛肠镜检查时对呼吸循环的抑制程度,以寻求更安全有效的方法。方法　随机双盲抽取无痛肠镜检查的老年患者 60 例,分为异丙酚-芬太尼组(Ⅰ组)和异丙酚-芬太尼-佳苏仑组(Ⅱ组),每组30例,Ⅰ组麻醉时缓慢静注异丙酚、芬太尼,Ⅱ组加用佳苏仑。观察两组的麻醉效果及对呼吸循环的抑制程度。结果　两组的麻醉效果无明显差异(P>0 05),但Ⅱ组对呼吸的抑制程度明显低于Ⅰ组(P<0 01)。结论　佳苏仑能有效对抗异丙酚、芬太尼的呼吸抑制作用,提高老年患者无痛肠镜检查的安全性,同时不影响麻醉效果。     

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.