肝素盐水间断静脉推注预防化疗性静脉炎的效果观察

目的降低大肠癌病人大剂量醛氢叶酸 +氟尿嘧啶持续静脉滴注 48h所致静脉炎的发生率。方法将 5 5例晚期大肠癌病人随机分为对照组 2 0例和观察组 35例 ,对照组于持续滴注期间每 4h推注 0 .9%氯化钠注射液10 ml,拔针前再推注 2 0 ml冲管。观察组于持续滴注期间每 4h推注肝素盐水稀释液 (肝素钠 12 5 0 0 U +0 .9%氯化钠注射液 2 5 0 ml) 10 m l,拔针前推注 2 0 ml冲管。结果观察组静脉炎发生率 2 5 .7% (9/ 35 ) ,对照组 90 .0 % (18/ 2 0 ) ,两组比较 ,χ2 =2 1.0 46 ,P<0 .0 1,差异有极显著性意义 ;观察组未发生 、 度静脉炎。结论肝素盐水稀释液能有效降低大剂量醛氢叶酸 /氟尿嘧啶持续滴注 48h所致静脉炎的发生率 ,减轻静脉炎的严重程度。     

静脉留置针封管方式对甘露醇所致静脉炎的影响

为探讨静脉留置针封管方式对甘露醇所致静脉炎发生率的影响 ,将准备接受甘露醇治疗的 6 0例病人随机分为常规组和改良组。常规组输液完毕后采用 2 .5ml肝素盐水封管 ;改良组先静脉滴注 0 .9%氯化钠注射液 2 0ml后 ,再用肝素盐水 2 .5ml封管。结果改良组静脉炎发生率明显低于常规组 ,差异有显著性意义 (P <0 .0 1 )。提示输入甘露醇后先静脉滴注 0 .9%氯化钠注射液 2 0ml,再用肝素盐水封管可显著降低静脉炎的发生率     

去氨加压素对体外循环病人术后激活凝血时间的影响

随机将 4 0例择期体外循环 (CPB)下心内直视手术病人分为两组 :用药组 2 0例 ,于CPB结束时将去氨加压素0 .3μg/kg加入 0 .9%氯化钠注射液 10 0ml中静脉滴注 (约 75gtt/min) ;对照组 2 0例不用去氨加压素。结果用药组病人激活全血凝固时间 (ACT)明显短于对照组 (P <0 .0 1) ,出血量少于对照组 (P <0 .0 5 )。提示去氨加压素可缩短CPB病人术后ACT ,可减少CPB后出血。     

血液透析时确保血管通路通畅的一种新方法

血液透析尤其是危重、急诊透析病人 ,病情重、血液循环差。虽然静脉血管通路可经常规静脉推注 0 .9%氯化钠方法证实在血管内 ,但由于血液透析时血流量必须达到 15 0～2 30 m l/ min,压力大 ,经开机透析时静脉血管常常又会出现肿胀 ,影响血液透析治疗的进行 ,甚至出现透析管道、透析器凝集现象。为了解决这一难题 ,2 0 0 0年 6月笔者设计了一种新方法来证实静脉血管通路是否通畅 ,经 6 0例临床应用 ,结果满意。静脉血管按常规消毒、铺巾、穿刺后 ,动脉血管暂不穿刺 ,用 0 .9%氯化钠溶液代替动脉血 ,将透析管道的动脉端连接在 0 .9%氯化钠溶液…     

高出血风险患者两段法枸橼酸抗凝血液透析的临床观察

目的观察两段法局部枸橼酸抗凝(RCA)对高危出血风险患者进行含钙透析液高通量血液透析的安全性和有效性。方法将具有高危出血风险的、符合RCA的89例血液透析患者分为2组。两段法RCA组(简称TS-RCA组),在透析器前持续泵入4%枸橼酸钠溶液的基础上,再在静脉壶输入前段量10%的4%枸橼酸钠溶液;简化RCA组(简称SRCA组),仅在透析器前持续泵入4%枸橼酸钠溶液。2组均使用标准含钙透析液,且不在静脉回路补充钙剂。观察并记录患者透析治疗参数、观察透析后透析器管路凝血情况,比较2组抗凝治疗中相关参数以及抗凝有效率。结果本研究共纳入89例患者,300例次高通量血液透析。其中180例次患者进行两段法RCA治疗,有效血流量150 ml/min,透析液流量300ml/min,持续泵入4%枸橼酸钠的速度分别为透析器前(225.6±14.2)ml/h,透析器后静脉壶(18.5±3.3)ml/h;S-RCA组有效血流量200 ml/min,透析液流量300 ml/min,持续泵入4%枸橼酸钠的速度为透析器前(275.6±25.4)ml/h。2组组间比较,抗凝有效率在透析器部位没有统计学意义的差别(97.3%比97.7%,X~2=0.024 4,P=0.876);静脉壶部位TS-RCA组明显高于S-RCA组(96.8%比69.6%,X~2=33.77,P=0.000)。结论对于高危出血风险的血液透析患者,两段法RCA是安全的,且较简化RCA抗凝有效率明显提高,值得进一步推广。     

甘露醇预防血液透析相关性低血压临床研究

目的 探讨甘露醇注射液预防血液透析相关性低血压的适应证、使用方法和临床效果.方法 选择血液透析过程中经常发生低血容量性低血压的患者40例,按随机数字表法分为研究组与对照组,每组20例.研究组在透析1 h后静脉滴注甘露醇150 ml,对照组在同一时间开始给予0.9%氯化钠注射液150 ml,透析最后1 h前结束这2种药物的使用.结果 甘露醇注射液研究组在透析中低血压发生率为7%,与对照组(48%)比较差异有统计学意义(P<0.01);同时透析间期急性心功能衰竭的发生率为5%,与对照组(30%)比较差异也有统计学意义(P<0.05).结论 甘露醇注射液能降低血液透析相关性低血压的发生率,更容易达到目标超滤量并减少透析间期急性心功能衰竭的发生率.     

甘露醇预防血液透析相关低血压临床研究

目的探讨甘露醇注射液预防血液透析相关性低血压的适应症、使用方法和临床效果。方法选择血液透析中经常发生低血容量性低血压的患者40例,随机分为研究组与对照组,每组20例。研究组透析1h后静滴甘露醇150ml,对照组同一时间开始给予0．9％氯化钠注射液150ml,透析最后1h之前停止使用两种药物。结果研究组透析中低血压发生率（7％）显著低于对照组（48％）,同时透析间期急性左心衰竭发生率（5％）也显著低于对照组（30％）。结论甘露醇注射液能降低血液透析相关性低血压的发生率,更容易达到目标超滤量,并因此减少透析间期急性左心衰竭的发生率。     

维生素B12与津恤力余液用于化疗致口腔溃疡的效果观察

随机将化疗致口腔溃疡 80例病人分为两组 ,各 40例。观察组采用维生素B12 注射液 10 0 0 μg ,均匀喷洒在溃疡处 ,3h后将津恤力空瓶 ( 4个 )用 0 .9氯化钠注射液 2ml冲洗后喷洒在溃疡处 ,2次 /d ;对照组用 0 .2 %甲硝唑含漱 10min ,2h后用强氧化离子电位水含漱 10min ,3次 /d。结果有效率观察组 10 0 .0 %,对照组 80 .0 %,两组比较 ,差异有极显著性意义 (P <0 .0 1)。提示津恤力与维生素B12 合用 ,可增加口腔免疫力 ,减轻化疗致口腔溃疡的程度 ,促进溃疡愈合。     

血液透析前补充左卡尼汀对改善终末期尿毒症患者透析耐受性的影响

目的 探讨不同时段静脉补充左卡尼汀对终末期维持性血液透析患者透析过程中发生低血压、肌肉痉挛及透析患者耐受性的影响和血浆游离肉碱浓度变化.方法 选择终末期维持性血液透析患者30例,按照数字表法随机分为3组:A组为对照组(透析结束后给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射)10例,B组(透析前给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射,透析结束后左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射)10例,C组(透析开始2h后给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射,透析结束后给予左卡尼汀1.0g加入0.9％氯化钠20ml静脉注射)10例.观察各组用药前、用药4周、8周及12周后各项指标的变化、血浆肉碱浓度和血液透析充分性.结果 B、C两组患者较对照组临床症状及分级显著好转,差异有统计学意义(P＜0.05);游离血浆肉碱浓度较对照组升高,差异有统计学意义(P＜0.05);患者透析的耐受力和尿素氮清除效率(Kt/V)明显好转,差异有统计学意义(P＜0.05).结论 在透析前或透析中给予左卡尼汀即刻补充剂量能降低患者发生透析不良反应的风险,增加患者的透析耐受力,提高患者透析的充分性.     

留置导尿拔管后预防尿潴留方法探讨

目的预防女性病人留置导尿拔管后尿潴留。方法随机将 76例女性留置导尿病人分为两组各 38例 ,观察组在膀胱部分充盈状态下 ,采取电脑脉冲按摩 2 0min后 ,膀胱内注入 2 %利多卡因 5 0mg、氧氟沙星 0 .2g加 0 .9%氯化钠注射液 10 0ml后拔管 ;对照组采用常规拔管法。结果观察组拔管后排尿情况显著优于对照组 (χ2 =2 3.93,P <0 .0 1) ,首次排尿时间显著短于对照组 (χ2 =11.81,P <0 .0 1)。结论拔管前脉冲按摩治疗联合膀胱内注药 ,可有效预防拔管后尿潴留。     

地塞米松对0·5%罗哌卡因腰丛-坐骨神经联合阻滞作用的影响

目的评价地塞米松给药方式对0.5%罗哌卡因腰丛-坐骨神经联合阻滞(CLPSNB)作用时效的影响。方法60例神经刺激器定位CLPSNB患者随机分为三组,每组20例。A组,0.5%罗哌卡因45ml加地塞米松10mg行神经阻滞,同时静脉注射生理盐水(NS);B组,0.5%罗哌卡因45ml加NS2ml行神经阻滞,同时静脉注射地塞米松10mg;C组,0.5%罗哌卡因45ml加NS2ml神经阻滞,同时静脉注射NS2ml。结果感觉、运动阻滞持续时间A组[(15.2±3.3)h、(12.6±2.8)h]显著长于B组[(10.1±2.1)h、(7.9±1.6)h]和C组[(10.4±2.5)h、(7.6±2.3)h](P0.05)。结论地塞米松可以通过局部作用机制延长0.5%罗哌卡因CLPSNB持续时间。     

氟比洛芬酯对喉癌喉裂开术患者围术期细胞因子及术后疼痛的影响

目的 观察氟比洛芬酯对喉癌喉裂开术患者术后疼痛及围术期细胞因子的影响.方法 择期行喉癌喉裂开术患者60例,随机均分为三组:术毕前10 min分别静脉注射氟比洛芬酯1.0mg/kg(F<,1>组)、氟比洛芬酯1.5 mg/kg(F<,2>组)、生理盐水5 ml(C组).VAS评分评定术后1、2、4、68、12、24 h的疼痛程度.监测术前、术毕和术后6、24 h血浆白细胞介素(11)-2、可溶性白细胞介素-2受体(SIL-2R)、IL-6、IL-10的浓度.结果 与术前比较,C组SIL-2R水平在术后6 h明显降低、术后24 h明显升高;F<,1>、F<,2>组SIL-2R水平明显降低;三组IL-6、IL-10水平明显升高和IL-2水平明显降低(P<0.05).与C组比较,术后1、2、4 h时F<,2>组VAS明显降低,术后4 h时F<,1>组VAS明显降低(P<0.05);术后6、24 h时F<,1>、F<,2>组的IL-10水平和术后24 h时的IL-2水平明显升高,且F<,2>组明显高于F<,1>组(P<0.05);F<,1>、F<,2>组在术后6 h时的IL-6水平和术后6、24 h时SIL-2R水平明显降低,且F<,2>组明显低于F<,1>组(P<0.05).结论 1.5 nag/kg氟比洛芬酯能有效地平衡细胞因子,缓解术后的免疫损伤,具有免疫保护作用.     

Epidural anesthesia worsens uterine blood flow and fetal oxygenation during hemorrhage in gravid ewes.

Recent studies suggest that epidural anesthesia initiated before hemorrhage may improve survival and acid-base status in laboratory animals. However, studies of hemorrhagic shock in nonpregnant animals may not be applicable to less severe hemorrhage in pregnant animals. The purpose of this study was to determine whether epidural anesthesia alters maternal and fetal hemodynamic and acid-base responses to hemorrhage in gravid ewes. Twenty-four experiments were performed in twelve chronically instrumented animals between 0.8 and 0.9 of timed gestation. The experimental sequence included: 1) T = 0 min: normal saline 500 ml intravenously; 2) T = 15 min: epidural administration of 0.5% bupivacaine (epidural group) or normal saline (control group); 3) T = 30 min: epidural administration of additional 0.5% bupivacaine (epidural group only) if the sensory level of anesthesia was below T10; 4) T = 45 min: maternal hemorrhage 20 ml/kg over 55 min; and 5) T = 110 min: transfusion of collected maternal blood over 55 min. At 45 min (i.e., 30 min after the epidural injection of bupivacaine), epidural bupivacaine resulted in a median sensory level of T9 in the epidural group. At that time, maternal mean arterial pressure was less (P less than 0.05) in the epidural group than in the control group (14 +/- 2% below baseline versus 4 +/- 1% above baseline, respectively). Maternal mean arterial pressure, heart rate, cardiac output, and uterine blood flow, and fetal PO2 and pH all were significantly less during hemorrhage (P less than 0.05) in the epidural group than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)     

苯二氮(艹卓)受体在小鼠不同静脉麻醉药遗忘效应中的作用

目的 评价苯二氮(艹卓)受体在小鼠异丙酚、依托咪酯和氯胺酮遗忘效应中的作用.方法 昆明小鼠288只,雌雄各半,体重18～23 g,采用随机数字表法,将其随机分为9组(n=32):生理盐水+生理盐水组(NN组)、生理盐水+脂肪乳组(NF组)、氟马西尼+生理盐水组(FN组)、生理盐水+异丙酚组(NP组)、氟马西尼+异丙酚组(FP组)、生理盐水+依托咪酯组(NE组)、氟马西尼+依托咪酯组(FE组)、生理盐水+氯胺酮组(NK组)和氟马西尼+氯胺酮组(FK组).NN组、NF组、NP组、NE组和NK组于训练前10 min时腹腔注射生理盐水10 ml/kg,于训练前5 min时分别腹腔注射生理盐水10 ml/kg、脂肪乳10 nl/kg、异丙酚25 mg/kg、依托咪酯3 mg/kg和氯胺酮20 mg/kg;FN组、FP组、FE组和FK组于训练前10 min时腹腔注射氟马西尼1 mg/kg,于训练前5 min时分别腹腔注射生理盐水10ml/kg、异丙酚25 mg/kg、依托咪酯3 mg/kg和氯胺酮20 mg/kg.分别采用避暗实验、跳台实验和Morris水迷宫实验测试认知功能.结果 与NN组比较,NF组和FN组认知功能各指标比较差异无统计学意义(P＞0.05),NP组跳台实验潜伏期缩短,NE组跳台实验潜伏期缩短,错误次数增多,NK组跳台实验潜伏期缩短,水迷宫实验潜伏期延长(P＜0.05);与NP组比较,FP组避暗实验潜伏期延长,水迷宫实验潜伏期缩短(p＜0.05);与NE组比较,FE组避暗实验潜伏期延长,避暗实验和跳台实验错误次数减少(P＜0.05);与NK组比较,FK组跳台实验潜伏期延长,水迷宫实验潜伏期缩短(P＜0.05).结论 小鼠异丙酚、依托咪酯和氯胺酮的遗忘效应与激活苯二氮(艹卓)受体有关.     

Effect of i.v. diamorphine on the regression of spinal block

Twenty patients undergoing transurethral prostatectomy underspinal anaesthesia were allocated randomly in one of two groups.After operation dermatomal levels to cold were measured every30 min until they had receded to T10. Patients in group 1 werethen given diamorphine 5 mg in 0.9% saline 5 ml i.v. and ingroup 2 0.9% saline 5 ml i.v. Block level to cold and degreeof motor block were assessed at 15-min intervals for 1 h afterinjection. Block regression continued in the control group whilethere was no decrease in the diamorphine group for 30 mm (P< 0.01) after which it then receded at a similar rate asthe control group. There was no significant difference in motorblock between the two groups. (Br. J. Anaesth. 1995; 74: 610–611)     

A randomised controlled trial of perineural vs intravenous dexamethasone for foot surgery

We used 20 ml ropivacaine 0.75% for ankle blocks before foot surgery in 90 participants who we allocated in equal numbers to: perineural dexamethasone 8 mg and intravenous saline 0.9%; perineural saline 0.9% and intravenous dexamethasone 8 mg; or perineural and intravenous saline 0.9%. Dexamethasone increased the median (IQR [range]) time for the return of some sensation or movement, from 14.6 (10.8–18.8 [5.5–38.0]) h with saline to 24.1 (19.3–29.3 [5.0–44.0]) h when given perineurally, p = 0.00098, and to 20.9 (18.3–27.8 [8.8–31.3]) h when given intravenously, p = 0.0067. Dexamethasone increased the median (IQR [range]) time for the return of normal neurology, from 17.6 (14.0–21.0 [9.5–40.5]) h with saline to 27.5 (22.0–36.3 [7.0–53.0]) h when given perineurally, p = 0.00016, and to 24.0 (20.5–32.3 [13.0–42.5]) h when given intravenously, p = 0.0022. Dexamethasone did not affect the rates of block success, postoperative pain scores, analgesic use, or nausea and vomiting. The route of dexamethasone administration did not alter its effects.     

赛霉安散加地塞米松保留灌肠治疗慢性结肠炎的疗效观察

为探讨赛霉安散加地塞米松保留灌肠治疗慢性结肠炎的疗效及复发率，回顾87例保留灌肠治疗的慢性结肠炎患者资料，按用药不同分为三组，即赛霉安散组、地塞米松组和复合组。赛霉安散组30例，用赛霉安散6g加20ml生理盐水保留灌肠，2次／d；地塞米松组25例，用地塞米松Stag加20ml生理盐水保留灌肠，2次／d；复合组32例，用赛霉安散6g加地塞米松5mg加20ml生理盐水保留灌肠，2次／d。10d为一疗程，3个疗程后评价疗效。结果显示，赛霉安散组显效17例，有效6例，无效7例，总有效率为76．7％（23／30），复发5例（16．7％）；地塞米松组显效10例，有效6例，无效9例，总有效率64．0％（16／25），复发7例（28．0％）；复合组显效24例，有效7例，无效1例，总有效率96．9％（31／32），复发1例（3．1％）。经统计分析，复合组疗效明显优于其他两组，P〈0．05。结果表明，赛霉安散加地塞米松保留灌肠治疗慢性结肠炎疗效显著。     

Prophylactic and therapeutic carboprost tromethamine bladder irrigation in rats with cyclophosphamide-induced hemorrhagic cystitis.

Recently, prostaglandins have been shown to be effective agents for the treatment of cyclophosphamide-induced hemorrhagic cystitis. Among the prostaglandins studied is carboprost tromethamine, a PGF2a analog. To determine the effectiveness of carboprost tromethamine therapy on the urothelium, we induced hemorrhagic cystitis in 81 rats. These were divided into two treatment arms. One arm was treated prophylactically at the time of cyclophosphamide injection, and the other started treatment only after hemorrhagic cystitis was established. Animals were divided equally into groups receiving 0, 0.4, 0.8, and 1.6 mg.% carboprost tromethamine in 0.9% normal saline by continuous bladder irrigation. All bladders were examined grossly for edema and hemorrhage, then histologically for mucosal ulceration, congestion, and perivascular hemorrhage. Results from the prophylactic arm, as compared to those for controls, revealed that all groups except those treated only with 0.9% normal saline had a lower incidence of hemorrhagic cystitis (p less than 0.05). In the established hemorrhagic cystitis arm, the group treated with 1.6 mg.% carboprost tromethamine showed the best response (p less than 0.05), whereas the group treated with 0.9% normal saline showed the poorest response. This study reveals that hemorrhagic cystitis in the rat model may be prevented by prophylactic continuous bladder irrigation with carboprost tromethamine, whereas established hemorrhagic cystitis may be treated effectively with intravesical instillation of carboprost tromethamine. Although the mechanism of action of this prostaglandin on the urothelium is unknown, it appears grossly and histologically to decrease ulceration, perivascular hemorrhage, and congestion in the mucosa and submucosa.     

Intermittent injection of bupivacaine into the margin or the cavity after reduction mammaplasty.

Twenty-seven operated women had postoperative intermittent injections of bupivacaine or saline for 24 hours after reduction mammaplasty. The injections were given five-hourly either subcutaneously along the submammary incision or deep into the wound. The patients were randomised into three groups of nine each: 5 ml bupivacaine 0.25% into the margin; 5 ml bupivacaine 0.25% into the cavity; and 5 ml physiological saline into the cavity. Postoperatively all patients received oral paracetamol and dextropropoxyphene. If additional analgesia was needed morphine was given intravenously. Total morphine consumption was significantly (p<0.03) lower in patients given bupivacaine into the margin (2.0 (0.9) mg) or into the cavity (2.4 (0.8) mg) compared with controls (6.9 (1.5) mg). VAS pain scores and vomiting did not differ among the three groups. Postoperative intermittent infusion of bupivacaine lowered morphine consumption after reduction mammaplasty, and the analgesic effect seemed to be independent of where the infusion was given.     

酒石酸布托啡诺对舒芬太尼诱发咳嗽反射的影响

目的观察酒石酸布托啡诺对舒芬太尼诱发咳嗽反射的影响。 方法择期行腹腔镜胆囊切除术患者82例,ASAⅠ或Ⅱ级,随机分为两组,分别于麻醉诱导前静注以生理盐水稀释至5 ml的酒石酸布托啡诺1 mg (试验组)或生理盐水5 ml(对照组),5 min后在3 s内静注舒芬太尼0.3 μg/kg,观察并记录两组患者2 min内咳嗽反射的发生率和强度。 结果试验组患者咳嗽反射的发生率、强度明显低于对照组。 结论酒石酸布托啡诺1 mg可以抑制舒芬太尼诱发的咳嗽反射。