氟比洛芬酯联合吗啡镇痛对胃癌患者T淋巴细胞亚群及自然杀伤细胞的影响

目的 观察氟比洛芬酯联合吗啡镇痛对胃癌根治术患者罔术期外周血T淋巴细胞亚群及自然杀伤(NK)细胞的影响.方法 40例择期全麻下行胃癌根治术患者随机分为氟比洛芬酯组(A组)和吗啡组(B组),每组20例,分别于术前0.5 h静注氟比洛芬酯或安慰药英脱利匹特,术后距第一次给药6 h再次静注氟比洛芬酯或英脱利匹特.两组患者术后均行患者自控静脉镇痛(PCIA).于麻醉前、手术开始后2 h、术后24、48、120 h五个时点用流式细胞仪检测T淋巴细胞亚群(CD3+、CD4+、CD8+)及NK细胞(CD3+CD6+CD56+).结果 与麻醉前比较,两组CD3+、CD4+、CD4+/CD8+和NK细胞在手术2 h、术后24、48 h均明显降低(P<0.05);术后120 h CD3+CD16+CD56+仍未恢复至麻醉前水平(P<0.05).与B组比较,A组CD3+、CD4+、CD4+/CD8+在术后24 h下降幅度较小(P<0.05),而NK细胞则在手术2 h和术后24 h下降幅度较小(P<0.05).结论 胃癌根治术患者围术期用氟比洛芬酯联合吗啡镇痛较单用吗啡镇痛对T淋巴细胞亚群和NK细胞有保护作用.     

曲马多和吗啡术后镇痛对胃癌手术患者免疫功能的影响

目的比较曲马多和吗啡术后镇痛对胃癌患者术后镇痛效果及免疫功能的影响。方法择期行胃癌根治术患者40例,ASAⅠ或Ⅱ级,随机均分为硬膜外吗啡镇痛组(Ⅰ组)、静脉吗啡镇痛组(Ⅱ组)、硬膜外曲马多镇痛组(Ⅲ组)和静脉曲马多镇痛组(Ⅳ组)。记录各时点视觉模拟(VAS)评分、术后48 h PCA有效按压次数、胃肠功能恢复时间、镇痛满意度及不良反应发生;同时测定T淋巴细胞亚群(CD3+、CD4+、CD8+)、NK细胞及镇痛期间血清中白细胞介素-2(IL-2)。结果四组患者均达到满意的镇痛效果。与麻醉前比较,术毕、术后1 d四组和术后2 dⅠ、Ⅱ组CD3+、CD4+、CD8+及NK细胞水平明显降低(P<0.05)。与Ⅱ组比较,术后1 dⅠ、Ⅲ、Ⅳ组CD3+、CD4+及NK细胞水平明显升高(P<0.05)。术后2 dⅢ、Ⅳ组恢复至麻醉前水平;术后3 dⅠ、Ⅱ组上述指标恢复至麻醉前水平。与麻醉前比较,术毕、术后1、2 d四组IL-2水平均降低,且Ⅰ、Ⅱ组显著低于Ⅲ、Ⅳ组(P<0.05),术后1 d达最低值后逐渐回升,于术后3 d达麻醉前水平。结论与吗啡比较,曲马多术后镇痛可减轻胃癌患者围术期T淋巴细胞亚群和NK细胞水平下降的程度...     

曲马多术后镇痛对妇科肿瘤病人T淋巴细胞亚群、NK细胞的影响

目的 比较曲马多用于妇科肿瘤病人术后静脉自控镇痛(PCIA)与硬膜外自控镇痛(PCEA)对T淋巴细胞亚群、NK细胞的影响。方法 39例妇科肿瘤病人,随机分为两组,Ⅰ组(n=21)为静脉自控镇痛组,E组(n=18)为硬膜外自控镇痛组。两组均用硬膜外麻醉。Ⅰ组曲马多800mg、氟哌啶醇5mg、生理盐水83 ml。E组曲马多400 mg、氟哌啶醇5 mg、生理盐水91 ml。负荷剂量:术毕前15 minⅠ组曲马多100 mg静脉缓注,E组硬膜外给药。PCA泵容量100 ml,背景输注速率2ml/h,单次泵药剂量0.5 ml,锁定时间15 min。术后1、2 d评定镇痛效果(VAS),并于术前30min、术后1、2 d抽取肘静脉血液1.5 ml,采用流式细胞仪检测T细胞亚群(CD3+、CD4+、CD8+)、NK细胞的百分率。结果 两组镇痛差异无显著性(P>0.05)。两组间各时点各免疫指标的差异均无显著性(P>0.05)。E组术后1、2 d NK细胞显著低于术前(P<0.05),Ⅰ组术后2 d NK细胞下降(P<0.05)。两组T细胞亚群指标与术前相比差异无显著性(P>0.05)。结论 曲马多PCIA与PCEA用于妇科肿瘤病人术后镇痛对T淋巴细胞亚群、NK细胞的影响相同。     

瑞芬太尼术后镇痛对肿瘤患者T淋巴细胞亚群的影响

目的观察瑞芬太尼和芬太尼术后镇痛对肿瘤患者T淋巴细胞亚群的影响。方法肿瘤手术患者40例,ASAⅠ或Ⅱ级,随机均分为瑞芬太尼组(R组)和芬太尼组(F组),两组患者均行静-吸复合麻醉。两组术毕分别采用瑞芬太尼或芬太尼行静脉自控镇痛(PCIA),于麻醉前、术后24、48、72 h抽血测定患者T淋巴细胞亚群(CD3+、CD4+、CD8+),并行VAS评分。结果两组患者术后VAS评分差异无统计学意义。术后24 h两组患者CD3+、CD4+、CD4+/CD8+均显著低于麻醉前(P<0.05)。术后48 h R组CD3+、CD4+、CD4+/CD8+已恢复到麻醉前水平,而F组仍明显低于麻醉前和R组(P<0.05)。术后72 h两组T淋巴细胞亚群均恢复至麻醉前水平。结论瑞芬太尼术后静脉自控镇痛能减轻肿瘤患者术后免疫抑制,对机体免疫功能有一定的保护作用。     

曲马多对胃肠道肿瘤患者术中免疫功能的影响

目的 观察曲马多对胃肠道肿瘤患者术中T淋巴细胞亚群和NK细胞数量的影响.方法 30例胃肠道肿瘤行根治手术的患者随机均分为观察组和对照组.观察组麻醉前肌注曲马多1 mg/kg,对照组不使用.于麻醉前、手术1 h和术毕抽取外周静脉血,用流式细胞仪检测T淋巴细胞亚群(CD3+、CD3+CD4+、CD3+CD8+)、活化T细胞(CD3+HLA-DR+)和自然杀伤(NK)细胞(CD3-CDl6+CD56+)数量的变化.结果 两组手术1 h CD3+、CD3+CD4+、CD3+CD4+、CD3+CD8+、CD3+HLA-DR+和NK细胞数量均较麻醉前明显下降,对照组明显低于观察组(P＜0.05);术毕两组各指标有所回升,但对照组仍明显低于麻醉前水平和观察组(P＜0.05).结论 曲马多可减轻胃肠道肿瘤患者术中T淋巴亚群和NK细胞下降的程度,明显改善机体细胞免疫功能的抑制.     

胸腺肽α1对神经外科肿瘤患者T淋巴细胞亚群和NK细胞的影响

目的了解胸腺肽α1对神经外科肿瘤患者围术期T淋巴细胞亚群和自然杀伤(NK)细胞数量的影响。方法选择30例神经外科肿瘤手术的患者,随机均分为研究组和对照组,研究组麻醉前用胸腺肽α1,对照组未使用。分别于麻醉前、手术1 h、术毕和术后5 d抽取外周静脉血,用流式细胞仪检测T淋巴细胞亚群(CD3 、CD4 、CD8 )和NK细胞(CD56 )数量的变化。结果研究组和对照组手术1 h CD3 、CD4 、CD4 /CD8 、NK细胞数量均较麻醉前明显下降(P<0.05或P<0.01),研究组下降幅度较对照组小(P<0.05),术毕研究组和对照组各指标有所回升,但研究组回升的幅度较对照组大,术后5 d研究组和对照组各指标均回到麻醉前水平。结论胸腺肽α1减小了神经外科肿瘤患者围术期T淋巴细胞亚群和NK细胞下降的程度,能明显减轻细胞免疫功能的抑制。     

帕瑞昔布钠对肿瘤术后T细胞亚群的影响

目的研究帕瑞昔布钠联合吗啡镇痛对肿瘤外科术后细胞免疫功能的保护效应。方法选择肿瘤外科手术患者40例,随机均分为两组:帕瑞昔布钠联合吗啡组(Ⅰ组)和单独吗啡组(Ⅱ组)。分别于麻醉诱导前(T0)、术毕(T1)、术后24 h(T2)、术后48 h(T3)抽取外周静脉血2 ml测定T细胞分化抗原(CD3+)、辅助性T细胞(CD4+)、抑制性T细胞(CD8+)的表达及杀伤细胞(NK细胞)水平。结果与T0时比较,T1时两组CD3+、CD4+、CD4+/CD8+及NK细胞水平均明显下降(P<0.05);T2时Ⅰ组CD3+、CD4+及NK明显高于Ⅱ组,T3时CD4+/CD8+明显高于Ⅱ组(P<0.05);两组CD8+水平在各时点差异无统计学意义。结论两组患者的细胞免疫功能在术后均有不同程度的抑制,但使用帕瑞昔布钠联合吗啡镇痛对细胞免疫功能有一定的保护作用。     

静脉全麻复合颈丛神经阻滞及术后镇痛对颈淋巴结结核患者术后呼吸、循环及T细胞亚群的影响

目的 观察静脉全麻复合颈丛神经阻滞及术后镇痛对颈淋巴结结核患者术后呼吸、循环及T细胞亚群的影响.方法 选择60例ASA Ⅰ或Ⅱ级择期行颈淋巴结结核病灶清除术的患者,随机均分为三组:A组(静脉全麻复合颈丛神经阻滞+患者自控颈丛镇痛),B组(静脉全麻复合颈丛神经阻滞+患者自控静脉镇痛(PCIA),C组(静脉全麻+PCIA).测定麻醉前30 min(T0)、术后4 h(T1)、24 h(T2)、2 d(T3)、3 d(T4)外周静脉血T淋巴细胞亚群CD3+、CD4+、CD8+百分比;观察T0～T3时、VT、肺活量(Vc)、RR、SpO2、MAP和HR;记录T1～T3时疼痛、镇静评分.结果 T1、T2时三组患者CD3+、CD4+、CD4+/CD8-均明显下降(P<0.05);A组T4时各免疫指标恢复至术前水平;B组和C组T1时RR较T0时明显增快(P<0.05),而T2时SpO2、Vc均较T0时明显下降(P<0.05),A组T1时RR低于B、C组(P<0.05),而V1高于B、C组(P<0.05),A组T1、T2时Vc、SpO2均高于B、C组(P<0.05);A组术后T1～T3时MAP、HR均无明显改变.结论 静脉全麻复合颈丛神经阻滞及术后镇痛可减轻颈淋巴结结核患者术后免疫功能的抑制,并改善呼吸、循环功能.     

全麻复合硬膜外麻醉及术后硬膜外镇痛对食管癌患者术后T细胞亚群及循环、呼吸的影响

目的探讨静脉全麻复合硬膜外麻醉(CGEA)及患者自控硬膜外镇痛(PCEA)对食管癌患者术后 T 细胞亚群及循环、呼吸的影响。方法选择60例 ASA Ⅰ或Ⅱ级择期行食管癌根治术的患者,随机均分为三组。A 组行 CGEA 及术后 PCEA,B 组行 CGEA 及术后患者自控静脉镇痛(PCIA),C 组行全凭静脉麻醉及术后 PCIA。分别于麻醉前30 min(T_0)、术后4 h(T_1)、1 d(T_2)、2 d(T_3)、3 d(T_4)、7 d(T_5)取外周静脉血2 ml,用流式细胞仪测定 T 淋巴细胞亚群,并观察各时间点循环、呼吸指标以及疼痛、镇静评分。结果三组患者 T_1～T_3时 CD3~ 、CD4~ 、CD8~ 、CD4~ /CD8~ 均明显下降(P<0.05)。B、C 组 RR 在T_1时明显快于 A 组(P<0.05)。T_4时 A 组 T 淋巴细胞亚群恢复至 T_0,B 组和 C 组 T_5时 CD3~ 、CD4~ 、CD8~ 、CD4~ /CD8~ 均基本恢复。结论 CGEA 辅以术后PCEA 可改善食管癌患者术后呼吸、循环功能并减轻免疫功能的抑制。     

舒芬太尼或曲马多术后镇痛对患者免疫功能的影响

目的通过评价自控静脉舒芬太尼或曲马多镇痛对腹腔镜胆囊切除术(LC)后患者血浆中细胞因子及免疫细胞的影响,探讨不同种类镇痛药物对术后早期患者免疫功能的影响。方法 80例LC术患者用抽签法随机分为2组(每组40例):A组患者为术后自控静脉舒芬太尼镇痛;B组患者为术后自控静脉曲马多镇痛。观察麻醉前30分钟、手术后即刻、术后24小时、术后72小时4个时点患者血浆中白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及T细胞总数、NK细胞、CD4+及CD8+细胞的水平,以视觉模拟评分法(VAS)评分评价各组患者术后2、24、48、72小时的镇痛效果。结果术后各时点A组、B组的VAS评分无统计学差异(P>0.05);两组除术毕即刻T细胞总数较麻醉前基础值升高外(均P<0.05),余时间段T细胞总数、NK细胞、CD4+及CD8+细胞的变化与基础值及组间比较均无统计学意义(均P>0.05);两组患者术毕即刻至术后72小时血浆IL-2水平与麻醉前值比较均降低(均P<0.05),两组患者术毕即刻IL-6、IL-10水平与麻醉前值比较均显著升高(均P<0.05),并持续升高至术后24小时达峰值后逐渐下降,但术后72小时两组患者IL-6、IL-10水平仍高于术前。结论舒芬太尼和曲马多对LC患者术后均取得良好的镇痛效果,并且两者的免疫抑制作用无明显差异。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。