顺阿曲库铵的药效学及其对组胺释放的影响

目的 比较全麻诱导期间不同保存条件下顺阿曲库铵和阿曲库铵的药效学及其对组胺释放的影响.方法 择期全麻手术患者45例,ASA Ⅰ或Ⅱ级,年龄16-71岁,随机分为3组(n=15):阿曲库铵冷藏组(ATR冷藏组)、顺阿曲库铵冷藏组(CIS冷藏组)和顺阿曲库铵常温组(CIS常温组).靶控输注异丙酚血浆靶浓度3μg/ml和瑞芬太尼效应室靶浓度3～5 ng/ml行麻醉诱导.ATR冷藏组静脉注射冷藏保存的阿曲库铵0.75 mg/kg,CIS冷藏组和CIS常温组分别静脉注射冷藏或室温保存的顺阿曲库铵0.15 mg/kg.使用肌松监测仪,采用单次颤搐刺激(频率0.1Hz,刺激持续时间0.2ms),测定刺激前臂尺神经拇内收肌的加速度.记录肌颤搐最大抑制程度、起效时间、作用时间和恢复指数.肌颤搐抑制达最大抑制时行气管插管,机械通气,评价气管插管条件.于麻醉诱导前(T0)、给予静脉全麻药后2min(T1)、给予肌松药后2min(T2)和5min(T3)时,记录MAP和HR,观察皮肤情况,同时采集桡动脉血样2ml,采用酶联免疫吸附法测定血浆组胺浓度.结果 CIS冷藏组和ATR冷藏组肌颤搐抑制均可达100%,CIS常温组仅53.33%的患者肌颤搐抑制最大达90%.与ATR冷藏组比较,CIS冷藏组起效时间延长,作用时间缩短(P<0.05),恢复指数差异无统计学意义(P>0.05);与CIS冷藏组比较,CIS常温组起效时间延长,作用时间缩短(P<0.05),恢复指数差异无统计学意义(P>0.05).ATR冷藏组和CIS冷藏组的气管插管条件优于CIS常温组(P<0.05).两组间不同时点血浆组胺浓度、MAP和HR比较差异无统计学意义(P>0.05);与T0时比较,ATR冷藏组T2,3时血浆组胺浓度升高,T1～3时MAP降低,CIS冷藏组T1～3时MAP降低(P<0.05).各组患者皮肤均未发现任何变化.结论 与冷藏保存的阿曲库铵相比,冷藏保存的顺阿曲库铵肌松作用强而起效较慢,作用时间较短,不引起组胺释放,可安全地应用于全身麻醉.但该药在室温下保存120d后,药效稳定性较差.     

内镜氩离子凝固术治疗胃黄色瘤的临床对照研究

目的：探讨黄色瘤内镜下氩离子凝固术的疗效及安全性。方法：内镜诊断胃黄色瘤并取病理的共97例,其中57例取病理但未行氩离凝固术（对照组）;40例患者活检并进行了氩离子凝固术治疗（APC组）。术后一个月胃镜复查随访。结果：病灶≥4mm的胃黄色瘤,APC组治愈率明显高于对照组（P=0.001）;病灶≥4mm,APC组治愈率稍高于对照组,但无显著性差异（P=0.128）。结论：胃黄色瘤活检后APC治疗是安全和有效的,尤其是对于较大的病灶。     

“饮食、运动、平衡”促健康服务模式在慢病管理中的应用及体会

随着人民生活水平的不断提高,与生活方式有关的一些慢性病的发病率和死亡率不断提高,由此引发医疗费用上涨,使国家和个人不堪重负。众所周知,糖尿病、高血压、高血脂的并发症很多,而这些疾病的发生又与肥胖有很大关系。高热量、高糖、高脂肪的膳食结构和缺乏体育锻炼是造成肥胖及其他慢性病的主要因素。因此,解决饮食、运动的量化管理问题是有效控制慢病发病率、提高慢病管理质量的根本之所在。     

顺阿曲库铵的药效学及其对组胺释放的影响

Objective To evaluate and compare the histamine-releasing,potencies of cis-atracurium and atracurium during induction of general anesthesia.Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=15 each):group Ⅰcis-atracurium (stored at 4-8℃)(group CIS1);groupⅡcis-atracurium (stored at room temperature)(group CIS2) and group Ⅲ atracurium (stored at 4-8℃)(group ATR).Anesthesia Was induced with TCI of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml).A bolus of cis-atracurium 0.15 mg/kg or atracurium 0.75 mg/kg Was given iv over 5-10 s as soon as the patients lost consciousness.Neuro-muscular block was monitored with TOF-Watch(R) SX(Organon,the Netherlands).Single stimulation (0.1 Hz) was apphed to the ulna nerve at wrist.The maximal degree of N-M block,onset time,duration of action and recovery index were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition Was evaluated.MAP and HR were continuously monitored.Changes in skin were scored (0=no change,Ⅰ=flushed>120 s,Ⅱ=erytbema,Ⅲ=urticaria).Blood samples were obtained before (T0,baseline),at 2 min after induction of anesthesia with TCI of propofol and remifentanil (T1) and 2 and 5 min after CIS/ATR administration (T2,T3) for determination of plasma histamine concentration using enzymatically amplified immunoassay.Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.     

失眠的中医辨证治疗

失眠临床上也称“不寐”,即无特殊病症而不能人眠的一种病患,本病在西医方面属神经衰弱的范畴。祖国医学文献中有“不寐”“不得卧“不得眠”“目不瞑”等皆失眠之谓也,究其病因多与思虑劳倦,内伤心脾,气血及脏腑功能失调,阴亏与内,阳浮于外,阴阳失交,使阳不入阴,心神不安,导致失眠。另外也有素体阳盛,突受惊吓,情绪不稳,导致肝郁痰阻。治疗以补虚泻实。调整阴阳为原则。     

血栓通注射液治疗急性脑梗死40例临床观察

目的观察血栓通注射液治疗急性脑梗死的临床疗效。方法将80例急性脑梗死患者随机分成治疗组和对照组各40例,分别给予常规治疗。治疗组加用血栓通注射液,对照组加用川芎注射液,用药14 d,2组治疗前后评价神经功能缺损评分并检查血液流变学指标。结果治疗组基本痊愈率28%,显著进步率32%,进步率23%,总有效率82%;对照组基本痊愈率18%,显著进步率25%,进步率25%,总有效率68%。2组比较有显著性差异。治疗组用药后血液流变学指标较用药前有显著性差异(P均<0.05)。结论血栓通注射液治疗急性脑梗死安全有效。     

X线透视下取出残留宫腔的爱母功能型节育器2例体会

病历资料 例1：患者,女,30岁,G1P1,因置爱母功能型宫内节育器（IUD）3年,无不良反应,在当地计划生育指导站行IUD取出术。术中节育器自两臂交接处断裂,取出一半,另一半残留于宫腔。先后3次以取环钩钩取及行刮宫术均未取出：于2007年10月18日就诊于我院。     

马来酸左旋氨氯地平治疗原发性高血压的临床观察

目的 评价马来酸左旋氨氯地平（玄宁）治疗原发性高血压的效果。方法 临床确诊的高血压患者，口服马来酸左旋氨氯地平。30d后进行疗效评价，并跟踪3个月监测血压。结果 治疗后平均收缩压（126＋10）mmHg，平均舒张压（72＋12）mmHg。治疗30d，显效92例，占73．0％；有效31例，24．6％；无效2例，1．6％；1例服药2d后出现头痛、眩晕停药，总有效率97．6％。跟踪随访监测血压3个月，血压控制较稳定。结论 马来酸左旋氨氯地平是一种安全、有效的降压药物。