硬膜外麻醉复合全麻对开胸手术患者早期恢复质量的影响

目的 探讨硬膜外腔阻滞复合全麻与肋间神经阻滞复合全麻对开胸手术患者早期恢复质量的影响。方法 选取行开胸手术患者76例,按随机数表法分为两组,硬膜外阻滞复合全麻组（E组）、肋间神经阻滞复合全麻组（C组）,每组38例。E组行硬膜外穿刺置管,术中0.2%罗哌卡因维持;C组行切口及上下肋间神经阻滞,两组全麻诱导及维持一致。采用术后恢复质量量表(quality of recovery QoR-40）对患者进行术前1d、术后3d恢复质量评分;采用视觉模拟评分法（visual analogue scale, VAS）对两组患者进行拔管后4 h、8 h、12 h、24 h安静和活动后的VAS评分;同时记录患者首次下床活动时间及住院时间。结果 E组在术后3dQoR-40各项评分均高于C组,差异有统计学意义（P <0.05）;E组静息和运动状态下术后各时间点VAS评分均低于C组,差异有统计学意义（P <0.05）;E组首次下床活动时间较早,住院时间较C组减少,差异有统计学意义（P <0.05）。结论 硬膜外阻滞复合全身麻醉用于开胸手术患者,不仅镇痛效果良好,还能明显提高术后早期恢复质量,...     

硬脂酸纳米吗啡用于硬膜外镇痛的实验研究

目的 观察硬脂酸纳米吗啡(SLN-M)单次注入大鼠硬膜外腔后的镇痛效应.方法 选择硬膜外置管后无神经损伤症状的SD雄性大鼠50只,随机均分为五组.A组(假给药组):经硬膜外腔给予硬脂酸纳米(SLN);B1组与B2组:分别给予0.2及1 mg普通吗啡;C1组与C2组:分别给予含0.2及1 mg吗啡的SLN-M.用药后测定热痛阈值评价镇痛效果,以最大镇痛效应(MPE)表示,以SpO2、角膜反射的变化、僵直症的发生率对药物不良反应进行评估.结果 B1与C1组及B2与C2组的MPE最高值差异无统计学意义.但随时间延长,B1与B2组MPE逐渐下降,12 h后开始显著低于C1与C2组(P＜0.05).B1与B2组达到MPE最高值的时间显著快于C1与C2组(P＜0.05),但持续时间显著缩短(P＜0.05).B1与B2组SpO2显著低于C1与C2组(P＜0.05),角膜反射的变化和僵直症的发生率要高于C1与C2组(P＜0.05),且与吗啡剂量呈正相关.结论 硬膜外腔单次给予SLN-M后可达到与普通吗啡一样的镇痛效果,有效镇痛时间明显延长,不良反应显著降低.     

云芝糖肽镇痛作用的实验研究

 目的：研究从云芝中提取的云芝糖肽对急性和慢性的炎症性疼痛的镇痛作用。方法：用Wistar大鼠建立甲醛溶液致炎、鹿角菜胶致炎和佐剂性关节炎3种炎症性疼痛的实验糢型，观察云芝糖肽的镇痛作用。结果：云芝糖肽对急性（甲醛溶液致炎和鹿角菜胶致炎）和慢性（佐剂性关节炎）的炎症性疼痛都有明显的镇痛作用，并呈明显的量效关系。用药后2h左右镇痛作用消退。与哌替啶（度冷丁）比较，云芝糖肽的镇痛强度较弱，持续时间较短。结论：云芝糖肽对急性和慢性的炎症性疼痛均有明显的镇痛作用。     

低剂量纳洛酮对芬太尼镇痛效应的影响

目的 观察低剂量纳洛酮(naloxone)对芬太尼(fentanvyl)镇痛效应的影响.方法 将试验小鼠80只随机分为两组,分别采用扭体法(40只,雌雄各半)和热板法(40只,均为雌性)观察纳洛酮对芬太尼镇痛小鼠热板法痛阈(HPPT)和扭体次数的影响.各组按分层随机设计分为Fs组(芬太尼与生理盐水合用)及FNl、FN2和FN3组(芬太尼分别与纳洛酮100、10、10ng,1n/kg合用组)四组.结果 与Fs组相比,FN2组HPPT在第5 min增大(P＜0.05);扭体次数FN1和FN2组均显著减少(P＜0.05).结论 纳洛酮在一定剂量范围内能够增强芬太尼的镇痛效应.     

复方亚甲蓝长效止痛剂用于肛肠科手术后止痛的疗效及时机观察

目的：观察复方亚甲蓝长效止痛剂用于肛肠科手术后止痛的疗效及时机。方法将448例需在硬膜外麻醉下行肛肠手术治疗患者,随机分为A、B、C、D 4组。 A、C组选择传统镇痛麻醉,B、D组选择超前平衡镇痛麻醉;A、B组术中采用利多卡因、盐酸布比卡因、地塞米松联合麻醉;C、D组给予甲磺酸罗哌卡因、利多卡因、0．9％氯化钠液、地塞米松、2％亚甲蓝等制成复方亚甲蓝长效止痛剂进行麻醉。比较各组患者术后各时期疼痛视觉模拟评分（ VAS）及麻醉后并发症。结果 D组麻醉术后各时期VAS评分低于C组和B组,A组麻醉术后各时期VAS评分高于C组,差异均有统计学意义（P＜0．05）。 D组麻醉后并发症发生率低于C组和B组,A组麻醉后并发症发生率高于C组,差异均有统计学意义（ P＜0．05）。结论超前平衡镇痛联合复方亚甲蓝长效止痛剂在肛肠科手术中具有良好的镇痛效果,并且麻醉后并发症发生率较低。     

Post-voiding residual volume in 154 primiparae 3 days after vaginal delivery under epidural anesthesia

OBJECTIVES: To use 3-dimensional ultrasonography (3D-US) to determine the frequency of post-voiding residual volume (PVRV) > or =100 mL in primiparae 3 days after receiving epidural anesthesia for vaginal delivery. Potential relationships between day-3 PVRV > or =100 mL and obstetrical-pediatric parameters, especially those possibly implicated in post-obstetrical bladder dysfunction, were examined. STUDY DESIGN: We recruited 154 primiparae who vaginally delivered term singletons following uncomplicated pregnancies in the maternity unit of a French teaching hospital. All women had been systematically catheterized 2-h postpartum to measure precisely the volume of urine retained. On the morning of discharge (day 3), when the patient felt the urge to urinate, her 3D-US pre-voiding bladder volume was determined with BladderScan (BVI-3000), then her spontaneously voided urine was collected to accurately quantify its volume and 3D-US was repeated immediately to evaluate the PVRV. PVRV > or =100 mL on day 3 was considered pathological. RESULT: Among these 154 women, 88 (57%) felt the need to urinate and 97 (63%) had a retained volume > or =500 mL at 2-h postpartum. On day-3 postpartum, the median [range] volumes for the entire cohort were: 426.7 [158-999.7] mL 3D-US-measured pre-voiding, 350 [15-1000] mL collected by spontaneous urination, 82.2 [5.3-433.3] mL 3D-US-determined post-voiding; PVRV exceeded 100 mL for 55 (36%). According to our univariate analysis, no factor considered was able to predict PVRV > or =100 mL on day 3. CONCLUSION: Our observations confirmed the existence of PVRV > or =100 mL on day 3 in more than one-third of these primiparae who delivered vaginally under epidural anesthesia. No obstetrical-pediatric factor could be implicated in this bladder dysfunction. Therefore, we recommend frequent and systematic non-invasive 3D-US monitoring of all postpartum patients at least until day 3 to avoid excessive urine retention.     

Premedication for tracheal intubation in neonates: confusion or controversy?

Tracheal intubation is performed frequently in the NICU and delivery room. This procedure is extremely distressing, painful, and has the potential for airway injury. Premedication with sedatives, analgesics, and muscle relaxants is standard practice for pediatric and adult intubation, yet the use of these drugs is not common for intubation in neonates. The risks and benefits of using premedications for intubating unstable newborns are hotly debated, although recent evidence shows that premedication for non-urgent or semi-urgent intubations is safer and more effective than awake intubations. This article reviews clinical practices reported in surveys on premedication for neonatal intubation, the physiological effects of laryngoscopy and intubation on awake neonates, as well as the clinical and physiological effects of different drug combinations used for intubation. A wide variety of drugs, either alone or in combination, have been used as premedication for elective intubation in neonates. Schematically, these studies have been of three main types: (a) studies comparing awake intubation versus those with sedation or analgesia, (b) studies comparing different premedication regimens comprising sedatives, analgesics, and anesthetics, and (c) case series of neonates in which some authors have reported their experience with a specific premedication regimen. The clinical benefits described in these studies and the need for pain control in neonates make the case for using appropriate premedication routinely for elective or semi-urgent intubations. Tracheal intubation without the use of analgesia or sedation should be performed only for urgent resuscitations in the delivery room or other life-threatening situations when intravenous access is unavailable.     

帕瑞昔布钠超前镇痛对髋关节置换术患者IL-6和TNF-α的影响

目的：探讨帕瑞昔布钠超前镇痛对髋关节置换术后患者炎症细胞因子的影响,并进一步观察术后镇痛效果。方法本组患者60例,年龄40~65岁,ASAⅠ-Ⅱ级,择期在全麻下行髋关节置换术。随机分成观察组和对照组,每组30例。麻醉前20 min观察组静脉注射帕瑞昔布钠40 mg（用生理盐水稀释成4 mL）,对照组静脉注射生理盐水4 mL。分别于静推帕瑞昔布钠或生理盐水前10 min（T1）、术毕（T2）、术后6 h（T3）、术后12 h（T4）、术后24 h（T5）采上肢静脉血样,测定IL-6、TNF-α的血浆浓度。采用视觉模拟评分法（VAS）评价术毕即刻、术后2 h、6 h、12 h、24 h镇痛效果。结果患者血浆IL-6浓度于T3、T4、T5时点较术前显著升高,差异有统计学意义（P〈0.05）;观察组血浆IL-6浓度于T3、T4、T5时点比对照组显著降低,差异有统计学意义（P〈0.05）。患者血浆TNF-α浓度于T4、T5时点较术前显著升高,差异有统计学意义（P〈0.05）;观察组血浆TNF-α浓度在T4、T5时间点比对照组显著降低,差异有统计学意义（P〈0.05）。观察组患者在术毕即刻、术后2 h、6 h、12 h VAS评分均显著低于对照组,差异有统计学意义（P〈0.05）。结论帕瑞昔布钠超前镇痛可有效缓解全髋关节置换术患者术后疼痛,抑制炎性介质释放,降低神经系统敏感性,利于患者术后康复。     

膝关节镜手术后应用氟比洛芬酯镇痛的疗效观察

目的观察膝关节镜手术后应用氟比洛芬酯镇痛的疗效和安全性。方法将接受膝关节镜手术的80例患者随机分成两组,每组40例患者,氟比洛芬酯组术后应用氟比洛芬酯静脉镇痛,芬术尼组术后应用芬太尼静脉镇痛,对比两组视觉模拟评分(VAS)、镇静评分(Ramsay)评分和不良反应发生率。结果两组在各个时间点的VAS评分和Ramsay评分比较,差异无统计学意义(P0.05),但氟比洛芬酯组不良反应发生率更低,两组间比较差异有统计学意义(P0.05)。结论膝关节镜手术后应用氟比洛芬酯镇痛效果好,不良反应明显减少,值得在膝关节镜手术后推广应用。     

Identifying c-fos Expression as a Strategy to Investigate the Actions of General Anesthetics on the Central Nervous System

Although general anesthetics have been used in the clinic for more than 170 years, the ways in which they induce amnesia, unconsciousness, analgesia, and immobility remain elusive. Modulations of various neural nuclei and circuits are involved in the actions of general anesthetics. The expression of the immediate-early gene c-fos and its nuclear product, c-fos protein, can be induced by neuronal depolarization; therefore, c-fos staining is commonly used to identify the activated neurons during sleep and/or wakefulness, as well as in various physiological conditions in the central nervous system. Identifying c-fos expression is also a direct and convenient method to explore the effects of general anesthetics on the activity of neural nuclei and circuits. Using c-fos staining, general anesthetics have been found to interact with sleep- and wakefulness-promoting systems throughout the brain, which may explain their ability to induce unconsciousness and emergence from general anesthesia. This review summarizes the actions of general anesthetics on neural nuclei and circuits based on a c-fos expression.