痛立克在无痛人工流产术中的应用

目的：了解痛立克在人工流产术（简称人流术）中的镇痛作用。方法：选门诊健康早孕妇女２５０例，分为两组。用药组肌注痛立克３０ｍｇ，５０ｍｉｎ后施术；对照组用０．２％利多卡因３ｍｌ，宫颈及宫腔局部麻醉，２ｍｉｎ后施术。结果：用药组显效率及总有效率较对照组明显增高，（Ｐ＜０．０５及Ｐ＜０．０１），而子宫收缩及术中出血量与对照组差异无显著性（Ｐ＞０．０５）。结论：痛立克在人流术中镇痛效果较利多卡因局麻更好。     

Effect of COX-2 inhibitors and non-steroidal anti-inflammatory drugs on a mouse fracture model

A randomised, blinded, prospective animal study with 296 male C57BL/6N mice was performed to evaluate the biomechanical, biomolecular, biochemical, and histological impact of anti-inflammatory medications on fracture healing. A reproducible closed tibia fracture was created and stabilised with an intramedullary pin. Animals were randomised to placebo, ketorolac, ibuprofen, celecoxib, or rofecoxib treatment groups with biomechanical and biochemical testing at 4, 8, and 12 weeks. A second arm of the study was conducted in which animals were randomised to indomethacin or placebo treatment with biomechanical testing at 12 weeks. Histological and biomolecular studies were performed at 2 weeks on all groups in the first arm of the study. Biomechanical testing consisted of three-point bending evaluating maximum load, energy absorbed to maximum load, and stiffness. Safranin O-Fast Green stain was performed for histology. Biochemical quantifications of chondroitin and dermatan sulphate, hydroxyproline, total protein, and DNA content were performed. Osteocalcin and collagen types II and X were evaluated by in situ hybridisation. Some mechanical differences were seen between ketorolac and placebo at 4 weeks with respect to energy absorbed, but there were no differences in maximum load or stiffness seen between any treatment group and placebo at any time point. Indomethacin, celecoxib, rofecoxib, ibuprofen, and ketorolac did not significantly affect fracture healing in this young murine model.     

酮咯酸氨丁三醇预防瑞芬太尼全麻苏醒期疼痛及躁动临床效果观察

目的:观察酮咯酸氨丁三醇预防瑞芬太尼全麻苏醒期疼痛及躁动的临床效果。方法:选择40～60岁择期行腹腔镜胆囊手术患者100例,ASA I～II级,随机分为两组,每组50例,观察组手术结束前30min静脉滴注酮咯酸氨丁三醇30mg,对照组手术结束前30min静脉滴0.9%氯化钠1mL,观察两组患者自主呼吸恢复时间、苏醒时问、拔管时间以及拔管后15、30min疼痛评分和烦躁程度评级。结果:两组自主呼吸恢复时间、苏醒时间、拔管时间差异均无统计学意义(P>0.05);观察组拔管后15、30min疼痛评分及躁动程度评级明显低于对照组,差异有统计学意义(P均<0.01)。结论:酮咯酸氨丁三醇可以预防瑞芬太尼全麻苏醒期疼痛和躁动。     

Comparison of Pain-relieving Effects of Fentanyl versus Ketorolac after Eye Amputation Surgery

Purpose

To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery.

Methods

Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 µg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed.

Results

The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups).

Conclusions

Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.     

酮咯酸氨丁三醇注射液用于无痛胃镜超前镇痛的临床观察

目的 观察酮咯酸氨丁三醇注射液用于无痛胃镜检查超前镇痛的临床效果。方法 选择2010年10月—2011年10月保定市急救中心无痛胃镜检查患者120例,随机分为观察组和对照组,观察组60例,术前30 min im酮咯酸氨丁三醇注射液60 mg;对照组60例,术前未用任何镇痛药。比较两组患者术前、术中、术后的血压（SBP）、心率（HR）、血氧饱和度（SPO2）、睫毛反射消失时间、术中不适情况、术毕清醒时间、丙泊酚总用量。结果 观察组术中SBP和HR的波动小于对照组;观察组丙泊酚总用药量及术中不适发生例数均小于对照组;观察组睫毛反射消失时间及清醒时间较对照组缩短,以上指标两组比较差异均有显著性（P＜0.05）。结论 酮咯酸氨丁三醇注射液用于无痛胃镜超前镇痛检查效果满意,可降低术中不适的发生率,减少丙泊酚用量,缩短苏醒时间。     

酮咯酸预先镇痛联合罗哌卡因局部浸润用于腹腔镜胆囊切除术患者术后镇痛的效果

目的 探讨酮咯酸预先镇痛联合罗哌卡因局部浸润用于腹腔镜胆囊切除术患者术后镇痛的效果.方法 全凭静脉麻醉腹腔镜下胆囊切除术患者90例,随机分为3组（n=30）：生理盐水组（S组）、0.375％罗哌卡因组（L组）和0.375％罗哌卡因加酮咯酸组（T组）,各组均加舒芬太尼.其中T组于麻醉诱导前15 min静脉注射酮咯酸30 mg.观察术后镇痛效果与不良反应.结果 S组和L组苏醒时间显著短于T组（P＜0.05）.拔管后口述疼痛评分与VAS评分S组最高,L组次之,T组最低（P＜0.05）.S组要求辅助镇痛药者较其他两组多（P＜0.05）.结论 腹腔镜胆囊切除术患者,酮咯酸预先镇痛可优化罗哌卡因局部浸润麻醉的术后镇痛效果.     

卡前列素氨丁三醇治疗产后出血高危因素孕妇的疗效观察

目的：探讨了卡前列素氨丁三醇治疗产后出血高危因素孕妇的疗效观察。方法：回顾性分析我院2010年2月～2013年2月收治的80例产后出血高危因素剖宫产产妇的临床资料,随机分为对照组和观察组,观察组产妇在常规治疗的基础上给予宫体注射卡前列素氨丁三醇治疗,对照组产妇在常规治疗的基础上给予米索前列醇、垂体后叶素宫体注射治疗。结果：产后2h、4h出血量比较,观察组均显著低于对照组,差异有显著性意义(P<0.05);观察组产后出血发生率为12.5%,对照组产后出血发生率为31.91%,两组对比统计学有显著性差异(P<0.05);观察组止血时间显著低于对照组,差异有显著性意义(P<0.05);观察组输血患者2例(5%),输血患者10例(25%),观察组显著低于对照组,两组差异有显著性意义(P<0.05);观察组没有患者行子宫切除术,对照组有2例行子宫切除术,统计学均有显著性差异(P<0.05)。观察组不良反应3例,对照组2例。结论：预防性宫体注射卡前列素氨丁三醇在产后出血高危因素孕妇剖宫产术中能明显减少产后出血量,降低产后出血发生率和输血率,缩短止血时间,减少近远期并发症,值得临床推广。     

无痛肠镜检查中使用酮咯酸氨丁三醇的效果评价

目的：评价酮咯酸氨丁三醇联合丙泊酚静脉麻醉用于无痛肠镜检查的麻醉效果及安全性。方法：选择120例自愿实施无痛肠镜检查患者,随机分为两组,A组仅使用丙泊酚,B组先静脉滴注酮咯酸氨丁三醇30 mg,5 min后静脉推注丙泊酚。记录两组患者在不同时间点的平均动脉压（MAP）、心率（HR）、呼吸（RR）及血氧饱和度（SpO2）数值,比较两组患者的丙泊酚用量、手术时间、术中肢动、清醒时间、疼痛评分。结果：所有患者均顺利完成手术,两组术中的MAP、HR均较术前显著降低（P<0.05）,但两组间比较差异无统计学意义（P>0.05）。B组的丙泊酚用量、疼痛评分、麻醉效果显著优于A组（P<0.05）。两组手术时间、清醒时间比较差异无统计学意义（P>0.05）。结论：在无痛肠镜检查中联合应用酮咯酸氨丁三醇-丙泊酚能增强麻醉效果,不增加麻醉风险,术后腹痛减少,患者满意,是一种安全、有效的麻醉方法,值得在临床上推广应用。     

国产酮咯酸氨丁三醇分散片的人体相对生物利用度研究

目的评价酮咯酸氨丁三醇分散片剂的人体相对生物利用度,并与胶囊剂比较其生物等效性。方法 18名男性健康受试者随机、自身对照交叉单剂量口服酮咯酸氨丁三醇分散片和胶囊,采用RP-HPLC法测定血浆中酮咯酸氨丁三醇的浓度。结果单剂量口服含酮咯酸氨丁三醇20 mg的受试和参比制剂,其达峰时间Tmax分别为(0.68±0.30)、(0.80±0.38)h;血药浓度峰值Cmax分别为(3 124.44±382.96)、(3 170.28±289.03)ng/mL;药时曲线下面积AUC(0→24)分别为(13 939.32±2 471.53)、(14 312.29±2 268.26)ng.h/mL。两种制剂的药物动力学参数比较差异无统计学意义(P>0.05),受试制剂的相对生物利用度(F)为97.86%±11.62%。结论两种制剂具有生物等效性。     

酮咯酸氨丁三醇注射液急诊治疗肾绞痛的临床观察

目的探讨肌内注射酮咯酸氨丁三醇注射液急诊治疗肾绞痛的效果。方法将肾绞痛患者108例随机分为两组,观察组56组例,对照组52例,观察组采用酮咯酸氨丁三醇注射液30mg肌内注射;对照组强痛定50mg肌内注射。结果观察组的临床总有效率明显比对照组（P〈0．01）,起效及显效时间快差异有统计学意义（P〈0．01）,不良反应小。结论采用肌内注射酮咯酸氨丁三醇注射液能有效提高止痛效果,起效快,不良反应小,值得临床推广。