罗哌卡因联合舒芬太尼在剖宫产术后镇痛中的临床效果分析

目的：探讨罗哌卡因联合舒芬太尼在剖宫产术后镇痛中的临床疗效。方法方便选取2014年3月—2015年3月该院麻醉科收诊的剖宫产产妇60例,随机法分为观察组及对照组各30例,对照组术后给予罗哌卡因联合吗啡镇痛治疗,观察组术后给予罗哌卡因联合舒芬太尼镇痛治疗,记录并分析两组产妇镇痛效果。结果观察组术后2h、8h、12 h、24 hVAS评分分别为(1.98±0.81)分、(2.28±0.78)分、(1.66±0.67)分、(1.17±0.61)分,均低于对照组(3.51±1.07)分、(3.82±1.03)分、(3.24±0.95)分、(2.16±0.55)分,且差异具有统计学意义(P<0.05)；观察组术后肌力恢复正常时间和肛门排气时间分别为(7.28±1.16)h、18.49±1.71)h,均低于对照组(15.67±3.59)h、20.84±2.10)h,且差异有统计学意义(P<0.05)；③观察组产妇术后不良反应发生率为6.67%,显著低于对照组26.67%,且差异具有统计学意义(P<0.05)；结论罗哌卡因联合舒芬太尼在剖宫产术后镇痛中的效果优于罗哌卡因联合吗啡,不良反应低,能有效缓解孕妇术后疼痛。     

经皮电刺激联合导乐镇痛对分娩结局的影响及安全性分析

目的 探讨经皮电刺激联合导乐分娩镇痛对分娩结局的影响及安全性。方法 选择160例在我院住院待产的产妇作为研究对象,随机将其分为观察组与对照组,每组各80例;其中对照组予导乐分娩镇痛,观察组给予经皮电刺激联合导乐分娩镇痛。观察比较两组的VAS评分、产程时间、产后出血、剖宫产率、产妇满意度、新生儿情况、不良反应发生情况等。结果 与镇痛前比较,观察组镇痛后各时间段VAS评分降低,P＜0.05;与对照组比较,观察组的产后2 h出血量、剖宫产率降低,产妇满意度提高,P＜0.05。结论 经皮电刺激联合导乐镇痛可减轻产妇痛苦,降低剖宫产率,减少产后出血,提高产妇满意度,且无明显不良反应,值得在临床上推广应用。     

Dopaminergic transmission in the hypothalamic arcuate nucleus to produce acupuncture analgesia in correlation with the pituitary gland

Acupuncture analgesia (AA) caused by low frequency stimulation of the acupuncture point (AP) was abolished by hypophysectomy and adrenalectomy. Termination of the AA producing pathway from the AP to the pituitary gland was in the medial hypothalamic arcuate nucleus (M-HARN). The origin of the descending pain inhibitory system associated with AA was in the posterior HARN (P-HARN). AA in the hypophysectomized rats, and enhanced neuronal activity in the P-HARN that were abolished during acupuncture stimulation, were both restored by intraperitoneal microinjection of 0.5 mg/kg morphine or 0.1 micrograms beta-endorphin into the P-HARN during acupuncture stimulation. Of the analgesia produced by dopamine or beta-endorphin injected into the P-HARN, that caused by beta-endorphin disappeared after denervation of the M-HARN. The P-HARN neurons that responded to acupuncture stimulation also responded to iontophoretic dopamine, but not to iontophoretic morphine nor ultramicroinjected beta-endorphin. The transmission between the M-HARN and P-HARN may be dopaminergic, and beta-endorphin might presynaptically modulate this transmission. Reduction of sodium ions may have been the reason for abolition of AA after adrenalectomy.     

硬膜外高渗氯化钠溶液术后镇痛的临床双盲研究

为观察高渗盐水硬膜外注射术后镇痛效果,用双盲法对60例病人进行了研究。生理盐水对照级术后镇痛优良率为3.33％,镇痛有效率为10％,均需用镇痛药;高渗盐水组术后镇痛优良率为86.67％,有效率为96.67％,很少使用镇痛药。两组差别显著(P<0.05,P<0.01)。对其他感觉和运动功能无明显影响。高渗盐水组与吗啡组比较镇痛效果相同(P>0.05),副作用少(P<0.01)。说明硬膜外高渗氯化钠溶液是一种安全有效的镇痛方法,有较高推广应用价值。     

Incidence of BK with Tacrolimus Versus Cyclosporine and Impact of Preemptive Immunosuppression Reduction

Our purposes were to determine the incidence of BK viruria, viremia or nephropathy with tacrolimus (FK506) versus cyclosporine (CyA) and whether intensive monitoring and discontinuation of mycophenolate (MMF) or azathioprine (AZA), upon detection of BK viremia, could prevent BK nephropathy. We randomized 200 adult renal transplant recipients to FK506 (n = 134) or CyA (n = 66). Urine and blood were collected weekly for 16 weeks and at months 5, 6, 9 and 12 and analyzed for BK by polymerase chain reaction (PCR). By 1 year, 70 patients (35%) developed viruria and 23 (11.5%) viremia; neither were affected independently by FK506, CyA, MMF or AZA. Viruria was highest with FK506-MMF (46%) and lowest with CyA-MMF (13%), p = 0.005. Viruria >/= 9.5 log(10) copies/mL was associated with a 3-fold increased risk of viremia and a 13-fold increased risk of sustained viremia. After reduction of immunosuppression, viremia resolved in 95%, without increased acute rejection, allograft dysfunction or graft loss. No BK nephropathy was observed. Choice of calcineurin inhibitor or adjuvant immunosuppression, independently, did not affect BK viruria or viremia. Viruria was highest with FK506-MMF and lowest with CyA-MMF. Monitoring and preemptive withdrawal of immunosuppression were associated with resolution of viremia and absence of BK nephropathy without acute rejection or graft loss.     

腰麻硬膜外联合麻醉在全产程中的镇痛效果及对母婴的影响

①目的　探讨腰麻硬膜外联合麻醉在全产程中的镇痛效果以及对母婴的影响。②方法　选择ASAⅠ～Ⅱ级、无禁忌证的单胎头位临产初产妇 30 0例 ,随机分为腰硬组 (腰麻硬膜外联合麻醉 )、硬外组 (硬膜外麻醉 )和对照组 (未用任何麻醉方法 )各 10 0例。行L2～ 3 椎间隙一点穿刺并一次成功。分别观察镇痛效果、起效时间、用药量、副作用、产程、分娩方式及母婴情况。③结果　腰硬组镇痛效果、起效时间以及用药量明显优于硬外组(uc=5 .34,t=16 .92～ 2 9.6 9,P <0 .0 1) ;与对照组比较 ,宫颈扩张加速 ,第一产程明显缩短 ,而第二产程延长 (t =3.34～ 4 8.4 9,P <0 .0 1) ,剖宫产率明显下降 ,而阴道助产率增高 ,胎儿宫内窘迫的发生率下降 (χ2 =6 .82～ 2 0 .35 ,P <0 .0 1)。④结论　腰麻硬膜外联合麻醉用于分娩镇痛优于硬膜外麻醉 ,是一种安全有效、更适合全产程镇痛的麻醉方法。     

左旋布比卡因复合舒芬太尼或芬太尼在分娩硬膜外自控镇痛的应用

目的探讨左旋布比卡因复合舒芬太尼硬膜外自控镇痛（PCEA）用于分娩镇痛的临床效果及安全性。方法随机选择120例美国标准协会（ASA）I-Ⅱ级初产妇，随机分为舒芬太尼组（A组）、芬太尼组（B组）、无镇痛组（C组），每组40例。A组和B组采用PCEA，C组不给予镇痛药物。观察各组不同时段视觉模拟评分（VAS）和不良反应的发生，同时记录3组产程时间、分娩方式、缩宫使用情况、产后出血量、新生儿Apgar评分。结果A、B2组和C组在PCEA20、60min及宫口开全时VAS差异有统计学意义（P〈0.05）；PCEA5min，A、B2组VAS差异有统计学意义（P〈0.05），2组Bromage评分、不良反应差异无统计学意义（P〉0.05）。3组产程时间、分娩方式、产后出血量、新生儿Apgar评分比较差异均无统计学意义（P〉0.05）。结论左旋布比卡因复合舒芬太尼或芬太尼用于分娩镇痛安全有效，对母婴无明显不良影响。     

气管内硬膜外联合麻醉下的超前镇痛

目的研究气管内硬膜外联合麻醉下,硬膜外给药时间不同、全麻诱导药物不同对术后镇痛产生的影响。方法开腹行切除肝癌、胃癌的病人120例,随机分为A、B、C、D4组,每组30例。A组:在T8-9经硬膜外注入1%利多卡因和0.25%布比卡因混合液6～8ml,再经硬膜外注入含吗啡2mg、氟哌利多2.5mg的生理盐水10ml;全身麻醉诱导药物为芬太尼3μg·kg-1,异丙酚1～1.5mg·kg-1,琥珀胆碱2mg·kg-1。B组:诱导药物中不使用芬太尼,用利多卡因1～1.5mg·kg-1代替,术中也不使用芬太尼,其余条件同A组。C组:在T8-9行硬膜外穿刺,之后行全身麻醉诱导,诱导药物为芬太尼3μg·kg-1,异丙酚2～2.5mg·kg-1,琥珀胆碱2mg·kg-1,必要时可加芬太尼2～3μg·kg-1。切皮后90min,经硬膜外注入1%利多卡因和0.25%布比卡因6～8ml,再经硬膜外注入含吗啡2mg、氟哌利多2.5mg的生理盐水10ml。D组:诱导药物中不使用芬太尼,用利多卡因1～1.5mg·kg-1代替,术中也不使用芬太尼,其余条件同C组。分别于术毕后4、8、24、48h观测VAS、镇痛药消耗量、恶心、呕吐、骚痒等指标。结果A组的药物消耗量最少、镇痛效果最好;B组和C组次之;D组的药物消耗量最大,镇痛效果最差。结论硬膜外复合气管内麻醉时,硬膜外麻醉与芬太尼同时使用,术后镇痛效果最好。     

术后镇痛10年后的质量控制探讨：1168例回顾性研究

目的 了解术后镇痛的现状，探讨术后镇痛的质量控制问题。方法 回顾近3个月1168例术后镇痛所采用的镇痛方法和预防术后恶心呕吐的方法，了解镇痛效果和副作用的发生情况，并分析影响镇痛效果和副作用发生率的有关因素，患者的满意度情况。结果 90％采用了连续硬膜外镇痛法，配方主要是小剂量吗啡复合低浓度布比卡因或罗比卡因，静脉镇痛主要采用吗啡复合氯诺昔康。预防术后恶心呕吐（PONV）的方法有5-HT3受体拮抗剂（昂丹司琼或阿扎司琼），氟哌啶，地塞米松等，单用或复合应用。连续硬膜外镇痛需要补救镇痛者约5％，静脉镇痛补救镇痛者约10％。PONV总体发生率低，妇科开腹手术低至20％，女性非妇科手术低至10％，剖宫产术低至1％，使用氟哌啶使妇科手术PONV降低约50％。1例高龄患者出现血氧饱和度下降至82％，经停药、吸氧等处理好转。硬膜外导管脱落0．5％。瘙痒、头晕等并发症小于5％。通过补救镇痛，及时处理并发症，患者满意度在90％以上。结论 硬膜外镇痛方法效果优于静脉镇痛方法，适度镇痛，减少镇痛药量，增加安全性，重视PONV的预防，及时处理镇痛不足和副作用，从而提高患者的满意度，是术后镇痛质量控制的可行的理念和方法。     

Post-surgical pain relief with zero-order intravenous infusions of meptazinol and morphine: a double-blind placebo-controlled evaluation of their effects on ventilation

Summary A double-blind, placebo-controlled study has been made of the analgesic and respiratory effects of constant rate infusions of meptazinol and morphine in 30 patients after abdominal surgery. Group I received meptazinol, loading dose 50 mg followed by i.v. infusion 0.5 mg · kg⁻¹ · h⁻¹, Group II received morphine, loading dose 5 mg and then an infusion of 0.05 mg · kg⁻¹ · h⁻¹, and Group III received saline. After recovery from inhalation anaesthesia (without opiates or a local anaesthetic) pain relief and chemoreceptor carbon dioxide tolerance were assessed before and at various times after starting the analgesic infusion. A similar degree of pain relief was found after 10 min in Groups I and II, which lasted until the end of observation period (20 h). Heart rate and systolic and diastolic blood pressures were lower in Group II than in Groups I and III, and respiratory rate fell in Groups I and II. After 6 h arterial carbon dioxide tensions (P_aCO₂) became significantly higher in Group II than Group III. The maximum percentage fall in mean tidal volume (V_T) and expired minute volume (0V_E) from the preinjection values was significant in Groups I and II. End-tidal carbon-dioxide (P_ETCO₂) and P_aCO₂ were significantly higher after 20 h of infusion in Group II compared to Group I. The slope of 0V_E/P_ETCO₂ (<S>) was increased in Group I and it was significantly reduced in Group II. Analysis of derived variables, such as the CO₂ intercept (CO₂I) and minute ventilation at 7 kPa (0V_E7), indicated a shift to the right of the slopes in Groups I and II, initially more so in Group I. It is concluded that constant rate infusions of meptazinol and morphine were effective in providing postoperative pain relief. However, their effects on the central regulation of respiration were different, as meptazinol did not impair CO₂ sensitivity whereas morphine did.