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11.
国产注射用盐酸瑞芬太尼有效性和安全性的评价 总被引:252,自引:4,他引:248
目的 采用随机、对照、双盲、多中心的Ⅱ期临床试验,评价国产注射用盐酸瑞芬太尼的有效性和安全性。方法201名受试者分成两组:对照组使用静脉芬太尼(2.5μkg诱导,0.03μg·kg-1·min-1维持)复合吸入66%氧化亚氮麻醉,试验组使用静脉瑞芬太尼(2μg/kg诱导,0.2μ·kg-1·min-1维持)复合吸入66%氧化亚氮麻醉。药物有效性的观察指标有:手术刺激时的应激反应,如血压、心率、流泪、麻醉质量。安全性的观察指标有:血压和心率、麻黄碱、阿托品、纳洛酮、乌拉地尔的使用量、手术失血量、心电图变化、术前和术后48 h内血中ALT、AST、肌酐、尿素氮、停止麻醉到可以拔除气管导管的时间、拔除气管导管前的PETCO2或PaCO2、停止麻醉(关闭氧化亚氮)后呼唤名字可以睁眼时间、术后送往麻醉恢复室或ICU情况以及不良事件。结果 瑞芬太尼与芬太尼在本试验剂量下,药效作用相似,但镇痛作用瑞芬太尼强于芬太尼,停止输注后其作用消退快于芬太尼。结论 国产瑞芬太尼用于全麻可产生良好的镇痛作用,且具有与芬太尼相同的安全性。 相似文献
12.
13.
目的观察舒芬太尼用于手外伤术后静脉镇痛(PCIA)的效果。方法急诊手外伤患者78例,随机分为I组(对照组)、II组(芬太尼组)和Ⅲ组(舒芬太尼组),每组26例。VAS评分法评估术后镇痛效果,进行术后镇静和恶心呕吐评分。结果与对照组比较,术后各时间点II组和Ⅲ组VAS评分均有显著差异(P〈0.01),II组在术后4h、24h、48h和Ⅲ组在术后各时间点的镇静评分有显著差异(P〈0.01),II组在术后8h的镇静评分有显著差异(P〈0.05);与II组比较,Ⅲ组术后8h和24h的VAS评分显著降低(P〈0.05),术后4h、12h和48hVAS评分均低于II组但差异无显著性意义,Ⅲ组术后各时间点镇静评分显著增高(P〈0.05)。Ⅲ组术后呕吐发生率明显低于II组,差异有显著性意义(P〈0.05)。结论舒芬太尼用于手外伤PCIA,镇痛确切,安全可靠,恶心呕吐发生率低于芬太尼且镇静作用强于芬太尼。 相似文献
14.
Takeshi Kubota Kazuyoshi Hirota Noriaki Otomo Tadanobu Yasuda Akimasa Miyata Asahei Maeda Hironori Ishihara Akitomo Matsuki 《Journal of anesthesia》1998,12(1):17-20
Purpose As the middle-ear cavity is one of the noncompliant gas-filled cavities, an increase in middle-ear pressure (MEP) instead
of volume expansion is observed with inhalation of nitrous oxide (N2O). Changes in MEP cause many complications, such as ear pain, temporary hearing impairment, and postoperative emesis. Therefore,
we investigated changes in MEP during total intravenous anesthesia (TIVA) with propofol, fentanyl, and ketamine (PFK) and
inhalation of N2O.
Methods Twelve patients were anesthetized with PFK until 60 min after the induction of anesthesia, and then N2O (60%) inhalation was started. MEP was measured by impedance audiometry (ranging from −300 daPa to +200 daPa) at 10-min intervals
during PFK, and at 2-min intervals after the inhalation of N2O.
Results MEP gradually but significantly increased from the preanesthetic value of 16±8 to 34±12 (SEM) daPa 50 min after the induction
of PFK. However, MEP did not exceed the normal limit. The values of MEP in all patients were more than 200 daPa within 36
min after the start of inhalation of N2O in oxygen.
Conclusion PFK had a minimal effect on MEP, whereas addition of N2O to PFK increased MEP dramatically. Therefore, TIVA, or at least PFK, would be a better choice for patients with middle-ear
or upper-airway diseases. 相似文献
15.
Cardiovascular depression occuring when diazepam is combined with fentanyl has been investigated using the benzodiazepine antagonist RO15-1788 in the dog.After the initial administration of fentanyl (40mcg/kg), the mean arterial pressure (MAP) decreased to 89% of its control value. Following the administration of diazepam (1.2mg/kg), the MAP and the total peripheral resistance (TPR) decreased significantly, to 75% and 83% of their control values respectively. After the administration of RO15-1788 (0.4mg/kg), the MAP increased significantly to 90% and the TPR to 102% of their control values and, lastly, the administration of naloxone (40mcg/kg) increased the MAP to 108% of its control value. No relationship was found between the changes in the catecholamines and the changes in the MAP after the administration of fentanyl, diazepam, and RO15-1788.The mechanism of circulatory depression when diazepam was used with fentanyl is interpreted as being a peripheral vasodilatory effect of diazepam acting by way of the benzodiazepine receptors since RO15-1788 was found to antagonize this effect.(Sone T, Kato T, Tsukahara I et al.: The effect of RO15-1788 on cardiovascular depression caused by fentanyl and diazepam. J Anesth 2: 69–76, 1988) 相似文献
16.
G. Barrier J. Attia M. N. Mayer Cl. Amiel-Tison S. M. Shnider 《Intensive care medicine》1989,15(Z1):S37-S39
We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 g/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature. 相似文献
17.
J. M. Maloteaux J. N. Octave E. C. Laterre P. M. Laduron 《Naunyn-Schmiedeberg's archives of pharmacology》1989,339(1-2):192-199
Summary There was stereospecific binding of 3H-lofentanil (K
D value = 1.53 nM) to membranes of neuroblastoma-glioma NG 108-15 cells which are known to bear high affinity binding sites for enkephalin derivatives (-opiate receptor subtype). There was no high affinity specific binding of the -opiate specific ligand 3H-sufentanil. The specific binding of 3H-lofentanil to -opiate receptor subtype was down-regulated (decrease in B
max value without change in the K
D value) after prolonged incubation of the cells in the presence of leu- and met- enkephalin (0.1 M). There was no down-regulation of the opiate receptors (3H-lofentanil and 3H-d-ala-d-leu-enkephalin specific binding) after incubation of NG 108-15 cells with drugs from the fentanyl series (alfentanil or sufentanil).In cultured neurones from rat forebrain (15 day old embryos), the 3H-lofentanil binding was specific with high affinity (K
D: 0.048 nM) and a slow dissociation rate similar to that in adult rat cortex. Drugs of the fentanyl series (4-anilino-piperidines) were potent displacers whereas agonists of the - (enkephalin derivatives), (phencyclidine, haloperidol, 3-hydroxyphenyl-propylpiperidine) or K- (U 50488) opiate sites had a low affinity (K
i > 0.5 M) for 3H-lofentanil specific binding sites. Since there was also specific binding of 3H-sufentanil, the opiate receptors in cultured neurones seem to be mainly of the -subtype and this is consistent with the ontogeny of opiate receptors subtypes. These receptors were down-regulated after incubation in the presence of etorphine, sufentanil and alfentanil but not enkephalin derivatives.These results strongly suggest specific binding of 3H-sufentanil and 3H-lofentanil mainly to the so-called -opiate receptors in cultured neurones and a specific binding of 3H-lofentanil to lower affinity -opiate receptors in neuroblastoma-glioma cells. The down-regulation of the -opiate binding sites in cultured neurones and that of the -site in neuroblastoma × glioma hybrid cells were dose-and temperature-dependent, induced by the corresponding high affinity agonists and prevented by naloxone. Morphine did not induce down-regulation of or receptor sites, possibly because of a partial antagonist effect on both receptor subtypes.
Send offprint requests to J. M. Maloteaux at the above address 相似文献
18.
目的:了解利多卡因混合芬太尼-潘库溴铵静脉局部麻醉能否降低利多卡因的剂量。方法:80例前臂和手部手术患者(ASAⅠ-Ⅱ级)分成二组,用0.6ml/kg的0.25%利多卡因(1.5mg/kg)混合1ug/kg芬太尼-0.5mg潘库溴铵或者0.5%利多卡因(3mg/kg)进行静脉局部麻醉。每5min1次,测量感觉和运动神经阻滞时间至手术开始,手术结束,松开止血带后,每5min1次,测量感觉和运动神经恢复时间;记录术后镇痛时间,结果:两组患者均取得满意的麻醉效果,两组间感觉和运动阻滞起效有明显差异,A组明显快于B组(P<0.05),松开止血带后,感觉和运动恢复时间,两组相比无明显差异(P>0.05),术后镇痛时间,两组间亦无明显差异(P>0.05),结论:25%利多卡因混合芬太尼-劣库溴铵具有0.5%利多卡因相同的静脉局部麻醉效果,可减少局麻药剂量和潜在系统毒性。 相似文献
19.
20.
目的 观察芬太尼对离体灌流心脏收缩力及心肌细胞钙离子移动的影响,研究其对心肌收缩力的作用。方法 (1) 以含不同浓度芬太尼的克汉二氏重碳酸盐缓冲液(KHB) 灌流大鼠心脏,测定心率(HR) 、左室收缩压(LVSP) 、左室舒张压(LVDP)、左室收缩压上升最大速率( + dp/dtmax)、左室舒张压下降最大速率( - dp/dtmax) ;(2) 用Fluo3AM 钙荧光指示剂染色急性分离的大鼠心肌细胞,在激光共聚焦显微镜下动态观察用药前和用不同浓度芬太尼后,KCl 诱发的细胞内钙离子浓度的变化。结果 1 ng/ml 和20 ng/ml 的芬太尼对心肌收缩力和心肌细胞钙离子移动的影响较小,心肌收缩力的各项指标和钙荧光强度与对照组相比,差异无显著性( P> 0.05) 。而200 ng/ml 芬太尼使心率减慢及+ dp/dtmax 、- dp/dtmax下降,且差异有显著性( P<0 .05) 。结论 芬太尼对心肌细胞钙离子的跨膜内流影响较小,而使心肌收缩力保持稳定。超临床使用浓度的芬太尼仍有抑制心肌的趋势。 相似文献