全麻复合硬膜外麻醉患者林格氏溶液的容量动力学

目的 通过确定全麻复合硬膜外时麻醉林格氏溶液的容量动力学模型参数，评价硬膜外复合全麻对晶体液扩容效应的影响。方法择期行肝癌切除术患者20例，随机分为2组：组Ⅰ麻醉诱导前行扩容治疗，组Ⅱ硬膜外复合全麻诱导后行扩容治疗。扩容采用30ml／kg乳酸钠林格氏溶液（LR）恒速输注，30min内输完，输注LR开始后90min内每5min测定血红蛋白（Hb）及红细胞压积（Hct），并记录总尿量及血液动力学数据。用容量动力学数学模型和物质守恒定律处理数据，获得结果。结果 组Ⅱ容量增加量、容量扩张效率、输注结束时液体保留率均高于组Ⅰ（P〈0．05）。一级容量动力学分析结果：组Ⅰ目标容积（V）和清除率（k1）均大于组Ⅱ（P〈0．05）。二级容量动力学分析结果：组Ⅱ的V1、k1、k1均高于组Ⅱ（P〈0．05）。扩容后组Ⅱ的平均动脉压、中心静脉压、心输出量均小于组Ⅰ（P〈0．05）。结论 全麻复合硬膜外麻醉可提高晶体液的容量扩张效率。     

术中输注氨基酸对硬膜外阻滞复合全麻开胸手术患者围术期体温的影响

目的评价术中输注氨基酸对硬膜外阻滞复合全麻食管癌和贲门癌手术患者围术期深部体温和代谢的影响。方法择期食管癌和贲门癌手术患者21例,ASAⅠ或Ⅱ级,随机分为3组(n =7):从麻醉诱导开始至手术结束,分别静脉输注氨基酸混合液240kJ·h-1(AA组)、等容量乳酸钠林格氏液(LR组)、葡萄糖溶液240kJ·h-1(GLU组)。麻醉诱导前至术后2h每5分钟测定鼓膜温度,于麻醉诱导前即刻、手术开始后1h和术后1h检测指尖血糖,采用4分表法评价术后2h内寒战的发生情况,采用间接测热仪测定术前与术后氧耗。结果与麻醉诱导前即刻比较,术后30min LR组和GLU组氧耗降低,AA组氧耗升高(P<0.01),术后2h LR组、GLU组鼓膜温度降低(P<0.05),AA组差异无统计学意义(P>0.05);与LR组和GLU组比较,AA组术后2h内寒战发生例数减少(P< 0.05),术后30min氧耗增多(P<0.05),LR组与GLU组比较差异无统计学意义(P>0.05)。结论硬膜外阻滞复合全麻开胸手术患者术中静脉输注氨基酸可通过提高基础代谢率,缓解围术期深部体温降低,减少术后寒战发生,而输注葡萄糖不产生此效应。     

青黛颗粒抗炎、镇痛作用的实验研究

目的 :通过对青黛颗粒抗炎、镇痛作用的实验研究 ,探讨该药治疗溃疡性结肠炎的作用机理。方法 :采用小鼠醋酸扭体法、大鼠棉球肉芽肿法和角叉菜胶所致大鼠足肿胀方法。结果 :青黛颗粒给药高、中、低剂量组和阳性对照药组均明显降低小鼠扭体次数 (P<0 .0 5～P<0 .0 1)。对大鼠棉球肉芽肿和大鼠足肿胀有显著的抑制作用 (P <0 .0 1～P <0 .0 0 1)。结论 :青黛颗粒分别对大鼠具有抗炎、对小鼠具有镇痛作用。且镇痛作用呈量效关系     

Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients

OBJECTIVES: Studies of emergency department (ED) pain management in patients with trauma have been mostly restricted to patients with fractures, yet the potential for undertreatment of more severely injured patients is great. The authors sought to identify factors associated with failure to receive ED opioid administration in patients with acute trauma who subsequently required hospitalization. METHODS: At an urban Level 1 trauma center and teaching hospital, a retrospective cohort study of trauma team activation patients requiring hospitalization between January 1 and December 31, 1999, was conducted. The authors excluded patients receiving opioids only within ten minutes of chest tube insertion or fracture manipulation. The main outcome measure was ED opioid administration. RESULTS: A total of 540 charts of hospitalized first-tier trauma team activation patients were reviewed. A total of 258 (47.8%) received intravenous opioid analgesia within three hours of ED arrival. The median time to receiving the first dose of opioids was 95 minutes. Patients were independently less likely to receive opioids if they were younger or older, were intubated, had a lower Revised Trauma Score, or did not require fracture manipulation. Patients with these factors were less likely to receive opioids independent of the amount of time they spent in the ED. CONCLUSIONS: Many trauma activation patients requiring hospitalization do not receive opioid analgesia in the ED. Patients at particular risk for oligoanalgesia include those who are younger or older and those who are more seriously injured, as defined by a lower Revised Trauma Score, lower Glasgow Coma Scale score, and intubation.     

产程中应用杜冷丁对产程及新生儿的影响

目的　观察杜冷丁对产程及新生儿的影响。方法　将 16 0例初产妇随机分为观察组和对照组 ,各 80例 ,观察组在宫口开大 1.2cm时杜冷丁 10 0mg肌肉注射 ,对照组未用药。结果　第一产程用药组与对照组相比明显缩短 ,有显著差异 (P <0 .0 5 ) ,第二、三产程无差异 (P >0 .0 5 ) ,对新生儿影响、产后 2小时内出血量及新生儿体重两组无差异 (P >0 .0 5 )。结论　产程中应用杜冷丁可减轻产妇疼痛 ,缩短第一产程 ,不增加新生儿窒息 ,值得推广应用     

脐带缠绕的临床护理

目的总结脐带缠绕的临床护理体会。方法通过对129例脐带缠绕患者的临床观察，根据病情辩证地提出施扣要点，给予整体护理。结果129例（占同期分娩602例的21．4％）脐带缠绕患者中初产妇104例（80．6％），经产妇25例（19．4％）；经产妇脐带缠绕发生率36．2％（25／69）较初产妇19．5％（104／533）显著增高p〈0．01（u=3．183）；结论对患者临产前、临产中、临产后的各阶段应进行细致临床观察和针对性护理，根据患者的个体特点进行针对性护理是获得满意效果的重要因素。     

Repeated unilateral epidural blockade

Unilateral epidural analgesia occurring in a parturient three times in successive pregnancies is reported. Possible causes are reviewed, and clinical and radiological evidence in support of the most likely explanation are presented.     

蛛网膜下腔注入小剂量吗啡术后镇痛与PCEA比较研究

目的 :探讨蛛网膜下腔小剂量吗啡术后镇痛的临床效果并与 PCEA相比较。方法 :将 ASA I～II级 6 0例妇科择期手术患者 ,随机分为两组 ,每组 30例。实验组采用腰麻 ,局麻药为 0 .75 %布比卡因 10～ 15 m g加入吗啡 0 .5 mg。对照组采用腰麻复合 PCEA,局麻药 0 .75 %布比卡因 10～ 15 mg,术后 PCEA。术后镇痛效果以视觉模拟评分 (VAS)、Ram say镇静评分、BCS舒适评分、成功率、不良反应并结合医疗费用比进行评价。结果 :VAS评分两组在 4、8、36 h时段无显著性差异 (P>0 .0 5 ) ;实验组在 12、2 4 h镇痛效果优于对照组 ,4 8、5 4 h对照组优于实验组。 BCS舒适评分、Ram say镇静评分两组间无显著性差异。结论 :蛛网膜下腔注入小剂量的吗啡用于术后镇痛的效果并不亚于 PCEA,如采用医疗费用与治疗效果比 ,更优于后者     

The influence of epidural administration of fentanyl infusion on gastric emptying in labour

The effect of epidural infusions containing fentanyl on maternal gastric emptying in labour was examined using the rate of paracetamol absorption. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with fentanyl 2.5 μgml⁻¹ at a rate of 10–12 mlh⁻¹. Paracetamol 1.5 g was given orally to women after either 30 ml of the infusion solution had been given (mean time 2.5 h, study A) or 40–50 ml (mean time 4.5 h, study B). Six venous blood samples were taken over the next 90 min for measurement of plasma paracetamol concentration. There were no significant differences in maximum plasma paracetamol concentration, time to maximum paracetamol concentration and area under the concentration–time curve between the two groups for study A. In study B the time to maximum plasma paracetamol concentration was significantly delayed in women receiving > 100 μg fentanyl compared with controls (p < 0.05). We conclude that the dose of fentanyl that may delay gastric emptying when given by epidural infusion is greater than 100 μg.