香烟烟雾引起的豚鼠肺气道炎性反应以及低剂量哌替啶的抑制作用

目的观察豚鼠2h内吸入香烟烟雾360ml后引起肺气道急性损伤的迟后反应以及低剂量哌替啶对该迟后反应的抑制作用及机制。方法模型制作：豚鼠经自主吸烟装置吸入75％浓度香烟烟雾60ml，间隔20min，重复吸烟共6次。将豚鼠分为对照组、实验组（分别以0．01、01、1mg·kg^-1哌替啶进行干预）及纳洛酮拮抗组（首次剂量0．4mg·kg^-1，重复剂量0.2mg·kg^-1），观察各组豚鼠肺气道微血管通透性和肺机械功能的变化，检测肺组织内一氧化氮浓度及一氧化氮合酶活性。结果豚鼠吸烟2h后，气道和肺实质的微血管通透性增加，气道阻力增加以及肺顺应性降低。低剂量哌替啶可以明显抑制香烟烟雾引起的肺气道血管通透性增加，尤以01mg·kg^-1抑制作用最为明显；而预先给予纳洛酮阻断阿片受体，01mg·kg^-1哌替啶的抑制作用几乎消失。吸烟前10min给予0.01、0．1、1mg·kg^-1的哌替啶，可不同程度的抑制吸烟所致的气道阻力增加和肺顺应性降低（P〈0.05或0．01）；而预先给予纳洛酮阻断阿片受体，0．1mg·kg^-1哌替啶的抑制作用几乎消失。结论低剂量哌替啶能有效减轻豚鼠2h内吸入香烟烟雾360ml后所引起的神经源性的肺气道急性炎性反应。     

异丙酚辅助下腹部手术硬膜外麻醉的临床观察

目的：比较硬膜外辅助用药的作用。方法：３０例病人随机分为三组,每组１０例。麻醉完善后,组Ⅰ,先静注异丙酚０８ｍｇ／ｋｇ,继之用微泵持续输注２ｍｇ·ｋｇ－１·ｈ－１;组Ⅱ,静注安定５ｍｇ,继之微泵持续输注异丙酚２ｍｇ·ｋｇ－１·ｈ－１。组Ⅲ,给予哌替啶５０ｍｇ、氟哌啶２５ｍｇ静注。结果：异丙酚组在用药后５ｍｉｎ呼吸抑制明显,１０ｍｉｎ后渐正常;组Ⅲ在１０至３０ｍｉｎ之间表现较强的呼吸抑制。组Ⅰ在用药后５至１０ｍｉｎ血压降低明显。组Ⅰ、Ⅱ病人ＶＡＳ优良率达９０％,组Ⅲ仅为４０％。结论：以安定５ｍｇ加异丙酚２ｍｇ·ｋｇ－１·ｈ－１辅助硬膜外麻醉具有诱导与维持平稳舒适、对循环呼吸功能影响轻微、术后恢复好、抗呕吐作用强等优点     

我院门急诊麻醉性镇痛药用药分析

目的:分析我院2001年～2003年门急诊麻醉性镇痛药使用情况,为临床合理用药提供参考。方法:统计3年中门急诊麻醉性镇痛药处方,对处方的一般情况、药品用量、肿瘤患者用量、药品的使用频度进行分析。结果:硫酸吗啡控释片和哌替啶注射液在肿瘤患者中的用量远高于非肿瘤患者,2003年哌替啶注射液的使用频度出现明显下降。结论:应合理使用麻醉性镇痛药,减少肿瘤患者哌替啶的使用。     

度非合剂镇痛在膈顶部肝癌射频消融术中的应用

目的探讨度非合剂镇痛在射频消融（RFA）治疗膈顶部肝癌的应用价值。方法应用度非合剂作为主要镇痛方案进行射频消融治疗38个膈顶部肝癌。结果所有患者均能完成全程治疗,无因为疼痛导致治疗中止的案例发生,穿刺时患者均能配合闭气,病灶刺中率100%,无严重并发症。结论度非合剂镇痛在射频消融治疗膈顶部肝癌中效果满意,值得进一步的研究和总结。     

CLINICAL STUDY OF ACUPUNCTURE-DRUG COMBINED ANESTHESIA FOR ANTERIOR APPROACH CERVICAL DISCECTOMY

The study compared the anesthetic effects between acupuncture-drug combined anes-thesia and local anesthetic-drug combined anesthesia for anterior approach cervical discectomy. Theresults demostrated that the analgesic effects have no difference between these two groups. Theacupuncture-drug combined anesthesia group had less postoperative complication, sooner recovery andbetter social and economic benefits. The method is worth using widely in clinical practice.     

Is intra-articular pethidine an alternative to local anaesthetics in arthroscopy?

We investigated the per- and postoperative pain-reducing effect of pethidine given intra-articularly (i. art.). Thirty patients subjected to knee joint arthroscopy, diagnostic and surgical procedures, were randomly assigned to one of three groups. Group A consisted of ten patients who received 250 mg prilocaine +200 g adrenaline (i. art.) in a volume of 50 ml, group B of ten patients who received 200 mg pethidine (i. art.) in 50 ml saline, and group C of ten patients who received 200 mg pethidine +200 g adrenaline (i. art.) in 50 ml saline. During arthroscopy the patients reported on pain intensity and discomfort using visual analogue scales. Ratings were low and did not differ significantly between the three groups. Two of three patients in each group requested additional analgesics or sedatives due to pain and discomfort, but again with no difference between the three groups. Postoperatively all patients rated their pain intensity at rest and during movement (at 0, 1, 2, 3, 4, 5, 6, 12 and 24 h). The patients receiving pethidine (group B) reported significantly less pain at rest and movement than group A patients, in general at 1–4 h postoperatively. A significant difference was detected between groups B and C at 4 h postoperatively. Calculating the total sum of pain scores, patients receiving pethidine (group B) reported significantly less pain both at rest and during movement than those receiving prilocaine (group A). Furthermore, patients in group B used significantly less analgesics than those in group A. Adrenaline did not potentiate the effect of pethidine. Reported side effects were mild and did not require clinical action. The present study provides evidence for pethidine as a potential alternative to prilocaine in arthroscopy using local anaesthetic techniques.     

不同药物用于病人自控镇静的疗效

目的 比较四种不同药物配方用于下腹部或下肢手术硬膜外麻醉中病人自控镇静（PCS）的临床效果。方法 60例下腹部或下肢择期手术病人随机分为四组,每组15例,分别接受丙泊酚（每次10mg,P组）、咪唑安定（每次1mg,M组）、D＋P（每次哌替啶12.5mg 异丙嗪6．25mg,D组）、Innovor（每次氟哌利多1．25mg 芬太尼0．025mg,I组）行PCS,观察生命体征、镇静效果、用药情况及副反应。结果 四组病人中,镇静程度满意的（镇静评分2－4分）,P组为100％（15／15）,M组为93．3％（14／15）,D组及I组均为100％（15／15）,各组间无显著差异（P＞0．05）。病人术中合作、术后满意,无明显副作用。四组病人使用PCS 5分钟后,BP、HR及焦虑程度均有所下降。P组的起效时间最短、清醒过程最快,而D组和I组清醒所需时间较长。M组病人存在着明显的药物顺行性遗忘作用。结论 PCS是一种合理有效的镇静方法。本研究病例的98．3％可通过PCS达到临床理想的镇静效果。其中,丙泊酚镇静效果好,恢复迅速,最适合用于PCS。而对于防止术中知晓方面,咪唑安定是较为理想的选择。虽然本研究中D＋P和Innovor用于术中PCS效果亦尚属满意,但可能引起病人镇静恢复时间延迟。     

Determination of pethidine in rabbit plasma by capillary gas chromatography

A simple and fast gas chromatographic method for the determination of pethidine hydrochloride in rabbit plasma is described and validated. This method is an improvement on the GC method which uses a glass column, and was described previously by Koska et al. [Anaesth. Analg. 60 (1981) 8]. The samples were analysed by a GC 5890 HP system using Rtx-5, fused-silica capillary column linked to a nitrogen-phosphorus ionization detector. Lidocaine hydrochloride was used as the internal standard. Calibration curves were linear within the range 5-200 ng/ml. The limit of quantification was about 5 ng using a 1-ml biological sample and no interference was observed in the blank plasma. The mean recovery of the drug from plasma samples was 95.71+/-2.82%. This procedure turned out to be sensitive and convenient enough for the use in pharmacokinetic studies of pethidine.     

Comparative study of the efficacy of dipyrone,diclofenac sodium and pethidine in acute renal colic

Summary A randomized, double-blind, multicentre clinical trial was designed to compared the analgesic efficacy of i.m. dipyrone 1 and 2 g, i.m. diclofenac sodium and i.m. pethidine in acute renal colic. The study was carried out in 451 patients in 13 Spanish hospitals. Ureteric colic was diagnosed by the clinical features, urinalysis, or when the presence of a ureteric calculus was confirmed. The severity of pain was assessed by the physicians and by patients using visual analogue scales. The main parameter of drug efficacy was the need for rescue treatment-pethidine 100 mg i.m. 30 min after the experimental treatment. Rescue treatment was required in 93 patients: they represented 24.1% of the group given dipyrone 1 g; 22.3% of those on dipyrone 2 g; 16.4% of those given diclofenac sodium; and 19.5% of those on pethidine.The differences between the groups were not significant. In the remaining 358 patients, no difference between treatments was observed.The results suggest that in acute renal colic the use of dipyrone 2 g is unjustified as dipyrone 1 g is equally effective. Diclofenac sodium is a valid alternative, which shows similar analgesic efficacy. Coordinating Centre: García-Alonso F., González de Suso M.J., López-Alvarez M., and Palop R. (Dirección General de Farmacia y Productos Sanitarios). Participating Centres: Lucena M.I., Marín R. and Sánchez de la Cuesta F. (Hospital Provincial, Málaga); Miralles R. and Torné J. (Hospital del Mar, Barcelona); Vargas E. and Moreno A. (Hospital Clínico, Madrid); Hernández G. and Santamaría J. (Hospital Clínico, Valencia); Valiente R. and Arellano F. (Hospital Marqués de Valdecilla, Santander); Palou J.A. and Carné X. (Hospital Valle de Hebrón, Barcelona); Martínez-Piñeiro J.A. and Frías J. (Hospital La Paz, Madrid); Pérez-Mateo M. and Horga J.F. (Residencia Sanitaria, Elche); Fernández M.C. (Hospital Torrecárdenas, Almería); Boada N. (Hospital General, Tenerife); Lloret J. (Hospital Santa Cruz y San Pablo, Barcelona); Jiménez J. and Puche E. (Hospital Clínico, Granada); Hevia A. and Serrano J.S. (Hospital Clínico, Sevilla). Steering committee: Arnau J.M., Camí J., García-Alonso F., Laporte J.R., and Palop R.     

曲马多和哌替啶防治硬膜外麻醉期间寒战反应的效果观察

目的观察曲马多和哌替啶在预防硬膜外麻醉期间寒战反应的临床表现。方法75例硬膜外麻醉随机分成3组:其中(A组)对照组25例;硬膜外麻醉后分别给予哌替啶0.5mg/kg(B组)、曲马多0.5mg/kg(C组)各25例,将随后发生寒战的结果进行比较。结果B组及C组发生寒战率显著降低,与A组相比差异呈显著性,而B组与C组之间无显著差异。结论曲马多与哌替啶均可有效预防硬膜外麻醉后寒战发生,而与哌替啶相比,曲马多更安全。