通络胶囊治疗偏头痛的临床与实验研究

认为正气不足、病理体质为偏头痛的发病基础 ,以气血失调为主 ,寒热虚实错杂是本病的基本病机。据此确立扶正固本、祛风活络、化瘀止痛的治疗原则 ,拟通络胶囊治疗偏头痛 30例 ,与太极通天液治疗 30例对照 ,结果表明 ,治疗组愈显率 83.33% ,总有效率 93.33% ,与对照组相比有显著性差别 (P<0 .0 1) ,在改善兼症方面亦优于对照组 (P<0 .0 5或 P<0 .0 1) ,并能改善患者颅内血管功能状态。动物实验表明 ,通络胶囊能提高实验动物痛阈 ,同时提高大鼠下丘脑 5 - HT及 β-内啡呔水平 ,并能改善大鼠软脑膜微循环。     

细胞因子在清肝化瘀汤治疗慢性粒细胞性白血病中的研究

目的观察中药清肝化瘀汤治疗慢性粒细胞性白血病(慢性期)的疗效,并探讨细胞因子水平变化的意义。方法收集45例慢性粒细胞性白血病慢性期患者(治疗组),用清肝化瘀汤治疗,观察患者的临床疗效、细胞因子水平。另用20名正常人作为对照(对照组)。结果治疗组完全缓解率40％,部分缓解率46.7％,总有效率86.7％。治疗组细胞因子水平中白介素2、可溶性白介素2受体、肿瘤坏死因子a治疗前后有显著差异(P<0.05);干扰素γ水平变化无显著差异。且与正常对照组比较无显著差异(P>0.05)。结论清肝化瘀汤有清热泻肝解毒、活血化瘀消癥的功效,研究结果显示,该药对慢性粒细胞性白血病慢性期(肝热血瘀型)疗效确切,其作用机理可能与改善细胞因子水平有关。     

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study

Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (S_pO₂ < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m⁻²); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94–1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.     

Nerve Conduction Studies in Surgical Cubital Tunnel Syndrome Patients

Background: Electrodiagnostic studies (EDX) serve a prominent role in the diagnostic workup of cubital tunnel syndrome (CBTS), but their reported sensitivity varies widely. The goals of our study were to determine the sensitivity of EDX in a cohort of patients who responded well to surgical cubital tunnel release (CBTR), and whether the implementation of the Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) criteria improves the sensitivity. Methods: We identified 118 elbows with clinical CBTS who had preoperative EDX and underwent CBTR. The EDX diagnoses were CBTS, ulnar neuropathy (UN), and normal ulnar nerves. We divided the 118 elbows into those that received above-elbow stimulation (XE group) and those that did not (non-XE group). We calculated the sensitivities for all groups and reinterpreted the results according to the AANEM guidelines. Results: Cubital tunnel release provided significant relief in 93.6% of the elbows. Based on the EDX reports, 11% patients had clear CBTS, 23% had UN, and 66% showed no UN. The sensitivities were 11.7% for CBTS and 34.2% for any UN. In the XE group, the sensitivity of the EDX reports for CBTS and UN climbed to 33.3% and 58.3%, respectively. When we calculated the across-elbow motor nerve conduction velocity, the sensitivity for CBTS and UN was 87.5% and 100%, respectively. The XE and non-XE groups showed no difference except for sex, bilaterality, concomitant carpal tunnel release, and obesity (P < .05). Conclusion: Implementing AANEM guidelines results in significant improvement in correlation of clinical and electrodiagnostic findings of CBTS.