不同剂量丙泊酚持续静注对心内直视手术病人肌钙蛋白Ⅰ的影响

目的　观察不同剂量丙泊酚对心内直视术病人肌钙蛋白 Ⅰ (CTn Ⅰ )的影响 ,寻求丙泊酚抑制心肌缺血再灌注损伤作用合适的剂量。方法　 2 7例心内直视手术患者随机分成A、B、C三组。咪唑安定、丙泊酚、维库溴铵、芬太尼诱导后 ,用微量泵持续输注丙泊酚 ,A组 2mg·kg-1·h-1、B组 5mg·kg-1·h-1、C组 8mg·kg-1·h-1。用化学发光法测定诱导后、停心肺转流 (CPB)即刻、CPB后30、6 0分钟和CPB后 3小时动脉血CTn Ⅰ浓度。结果　三组病人CPB后CTn Ⅰ均显著升高 (P <0 0 1)。组间比较 ,B组CPB后CTn Ⅰ值比A组低 (P <0 0 5和P <0 0 1)。C组和A组间CTn Ⅰ值无统计学差异。结论　心脏手术术中及术后CTn Ⅰ升高提示心肌存在不同程度损伤。术中 5mg·kg-1·h-1丙泊酚持续静注是较为理想的具有心肌保护作用的临床用药剂量     

针刀枢椎棘突松解术对椎动脉型颈椎病疗效评价

目的:探求针刀枢椎棘突松解术对椎动脉型颈椎病的临床疗效。方法:将87例患者随机分为A、B组,A组43例采用针灸治疗;B组44例采用单纯针刀枢椎棘突松解术治疗。结果:A组治愈率60.47%,B组81.82%,两组比较(P0.05)的差异有统计学意义。B组治疗前后,对椎动脉(V A)和基底动脉(B A)进行检测,其收缩峰期血流速度(V P)、舒张末期血流速度(V m)显著上升,博动指数(PI)、阻力指数(RI)显著下降,差异具有统计学意义(P0.05或P0.01)。结论:针刀枢椎棘突松解术对椎动脉型颈椎病患者有确切疗效,值得临床推广。     

Intravenous lidocaine simultaneously infused with sufentanil to accelerate gastrointestinal function recovery in patients after thoracolumbar surgery: a prospective,randomized, double-blind controlled study

Purpose

Postoperative gastrointestinal dysfunction is one of the common complications of surgery, especially after surgery for a thoracolumbar spinal fracture. Intravenous lidocaine is a potential method to improve postoperative gastrointestinal function in surgical patients, reduce opioid use and shorten hospital stays. The purpose of this study is to explore the effect of intravenous lidocaine on the recovery of gastrointestinal function in patients after thoracolumbar surgery.

Methods

In this study, 48 eligible patients undergoing elective thoracolumbar spine fractures resection and internal fixation surgery were enrolled to receive intravenous injections of lidocaine in different concentrations during the perioperative period. Patients were randomly divided into three groups: control group (group A), low concentration of lidocaine group (group B) and high concentration of lidocaine group (group C), 16 patients in each group. First postoperative exhaust time, numbers of bowel sound at preoperative and postoperative 3, 6, 12, 24 h, pain scores at postoperative 0, 3, 6, 12, 24, 48 h, total sufentanil use in PACU and perioperative periods, postoperative hospital stay and analgesic remedy within postoperative 48 h were recorded and compared. The primary endpoints include: the time of first flatus passage after the operation, the number of bowel sounds per minute counted with stethoscope at 30 min before anesthesia induction and at 3, 6, 12 and 24 h postoperative. The secondary endpoints included: the pain scores at PACU (after entering into PACU), 3, 6, 12, 24 and 48 h postoperative, the amount of sufentanil administrated by intravenous push during operation and the numbers of patients needed rescuing sufentanil in PACU, and the numbers of patients needed administration of gastric motility drugs or non-steroidal analgesics at ward within 48 h postoperation, length of hospital stay (from the first day after surgery to discharge from hospital) and the incidence of adverse reactions.

Results

Compared with group A, the first postoperative exhaust time in group B and C occurred much earlier (23.3 ± 11.0 h vs. 16.0 ± 6.6 h, 16.6 ± 5.1 h, P < 0.05). Compared with preoperation, the numbers of bowel sound significantly increased at 24 h postoperatively in group B, while group B at 6 h and group C at 6 and 24 h postoperatively had significantly more active bowel sounds compared to group A (P < 0.05). There were no remarkable differences in VAS scores within 12 h postoperatively among three groups, and however, significantly lower VAS scores were found at 12, 24 and 48 h postoperatively in group C when comparing to Group A (p < 0.05). There was no statistical significance in the incidence of postoperative flatulence and nausea and vomiting, the number of patients needed rescuing sufentanil in PACU, the length of postoperative hospital stay and the number of patients requiring non-steroidal analgesics at ward within 48 h postoperation.

Conclusions

Intravenous lidocaine infusion together with patient-controlled analgesia of sufentanil expedited the early recovery of gastrointestinal function and improved analgesic quality of sefentanyl in patients undergoing thoracolumbar surgeries.

     

重型脑损伤后Terson综合征

目的：研究重型脑损伤（SBI）后Terson综合征（TS）发生的相关因素和临床特点。方法：监测161例脑损伤病人的颅内压（ICP）、眼内压（IOP）、脑灌注压（CPP）、视觉诱发电位（VEP）和视力,分析它们与SBI后TS的关系。结果：SBI后TS的发生率显著高于对照组;TS的发生与急性ICP和IOP增高密相关,发生TS病人的ICP和IOP显著高于对照组;急性IOP增高与急性ICP增高呈正相关,ICP曲线上出现A波者大多发生TS。结论：SBI后IOP和ICP明显增高的病人易发生TS;有效控制ICP和IOP,防止ICP曲线上A波出现,有助于减少TS的发生和改善病人预后。     

中长链脂肪酸丙泊酚减轻小儿注射痛的效果观察

目的 观察中长链脂肪酸丙泊酚是否能减轻小儿静脉麻醉诱导注射痛。方法 对择期儿科手术的160 例患儿采用随机数字表法分成S 组、L 组、L+P 组和M组,每组各40 例。S 组：静脉注射0.9%氯化钠溶液2ml,30s 后注射丙泊酚2.5mg/kg（1%丙泊酚18ml+2ml 氯化钠溶液）;L 组：静脉注射利多卡因0.5mg/kg（稀释成2ml）,30s 后注射丙泊酚2.5mg/kg（1%丙泊酚18ml+2ml氯化钠溶液）;L+P 组：静脉注射0.9%氯化钠溶液2ml,30s 后注射利多卡因混合丙泊酚2.5mg/kg（1%丙泊酚18ml+2%利多卡因2ml）;M 组：静脉注射0.9%氯化钠溶液2ml,30s 后注射中长链脂肪酸丙泊酚2.5mg/kg（1%中长链脂肪酸丙泊酚18ml+2ml 氯化钠溶液）。丙泊酚注射期间使用VRS 四分法对患儿进行注射痛评分;并记录丙泊酚注射前和注射时心率,观察注射过程和注射后的不良反应,评价各组疼痛发生率及程度。结果 4组患儿注射痛发生率分别是：S组38 例（95%）,L 组32 例（80%）,L+P 组20 例（50%）,M组19 例（47.5%）,L 组、L+P 组、M 组注射痛发生率均低于S组38 例（均P＜0.05）,L+P 组、M 组注射痛发生率低于L组（P＜0.05）,其余各组间比较差异无统计学意义（P＞0.05）;各组丙泊酚注射时心率均增快（P＜0.05）;与S 组比较,丙泊酚注射时L+P 组、M 组心率低于S 组（P＜0.05）,与L组比较,丙泊酚注射时L+P 组心率低于L 组（P＜0.05）;其余各组患儿丙泊酚注射时心率比较差异无统计学意义（P＞0.05）;各组间不良反应的差异无统计学意义（P＞0.05）。结论 中长链脂肪酸丙泊酚能减轻小儿静脉麻醉诱导注射痛,与利多卡因混合丙泊酚注射效果相当。     

联合应用STR与A／C连锁分析进行PKU的产前基因诊断

目的：对经典ＰＫＵ快速,高效易推广的产前基因诊断方法进行探讨。方法：用ＳＴＲ－Ａｍｐ－ＦＬＰ和ＰＣＲ－ＳＳＣＰ对云南１３个ＰＫＵ家系的ＰＫＵ家系的ＰＡＨ基因内与Ａ／Ｃ位点进行连锁分析。结果：检出２４２－２５２ｂｐ的ＳＴＲ８个等位片段,ＰＩＣ为０．６９８,杂合率是５７．６９％,用ＳＴＲ和ＳＴＲ加Ａ／Ｃ的１００％基因诊断率是４６．１５％和６１．５４％,且ＳＴＲ加入Ａ／Ｃ对所有家系均能提供信息。完成１例     

不同剂量异丙酚对心内直视手术患者心肌酶谱的影响

目的 :比较不同剂量异丙酚对心内直视手术患者心肌酶谱的影响。方法 :30例心内直视手术病人 ,麻醉诱导后给予持续输注异丙酚A组 2mg·kg- 1 ·h- 1 ,B组 5mg·kg- 1 ·h- 1 ,C组 8mg·kg- 1 ·h- 1 ,并监测诱导后、停体外循环 (CPB)即刻、CPB后30min、6 0min、3h五个时间点心肌酶AST、LDH、α -HBDH、CK -MB浓度变化。结果 :三组患者体外循环 (CPB)后心肌酶指标与诱导后相比均有不同程度升高。与A组相比 ,B组患者不同时间点AST、CK -MB、LDH值较低 (P <0 0 5或P <0 0 1) ,α -HB DH无明显差异 (P >0 0 5 )。A组与C组相比无明显差异 (P >0 0 5 )。结论 :术中 5mg·kg- 1 ·h- 1 异丙酚是较为理想的具心肌损伤保护作用的临床维持用药剂量     

中药外洗与穴位按摩治疗卒中后遗症患者的护理

目的探讨社区门诊卒中后遗症患者的辨证施护方法。方法对40例社区门诊采用中药外洗配合穴位按摩治疗卒中后遗症患者,给予心理干预、中药外洗与穴位按摩护理、饮食干预、基础护理、康复指导及护理等。结果40例中20例功能完全或基本恢复,18例病情好转,运动功能、语言功能及认知功能指标得到不同程度恢复,2例无效;治疗、护理期间未发生严重并发症。结论中药外洗配合穴位按摩是社区卒中后遗症患者康复治疗的有效方法,加强治疗中的护理干预能促进患者早日康复。     

1岁以下小儿围术期早期死亡风险因素流行病学调查

目的： 研究1岁以下小儿围术期早期（≤3 d）死亡相关风险因素的临床流行病学特征。 方法： 遴选2011年至2013年温州医科大学附属第二医院76例新生儿及婴儿手术后死亡病例的临床资料,对其性别、出生孕周、年龄、出生体质量、术前体质量、术前是否存在合并症（心血管、呼吸、血液、肝肾等疾病）、术前意识状态、电解质紊乱情况、营养情况、美国麻醉医师协会（ASA）分级、手术部位、手术类型、手术持续时间、手术分级共15项可能的风险因素进行回顾性分析及统计学处理。 结果： 对新生儿及婴儿的出生体质量、术前合并呼吸系统疾病、ASA分级、意识状态与死亡时间行spearman秩相关分析,结果P值均小于0.05。以上4 种风险因素经logistic逐步回归分析,只有术前合并呼吸系统疾病及麻醉ASA分级2个风险因素保留。受试者工作特征曲线（ROC）分析显示,与新生儿及婴儿围术期早期（≤3 d）死亡时间高度相关的风险因素是术前合并呼吸系统疾病（ROC曲线下面积为0.643）和麻醉ASA分级（ROC曲线下面积为0.694）。结论： 术前合并呼吸系统疾病和麻醉ASA分级是新生儿及婴儿围术期早期死亡的有效预测因子,且ASA分级相对预测作用更强。