盐酸戊乙奎醚用于麻醉前用药的临床研究

观察临床上盐酸戊乙奎醚(长托宁)对心率和血压的影响,及对腺体(口腔唾液腺、气道腺体)分泌的影响。方法:全麻下行择期手术患者265例,随机分为3组:A组为肌肉注射阿托品注射液0.5mg,B组为肌肉注射戊乙奎醚注射液0.5mg,C组为肌肉注射0.9%氯化钠注射液1mL,注射时间均在麻醉前30min。每隔5分钟记录1次心率、收缩压、舒张压、平均动脉压及SpO2,并且在患者入手术室时和注药后30min用视觉模拟评分方法(VAS)测定口干程度、唾液分泌量、术毕用吸痰法吸尽口咽腔分泌物并测量。并记录不良反应。结果:给药后30min,阿托品、盐酸戊乙奎醚和生理盐水组HR分别较给药前变化(11.65±1.99)次/分、(-4.30±6.02)次/分、(-0.55±1.85)次/分;唾液分泌量分别较给药前变化(-17.64±18.53)mg(、-22.30±18.04)mg(、-4.67±10.17)mg;VAS阿托品、盐酸戊乙奎醚较用药前明显增加;术毕口咽腔气管内分泌物量A组(11.5±2.4)mL、B组(4.2±1.6)mL、C组(20.2±3.0)mL。观察期间无严重不良反应。结论:盐酸戊乙奎醚作为全麻术前用药,可明显减少唾液分泌,无HR增快,无明显不良反应。     

腹腔镜胆囊切除术中转原因及其并发症防治(附5000例报告)

目的 探讨腹腔镜胆囊切除术中转原因和(LC)并发症的原因及预防措施.方法 总结分析1997年5月至2007年5月5000例LC患者临床资料.结果 5000例LC患者中转开腹247例,中转率4.94%,发生并发症31例,占0.6%,其中腹腔内出血16例,胆管损伤4例,手术胆漏6例,残留胆管结石2例,胆囊窝积液3例.结论 术中仔细操作,炎症粘连重、解剖关系不清时不强行分离电凝电切,果断中转开腹是防治LC严重并发症的可靠保证.对微小结石病人,术晨询问夜间是否发生过胆绞痛;术晨常规B超了解胆管有无结石和扩张;术中勿反复牵拉挤压;在靠近胆囊侧先施小钛夹夹闭胆囊管再手术;胆囊管直径＞1cm,应作术中造影和(或)术中B超是防止术后遗留胆总管结石的有力措施.预防性放置引流管是防止胆囊窝积液和感染的可靠保证.     

急性重症胰腺炎胰性脑病13例

1材料和方法 1982-10/2000-02我院收治急性重症胰腺炎86例,手术治疗61例(72%),非手术治疗25例(29%),发生各种并发症65例(75%),死亡19例(病死率为21%),其中胰性脑病13例(发生率为15%),死于胰性脑病6例(46%).男6例,女7例,年龄31岁～82岁(平均47.4岁).     

急性出血坏死性胰腺炎首发症状为胰性脑病一例

一、临床资料患者女 ,35岁。因头昏、抑郁、记忆力和判断力下降 1ｄ于 1999年 3月 9日入院。无腹痛、腹胀。查体 :体温 36 0℃ ,脉博 70次 /ｍｉｎ ,呼吸 2 0次 /ｍｉｎ ,血压 10 0 / 6 5ｍｍＨｇ。精神抑郁 ,回答问题基本切题。双侧瞳孔等大等圆 ,对光反射灵敏 ,双眼底视乳头边界清楚。腹平软 ,无明显压痛 ,肝脾未触及 ,移动性浊音阴性 ,肠鸣音正常。浅感觉、深感觉、复合感觉正常。肌张力正常 ,肌力Ⅴ级。腱反射正常 ,无颈强直 ,巴氏征阴性 ,克氏征阴性。实验室检查 :ＷＢＣ 10 4× 10 9/Ｌ ,Ｎ 0 88,Ｌ0 12 ,血钙 4 3ｍｍｏｌ/Ｌ。腰…     

《季氏将伐颛臾》教学设计

一、教学内容《季氏将伐颛臾》是苏教版高中语文必修四的"我有一个梦想"专题的的第一篇文章,在第3页。二、教材分析"我有一个梦想"专题有"经世济民"和"英名与事业"两个学习模块。其中,"经世济民"模块中《季氏将伐颛臾》和《寡人之于国也》是儒家著作《论语》和《孟子》中有代表性的选文,是两千多年来学子熟读的经典作品。面对经典,如何探索生动有效的教学思路?如何寻找一个恰当的切入点,使学生感悟经典文本的语言魅力,理     

急性重症胰腺炎的心脑肺损伤的诊治

目的 为了解急性重症胰腺炎(SAP)的心脑肺损伤的情况与SAP病死率的关系.方法通过对18年我院肝胆外科收治的96例SAP回顾调查,了解SAP并发休克、ARDS和胰性脑病的发生及治疗情况和SAP死亡的主要因素.结果1982-10/2000-08我科共收治SAP 96例,手术治疗69例(72%),非手术治疗27例(28%),治愈77例(80%),死亡19例(20%),发生各种并发症68例(71%).SAP合并心脑肺损伤33例(34%),死亡16例(17%),SAP无心脑肺损伤63例(66%),死亡3例(3%),两者差异有统计学意义(P＜0.05).SAP伴ARDS 14例(15%),8例ARDS治愈(57%),6例ARDS死亡(43%).SAP伴休克13例(14%),5例休克治愈(38%),8例休克病人死亡(62%).SAP伴胰性脑病13例(14%),6例胰性脑病死亡(46%),7例治愈(54%).7例(7%)同时有两种心脑肺损伤,其中4例SAP同时有休克和ARDS,2例SAP病人有胰性脑病和ARDS,2例SAP合并休克和胰性脑病,死亡5例.结论SAP心肺脑损伤治疗困难,其病死率明显高于无心脑肺损伤的SAP,ARDS、休克和胰性脑病是导致SAP死亡的主要并发症和主要致命因素.     

不含局麻药单用吗啡行术后硬膜外持续镇痛的观察

目的观察临床上不含局麻药单用吗啡行术后硬膜外持续镇痛的效果、不良反应。方法持续硬膜外麻醉下行择期手术术后365例,按镇痛方式随机分为3组:Ⅰ组吗啡—昂丹司琼组(121例),Ⅱ组吗啡-布比卡因-昂丹司琼组(121例),Ⅲ组吗啡-甲磺酸罗哌卡因-昂丹司琼组(123例)。在缝皮肤时先硬膜外腔注入吗啡盐水稀释液2mg(1mL),然后以2mL/h速度持续泵入镇痛混合液。Ⅰ组成分为吗啡8mg+昂丹司琼8mg+0.9%氯化钠100mL,Ⅱ组成分为吗啡8mg+布比卡因125mg+昂丹司琼8mg+0.9%氯化钠100mL,Ⅲ组成分为吗啡8mg+甲磺酸罗哌卡因125mg+昂丹司琼8mg+0.9%氯化钠100mL。3组均在镇痛后1、2、6、12、24、48h,测定平均动脉压(MAP)、心率(HR)、呼吸次数(RR)、VAS评分、PHS评分、SS评分,观察不良反应并记录。结果3组在镇痛期间同时点MAP、HR、RR、VAS评分、SS评、PHS评分差异无统计学意义。镇痛后2hⅠ组无一例,Ⅱ组1例,Ⅲ组1例出现呼吸抑制,3组间比较差异无统计学意义(P>0.05)。镇痛后6hⅡ组8例,Ⅲ组6例出现双下肢略乏力、全身麻木,两组与Ⅰ组比较差异有统计学意义(P<0.05)。结论不含局麻药单用吗啡行术后硬膜外持续镇痛具有安全性、可行性。     

急性重症胰腺炎治疗探讨

目的评价急性重症胰腺炎以手术为主的治疗和以非手术为主的综合治疗的效果，并选择合理的治疗方案。方法回顾性分析53例急性重症胰腺炎以手术为主的治疗和以非手术为主的综合治疗。比较两种治疗方案的治愈率、并发症发生率、病死率。结果两种治疗方案在治愈率、并发症发生率、病死率上比较差异无统计学意义（P〉0．05）。结论在方法得当的情况下，对急性重症胰腺炎患者采取以手术为主的治疗和以非手术为主的综合治疗均可取得较好效果，对经济情况较差的患者可考虑以手术为主的治疗方案。     

清醒心肌缺血模型的可控冠状动脉狭窄程度

BACKGROUND:Anesthesia is a protective measure to animals in animal experiments, but the use of the corresponding anesthetic drugs will have different effects on the experimental results. OBJECTIVE:To analyze the differences of various indexes and the therapeutic effect of myocardial ischemia canine model of coronary stenosis under the condition of consciousness and anesthesia. METHODS:Twenty Beagle canine myocardial ischemia models were equally assigned to five groups, and prepared according to the complete orthogonal Latin square arrangement for the experiment. Intervention procedures included the normal observation (normal control for 10 minutes, observation for 30 minues), conscious model (after normal control, coronary artery stenosis for 10 minutes, and observation for 30 minutes), conscious treatment (after normal control, coronary artery stenosis for 10 minutes, 50 μg/kg nitroglycerin sublingually buccal, and observation for 30 minutes), anesthesia model (animals received anesthesia; after normal control, coronary artery stenosis for 10 minutes, and observation for 30 minutes), anesthesia treatment (animals received anesthesia; after normal control, coronary artery stenosis for 10 minutes, 50 μg/kg nitroglycerin sublingually buccal, and observation for 30 minutes). We recorded canine electrocardiogram, blood pressure, heart rate and body temperature level when animals were conscious after coronary artery stenosis, and mean arterial blood pressure, body temperature, heart rate, electrocardiogram ST segment changes in conscious and anesthetic states in myocardial ischemia dogs, and observed the therapeutic effect of nitroglycerin on conscious and anesthetic states in myocardial ischemia dogs. RESULTS AND CONCLUSION:The electrocardiogram, blood pressure, heart rate and body temperature were changed after the coronary artery stenosis in conscious dogs, and the ST segment of electrocardiogram was significantly increased. The blood pressure and heart rate were significantly higher than that in the conscious state (P < 0.05), and the ST segment of electrocardiogram in dogs was significantly increased in conscious and anesthetic states. After the treatment of nitroglycerin, the effect was obvious in the myocardial ischemia model in conscious state. The results showed that the model of myocardial ischemia and the clinical fitting degree were higher, which could reduce the effect of anesthesia on the experimental results.