晕可宁颗粒对急、慢性梅尼埃病模型的影响

目的　探讨晕可宁颗粒的主要药效学 ,为临床提供药效学资料及治疗学基础。方法　采用三氯甲烷破坏豚鼠一侧膜迷路感受器模型 ,探讨受试药对眼震颤、摆头及旋转的影响 ;采用内淋巴囊和内淋巴管阻塞手术复制豚鼠膜迷路实验性膜迷路积水模型 ,研究内耳组织平均中阶面积 (SMA)增加率及形态学的变化。结果　抑眩宁阳性对照组、晕可宁颗粒 (8、16g/kg)模型给药组豚鼠眼球震颤次数减少 ,差异有显著意义 (P <0 .0 5 )。成功复制了不同程度膜迷路积水豚鼠模型 ,表现为前庭膜重度膨出 ,前庭阶缩小 ,膜蜗管增大 ,SMA增加率变大 ,差异有显著意义 (P <0 .0 1) ;晕可宁颗粒灌胃后可减轻豚鼠实验性膜迷路积水的程度 ,差异有显著意义 (P <0 .0 1) ;但与空白对照组比较SMA增加率差异无显著意义 (P >0 .0 5 )。结论　晕可宁颗粒可以减轻内淋巴囊积水程度 ,对梅尼埃病症状有对抗治疗作用。     

综合评价法在计划免疫评价中的应用

目的：评价计划免疫工作。方法：应用综合系数法对通州市1999-2003年计划免疫工作进行评价。结果：通州市近5年计划免疫综合指标各年均达标，分类指标除2002、2003年效益指标未达标外，其余均达标。结论：利用综合系数法评价计划免疫工作是可行的。     

Assistance par extracorporeal membrane oxygenation au cours d’un syndrome de tako-tsubo après césarienne en urgence

Tako-tsubo syndrome is a rare cardiomyopathy secondary to catecholamine toxicity responsible of myocardial stunning. Severe complications such as cardiogenic shock or ventricular arrhythmia can occur. We presented the case of a 32-year-old woman victim of a tako-tsubo syndrome with severe cardiogenic shock during surgical procedure for urgent caesarean section. After refractory haemodynamic failure, the patient benefits from extracorporeal membrane oxygenation support device with success.     

Réhabilitation précoce après césarienne programmée : enquête de pratique auprès des maternités des régions Provence - Alpes - Côte d’Azur et Île-de-France

Aims

Although most components of an enhanced recovery programme (ERP) can be applied to caesarean delivery, it is unknown if their implementation is large in France.

Type of study

Structured interview by telephone or e-mailing of an anaesthetist to describe usual perioperative practice in two French regions (Provence - Alpes - Côte d’Azur [PACA] and Île-de-France [IDF]).

Methods

Questionnaire related to scheduled caesarean delivery.

Results

Response rate 74% (111/149 maternity units). Multimodal analgesia was almost universally applied and intrathecal/epidural morphine used by 86% of respondents. Oral administration of analgesic drugs was started before h24 in 50% of responding units and immediately after delivery in 7% of them. The urinary catheter was withdrawn after h24 in 71% of responding centres. Women were allowed to drink between h4 and h6 (60%), in an unlimited amount (79%). The first meal was authorised after h6 (89%) but before h24 (65%) or after recovery of bowel function (13%). Oxytocin was used in 69% of respondents and maintained postoperatively for 12 to 24 hours (70% of oxytocin users). Carbetocin was used in the remaining 31%, usually without any maintenance oxytocic drug. Attributing one point to each major component of the ERP protocol (0–6), the median value was 3 (2–4). An ERP protocol was available in 14% of responding units and was associated with a shorter duration of intravenous and urinary catheters use.

Conclusion

The study shows that the components of an ERP are insufficiently implemented in France after caesarean delivery. Moreover, significant heterogeneity exists between maternity units and among regions.     

Infiltration peropératoire de lévobupivacaïne après césariennes : étude randomisée en double insu contre placebo

Objectives

The efficacy of single-dose intraincisional infiltration with levobupivacaine in postoperative analgesia and chronic pain after caesarean sections is unknown.

Study

A placebo-controlled double-blind randomized trial.

Patients and methods

After ethical approval, and written inform consent, 140 women scheduled for a caesarean section were randomly assigned and received 30 mL of levobupivacaine 0.5% (L group) or saline (placebo-P group) into their wound. The primary endpoint was morphine consumption (using intravenous morphine patient-controlled analgesia) for the first 24 h after surgery. At 1 h to 48 h, side effects, pain at rest and pain 2 months later were recorded.

Results

All included patients had similar demographic and surgical characteristics. The morphine consumption was significantly lower in the L group at h6, h8 and h12 (considering both total intake and each request). At h4, the mean total morphine consumption was 25 (12) mg in the L group versus 31 (14) mg in the P group (P = 0.05). Time until discharge and side effects including nausea-vomiting (14 vs 20%), wound scar complications (6 vs 8%) and chronic pain after 2 months (25% in both groups complained of small pain, and 75% no pain) were similar between the two groups (P > 0.05).

Conclusion

Single-dose local infiltration of levobupivacaine 0.5% reduced opioid requirement at 12 h, with no difference after 24 h. www.clinicaltrials.com, number: NCT00621907.     

艾灸神阙穴对不同程度力竭运动大鼠海马区单胺类神经递质的影响

目的:探讨艾灸神阙穴对不同程度力竭运动大鼠海马区单胺类神经递质的影响。方法:将72只SD雄性大鼠按随机数字表法分为正常组8只、模型组和艾灸组各32只,根据造模或治疗时间将模型组和艾灸组随机分为1、4、7、10次亚组,每亚组8只,采用游泳实验建立力竭模型。艾灸各亚组大鼠造模后即刻温和灸神阙穴15min,隔日1次,各亚组大鼠完成相应力竭运动后24 h检测海马组织5-HT、DA、NE的含量。结果:与正常组比较,模型各亚组5-HT含量均明显升高,模型1、4、7次亚组NE含量均明显升高,模型1次亚组DA含量明显升高,模型10次亚组却明显降低。与相应模型亚组比较,艾灸4次亚组NE含量明显升高,艾灸7、10次亚组5-HT含量显著降低,DA、NE含量明显升高。结论:艾灸神阙穴可以通过调节反复力竭运动大鼠海马区神经递质,促进神经细胞的功能恢复,改善机体疲劳状态,为今后临床应用提供一定的实验基础。     

卡介菌多糖核酸治疗小儿咳嗽变异性哮喘

目的：观察卡介菌多糖核酸注射液在小儿咳嗽变异性哮喘治疗应用的疗效。方法：将本科40例咳嗽变异性哮喘患儿，随机分为治疗组和对照组（各20例）。治疗组给予BCG—PSN＋必可酮气雾剂，对照组：给予单用必可酮气雾剂吸入，连续吸入6周，观察疗效，并进行统计学处理。结果：治疗组总有效率为95％，对照组总有效率为70％，统计学处理总有效率有显著差异（P〈O．01）。结论：卡介菌多糖核酸（polysaccharide nucleic acidfraction of BCG，BCG—PSN）能有效地控制咳嗽变异性哮喘（CVA）的呼吸道的反复感染，提高免疫功能；与必可酮配合，能有效地控制CVA的复发。