硬膜外复合咪达唑仑用于产科术后镇痛的临床观察

目的观察硬膜外复合咪达唑仑用于产科术后镇痛的效果。方法将40例剖宫产病人随机分为两组，每组20例。所用的镇痛药配方Ⅰ组为：咪达唑仑10mg、芬太尼0．5mg、丁卡因250mg以生理盐水稀释至250ml；Ⅱ组为：芬太尼0．5mg．丁卡因250mg以生理盐水稀释至250ml，分别从硬膜外腔持续泵入，速率为5ml／h。观察术后0h、2h、4h、8h、12h、24h、36h、48h的血压、心率、镇痛效果、镇静程度、感觉和运动阻滞程度及不良反应。结果两组的血压、心率、镇静程度在统计学上无显著差异（P〉0．05），两组的镇痛效果在统计学上有显著差异（P〈0．01），Ⅰ组优于Ⅱ组，Ⅱ组中有3例镇痛效果较差，需追加镇痛药，两组均未出现嗜睡及其他不良反应。结论硬膜外持续泵入咪达唑仑-芬太尼-丁卡因复合液用于产科镇痛效果较好，不良反应少，适用于产科术后镇痛。     

右美托咪定在早发型重度子痫前期产妇剖宫产术后的应用研究

目的观察比较右美托咪定和咪达唑仑在早发型重度子痫前期产妇剖宫产术后镇静的临床应用疗效。方法选取30例早发型重度子痫前期剖宫产产妇,随机分为对照组(咪达唑仑组)、观察组(右美托咪定组)。所有入组产妇在蛛网膜下腔麻醉(腰麻)联合连续硬脊膜外阻滞麻醉下行剖宫产术,镇痛泵镇痛。术后观察组产妇泵入右美托咪定注射液,对照组泵入咪达唑仑注射液,持续泵入24 h,调节药物速度使Ramsay镇静评分维持在2～4分。记录两组产妇术前(T_0)、用药前(T_1)、用药后1 h(T_2)、用药后6 h(T_3)、用药后12 h(T_4)、用药后24 h(T_5)这6个时间点的收缩压(SP)、舒张压(DP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO_2),记录镇静评分Ramsay2分到达时间、停药后清醒时间、用药后1～2 h内干预次数、24 h内不良反应,记录镇痛视觉模拟评分(VAS)≥3分、患者舒适度≥8分发生情况。结果对照组、观察组产妇收缩压、舒张压在T_1、T_2、T_3、T_4、T_5明显低于T_0,差异有统计学意义(P0.05),而各组间比较差异无统计学意义(P0.05)。观察组心率在T_2、T_3、T_4、T_5明显低于其T_0、T_1,差异有统计学意义(P0.05);观察组心率在T_2、T_3、T_4、T_5分别明显低于对照组T_2、T_3、T_4、T_5,差异有统计学意义(P0.05)。对照组、观察组呼吸频率、血氧饱和度在T_0、T_1、T_2、T_3、T_4、T_5比较差异无统计学意义(P0.05)。观察组产妇Ramsay 2分到达时间长于对照组(P0.05)。观察组停药后清醒时间短于对照组(P0.05)。观察组用药后1～2 h内干预次数少于对照组(P0.05)。观察组术后24 h内不良反应发生率低于对照组(P0.05),镇痛效果及产妇舒适度明显优于对照组(P0.05)。结论右美托咪定和咪达唑仑在早发型重度子痫前期产妇剖宫产术后24 h均能提高镇静效果,血液动力学均较平稳;但右美托咪定组术后镇痛效果、产妇舒适度明显优于咪达唑仑组,且右美托咪定具有停药后清醒时间短、用药后24 h内不良反应少等优点。     

国产咪达唑仑作为老年人股骨头置换术前用药的效果评价

目的　观察国产咪达唑仑 (力月西 )作为老年人股骨头置换术前用药的临床效果。方法　选择行股骨头置换术的老年患者 (>65岁 ) 46例 ,随机分为两组 ,每组 2 3例。分别于术前 3 0min肌注咪达唑仑 0 .0 5mg/kg(咪达唑仑组 )或苯巴比妥钠 2mg/kg(苯巴比妥钠组 )。观察比较两组用药前及用药后 3 0min内心率 (HR)、呼吸频(RR)、平均动脉压 (MAP)、脉搏血氧饱和度 (SpO2 )以及用药后的镇静、抗焦虑、记忆与不良反应。结果　用药后 10min、2 0min、3 0min ,咪达唑仑组HR、MAP显著降低 ,与苯巴比妥钠组比较 ,差异具显著性意义 (P <0 .0 5) ,而RR、SpO2 两组间的差异无显著性意义 (P >0 .0 5)。咪达唑仑组在用药后 10min即出现明显的镇静与抗焦虑作用 ,与苯巴比妥钠组比较 ,差异具显著性意义 (P <0 .0 1)。术后 2 4h随访 ,咪达唑仑组中大部分患者对静脉穿刺、腰穿、手术情况等完全不能记忆或记忆模糊 ,而苯巴比妥钠无此作用。两组患者均未观察到明显副作用。结论　国产咪达唑仑于老年人股骨头置换术是一种安全、有效、较为理想的术前用药     

硬膜外穿刺中应用咪达唑仑的临床观察

为观察硬膜外穿刺前应用国产咪达唑仑注射液的最适剂量 ,选择 1 5 0例病人随机双盲分成 5组 ,每组 3 0人。第 1组为对照组 ,第 2、3、4、5组分别静脉注射咪达唑仑注射液 0 .0 2、0 .0 4、0 .0 6、0 .0 8mg/kg。观察平均动脉压、心率、呼吸、血氧饱和度、记忆及镇静程度的变化。第 1、2组硬膜外穿刺操作后平均动脉压增加 2 .3kPa、心率平均增加 1 1次 /min ,第 1、2组间无差异 ;且 2组用药前后平均动脉压与心率无差异 ;第 3组操作前后和用药前后平均动脉压、心率均无显著差异。用药后与用药前相比 ,第 4、5组平均动脉压下降 ,心率减慢 ,但均在正常范围 ;用药后组间平均动脉压与心率无差异。呼吸及血氧饱和度各组均在正常范围。第 1、2、3、4、5组记忆率分别为 1 0 0 %、87%、40 %、1 7%及 0 ,用药后均有顺行性遗忘作用 ,第 3、4组顺行性遗忘作用强。镇静程度 :第 1～ 4组均为清醒或入睡可唤醒 ,第 5组有 9例病人入睡唤醒困难但睫毛反射存在 ,用药后第 2、3、4组患者均可主动配合操作 ,第 5组有少数病人不能主动配合。提示 :硬膜外穿刺前静脉注射 0 .0 4～ 0 .0 6mg/kg咪达唑仑可稳定生命体征 ,消除对不良刺激的记忆 ,且患者可主动配合操作 ,因此 ,值得在硬膜外穿刺前应用     

硬膜外联合注射咪达唑仑氯胺酮预防麻醉后寒战

目的研究硬膜外预防性联合使用咪达唑仑与氯胺酮对麻醉后寒战（PAS）的作用。方法选择120例ASAⅠ-Ⅱ行子宫全切除术患者,随机分为对照组（C组）、咪达唑仑组（M组）、氯胺酮组（K组）、咪达唑仑加氯胺酮组（KM组）。L3-4穿刺成功后,蛛网膜下腔注入0．75％罗哌卡因2mL后,对照组硬膜外注入5mL生理盐水,实验组注入等体积咪达唑仑0．05mg/kg 5mL、氯胺酮0．5mg／kg、咪达唑仑0．05mg／kg加氯胺酮0．5mg／kg。麻醉起效15min后,观察并记录患者寒战发生率,评估患者恶心呕吐以及精神症状,观测脉氧饱和度变化,氧饱和度小于90070者给予面罩吸氧,术后24h进行VAS评分。结果对照组有1例与M组2例患者术中输血退出。KM组（7例,23％）PAS发生率显著低于其他各组（16例占53％,P〈0．01）。恶心呕吐,精神症状及呼吸抑制各组间无显著差异（M组3例,C组1例,P〉0．05）。结论硬膜外联合注射咪达唑仑可以预防PAS发生,且无明显不良反应发生。     

咪达唑仑-舒芬太尼在机械通气治疗多发肋骨骨折患者的镇痛镇静作用分析

目的:探讨咪达唑仑-舒芬太尼在机械通气治疗多发肋骨骨折患者的中镇痛镇静效果。方法:18例接受机械通气患者均予首剂静脉注射咪达唑仑0.15～0.3mg/kg、舒芬太尼1～2μg/kg镇痛镇静负荷量,后予咪达唑仑0.05～0.1mg/kg/h、舒芬太尼0.3～1.5μg/kg/h微泵注射维持,根据患者情况个体化调整入量,维持镇静Ramsay评分在3～4分水平,通过监测患者心率、呼吸、平均动脉压及动脉血气分析进行治疗前后对比评估。结果:在负荷剂量及维持量下所有患者均能够达到目标镇痛镇静效果,Ramsay评分均在3～4分。患者用药1h后HR、RR、SaO2,平均动脉压及动脉血气pH值、PaO2、PaCO2均较用药前明显改善(P<0.01)。结论:对ICU机械通气治疗多发性肋骨骨折的患者,咪达唑仑-舒芬太尼能显著提高患者的镇痛镇静效果,避免"人-机对抗",改善氧合,降低耗氧,效果确切。     

单纯胆囊切除术后患者自控硬膜外镇痛的疗效观察

本研究拟比较等效剂量吗啡和曲马多用于患者术后硬膜外自控镇痛 (PCEA)的镇痛效果及不良反应。1　资料与方法1.1　一般资料 :40例单纯胆囊切除术患者 ,ASA ～ 级 ,男 18例 ,女 2 2例 ,年龄 19～ 5 0岁 ,体重 46～ 70 kg。1.2　治疗方法 :术前肌注阿托品 0 .5 m g,苯巴比妥钠 0 .1g。入手术室后行 T8～ 9穿刺 ,硬膜外朝头端置管 3cm,从硬膜外导管注入 2 %利多卡因 5 ml,确定硬膜外阻滞有效后为患者行快速静脉诱导气管插管 ,气管内麻醉下行单纯胆囊切除术。麻醉诱导 :芬太尼 0 .0 0 4m g· kg- 1 、咪达唑仑 0 .2 mg/ kg、维库溴胺 0 .0 …     

脊椎硬膜外联合麻醉复合咪达唑仑对术中遗忘作用的观察

目的 探讨脊椎硬膜外联合麻醉复合咪达唑仑对术中遗忘作用的发生情况.方法 选择美国麻醉医师协会体格检查分级Ⅰ～Ⅱ级择期脊椎硬膜外联合麻醉下手术患者200例,随机分为A组(咪达唑仑+芬氟合剂组)和B组(芬氟合剂组).A组蛛网膜下腔阻滞平面满意及循环稳定后施行镇静,静脉滴注咪达唑仑0.04 mg/kg.手术开始后,2组患者均静脉滴注半量芬氟合剂(氟哌啶醇2.50 mg和芬太尼0.05 mg).观察用药后患者意识状态,术后24 h遗忘情况.结果 A组的遗忘作用及镇静效果优于B组.结论 脊椎硬膜外联合麻醉复合咪达唑仑有较好的术中遗忘作用.     

咪达唑仑复合丙泊酚在ICU机械通气患者中的应用

①目的 探讨咪达唑仑复合丙泊酚用于ICU机械通气患者的镇静效果.②方法 诱导量:咪达唑仑组0.1～0.2mg/kg,丙泊酚组1～2mg/kg,咪达唑仑联合丙泊酚联合用药组0.1mg/kg+丙泊酚1mg/kg;维持量:咪达唑仑组0.04～0.16 mg/(kg·h),丙泊酚组0.5～4mg/(kg·h),咪达唑仑+丙泊酚组咪达唑仑0.08mg/(kg·h)+丙泊酚1～2mg/(kg·h).③结果 咪达唑仑+丙泊酚组在药物起效时间、达到满意深度时间、恢复时间及清醒后再入睡率等与咪达唑仑组比较,差异有统计学意义(P<0.05).④结论 咪达唑仑与丙泊酚联合应用,镇静效果满意,可以减少不良反应,降低费用,是ICU机械通气患者镇静治疗较为理想的治疗方案.     

硬膜外腔连续镇痛用于肿瘤术后病人的临床观察

目的　观察硬膜外腔连续镇痛用于肿瘤术后病人的可行性。方法　 6 0例在硬膜外麻醉下行肿瘤切除术的患者随机分为硬膜外匀速输入组 (CCEA) ,即 4 8h内持续匀速注 0 12 5 %布比卡因 5ml/h和曲马多 12～ 2 0mg/h组和单次硬膜外注入组 (EPI)组 ,即手术结束时单次注入硬膜外腔吗啡 2mg。观察术后 4 8h内 2组呼吸、循环、镇痛、镇静评分及副作用。结果　术后 0～ 12h内CCEA组与EPI组镇痛效果相似 (P >0 0 5 )。镇静程度CCEA组高于EPI组 (P <0 0 5 )。 12h后CCEA组镇痛效果优于EPI组 (P <0 0 5 )。皮肤瘙痒EPI组 5例。结论　硬膜外腔连续镇痛效果确切 ,持续时间长、副作用少 ,可安全应用于肿瘤术后病人。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.