疼痛是困扰患者的主要问题之一,已被列为继体温、脉搏、呼吸、血压之后的第五大生命体征 [1] 。疼痛使得人们的生活质量显著降低。目前,阿片类药物是治疗疼痛最有效的药物,如芬太尼等。但长期使用会出现耐药性,成瘾性,戒断反应,呼吸抑制等不良反应。曲马多是一种人工合成的阿片类中枢系统镇痛剂,它是相对较弱的μ-阿片受体激动剂,并且可以抑制5-羟色胺和去甲肾上腺素的重吸收。

Objective To study radical cure effect of introducing different doses of midazolam anesthesia on postoperative analgesia in patients with thoracoscope lung carcinoma.Methods Between August 2014 and July 2015, choosing 82 patients with thoracoscope lung cancer in our hospital, according to the draw method, they were divided into observation group (41 cases) and control group (41 patients).Observation group were treated with 0.1 mg/kg of midazolam anesthesia induction, control group were given the dose of 0.05 mg/kg of midazolam for induction of anesthesia.Two groups of patients with preoperative and 48 h postoperative inflammatory factor levels, blood oxygen saturation, mean arterial pressure, heart rate changes were compared, the two groups of patients with surgery situation were analyzed.Results postoperative 48 h, observation group with IL-6, IL 8, IL-1β, TNF alpha inflammation factor index were lower than the control group[(58.43±3.21)μg/L, (2.03±0.25)μg/L, (2.97 ±0.43)μg/L, (5.32±0.76)μg/L vs.(96.43±4.53)μg/L, (3.22±0.32)μg/L, (3.76±0.43)μg/L, (7.63±0.98)μg/ L](P<0.05).After 48 h surgery, observation group of blood oxygen saturation, mean arterial pressure, heart rate were significantly lower than the control group[(93.78±1.07)％, (93.21±3.45)mmHg, (87.54±2.34)time/min vs.(97.12±1.02)％, (96.43±4.02)mmHg, (91.04±2.88) time/min] (P<0.05).Two groups of patients with blood loss, operative time, anesthesia time had no significant difference (P>0.05), but the observation group of patients with open time, extubation time was significantly shorter than the control group (P<0.05), postoperative pain score, the total dosage of propofol, rui total fentanyl was significantly less than the control group (P<0.05).Conclusions In patients with thoracoscope lung cancer treated using dose of 0.1 mg/kg of midazolam anesthesia induction, relative to the dose of 0.05 mg/kg of midazolam, can effectively inhibit the inflammatory response, maintain anesthesia narcotic drug usage, to ensure more smoothly, the perioperative period in patients with effective alleviate postoperative pain patients, belongs to the ideal dosage regimen.

Objective To investigate the effect of ultrasound guided transversus abdominal plane block (TAP) on laparoscopic inguinal hernia surgery in children.Methods Sixty children of inguinal hernia were randomly divided into two groups: TAP group children were induced by bilateral ultrasound-guided TAP block intravenous anesthesia with 0.25% ropivacaine hydrochloride (0.5 ml/kg) on each side after intravenous anesthesia, NS group children were injected equal saline on each side.General anesthesia was maintained with 2% to 5% sevoflurane and remifentany l infusion.General conditions, intraoperative vital signs, operative time, postoperative recovery time, postoperative pain score and the use of tramadol were observed and compared.Results There were no significant differences in gender, age, height, weight, operation time and recovery time between the two groups (P>0.05).During the surgery, there were no significant differences in the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and oxygen saturation (SpO2) of children before the skin incision;the HR, SBP and DBP of TAP group were significantly lower than that of the NS group 2 minutes after the skin incision (P<0.05).VAS and FLACC pain scores of TAP group were significantly lower than those of NS group 30 minutes after recovery, 6 hours and 12 hours after the surgery (P< 0.01,P<0.05).However, there was no significant difference in VAS patients in NS group (26.7%) received intravenous tramadol, two patients in TAP group (6.7%) received intravenous tramadol which was significantly lower than that of NS group (P< 0.01).Conclusion TAP on laparoscopic inguinal hernia surgery in children can be safe and effectively improve the vital signs of during the surgery and relieve the pain of children after the surgery.

Objective To study curative efficacy of high oxygen liquid of one lung ventilation anesthesia in children.Methods 30 children of one lung ventilation anesthesia who received therapy from July 2014 to July 2016 in our hospital were selected as research objects.According to random number table,all underwent pulmonary lobectomy,those children were divided into the A group (n =15) and the B group (n =15).The A group after one lung ventilation,was treated with the 30 ml (kg · h) speed,constant speed input acetated glygoyle liquid oxygen,while the B group was treated with acetated ringer liquid injected the same speed.Then intraoperative blood gas analysis and inflammatory factor changesand postoperative conditions were compared.Results The pH,arterial oxygen partial pressure (PaO2),mixed venous oxygen partial pressure (P(v)O2) and mixed venous oxygen saturation (S(v)O2) in the two groups were decreased in different degrees in T0 (before ventilation),T1 (ventilation 10 min),T2 (ventilation 30 min),T3 (ventilation 60 min),T4 (ventilation 2 h) (P＜0.05),but the levels of pH,PaO2,P(v)O2,S(v)O2 in A group were higher than the B group in T1,T2,T3,T4(P＜0.05);the levels of tumor necrosis factor (TNF)-α,interleukin (IL)-6,IL-8,IL-10,malondialdehyde (MDA) in the T1,T2,T3,T4 compared with T0,were all increased in different degrees in the two groups(P＜0.05),but the level of TNF-α,IL-6,IL-8,MDA in A group were lower than B group in T1,T2,T3,T4(P＜0.05);the recovery time in A group was shorter than that the B group(P＜0.05),the incidence rate of agitation was lower than the B group(P＜0.05).Conclusions The constant input of acetated high oxygen liquid is well for one lung ventilation anesthesia in children,which can preventing the occurrence of hypoxia,reduce the inflammatory reaction,high security,it's worthy of application and promotion.

Objective:To explore the effect of maternal hemodynamics and fetal acid-base values of immediate expansion of hydroxyethyl starch and phenylephrine hydrochloride on combined spinal-epidural analgesia.Methods: According to the different ways of dealing with hypotension,51 cases of elective cesarean section under combined spinal-epidural analgesia were divided into two groups: Phenylephrine hydrochloride group (group P) and Hydroxyethyl starch immediate expansion group (group C).Mean arterial pressure, heart rate, standard volume of output and cardiac output (CO) at the time of anesthesia and post anesthesia between the two groups were compared.The blood gas results of umbilical vein blood of the two groups were compared.Apgar scores at 1 min and 5 min after delivery, and the time from anesthesia to neonatal delivery (IDI) of the two groups were compared.Results: There was no significantly difference of mean arterial pressure, cardiac output and cardiac output between the two groups (P> 0.05).The heart rate of the two groups were increased and then decreased, then increased.The heart rate of group C was significantly lower than that of group P at T2, T3, T4, T5, T6, T7 and T8 (P <0.05).The levels of pH, PO2, PCO2 and HCO3 in the umbilical vein blood of the two groups were all within the normal range, there was no significantly difference between the two groups (P>0.05).The duration of cesarean section, and Aparg score at 1 minute and 5 minutes after umbilical cord cut short were no significantly difference (P> 0.05).Conclusion: Combined spinal-epidural analgesia with hydroxyethyl starch immediate expansion can obviously reduce the hypotension at elective cesarean section;deoxidation adrenaline can maintain the maternal systemic stability, and does not increase heart work, little influence on newborn blood gas analysis.

目的 检测检测高迁移率族蛋白-1(HMGB-1)在甲状腺乳头状癌(PTC)组织中的表达情况,并探讨其临床意义.方法 采用实时荧光定量聚合酶链反应(RT-PCR)法检测50例PTC患者肿瘤组织中HMGB-1的表达水平,同时选择30例结节性甲状腺肿和30例正常人甲状腺组织作为对照.分析PTC癌组织中HMGB-1的表达与PTC临床病理参数间的关系.结果 PTC患者肿瘤组织中HMGB-1 mRNA表达相对水平为(1.47±0.32),明显高于结节性甲状腺肿组织(0.74±0.12)和正常甲状腺组织(0.72±0.09)(P＜0.05).PTC肿瘤组织中HMGB-1的表达与不同TNM分期、腺外侵润、远处转移和淋巴结转移有关(P＜0.05).结论 HMGB-1在PTC肿瘤组织中的表达明显升高,且其表达水平与PTC临床病理特征相关,可能用于PTC早期临床诊断以及对PTC肿瘤浸润、转移的评估.

胃小细胞癌是胃恶性肿瘤的一种特殊类型，是一种高度恶性的神经内分泌性肿瘤，大约能占到胃恶性肿瘤的0．6％〔1〕。原发性胃小细胞癌的临床病理学特征和生物学特征类似于小细胞肺癌，与小细胞肺癌相比对化疗更加不敏感，恶性度更高，预后更差〔2〕。本文从其病理、临床表现、诊断、治疗和预后等多方面进行分析总结，为临床诊治胃小细胞癌提供参考。

Objective To evaluate the efficacy of caudal block with dexmedetomidine mixed with ropivacaine for the management of perioperative analgesia in children.Methods Sixty pediatric patients,aged 1-5 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective hypospadias repair,were equally and randomly assigned into 2 groups using a random number table:ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR).Each patient received a single caudal dose of 0.25％ ropivacaine 1 ml/kg in group R.Each patient received a single caudal dose of 0.25％ ropivacaine 1 ml/kg mixed with dexmedetomidine 2 μg/kg in group DR.Postoperative analgesia was assessed using FLACC scale,and the degree of motor block was assessed using modified Bromage scale within 24 h after the end of operation.The duration of analgesia (the time from onset of caudal block to first requirement for the rescue analgesic) and development of side effects were recorded.Results Compared with group R,the duration of analgesia was significantly prolonged,and the incidence of bradycardia and oversedation was increased in group DR.Hypoxemia,hypotension and postoperative motor block were not found in either group.Conclusion Addition of dexmedetomidine 2 μg/kg to caudal ropivacaine can significantly optimize the efficacy of caudal block with ropivacaine alone for the management of perioperative analgesia in children.

患者男，64岁，因“上腹痛1年，发现脐部肿物15 d”于2014年3月20日入院；患者40年前因十二指肠穿孔行胃大部切除术。查体示：腹平坦，腹部正中见一长约15 cm手术瘢痕，脐部见一2．3 cm×1．3 cm大小肿物，上腹部伴有压痛；腹壁彩超示：脐部探及2．3 cm×1．3 cm的低回声团，边界不清，该光团内部未见明显血流信号；血常规示：血红蛋白96 g／L，肝肾功能和尿常规正常，诊断为“脐部肿物”。术前留置胃管引出暗红色液体约20 ml，于3月24日行脐部肿物局部切除术，取脐部肿物梭形切口，逐层切开皮肤、皮下组织至腹白线，从肿物上方进入腹腔，见腹腔有中等量腹水，吸出草绿色腹水约200 ml，继续探查，见脐部正常结构消失，未见与腹腔脏器相连，遂完整切除脐部肿物，见图1；因切口问题未探查残胃。术后病理示：脐部皮下见异型腺体，有分裂像，有黏液产生，形态符合腺癌，皮肤有累及，见图2a；免疫组织化学（免疫组化）示：CEA （＋）、CDX2（－）、CK20（－）、CK7（＋）、Ki-67（阳性率50％），见图2b。随后即查胃部CT示胃壁增厚，见图3；后查PET-CT示残胃充盈欠佳，壁弥漫增厚，放射性不均匀增高，最大值介于3．8～5．7之间。予以复查胃镜，提示残胃癌，病理示中分化腺癌，见图4；免疫组化示：CDX2（－）、CEA （－），CK （AE1／AE3）（＋）、Ki67（阳性率30％）、P53（＋）；肿瘤标志物CEA为6．62滋g／L， CA199为1565．4 kU／L，结合病史及辅助检查考虑为残胃癌脐转移。患者因自身因素拒绝行残胃癌根治术，予以XELOX&nbsp；（奥沙利铂加希罗达）化疗，于化疗第3天呕出暗红色血性液体约40 ml，排黑粪1次（约100 ml），急查血常规示：血红蛋白41 g／L，遂停止化疗，予以禁食水、止血、抑酸、抑酶、补液及输血等对症支持治疗，治疗3d后止血确切，观察4d后继续予以口服希罗达，此疗程结束，患者出院，患者术后脐部外观见图5。后因经济因素未行后续辅助性化疗，随访至2014年11月，患者一般状况尚可。

目的:研究人工流产中最佳镇痛方法。方法:对400例早期妊娠育龄妇女分别采用利多卡因宫颈局部注射,还有丙泊酚静脉注射两种镇痛方法。结果:用利多卡因局部镇痛作用行负压吸引术,对子宫肌壁刺激减轻,而丙泊酚静脉注射对子宫肌壁刺激痛良好效果。结论:丙泊酚行人工流产手术效果良好,值得推广和临床应用。

目的:探讨高龄阑尾炎患者病情严重程度与相关诊断症状关系。方法:选择急性阑尾炎患者共82例,根据阑尾炎的炎性反应程度分为两组,炎性反应轻组和炎性反应重组,分析两组患者中与诊断相关症状的发生情况,与诊断相关症状和体征包括转移性右下腹痛、恶心、呕吐、腹泻等消化道症状、体温、右下腹压痛、右下腹反跳痛、白细胞升高、中性粒细胞升高。结果:炎性反应重组转移性右下腹痛、体温升高、右下腹反跳痛、白细胞升高、中性粒细胞升高发生率高于炎性反应轻组,差异有统计学意义(P<0.05)。结论:转移性右下腹痛、体温升高、右下腹反跳痛、白细胞升高、中性粒细胞升高在对高龄阑尾炎严重程度诊断分析时有一定的参考意义,区分高龄阑尾炎严重程度时要注意上述症状和体征改变情况。

目的:探讨老年腹股沟疝在基层卫生院更为安全、有效、易于推广的手术方法。方法:采用无张力疝修补与传统疝修补法在术后疗效、疼痛时间、肺部并发症等方面进行对照。结果:无张力修补法(105例)与传统修补法(63例)在术后48 h切口疼痛、术后肺部感染及复发率分别为2/99、3/28和0.85/15,差异均有统计学意义(P<0.01)。结论:老年腹股沟疝采用无张力修补安全有效,易于掌握,基层医院值得推广。

目的:探讨不同通气给氧技术对小儿气管异物取出术的临床效果.方法:40例行气管异物取出术患儿随机分为使用肌松药的高频喷射通气组(Ⅰ组)和保留自主呼吸组(Ⅱ组)各20例,比较两组手术时间、苏醒时间和术中、术后各时点生命体征变化,并比较术中、术后并发症发生率.结果:Ⅰ组患儿在置镜、术中、退镜时点上的平均动脉压及心率显著低于Ⅱ组(P＜0.05),而且血氧饱和度显著高于Ⅱ组(P＜0.05),且Ⅰ组患儿术中、术后并发症发生例数＜Ⅱ组(P＜0.05).结论:使用肌松药的正压通气能维持术中呼吸、循环稳定、麻醉平稳,有利于手术操作,是手术成功的重要因素.

探讨人工全髋置换术麻醉的特殊注意事项。自人工股骨头及全髋关节问世以来,人工关节置换使越来越多的患者解除了疼痛,改善了生活质量。人工关节置换术使骨科学的范围和内容有了很大改变,也给麻醉带来了新的课题,提出了更高的要求。