[目的]探讨不同剂量纳洛酮对吗啡硬膜外自控镇痛(PCEA)用于剖宫产妇镇痛效能及副作用的影响.[方法]160例剖宫产术后镇痛患者随机分为4组,采用不同的药物进行PCEA.M组:吗啡7 mg+罗哌卡因150 mg+昂丹司琼8 mg;MN1组:吗啡7 mg+罗哌卡因150 mg+ 纳洛酮0.25 mg;MN2组:吗啡7 mg+罗哌卡因150 mg+纳洛酮0.40 mg;MN3组:吗啡7 mg+罗哌卡因150 mg+纳洛酮0.55 mg.各组均加盐水至100 mL,在镇痛开始后48 h内不同时间观察VAS疼痛评分、Ramsay's评分、恶心呕吐、瘙痒、排气时间及呼吸抑制.[结果]MN1组、MN2组和M组的VAS评分差异无显著性(P>0.05),MN3组的VAS评分则明显升高,与M组比较,MN1组的副作用发生率差异有显著性(P<0.05),但MN2组与M组比较差异有显著性(P<0.01).[结论]7 mg吗啡伍用0.40 mg纳洛酮用于PCEA对吗啡镇痛效果无影响,并可有效地减少吗啡术后镇痛并发症.

Objective To compare the analgesic effects of three kinds of nerve block on collarbone surgery. Methods 60 patients, ASA physical status of Ⅰ～Ⅱ, undergoing collarbone surgery were randomly allocated into three groups: Group A was given cervical plexus nerve block(CPNB); Group B was given brachial plexus block(BPNB); Group C was given CPNB combination with BPNB. All patients were use the same local anaesthetic drugs (1%Lidocaine and 0.25% bubivacaine), The BP, SPO2 and ECG were simultaneously monitored, The analgesia effects and complications were recorded. Results The satisfactory analgesia ration were 95% in group C, and 65% in group A or B, group C was significantly higher than group A or B(P0.05). The cardiovascular response to operative stimulation was mild, systolic blood pressure and heart rate were not significantly different compared with those before operative in group C(p0.05), which were significantly incread in group A and B (p0.05), complications occurred 1 cases in group A and C, 0 cases in group B. Conclusions CPNB combination with BPNB provides better analgesia effect for collarbone surgery than CPNB or BPNB alone.

Objective To investigate preemptive analgesic effect of lornoxicam in patients receiving thyoidectomhy.Methods 50 patients receiving thyoidectomy under cervical plexus block were randomized to receive intravenously either lornoxicam 16 mg (group A) or normal saline 4 ml (group B) 30 minutes before cervical plexus block.The clinical responses were evaluated using the VAS Score,volume of fentanyl,Ramsay sedation scale,indexes of respiratory and circulation system,andadverse events within 24 hours postoperation.Results Compared with the normal saline group,patients administrated with lornoxicam showed lower VAS score,and had less volume and frequency of fentanyl.(P<0.05),Patients experienced fewer side-effects such as nausea and vomiting.Conclusion Preemptive analgesia with lornoxicam 16 mg can provide sufficient analgesic effects in the thyoidectomy.

目的评价3种麻醉方法用于老年人行经尿道前列腺电切术(TURP)的麻醉效果及其副作用。方法75例行TURP老年随机分为E,SP,SA组,每组25例,E组0.375%布比卡因用于连续硬膜外阻滞(L3-4间隙);SP组和SA组采用腰硬联合麻(L3-4间隙),SP组0.75%布比卡因1.5 ml加脑脊液稀释成3 ml用于脊麻;SA组0.75%布比卡因0.8 ml和40μg芬太尼加脑脊液稀释成3 ml用于脊麻。观察并记录:骶神经阻滞效果;感觉阻滞最高平面;到达感觉阻滞最高平面时间;最高平面消退时间;改良Bromage评分法判断运动神经阻滞程度;运动神经阻滞消退时间;血压与心率变化以及恶心、呕吐、寒战、呼吸抑制等副作用。结果E组骶神经阻滞成功率较低,感觉阻滞最高平面较高,出现较迟,而且消退时间长,低血压和寒战发生率高,围术期血压波动幅度大;SP组和SA组的阻滞效果较完善,平面出现和消退时间相当,但SA组平面较低,Bromage评分低,运动神经阻滞持续时间短,低血压和寒战的副作用发生率明显低于E组和SP组(P<0.05)。结论0.75%布比卡因0.8 ml加芬太尼40μg用脑脊液稀释成3 ml用于CSEA中,既能取得满意的阻滞效果,而且副作用少,适用于老年人的TURP。

OBJECTIVE:To investigate the effect of electro-acupuncture-anesthesia device (EAAD) as an auxiliary localizing method for brachiplex nerve blocking.METHODS:One hundred and twenty patients scheduled for operation in upper limbs were randomly divided into group A and group B, 60 in each group. Bupivacaine 25 ml (0.375% in concentration) was used to block intermuscular plexus brachialis in the operation for anesthesia and EAAD was used for adjunctive localizing in group A, while in group B paresthesia elicitation was used.RESULTS:In group A, the blocking was complete in 56 cases and incomplete in 4, the anesthesia effect was superior to that in group B, complete in 46, incomplete in 9, and of inefficient in 5 (P < 0.01).CONCLUSION:EAAD provides a localizing method for plexus brachialis blocking more precise than paresthesia elicitation.

Obiective To explore the changes of total bile acid(TBA)in serum of women during normal pregnancy.Methods The levels of TBA,total bilirubin(TBIL),direct bilirubin (DBIL),alanine transamlnase(ALT)were detected by BACKMAN CX9 analyzer.Results Compared with those of control group,the level of TBA of pregnant women in the Ⅱand Ⅲ gestational period was significant increased,the levels of TBIL,DBIL and ALT in the Ⅲ gestational period were significant increased.The levels of TBA and ALT in postpartum group were decreased than those of the women during normal pregnancy in Ⅲ gestational period.Conclusion The level of TBA of pregnant women increase with gestational period prolonged.It is a sengitiveindexfor diagnosis of intrahepatic cholestasis.

[Objective]To evaluate the clinical effect of three different analgesic methods on complications following thoracotomy in aged patients.[Methods]One hundred and six patients (male 79, female 27)underwent thoracotomy were randomly assigned to 3 groups.group Ⅰ:epidural analgesia(n=36); group Ⅱ: intravenous analgesia (n=33); group Ⅲ: muscular injection analgesia(n=37). Main complications of cardio-pulmonary system and side effects were compared.[Results]In epidural analgesia group, the scores of analgesic scale was significantly superior to the two other groups, and complications including arrhythmia, hypertension, angina, atelectasis, lung infection, hypoxemia were fewer.[Conclusion]Epidural analgesia lessens the complications of cardio-pulmonary system obviously, it is a good method of easing pain for aged patients after thoracic surgery.

目的评价预防术后镇痛所致恶心呕吐二种用药方案的临床疗效.方法选择妇科手术患者100例,随机分为地塞米松组(D组,50例)、欧贝组(O组,50例).所有病例采用腰麻-硬膜外联合麻醉,手术麻醉过程顺利,术毕关腹腔时经硬膜外导管一次注入:D组0.25%布比卡因加地塞米松5mg的复合液5ml,O组0.25%布比卡因5ml同时静脉注射欧贝4mg.然后连接一次性微量止痛泵行硬膜外腔自控镇痛(PCEA),止痛泵复合液配方:布比卡因187.5mg加氟哌利多5mg加曲马多400mg加生理盐水至100ml.D组加地塞米松10mg,O组加欧贝8mg.术后4h、24h、48h随访并记录术后镇痛效果和恶心呕吐发生率.结果所有患者术后镇痛效果都较满意,两组相比(P＞0.05),无统计学意义.恶心呕吐发生率两组相比(P＞0.05),无统计学意义. 结论地塞米松、欧贝都可以有效减轻曲马多复合液术后行PCEA时所致恶心呕吐的发生率,不影响镇痛效果,不增加副作用.

s:Objective To investigate changes of plasma coagulation parameters in type 2 diabetes mellitus,and the relationship of plasma coagulation parameters with angiopathy.Methods The levels of prothrombin time(PT),partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),triglyceride(TG),total cholesterol(CH) were determined in patients with type 2 diabetes mellitus(n=85) and controls(n=60).Results Compared with those of control group,the levels of PT,APTT were significantly shorter in diabetes mellitus,the level of fibrinogen(FIB) increased.Furthermore,in diabetes patients,those with micro or macroangiopathy showed shorter the levels of APTT,TT and higher the level of FIB.These changes of plasma coagulation parameters have independent relationship with serum TG.Conclusions Patients with type 2 diabetes mellitus could cause coagulation disturbance,there were increasement of blood clotting activity in the paitents with micro or macroangiopathy.

Objective: To compare the effect of epidural PCA with venous PCA on postoperative analgesia of esophageal carcinoma. Method: 70 cases were randomly divided into two group: epidural PCA(pupivocaine and fentanyl) and venous PCA(morphine and droperidol).Visual analogue scale(VAS), sedation scale, respiratory rate,pulse, SpO 2 ,side-effect of operation and satisfactory degree of patients were compared between two groups. Result: VAS and sedation scale in group using venous PCA were significantly higher than in group using epidural PCA(P0.05). there were no significant difference in respiratory rate and SpO 2 between two groups(P0.05). Incident rates of nausea and spew in group using venous PCA were significantly higher than in group using epidural PCA(P0.05). Satisfactory degree of epidural PCA(91.3) were significantly higher than venous PCA(80.0%)(P0.05).Conclusion: There was a higher satisfactory degree in the patients who used PCA, furthermore, effect of epidural PCA was better than venous PCA.

Objective To evaluate the curative efficiency and the side effect of the application of xafon and fentanyl in the postoperative patient controlled intravenous analgesia(PCIA) of thoracic surgery,and discuss the feasibility of this use.Methods 200 cases of patients undergoing thoracic surgery are random to be divided into two groups:group of PCIA (100 cases),the patients receive patient controlled intravenous analgesia,xafon and fentany are put in the anlgesia pump;group of PCIA(100 cases),the patients receive patient controlled epidural analgesia(PCEA),mophine and bupivacaine are put into the anlgesia pump.1 h,2 h,12 h,24 h,48 h after the operation ,using the VAS method to score the effect of analgesia of the two group patients,record the incidence of the side effect and record the objective sign of life.Results The effects of two analgesia methods in diffence groups are similar(P0.05),but the incidences of nausea,vomiting,dizziness and skin itchy of group PCEA are higher than those of guoup PCIA(P0.05);the incidences of lethargy in the two groups are similar too(P0.05).Conclusion The effect of analgesia method of group PCIA is better than that in Group PCEA,and get less side effect,so this analgesia method is worthy to be used in clinic.

Objective: To estimate effect of propofol by target-controlled infusion(TCI) in outpatient artificial abortion. Method: 90 patients were randomly divided into two group: group E(target-controlled infusion) and group H(hand-controlled infusion). Each group is 45 cases. Effectiveness of narcosis, change of respiration and circulation, BIS and side-effect of operation were observed and recorded. Result: Total amount of propofol used in group H was significantly more than group E(P0.05). The recovery time in group H was more longer but the induced time in group H was more shorter. There were not significantly different in heart rate and blood pressure in operation process between two group(P0.05). SpO 2 was significantly lower in group H than in group E(P0.05). There was no significant difference in BIS values between the two groups(P0.05). There were much more side-effect of operation in group H than in group E(P0.05). Conclusion: Target-controlled infusion of propofol had a better effect in outpatient artificial abortion than hand-controlled infusion and could be widely applied.

Objective: To investigate and compare the clinical effects of patient controlled intravenous analgesia (PCIA) with tramadol or morphine for patients after thoracotomy. The analgesic efficacy, side effects such as nausea and vomiting and safety in cardiorespiratory system were evaluated. Method: 60 patients undergoing thoracotomy were randomly divided into two groups: tramadol and morphine group (n =30). The induction and maintenance of anesthesia were same in two groups. PCIA was started just after the extubation at the end of operation and kept for 48 hours. The model of PCIA was bolus + basal dose + PCIA. Patients were visited 4, 8, 12, 24, and 48 hours postoperatively and recorded blood pressure, pulse rate, respiratory rate, analgesic dose, pain scores, and side effects such as nausea, vomiting, pruritus, etc. Results: There were no statistical significant differences in pain scores between tramadol and morphine group. The side effects on patients with PCIA tramadol were less than that on patients with PCIA morphine. Conclusion: Tramadol in compared with morphine as intravenous PCA drug for postoperative pain control has good clinical effect. Tramadol PCIA is an effective and safe method to postoperative pain relief.

Objective: The authors retrospectively evaluated the use of propofol as an adjunct to continous epidural block in children. Method: Children aged 2～14 year-old undergoing low abdominal,lower exeremity surgery and pelvic surgery were selected. Continous epidural block was performed for operation, in the same time,propofol was continous infused 2mg/kg·h,intervenously,and Bp,SpO 2,EKG,HR,RR were monitored. Results: All children 's Bp,SpO 2,EKG,HR,RR were normal, SpO 2 were 98% or upper.They keeped sleeping or calm during operation, and waked up 10min postoperation.They were no agitation. Conclusion: Propofol as an adjunct to continous epidural block had a good effective in children surgery.

ObjectivesTo observe the clinical efficacy of patient self-controlled intravenous analgesia (PCIA) with tramadol after thoracotomy.MethodsSixty patients subjected to thoracotomy were randomly divided into two groups:①PCIA group (n=30), 800 mg tramadol plus 5 mg droperidol was diluted to 100 ml with normal saline (NS). The sustained infusion was 2 ml/h plus PCIA 0.5 ml for each time , whereas the lockout time of safety was 15 min.②Control group (n=30), intramuscular injection of pethidine was scheduled intermittently as patients required. Patients were followed up postoperatively and PCIA using times, pain scores, respiratory rate, blood pressure, sedation status, and side effects such as nausea, vomiting, pruritus, urine retention, etc. were recorded.ResultsStatistically significant differences in pain scores and sedation status existed between PCIA and control groups. The pain control rate of PCIA group achieved 100% .ConclusionTramadol as PICA drug for postoperative pain shows better clinical efficacy.

目的：观察术后病人硬膜外自控镇痛(PCA)方法和临床效果。方法：腹部手术60例分为2组：PCA组(n=30)，吗啡15mg、氟哌利多5mg、布比卡因100mg＋0.9%NS稀释至100mL。持续量1mL/h+PCA量0.5mL/次，安全锁定时间15min。对照组(n=30)，术后根据病人需要间断肌注哌替啶。术后随访并记录PCA使用次数、疼痛评分、呼吸频率、血压、镇静状态及恶心、呕吐、搔痒、尿潴留等副作用。结果：两组疼痛评分、镇静状态等观察指标有显著性差异。PCA组疼痛控制率达100％。结论：自控镇痛方法用药量小，止痛效果可靠，较传统术后止痛方法优越。