Objective To observe the changes of serum potassium level and the factors that affected it when preoperative intravenous administration of gelofusine was given rapidly at high dose. Methods Thirty patients scheduled for upper abdominal operation were selected for the study and they were randomizely divided into test group (gelofusion group) and control group with 15 cases in each group. The first blood and urine sample was taken after epidural puncture and the potassium value was used as basic values. Then an intravenous administration of gelofusion at a dose of 10ml/kg was given in gelofusion group within 30min and then the second sample was obtained. Another intravenous administration of gelofusion at a dose of 10 ml/kg was given within 1 hour and the third sample was taken, while the fourth and fifth samples were taken 30 and 90 minutes after the third samples taken respectively. All the blood samples were tested for serum level of electrolytes (Na+,K+,Cl-,Ca2+,Mg2+), pH, Osm, Hct. The value of electrolytes (Na+,K+,Cl-,Ca2+,Mg2+) of urine samples were determined too. The intracellular levels of K+ and Mg2+ of erythrocyte were tested. The gelofusion were replaced by saline solution in control group and the other procedures were the same.Results The serum level of potassium was decreased progressively after rapid intravenous administration of gelofusine at high dose. Conclusion The serum level of potassium will decrease significantly after rapid intravenous administration of gelofusion at high dose during operation.
目的 探讨宫颈癌骨转移相关因素。 方法 回顾分析2008年6月－2011年8月收治的352例宫颈癌患者的临床资料，其中鳞癌326例，腺癌26例；临床分期Ⅰ期60例、Ⅱ期184例、Ⅲ期90例、Ⅳ期18例。比较不同期别、不同病理类型、不同组织分级患者的骨转移情况。 结果 352例宫颈癌中有18例发现骨转移，转移率为5.1%；转移时间为3～48个月，2例于骨转移后1年内死亡。鳞癌326例，骨转移率为5.2%；腺癌26例，骨转移率为3.8%。Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的骨转移率分别为0.0%、3.8%、5.6%和33.3%，晚期与早期相比有统计学意义（P＜0.05）；高、中和低分化患者骨转移率分别为3.1%、3.1%和6.3%，高分化与中分化相比，差异无统计学意义（P＞0.05），低分化与高中分化相比差异有统计学意义(P＜0.05)。 结论 宫颈癌骨转移与宫颈癌临床分期、病理类型、细胞分级密切相关。在宫颈癌的治疗过程中，做到早发现、早治疗，可提高患者的治疗效果，延长生存时间。
目的:比较舒芬太尼与芬太尼复合七氟烷麻醉在神经外科手术中对血流动力学、拔管时间、苏醒时间及术后疼痛情况的影响。方法:择期开颅手术患者60例,随机分为舒芬太尼(S)组和芬太尼(F)组,每组30例。将S和F的效能比定为10:l,复合咪唑安定、维库溴胺、异丙酚来进行麻醉诱导;麻醉维持均复合七氟烷。分别记录麻醉前、诱导后、插管时和拔管时血压和心率变化;呼吸恢复、睁眼和拔管时间以及拔管后半小时疼痛评分(VAS评分)。结果:两组麻醉诱导后收缩压(SBP)、舒张压(DBP)、心率(HR)均较诱导前有显著性下降(Plt;0．05)。F组插管及拔管时,血流动力学变化均较S组有显著性升高(Plt;0.05)。S组苏醒期呼吸恢复、睁眼、拔管时间较F组明显缩短;拔管后半小时疼痛评分(VAS评分)S组低于F组。结论:与芬太尼相比,等效剂量的舒芬太尼用于脑外科手术患者麻醉诱导可更有效地减轻全麻诱导气管插管时的心血管反应;在麻醉苏醒期,更有利于呼吸管理及术后镇痛。舒芬太尼在神经外科麻醉中具有很好的临床应用价值。
Objective To investigate whether the peri pheral administration of amitri ptyl ine and bupivacaine produces anti-hyperalgesic effect and to screen the neurotoxicological effect on sciatic nerve blockade in a rat model of neuropathic pain. Methods Twenty-four adult male SD rats [weighing (200 ± 20) g] were made the models of chronic constriction injury (CCI) and randomly divided into 3 groups (n=8) 5 days after operation: group A (amitriptyl ine), group B (bupivacaine) and group C (normal sal ine). 0.5 mL 0.5% amitriptyl ine, 0.5% bupivacaine or normal sal ine were given in group A, group B, and group C, respectively through implanted cannulas after 5, 7 and 9 days of CCI once a day for successive 3 days. The motor function was measured before administration and 1, 2, 4, 8, 12 and 24 hours after every administration. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured before administration and 1, 3, 5 and 7 days after the third administration. The operated sciatic nerve samples were obtained for neuropathological examination under l ight microscope. Results Twenty-four CCI rats were all survival without infection, palsy and catheter fall ing off. Compared with group C, the rats of group A and group B both produced significant ambulation deficits after every administration (P lt; 0.05). The ambulation deficits lasted 2 hours (group B) and 8 hours (group A) respectively. But the ambulation deficits of CCI rats were all reversible. The MWT and TWL of group A 1 and 3 days after the third administration increased when compared with those before administration and 5 and 7 days after the third administration, and when compared with group B and group C (P lt; 0.05). There was no significant difference (P gt; 0.05) in l ight microscopic neuropathological examination among three groups. Epineurial tissue and endoneurium tissue integrity, tidy arrangement of fibers, less inflammatory cell and no marked degeneration of myel inated fibers were observed. Conclusion Repeated sciatic nerve blockade with 0.5% amitriptyl ine has peripheral anti-hyperalgesic effects on neuropathic pain of rats. No morphological evidence of neurotoxicity in the sciatic nerve of rats is observed in 0.5% amitriptyl ine.
Objective To investigate whether the peri pheral administration of amitri ptyl ine produces antihyperalgesiceffect following the chronic constriction injury (CCI) of the sciatic nerve in rats. Methods Forty-eight maleCCI rats weighing (220 ± 20) g were randomly divided into 6 groups (n=8)：group NS, group A2.5, group A5, group A10,group A15.9 and group Aip. In the group NS, group A2.5, group A5, group A10 and group A15.9, sciatic nerve blockade was locally performed with 0.5 mL normal sal ine, and 2.5, 5.0, 10.0, 15.9 mmol/L amitriptyl ine respectively through implanted cannulas on the 7th day after operation. In the group Aip, amitriptyl ine (2.5 mg) was administered by intraperitoneal injection. The mechanical withdrawal threshold (MWT), thermal withdrawal latency (TWL) and motor function were measured before and 1, 2, 4, 8, 12, 24 and 48 hours after sciatic nerve blockade. Results Forty-eight CCI rats were all survival without infection palsy and catheter fall ing off. The rats of group A2.5, group NS and group Aip didn’t produce ambulation deficits. There were no significant difference in these 3 groups (P gt; 0.05). However compared with group A2.5, group NS and group Aip, the rats of group A5, group A10, group A15.9 all produced significant ambulation deficits (P lt; 0.05). The ambulation deficits lasted 2 hours (group A5), 4 hours (group A10), 8 hours (group A15.9) respectively. But the ambulation deficits of CCI rats were all reversible. The MWT and TWL of groups with local injection of amitriptyl ine increased when conpared with group NS, group Aip and those of before injection (P lt; 0.05). Sciatic nerve blockade with amitriptyl ine significantly suppressed mechanical hyperalgesia and thermal hyperalgesia in neuropathic rats. The peripheral anti-hyperalgesic effects lasted 2 hours (A2.5 group), 4 hours (group A5), 24 hours (group A10), 24 hours (group A15.9) respectively. But there were no significant difference between A10 group and A15.9 group (P gt; 0.05). There were no significant difference between group NS and group Aip (P gt; 0.05). Conclusion The peri pheral anti-hyperalgesic effects can be found in sciatic nerve blockade of amitri ptyl ine on CCI rats. And this effect of amitri ptyl ine has concentration dependent and ceil ing effect. Amitri ptyl ine of 5.0-15.9 mmol/L can produce significantambulation deficits which are reversible.
【摘要】 目的 比较舒芬太尼与等效剂量芬太尼在髋关节置换术后患者硬膜外镇痛的临床效果。 方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髋关节置换术患者，随机分为两组（n=25）。芬太尼组（A组）:芬太尼0.75 mg加0.894%甲磺酸哌卡因20 mL加生理盐水至100 mL；舒芬太尼组（B组），舒芬太尼75 μg加0.894%甲磺酸哌卡因20 mL加生理盐水至100 mL硬膜外镇痛。其中，A组患者于手术结束时，静脉滴注格拉司琼3 mg。持续剂量2 mL/h，单次给药量（PCA）0.5 mL/次，锁定时间15 min。观察两组的镇痛效果，恶心、呕吐次数，记录脉搏血氧饱和度、心率、呼吸的变化。 结果 镇痛泵开机后，B组各时段镇静评分，2分以上者明显多于A组，镇痛评分明显低于A组，有统计学意义（Plt;0.05），两组术后恶心、呕吐发生率都较低，组间差异无统计学意义（Pgt;0.05）。两组4、12、24 h的呼吸频率和脉搏血氧饱和度差异有统计学意义（Plt;0.05），但48 h的呼吸频率和脉搏血氧饱和度无统计学意义（Pgt;0.05）。 结论 在等效剂量下，髋关节置换术后患者硬膜外镇痛，舒芬太尼明显优于芬太尼。【Abstract】 Objective To compare the clinical effect of epidural analgesia with sufentanil and fentanyl in an equivalent dose after hip replacement. Methods From December 2006 to September 2008, fifty cases of epidural anesthesia after hip replacement were randomly divided into two groups, each group had 25 cases. Group A (fentanyl group): fentanyl mesylate 0.75 mg+0.894% ropivacaine 20 mL+0.9% sodium chloride solution to 100 mL; group B (sufentanil group): sufentanil 75 μg+0.894% ropivacaine mesylate 20 mL+0.9% sodium chloride solution to 100 mL epidural analgesia. Patients in group A received intravenous infusion of granisetron 3 mg at the end of surgery. Continuous dose was 2 mL/h, with the volume of single dose (PCA) 0.5 mL per time and lockout time of 15 minutes. The analgesic effect, nausea, and vomiting frequency were observed, and the pulse oxygen saturation, heart rate, and breathing changes were recorded. Results After boot analgesia, S sedation scores for each phase and pain score in group B were significantly different compared with those in group A (Plt;0.05). Both groups had low incidence of nausea and vomiting, and the difference was not statistically significant (Pgt;0.05). The difference of respiratory rate and pulse oxygen saturation at 4 h, 12 h, 24 h was statistically significant between two groups (Plt;0.05), but at 48 h the difference was not significant (Pgt;0.05). Conclusion In the equivalent dose, epidural analgesia with sufentanil in the patients with hip replacement is superior to fentanyl.