【摘要】 目的 確定在不同濃度七氟醚復合瑞芬太尼誘導無肌松氣管插管時瑞芬太尼的半數有效量（ED50）。 方法 2009年7月-2009年11月擇期手術患者60例，ASA I~II，年齡20~59歲，按照入室的順序隨機分為Ⅰ組（2%七氟醚組）和Ⅱ組（3%七氟醚組），預沖8%七氟醚誘導，眼瞼反射消失后，調節七氟醚呼氣末濃度分別維持在2%或3%，同時按照序貫法注入瑞芬太尼，瑞芬太尼注射90 s后氣管插管。記錄麻醉誘導前、患者意識消失時、插管前1 min、插管后1 min及插管后3 min心率、平均動脈壓的變化。 結果 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量（ED50）及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 結論 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.
Objectives To analyze the effect of improved oven for defluorination in coal-burning endemic fluorosis areas in China, and to provide evidence for the prevention and control of fluorosis. Methods Electronic databases including CNKI, CBM, VIP and CDMD-D (1989 to 2005), were searched. We also checked the reference lists of relevant articles. We selected relevant articles according to the predefined inclusion and exclusion criteria. The methodological quality was assessed . Data on room heat preservation and the effect of improved oven for defluorination were collected in the surveillance spots of Three Gorges Reservoir. Correlation analyses were conducted between the improved oven and its effect parameters. Results Twelve articles of low quality met the selection criteria, of which 9 were graded C and 3 were graded D in terms of the methodological quality. A negative correlation was found between the decreasing rate of normal oven use and the decreasing rate of dental fluorosis as well as of urine fluorine (Pearson correlation coefficient r = – 0.87, – 0.63, Plt;0.01, lt;0.05, respectively). Analysis also revealed a positive correlation between room heat preservation and the decreasing rate of dental fluorosis as well as of normal oven use (the two Spearman correlation coefficients and P values were the same: r = –1.00, Plt;0.01). Conclusion High-quality studies on the effect of improved oven for defluorination in China are not available. Based on the current evidence, the improved oven for defluorination and the correct use, maintenance and house rebuilding for heat preservation may help to prevent fluorosis.
ObjectiveTo investigate the value of different minimally invasive surgical techniques, stent placement, laparoscopic surgery, and sustained-releasing 5-fluorouracil, in solving intestinal obstruction due to colorectal cancer. MethodsFrom May 2000 to May 2010, total 68 patients with obstructed colorectal cancers in three centers were treated in two ways in terms of the stage: The first, patients with resectable tumors underwent colorectal stent placement as a ‘bridge to surgery’ guided by enteroscope under X-ray. After clinical decompression and bowel preparation, laparoscopic radical resection was performed. The second, patients with unresectable tumors underwent rectal stent placement just for palliation. Sustained-releasing 5-fluorouracil was implanted into the local cancerous intestinal tract through stent walls. ResultsFifty-one of 52 patients underwent laparoscopic radical resection successfully following stent placement, while one failed and died during follow-up 93 d postoperatively. Forty patients with successful laparoscopic surgery were followed up in 3 to 36 months (with an average of 15 months) without tumor planting in the incision, postoperative local recurrence or anastomotic stricture. Fifteen unresectable patients and one high-risk, intolerable patient underwent rectal stent placement and implantation of sustained-releasing 5fluorouracil. During follow-up 3 to 24 months (with an average of 14 months), 11 died, who survived for (350±222) d (range 101-720 d), and 5 were still alive for 3 to 13 months (with an average of 9 months) without intestinal obstruction. ConclusionsLaparoscopic surgery combined with stent placement is an effective and safe procedure for resectable obstructed colorectal cancer. For unresectal obstructed rectal cancer, rectal stent placement combined with sustained-releasing 5-fluorouracil can prolong survival time avoiding colostomy.
bjectiveTo observe the effecacy of immunosuppressive agents on modulation of the disorders of inflammatory and antiinflammatory cytokines in acute pancreatitis, and to investigate the mechanism of treatment of acute pancreatitis with immunosuppressive agents. MethodsSD male rats were divided into 6 groups: group 1, the normal control group (n=6); group 2, acute pancreatitis induced by ductual injection of 5%sodium cholate sulfur at the volume of 1.0 ml/kg without treatment (n=8). After the pancreatitis were induced, the rest rats were injected intravenously with 5Fu 40 mg/kg (group 3, n=6); or methylprednisolone 30 mg/kg (group 4, n=6); or cyclophosphamide 20 mg/kg (group 5, n=6); or methotrexate 1.2 mg/kg (group 6, n=6). Twentyfour hours afteroperation, the animals were killed, the blood samples were taken for measurement of TNFα, IL1, IL6 (by bioassay), and IL10, TGFβ (by ELISA) as well as amylase. ResultsThe inflammatory cytokines (TNFα,IL1,IL6 ) and the antiinflammatory cytokines (IL10 and TGFβ), in blood of acute pancreatitis were increased significantly. After treated with immunosuppressive agents, both the inflammatory and antiinflammatory cytokines were decreased in different degrees. Some indexes of the severity of acute pancreatitis, such as amylase and pancreatic weight were improved obviously.ConclusionImmunosuppressive agents can regulate inflammatoryassociated cytokines increased remarkably in the acute pancreatitis. Therefore, improvement of acute pancreatitis can be achieved through rectifying the abnormal immunity and relieving the pathophysiological disorders of the acute pancreatitis by immunosuppressive agents.
