目的 觀察酒石酸布托啡諾與芬太尼合用于術后靜脈自控鎮痛（PCIA）的效果及最佳混合比例。 方法 2010年8月－2011年1月100例婦科手術患者，隨機分為5組，每組20例。均全身麻醉術后采用負荷量+持續背景劑量+PCIA方案鎮痛。根據不同配方分為F組：芬太尼1 mg+生理鹽水至100 mL；B組：酒石酸布托啡諾10 mg+生理鹽水至100 mL；BFⅠ組：芬太尼0.6 mg+酒石酸布托啡諾3 mg+生理鹽水至90 mL；BFⅡ組：芬太尼0.5 mg+酒石酸布托啡諾5 mg+生理鹽水至100 mL；BFⅢ組：芬太尼0.3 mg+酒石酸布托啡諾6 mg+生理鹽水至90 mL。觀察術后各時點視覺模擬評分（VAS）及鎮靜評分，患者滿意度以及不良反應情況。 結果 術后早期BFⅢ組和B組VAS評分大于F組；鎮靜評分B組大于F組；B組滿意度優良率小于其余各組；惡心嘔吐發生率F組高于BFⅠ組及BFⅡ組。 結論 酒石酸布托啡諾和芬太尼合用于PCIA，鎮痛效果確切，不良反應發生率低。推薦配比：BFⅠ組和BFⅡ組。
Objective To analyze the risk factors for postoperative cognitive confusion in a surgical intensive care unit. Methods A total of 388 consecutive patients in Surgical Intensive Care Unit of General Hospital of PLA were retrospectively studied. We posed clinical questions according to the patients with older age and large dosage corticosteroid. Using “Postoperative cognitive confusion” and“Intensive Care” as key words, we searched for evidence from MEDLINE (1968-2004). Results We found 3.1% (10/388) of the patients developed postoperative cognitive confusion. Of the 10 postoperative cognitive confusion patients, 9 were over 65 years old. 6.6% (9/136) of the patients (≥ 65 years old) developed postoperative cognitive confusion. While 0.4%(1/252) of the patients (＜65 years old) developed postoperative cognitive confusion. Older age (≥ 65 years old) may induce more postoperative cognitive confusion (P＜0.05). While 7.0% (5/71) of the patients treated by large dose corticosteroids (≥1 000 mg) developed postoperative cognitive confusion. And 1.65% (5/317) of the patients received corticosteroid with large dosage (＜1 000 mg) developed postoperative cognitive confusion. Large dosage corticosteroid (≥1 000 mg) may induce more postoperative cognitive confusion (P＜0.05). Conclusion Older age (≥ 65 years old) and high dose corticosteroid (≥1 000 mg) may be the two main risk factors for postoperative cognitive confusion.
ObjectiveTo evaluate the clinical feasibility of retroperitoneal necrosectomy using percutaneous nephroscope in management of post-traumatic pancreatitis. MethodsSix patients with post-traumatic pancreatitis were treated by percutaneous nephroscopic necrosectomy in our hospital. ResultsThere were no operative mortality and morbidity except that 1 patient developed hemorrhage in 11 days after operation. ConclusionPercutaneous nephroscopic necrosectomy has the advantage of small operation wound, little postoperative discomfort, and preventing relaparotomy. It is an ideal method for treating post-traumatic pancreatitis.