目的 探討宮頸癌骨轉移相關因素。 方法 回顧分析2008年6月－2011年8月收治的352例宮頸癌患者的臨床資料，其中鱗癌326例，腺癌26例；臨床分期Ⅰ期60例、Ⅱ期184例、Ⅲ期90例、Ⅳ期18例。比較不同期別、不同病理類型、不同組織分級患者的骨轉移情況。 結果 352例宮頸癌中有18例發現骨轉移，轉移率為5.1%；轉移時間為3～48個月，2例于骨轉移后1年內死亡。鱗癌326例，骨轉移率為5.2%；腺癌26例，骨轉移率為3.8%。Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的骨轉移率分別為0.0%、3.8%、5.6%和33.3%，晚期與早期相比有統計學意義（P＜0.05）；高、中和低分化患者骨轉移率分別為3.1%、3.1%和6.3%，高分化與中分化相比，差異無統計學意義（P＞0.05），低分化與高中分化相比差異有統計學意義(P＜0.05)。 結論 宮頸癌骨轉移與宮頸癌臨床分期、病理類型、細胞分級密切相關。在宮頸癌的治療過程中，做到早發現、早治療，可提高患者的治療效果，延長生存時間。
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.
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 比較舒芬太尼與等效劑量芬太尼在髖關節置換術后患者硬膜外鎮痛的臨床效果。 方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髖關節置換術患者，隨機分為兩組（n=25）。芬太尼組（A組）:芬太尼0.75 mg加0.894%甲磺酸哌卡因20 mL加生理鹽水至100 mL；舒芬太尼組（B組），舒芬太尼75 μg加0.894%甲磺酸哌卡因20 mL加生理鹽水至100 mL硬膜外鎮痛。其中，A組患者于手術結束時，靜脈滴注格拉司瓊3 mg。持續劑量2 mL/h，單次給藥量（PCA）0.5 mL/次，鎖定時間15 min。觀察兩組的鎮痛效果，惡心、嘔吐次數，記錄脈搏血氧飽和度、心率、呼吸的變化。 結果 鎮痛泵開機后，B組各時段鎮靜評分，2分以上者明顯多于A組，鎮痛評分明顯低于A組，有統計學意義（Plt;0.05），兩組術后惡心、嘔吐發生率都較低，組間差異無統計學意義（Pgt;0.05）。兩組4、12、24 h的呼吸頻率和脈搏血氧飽和度差異有統計學意義（Plt;0.05），但48 h的呼吸頻率和脈搏血氧飽和度無統計學意義（Pgt;0.05）。 結論 在等效劑量下，髖關節置換術后患者硬膜外鎮痛，舒芬太尼明顯優于芬太尼。【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.