目的:研究低温环境下使用小剂量罗哌卡因行神经刺激仪联合超声引导腋路臂丛神经阻滞的临床效果。方法:选取本院2017年1-3月收治的需行前臂及手部手术患者120例,采用双盲随机分组将患者分为Ⅰ组(室温组)、Ⅱ组(低温组)、Ⅲ组(低温小容量...目的:研究低温环境下使用小剂量罗哌卡因行神经刺激仪联合超声引导腋路臂丛神经阻滞的临床效果。方法:选取本院2017年1-3月收治的需行前臂及手部手术患者120例,采用双盲随机分组将患者分为Ⅰ组(室温组)、Ⅱ组(低温组)、Ⅲ组(低温小容量组),每组40例。采用高频超声行腋路臂丛神经扫描,神经刺激器穿刺针在高频超声的实时监控下进针到达目标神经,经神经刺激仪(0.4 m A,2 Hz,0.1 ms)引出相应的目标肌肉运动,确定目标神经后,分别在桡神经、正中神经、尺神经、肌皮神经周围注入预设量的局麻药。Ⅰ组每一支神经注射室温0.4%罗哌卡因10 m L;Ⅱ组注射4℃0.4%罗哌卡因10 m L;Ⅲ组注射4℃0.4%罗哌卡因6 m L。观察各组阻滞起效时间、麻醉效果、臂丛阻滞并发症、止血带反应的发生例数等。结果:Ⅱ组平均麻醉时间显著高于Ⅰ组(P<0.05);Ⅲ组平均麻醉时间介于Ⅰ、Ⅱ组间,差异无统计学意义(P>0.05);Ⅰ组麻醉后桡神经、正中神经、尺神经、肌皮神经阻滞起效时间均明显长于Ⅲ组(P<0.05),Ⅱ组桡神经阻滞起效时间和肌皮神经均明显短于Ⅰ组(P<0.05);Ⅲ组与Ⅱ组的各类神经阻滞时间比较中,除Ⅲ组尺神经阻滞起效时间明显短于Ⅱ组(P<0.05),其他神经阻滞起效时间比较,差异均无统计学意义(P>0.05);三组均无穿刺部位明显血肿、误刺血管、局麻药中毒等严重麻醉并发症发生。结论:使用低温小容量罗哌卡因行神经刺激仪联合超声引导腋路臂丛神经阻滞较常温使用常规量麻醉起效时间更快,有效缩短了患者手术麻醉等待时间,且平均麻醉时间略长于常温使用常规量,而小于低温常规量,不会导致麻醉时间过短,且无严重麻醉并发症发生,是一种高效安全的临床麻醉方式,值得临床推广使用。展开更多
A universal platform with M_n doping and hyaluronic acid （HA） modification, based on mesoporous silica （mSiO2）, was designed and used as a basic multifunctional material with magnetic resonance （MR） imaging. Fur...A universal platform with M_n doping and hyaluronic acid （HA） modification, based on mesoporous silica （mSiO2）, was designed and used as a basic multifunctional material with magnetic resonance （MR） imaging. Furthermore, we added flexible functions through the addition of functional molecules. Specially, two typical compounds, hydrophobic perfluorooctyl bromide （PFOB） and hydrophilic doxorubicin （DOX）, were loaded into the channels to obtain PFOB@Mn@mSiO2@HA （PMMH） or DOX@Mn@mSiO2@HA （DMMH） or imaging and therapy, respectively. The were highly targeted to the lymph system in nanoparticles for dual-mode imaging PMMH and DMMH nanoparticles vitro and in vivo. MR and ultrasound imaging of PMMH nanoparticles were performed in the lymph system, while MR imaging and chemotherapy of DMMH nanoparticles was used to detect cancer. These results showed that both PMMH and DMMH nanoparficles can be designed with high lymph targeting efficiency. PMMH nanoparticles are a dual-mode contrast agent for both ultrasound and MR imaging for the lymph system and DMMH nanoparticles are powerful agents for the combined diagnosis and therapy of cancer in vivo.展开更多
文摘目的:研究低温环境下使用小剂量罗哌卡因行神经刺激仪联合超声引导腋路臂丛神经阻滞的临床效果。方法:选取本院2017年1-3月收治的需行前臂及手部手术患者120例,采用双盲随机分组将患者分为Ⅰ组(室温组)、Ⅱ组(低温组)、Ⅲ组(低温小容量组),每组40例。采用高频超声行腋路臂丛神经扫描,神经刺激器穿刺针在高频超声的实时监控下进针到达目标神经,经神经刺激仪(0.4 m A,2 Hz,0.1 ms)引出相应的目标肌肉运动,确定目标神经后,分别在桡神经、正中神经、尺神经、肌皮神经周围注入预设量的局麻药。Ⅰ组每一支神经注射室温0.4%罗哌卡因10 m L;Ⅱ组注射4℃0.4%罗哌卡因10 m L;Ⅲ组注射4℃0.4%罗哌卡因6 m L。观察各组阻滞起效时间、麻醉效果、臂丛阻滞并发症、止血带反应的发生例数等。结果:Ⅱ组平均麻醉时间显著高于Ⅰ组(P<0.05);Ⅲ组平均麻醉时间介于Ⅰ、Ⅱ组间,差异无统计学意义(P>0.05);Ⅰ组麻醉后桡神经、正中神经、尺神经、肌皮神经阻滞起效时间均明显长于Ⅲ组(P<0.05),Ⅱ组桡神经阻滞起效时间和肌皮神经均明显短于Ⅰ组(P<0.05);Ⅲ组与Ⅱ组的各类神经阻滞时间比较中,除Ⅲ组尺神经阻滞起效时间明显短于Ⅱ组(P<0.05),其他神经阻滞起效时间比较,差异均无统计学意义(P>0.05);三组均无穿刺部位明显血肿、误刺血管、局麻药中毒等严重麻醉并发症发生。结论:使用低温小容量罗哌卡因行神经刺激仪联合超声引导腋路臂丛神经阻滞较常温使用常规量麻醉起效时间更快,有效缩短了患者手术麻醉等待时间,且平均麻醉时间略长于常温使用常规量,而小于低温常规量,不会导致麻醉时间过短,且无严重麻醉并发症发生,是一种高效安全的临床麻醉方式,值得临床推广使用。
基金The work is supported by Shanghai Rising-Star Program （No. 13QB1402200）, Shanghai Minhang district talent development special fund, National Key Technology Research and Development Program （No. 2014BAK05B02） and National Natural Science Foundation of China （Nos. 81271638 and 81371622）.
文摘A universal platform with M_n doping and hyaluronic acid （HA） modification, based on mesoporous silica （mSiO2）, was designed and used as a basic multifunctional material with magnetic resonance （MR） imaging. Furthermore, we added flexible functions through the addition of functional molecules. Specially, two typical compounds, hydrophobic perfluorooctyl bromide （PFOB） and hydrophilic doxorubicin （DOX）, were loaded into the channels to obtain PFOB@Mn@mSiO2@HA （PMMH） or DOX@Mn@mSiO2@HA （DMMH） or imaging and therapy, respectively. The were highly targeted to the lymph system in nanoparticles for dual-mode imaging PMMH and DMMH nanoparticles vitro and in vivo. MR and ultrasound imaging of PMMH nanoparticles were performed in the lymph system, while MR imaging and chemotherapy of DMMH nanoparticles was used to detect cancer. These results showed that both PMMH and DMMH nanoparficles can be designed with high lymph targeting efficiency. PMMH nanoparticles are a dual-mode contrast agent for both ultrasound and MR imaging for the lymph system and DMMH nanoparticles are powerful agents for the combined diagnosis and therapy of cancer in vivo.
