目的探讨不同剂量昂丹司琼（ondansetron）用于预防妇科腹腔镜术后恶心、呕吐（postoperative nausea and vomiting,PONV）的临床效果。方法选取2009年10月至2010年3月,在同济大学附属上海市第一妇婴保健院行择期妇科腹腔镜手术的120例...目的探讨不同剂量昂丹司琼（ondansetron）用于预防妇科腹腔镜术后恶心、呕吐（postoperative nausea and vomiting,PONV）的临床效果。方法选取2009年10月至2010年3月,在同济大学附属上海市第一妇婴保健院行择期妇科腹腔镜手术的120例患者为研究对象。将其随机分为4组,A组（n=30）,静脉注射昂丹司琼8mg;B组（n=30）,静脉注射昂丹司琼4mg＋地塞米松5mg;C组（n=30）,静脉注射昂丹司琼4mg;对照组（n=30）,静脉注射生理盐水5mL。纳入标准：根据美国麻醉师协会（American society of Aanesthesiologists,ASA）分级标准分为Ⅰ~Ⅱ级,患者年龄为20~57岁,术前无恶心、呕吐病史,未接受抗恶心、呕吐治疗患者（本研究遵循的程序符合同济大学附属上海市第一妇婴保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象的知情同意,并与之签署临床研究知情同意书）。麻醉诱导前1min,对4组患者分别静脉注射相应药物。4组患者年龄、体重、ASA分级、术前病史,术中麻醉时间、气腹压及气腹时间等比较,差异无显著意义（P〉0.05）。观察4组患者术后24h内恶心、呕吐发生情况。结果 A组患者术后24h内恶心、呕吐发生率明显低于对照组,两组比较,差异有显著意义（P〈0.01）;B组和C组术后24h内恶心、呕吐发生率比较,差异无显著意义（P〉0.01）;B,C组术后24h内恶心、呕吐发生率明显低于对照组,两组比较,差异有显著意义（P〈0.05）。结论静脉注射昂丹司琼8mg预防妇科腹腔镜术后恶心、呕吐失败率最低。静脉注射昂丹司琼4mg＋地塞米松5mg并不比单用昂丹司琼4mg预防妇科腹腔镜术后恶心、呕吐更有效。展开更多
Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas...Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.展开更多
Objective: To observe the analgesic effects of tramadol in general anaesthesia for laparoscopic surgery. Methods: To operate 80 laparoscopic surgeries under the circumstance of general anaesthesia. Randomly divide the...Objective: To observe the analgesic effects of tramadol in general anaesthesia for laparoscopic surgery. Methods: To operate 80 laparoscopic surgeries under the circumstance of general anaesthesia. Randomly divide them into 4 groups,with 20 cases in each group and the intravenous injection should be finished before the operation. Group Ⅰ: 2 ml normal saline; Group Ⅱ: 1.5 ml/kg tramadol; Group Ⅲ: 2mg/kg tramadol; Group Ⅳ : 2.5 mg/kg tramadol. Use VAS and Ramsay sedation marking system to assess the degree of pain-feeling and sedation in these circumstances: after pulling out oxygen hose, before leaving the operation room and1, 2, 4, 8, 12, 24 h after the operation. Meanwhile, record such side effects as nausea,vomiting, dizziness, hypersomnia, restless, nightmares, itchy and sweating. Results:The VAS score was significantly lower within postoperative 8 h in Group Ⅱ, Ⅲ andⅣ than that in Group I, while no significant difference was found among GroupⅡ, Ⅲand Ⅳ at each time point. The postoperative Ramsay sedation score was 0-2 in each group. Incidence of postoperative nausea, vomiting, and sweating were more in GroupⅡ, Ⅲ and IV than that in Group I. Group Ⅳ and Group I have statistical differences, in which P<0.05 or P<0.01. However, Group Ⅱ, Ⅲ and Group Ⅳ have no statistical differences. Conclusion: The study suggests that preoperative injection of 1.5-2 mg/kg tramadol provides satisfactory preoperative analgesia in patients undergoing gynaecological laparoscopy, reducing the use of analgesics and the incidence of side effects.展开更多
目的观察曲马多术前骶管阻滞用于妇科腹腔镜全麻术后镇痛的效果。方法全麻下行妇科腹腔镜手术60例,随机分为2组,每组30例:A组术前经骶管注入含曲马多100 mg+2%利多卡因5 m l+恩丹西酮4 mg+生理盐水共20 m l溶液,B组手术结束前10 m in由...目的观察曲马多术前骶管阻滞用于妇科腹腔镜全麻术后镇痛的效果。方法全麻下行妇科腹腔镜手术60例,随机分为2组,每组30例:A组术前经骶管注入含曲马多100 mg+2%利多卡因5 m l+恩丹西酮4 mg+生理盐水共20 m l溶液,B组手术结束前10 m in由莫非氏壶滴入曲马多100 mg+恩丹西酮4 mg。采用VAS评分和Ram say镇静评分对患者拔管后、离室前以及术后1、3、6 h进行痛觉和镇静程度评分,并记录有无躁动、头晕、嗜睡、恶心、呕吐等不良反应。结果A组拔管后,离室前,术后1、3 h的VAS评分显著低于B组(t=-5.961,-8.362,-4.038,-3.565;P=0.000),术后6 h VAS评分2组无显著性差异(t=-1.403,P=0.166);A组患者的镇静评分在拔管后,离室前,术后1、3 h明显高于B组(t=9.409,10.407,8.167,4.082;P=0.000),2组术后6 h的镇静程度评分无显著性差异(t=0.428,P=0.670)。B组患者拔管后、离室前躁动及术后头晕、恶心、呕吐的发生率明显高于A组(2χ=12.000,P=0.001;2χ=9.600,P=0.002;2χ=13.017,P=0.000)。结论曲马多100 mg术前骶管阻滞是妇科腹腔镜全麻术后较好的镇痛方法之一。展开更多
文摘目的探讨不同剂量昂丹司琼（ondansetron）用于预防妇科腹腔镜术后恶心、呕吐（postoperative nausea and vomiting,PONV）的临床效果。方法选取2009年10月至2010年3月,在同济大学附属上海市第一妇婴保健院行择期妇科腹腔镜手术的120例患者为研究对象。将其随机分为4组,A组（n=30）,静脉注射昂丹司琼8mg;B组（n=30）,静脉注射昂丹司琼4mg＋地塞米松5mg;C组（n=30）,静脉注射昂丹司琼4mg;对照组（n=30）,静脉注射生理盐水5mL。纳入标准：根据美国麻醉师协会（American society of Aanesthesiologists,ASA）分级标准分为Ⅰ~Ⅱ级,患者年龄为20~57岁,术前无恶心、呕吐病史,未接受抗恶心、呕吐治疗患者（本研究遵循的程序符合同济大学附属上海市第一妇婴保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象的知情同意,并与之签署临床研究知情同意书）。麻醉诱导前1min,对4组患者分别静脉注射相应药物。4组患者年龄、体重、ASA分级、术前病史,术中麻醉时间、气腹压及气腹时间等比较,差异无显著意义（P〉0.05）。观察4组患者术后24h内恶心、呕吐发生情况。结果 A组患者术后24h内恶心、呕吐发生率明显低于对照组,两组比较,差异有显著意义（P〈0.01）;B组和C组术后24h内恶心、呕吐发生率比较,差异无显著意义（P〉0.01）;B,C组术后24h内恶心、呕吐发生率明显低于对照组,两组比较,差异有显著意义（P〈0.05）。结论静脉注射昂丹司琼8mg预防妇科腹腔镜术后恶心、呕吐失败率最低。静脉注射昂丹司琼4mg＋地塞米松5mg并不比单用昂丹司琼4mg预防妇科腹腔镜术后恶心、呕吐更有效。
文摘Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.
基金Zaozhuang Science Technology Foundation Project of Shandonggrant number:Z2007623
文摘Objective: To observe the analgesic effects of tramadol in general anaesthesia for laparoscopic surgery. Methods: To operate 80 laparoscopic surgeries under the circumstance of general anaesthesia. Randomly divide them into 4 groups,with 20 cases in each group and the intravenous injection should be finished before the operation. Group Ⅰ: 2 ml normal saline; Group Ⅱ: 1.5 ml/kg tramadol; Group Ⅲ: 2mg/kg tramadol; Group Ⅳ : 2.5 mg/kg tramadol. Use VAS and Ramsay sedation marking system to assess the degree of pain-feeling and sedation in these circumstances: after pulling out oxygen hose, before leaving the operation room and1, 2, 4, 8, 12, 24 h after the operation. Meanwhile, record such side effects as nausea,vomiting, dizziness, hypersomnia, restless, nightmares, itchy and sweating. Results:The VAS score was significantly lower within postoperative 8 h in Group Ⅱ, Ⅲ andⅣ than that in Group I, while no significant difference was found among GroupⅡ, Ⅲand Ⅳ at each time point. The postoperative Ramsay sedation score was 0-2 in each group. Incidence of postoperative nausea, vomiting, and sweating were more in GroupⅡ, Ⅲ and IV than that in Group I. Group Ⅳ and Group I have statistical differences, in which P<0.05 or P<0.01. However, Group Ⅱ, Ⅲ and Group Ⅳ have no statistical differences. Conclusion: The study suggests that preoperative injection of 1.5-2 mg/kg tramadol provides satisfactory preoperative analgesia in patients undergoing gynaecological laparoscopy, reducing the use of analgesics and the incidence of side effects.
文摘目的观察曲马多术前骶管阻滞用于妇科腹腔镜全麻术后镇痛的效果。方法全麻下行妇科腹腔镜手术60例,随机分为2组,每组30例:A组术前经骶管注入含曲马多100 mg+2%利多卡因5 m l+恩丹西酮4 mg+生理盐水共20 m l溶液,B组手术结束前10 m in由莫非氏壶滴入曲马多100 mg+恩丹西酮4 mg。采用VAS评分和Ram say镇静评分对患者拔管后、离室前以及术后1、3、6 h进行痛觉和镇静程度评分,并记录有无躁动、头晕、嗜睡、恶心、呕吐等不良反应。结果A组拔管后,离室前,术后1、3 h的VAS评分显著低于B组(t=-5.961,-8.362,-4.038,-3.565;P=0.000),术后6 h VAS评分2组无显著性差异(t=-1.403,P=0.166);A组患者的镇静评分在拔管后,离室前,术后1、3 h明显高于B组(t=9.409,10.407,8.167,4.082;P=0.000),2组术后6 h的镇静程度评分无显著性差异(t=0.428,P=0.670)。B组患者拔管后、离室前躁动及术后头晕、恶心、呕吐的发生率明显高于A组(2χ=12.000,P=0.001;2χ=9.600,P=0.002;2χ=13.017,P=0.000)。结论曲马多100 mg术前骶管阻滞是妇科腹腔镜全麻术后较好的镇痛方法之一。
