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Objective To compare the analgesic effect and adverse event of butorphanol and dezocine which are combined with sufentanil and flurbiprofen axetil in PCIA,to screen out a relatively good analgesic.Methods 110 laparotomy cases from hepato-pancreato-biliary (HPB) department and 160 laparoscopy cases from general surgery(GS) department of xinqiao hospital of third medical university were included in our study.All patients were randomly divided into two groups according to the random number table method,namely the butorphanol group and dezocine group.Butorphanol 0.04 mg/kg,sufentanil 2.8 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg were used in HPB butorphanol group.Dezocine 0.2 mg/kg,sufentanil 2.8 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg were used in HPB dezocine group.Butorphanol 0.04 mg/kg sufentanil 2.5 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg was used in GS butorphanol group.Dezocine 0.2 mg/kg,sufentanil 2.5 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg was used in GS dezocine group.The mean arterial pressure(MAP),heart rate(HR),facial expressions of pain score,sedation score,PONV score,NRS score and respiratory depression were observed in postoperative 0 hour,6 hours,24 hours,48 hours.Results For both two departments,the numbers of patients with NRS score and facial expressions of pain scores greater than 3 in dezocine group were more than those in butorphanol group,the differences were significant(P ＜ 0.05).There was no statistically significant difference in numbers of patients with NRS score and facial expressions scale of 1 to 3 (P ＞ 0.05).while the number of cases with sedation score ranged from 1 to 3 in dezocine group was less than that in both HPB and GS butorphanol group(P ＜ 0.05).There was no statistically significant difference in PONV score and itching score which was or less than 3 or more than 3 (P ＞ 0.05).Conclusion For postoperative analgesia in PCIA,butorphanol has better analgesic effect than the same dose of dezocine,and stronger sedation effect than dezocine.
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<p><b>OBJECTIVE</b>To explore the clinical effects of one-stage posterior transpedicular screw system internal fixation combined with anterior debridement and bone grafting with modified inverted L-shape incision by extraperitoneal approach in treating multiple lumbosacral tuberculosis.</p><p><b>METHODS</b>The clinical data of 15 patients with multiple lumbosacral tuberculosis underwent operation from February 2008 to December 2014 were retrospectively analyzed. There were 9 males and 6 females with an average of (47.0±13.9) years old. The lesions involved L₄-S₁ in 12 cases, L₄-S₂ in 1 case, L₃-S₁ in 2 cases. Five cases complicated with nerve root symptoms and 2 cases with cauda equina symptoms. All patients were treated with posterior transpedicular screw system internal fixation combined with anterior L₄,₅, L₅S₁ debridement and bone grafting with modified inverted L-shape incision by extraperitoneal approach. Operation time, blood loss, incision length, first passage of gas by anus were recorded. The condition of bone fusion and focus absorption were observed by lumbar CT and MRI; and ESR and CRP were regularly rechecked.</p><p><b>RESULTS</b>Fifteen patients were followed up for 18-24 months with an average of (20.0±2.73) months. All lumbosacral pain obtained improvement, and no hardware loosening, breaking, or bone graft block loosening was found. The operative time of anterior-posterior approach surgery was 210-250 min with an average of (231.0±12.1) min; the blood loss was 320-705 ml with an average of(495.0±130.3) ml; the incision length was 15-21 cm with an average of (16.4±3.4) cm, and the extended length of inverted L-shape incision was 6 to 9 cm with an average of (7.1±2.6) cm. The time of first passage of gas by anus was 14 to 40 h with an average of (24.1±7.4) h after operation. All bone graft obtained fusion at final follow-up, and spinal cord symptoms got recovery, ESR and CRP restored normal level with no recurred at 3 months after drug withdrawal.</p><p><b>CONCLUSIONS</b>The treatment of multiple lumbosacral tuberculosis with posterior transpedicular screw system internal fixation combined with anterior debridement and bone fusion with modified inverted L-shape incision by extraperitoneal approach is feasible and practical. This method has advantages of little trauma, good exposure, less complications and high security.</p>
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<p><b>OBJECTIVE</b>To investigate the mid-term outcome of operation for thoracolumbar tuberculosis. METHODS : Twenty-eight patiens with thoracolumbar tuberculosis underwent one stage anterior debridement,interbody fusion with bone graft and posterior pedicle screw internal fixation treatment from July 2006 to July 2011. There were 17 males and 11 females. Total 17 patients had nerve injuries ,including 6 cases of grade B, 5 cases of grade C, 6 cases of grade D according to Frankel classification. The poisoning symptoms of tuberculosis and recovery of spinal function were observed. The bone fusion and recovery of [umbar function were evaluated.</p><p><b>RESULTS</b>All the patients were followed up ,and the duration ranged from 39 to 85 months (mean 57 months). The clinical symptoms were controlled gradually, and the thoracolumbar back pain was alleviated after operation. Among the 17 patients with complications of nerve injuries, 3 patients were improved from preoperative grade B to postoperative grade D, 3 patients were improved from preoperative grade B to postopertive E, 5 patients with preoperative grade C and 6 patients with preoperative D were almostly recovered to normal after operation. According to JOA scoring system for curative effect evaluation, the excellent and good rate at the 3rd month, the 1st year, the 3rd year and the 5th year after operation were 67.86% ,82.14% ,85.71% ,89.29% and 91.30% respectively. The results at the 6th month and the 1st year had no statistical differences compared to the results at the 3rd month (P > 0.05); but the results at the 3rd year and the 5th year were better than that at 3 months after operation (P < 0.05); and the results between 3 yesrs and 5 years after operation had no statistical differences (P < O.05). The degeneration of adjacent segments were evaluated according to the California University (Universith of California at Los Angeles , UCLA) score. The degeneration rate was 53.57% (15/28) at the 3rd year after surgery, which was better than that before surgery. Twenty-three patients were followed up for 5 years ,and the degeneration rate was 86.96% (20/23) ,which was better than those of before surgery and 3 years after surgery.</p><p><b>CONCLUSION</b>The surgical treatment for thoracolumbar spinal tuberculosis can achieve the thorough debridement, reconstruction of spinal stability, recovery of lumbar function and promote the functional recovery of the spinal cord, which is an effective method of treatment. However, the mid term follow-up showed that more severe degenerative changes were found in the postoperative adjacent segment.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae , General Surgery , Spinal Fusion , Methods , Thoracic Vertebrae , General Surgery , Tuberculosis, Spinal , General SurgeryABSTRACT
To clarify the pathogenesis of Duck enteritis virus (DEV), the cDNA library of duck's liver infected by DEV and a bait plasmid containing DEV nucleocapsid protein (NP) gene were constructed, then the receptor was screened from the cDNA library plasmid by the yeast two-hybrid system and verified by GST pull-down test. The results showed that the capacity of the primary cDNA library was 1 x 106 CFU with insertion size from 0.5 to 1 kb, and the bait plasmid of pGBKT7-NP showed no self-activation. The receptor reacting with DEV NP in duck liver was initially confirmed as the protein kinase C inhibitor (PKCI). These results provide new clues for further investigation on pathogenesis of DEV.