关键词： Cholangiopancreatography   Endoscopic Retrograde   Conscious Sedation   Adolescent   Adult   Analgesia   Patient-Controlled   Analgesics   Opioid   Comparative Study   Drug Combinations   Female   Humans   Hypnotics and Sedatives   Infusions   Intravenous   Male   Meperidine   Midazolam   Middle Aged   Treatment Outcome  

摘要： Background: Adequate comfort is essential to patients undergoing invasive procedures. This study was designed to evaluate whether patient-controlled analgesia could improve sedation for ERCP. Methods: Patients were randomized to receive standard sedation (n = 31) or patient-controlled analgesia (n = 31). The patients were blinded to the randomization. After the procedure the patient, physician, and nurse each rated their satisfaction with sedation using a verbal rating scale. Results: There was no significant difference between the patient's mean satisfaction score for the conventional and patient-controlled analgesia groups (9.3 and 9.6, respectively, p = 0.5). The physicians rated sedation higher in the conventional group compared with the patient-controlled analgesia group (8.6 and 8.2, respectively, p = 0.02). Physicians' and nurses' scores correlated (r = 0.53, p = 0.0001), but there was no correlation between scores reported by either physicians or nurses and the patients' scores (r = 0.2 and r = 0.05, respectively). Oxygen saturation less than 90% occurred for more than 1 minute in three patients who received standard sedation but in none who used patient-controlled analgesia. Conclusion: This trial demonstrates that patient-controlled analgesia during ERCP is as effective as standard sedation with respect to patient satisfaction. Physicians and nurses, however, are not good proxies for assessing patient satisfaction.

摘要： AIM: To compare the effectiveness and safety of ketorolac and midazolam to meperidine and midazolam during elective GI endoscopy. Ketorolac has been shown to be as effective an analgesic as meperidine in controlled studies and is free of the adverse hemodynamic and central nervous system depressive effects of meperidine. Single dose administration of ketorolac is not known to produce platelet dysfunction or increase the risk of GI bleeding. Patients and Methods: 54 patients (38m/16f;mean age 59 yrs) were randomized in double blind fashion to receive I mg of midazolam followed by 30 mg of ketorolac (group 1) or 50 mg of meperidine (group 2) in four divided doses over 10 minutes. Additional midazolam in 1 mg doses was given to the discretion of the attending physician until adequate conscious sedation was obtained. Patients in group 1 (27 pts) underwent 13 colonoscopies (COL) and 14 upper GI endoscopies (EGD), while in group 2 (27 pts) 18 EGD and 9 COL were performed. Examination of the I.V. site, constant pulse oximetry and heart rate monitoring and blood pressure monitoring every 3 min were done during the sedation period, throughout the endoscopic procedure and 30 min after the procedure was terminated. The endoscopist and patient were then asked to fill questionnaires regarding the procedure. Complications during the procedure (desaturation < 90% for > 30 sec, HR < 60, and fall in BP > 20%) were recorded. Results: Patients in group 1 received a mean dose of 3.48 mg of midazolam, compared with 3.20 mg for group 2 (P=0.60). There was one episode of prolonged hypotension and one of oxygen desaturation in each group. Differences in the ease of examination (P=0.4), degree of sedation (P=0.78), patient cooperation (P=0.4) and retching that interfered with the procedure (P=0.52) were not statistically significant between both groups. Differences in patient recollection of events (P=0.11), amount of pain during the procedure (P=0.97) and the willingness to undergo a repea

关键词： benzamides   5-HT4 receptors   GR125487   small intestinal transit  

摘要： Cisapride and metoclopramide are used clinically in the treatment of gastro-oesophageal reflux disease and also in a variety of motility disorders of the gastrointestinal tract. Their prokinetic effect is thought to be due to the augmentation of acetylcholine release from the myenteric plexus, an effect likely to be mediated through the stimulation of 5-HT4 receptors. The role of 5-HT4 receptors in the control of intestinal motility in man and animals is not clear, therefore we have investigated their role in the control of small intestinal transit in the rat. Radioactive microspheres were administered into the proximal duodenum of fasted conscious rats through an indwelling cannula. The extent of small intestinal transit was examined by determining the distribution of the microspheres within the intestine. Following i.p. injection small intestinal transit was inhibited (78%) by atropine (3 mg/kg), suggesting the presence of a basal cholinergic influence. Furthermore, in the presence of p-amino clonidine intestinal transit was stimulated (126%) by bethanechol (3 mg/kg). The. 5-HT4 receptor agonists cisapride (1.0 mg/kg) and zacopride (1.0 mg/kg) failed to increase small intestinal transit. The 5-HT4 receptor selective antagonist GR125487 (1 mg/kg) was also without effect. These data suggest that 5-HT4 receptors are not involved in the control of small intestinal transit in the fasted conscious rat.

关键词： 5-HT (5-hydroxytryptamine, serotonin)   5-HIAA (5-hydroxyindoleacetic acid)   blood pressure   veratridine   tetrodotoxin   hypothalamus   noradrenaline   hypervolemia   hypovolemia   push-pull cannula  

摘要： The push-pull technique was used to investigate the effects of neuroactive compounds and experimentally induced blood pressure changes on the release of endogenous serotonin in the posterior hypothalamic area of the rat. Hypothalamic superfusion with artificial cerebrospinal fluid which contained 80 mM K+ or 1 mu M veratridine enhanced the rate of serotonin release. Superfusion with tetrodotoxin (5 mu M) led to a pronounced decrease in the serotonin release rate. Increases in blood pressure elicited by intravenous infusions of noradrenaline (3-4 mu g/kg/min) or phenylephrine (10 mu g/kg/min) enhanced the release of serotonin in the hypothalamus. Similarly, the serotonin release rate was enhanced by hypervolaemia. Decreases in blood pressure elicited by intravenous administration of nitroprusside (30-40 mu g/kg/min) or chlorisondamine (3 mg/kg) reduced the release of serotonin. Likewise, the serotonin release rate was decreased by hypovolaemia. With one exception (hypothalamic superfusion with tetrodotoxin) neither neuroactive drugs, nor experimentally elicited blood pressure changes modified the release rate of the metabolite 5-hydroxyindoleacetic acid (5-HIAA). These findings show that changes in blood pressure lead to counteractive alterations in the release of serotonin. Thus, serotoninergic neurons of the posterior hypothalamus seem to be involved in the homeostasis of blood pressure by exerting a hypotensive function. At least in the hypothalamus, the concentration of 5-HIAA in the superfusate does not seem to be a reliable marker for the activity of serotoninergic neurons.

关键词： Conscious Sedation   Endoscopy   Digestive System   Preanesthetic Medication   Adjuvants   Anesthesia   Atropine   Child   Comparative Study   Double-Blind Method   Humans   Injections   Intravenous   Prospective Studies   Research Support   Non-U.S. Gov't  

摘要： Background: The usefulness of intravenous atropine as an adjunct to conscious sedation in pediatric esophagogastroduodenoscopy remains an unresolved issue. Methods: This prospective, double-blind, randomized study examined 101 patients, who were randomized to receive either intravenous atropine 0.02 mg/kg (maximum 0.4 mg) or a placebo of normal saline solution prior to the procedure. Results: The mean maximum heart rate during the procedure and the percentage of time that the heart rate was more than 1 standard deviation above mean for age was significantly greater in the atropine group as compared to the placebo group (p < 0.0005). There was no significant difference between groups in the amount of secretions noted, gastric motility, retching or vomiting, facial flushing, or dysphoria. There were no cases of significant bradycardia or hypotension in either group. There was a significant number of patients greater than 5 years of age and receiving meperidine and atropine (as compared with meperidine and placebo) whose arterial oxygen saturation dropped below 90% during the procedure (p = 0.0485). Conclusions: We found that the use of atropine when used as an adjunct to conscious sedation in children undergoing upper endoscopy did not increase the safety of the procedure or provide significant benefits. We do not recommend the routine use of atropine for upper endoscopy in pediatric patients.

关键词： 实践控制   人与自然关系   控制意识   自然界   人的本质力量   协调发展   生态系统   良性运行   人的自然属性   真实关系  

摘要： 应当树立实践控制意识王朝增人们通常认为，实践是对客观世界积极能动地改造，是人类生存和发展的基础，具有天然合理性和绝对权威性。但实践在现代的发展愈来愈向人们显示，它在对客观世界改造时，也会产生负效应，它在对人的本质力量肯定时，也会产生反主体化。在造成实...

关键词： 企业群体意识   企业员工   企业文化  

摘要： 企业群体意识正义─—兼谈企业员工群体意识的控制江若尘在企业文化研究领域中，常见企业群体意识这一词组。但在许多研究成果中，往往把企业群体意识与企业意识、企业员工的群体意识，界定不清，甚至完全等同起来。这些基本概念的不清晰，不仅给企业文化的理论研究带来麻...

关键词： MU OPIOIDS   URINE FLOW RATE   URINARY SODIUM EXCRETION   RENAL FUNCTION  

摘要： Central administration of the selective mu opioid agonist, dermorphin, produces a concurrent diuretic and antinatriuretic response in conscious rats. To determine whether central mu opioids differentially affect the renal excretion of water and sodium, we examined changes in renal function produced by intracerebroventricular (i.c.v.) administration of dermorphin during continuous intravenous (i.v.) infusion of a synthetic ADH analogue in conscious Sprague-Dawley rats. During ADH infusion the typical diuresis produced by i.c.v. dermorphin was abolished although the antinatriuresis remained intact. Alone, i.v. ADH produced a decrease in urine flow rate without significantly altering urinary sodium excretion. In other studies, the effects of i.c.v. dermorphin were examined on the renal responses produced by i.v. infusion of a V-2-ADH receptor antagonist. In these studies the magnitude of the V-2 antagonist-induced diuresis was not altered by i.c.v. dermorphin but the increase in urinary sodium excretion produced by this antagonist was converted to an antinatriuresis. Central dermorphin did not alter heart rate or mean arterial pressure in either study. These findings suggest that the effects of central dermorphin on renal sodium and water handling are mediated by separate mechanisms;the effects on water involving changes in circulating ADH levels and the effects on sodium independent of the action of this hormone.

关键词： 侵犯行为   幼儿   行为规范   遵守规则   自我意识能力   行为控制   情感体验   自我控制   积极行为   孩子们  

摘要： 下课了,操场上这边是“老鹰捉小鸡”,那边在滑滑梯,孩子们玩得真欢！突然,传来了嚎哭声,我扭头一看,原来是颖颖小朋友。只见她满脸都是鼻涕和眼泪,哭得挺“伤心”。我连忙走过去问他:“颖颖,你为什么哭呀?”是……是兵兵打的。”颖颖抽泣着回答。我又问:“兵兵为什么打你?”“不知道。”我找到了兵兵,兵兵若无其事地说出了理由:“我打着玩的。” 兵兵为什么会打人玩呢?幼儿们在一起游玩,打打闹闹是常事,至于“打人玩”看起来不寻常,细分析起来也并不奇怪,主要有这样几个原因: