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Renal function after laparoscopic cholecystectomy and analgesia with tramadol and dipyrone or ketorolac

Health 2013年第11期5卷 35-41页

作者： Tiago Pechutti Medeiros Pedro Thadeu Galvao Vianna Leopoldo Muniz da Silva lidia raquel de carvalho Gilberto Elias Wady Leandro Gobbo Braz Yara Marcondes Machado Castiglia Graduate Program in Anesthesiology Botucatu Medical SchoolUNESP-Universidade Estadual PaulistaBotucatuBrazil Department of Anesthesiology Botucatu Medical SchoolUNESP-Universidade Estadual PaulistaBotucatuBrazil Sao Luiz Hospital Sao PauloBrazil Department of Biostatics Institute of BiosciencesUNESP-Universidade Estadual PaulistaBotucatuBrazil Mercy Hospital Sao CarlosBrazil

Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of analgesia with tramadol combined with either dipyrone or ketorolac on the postoperative renal function of patients submitted to LC. Methods: Pre-and post-operatively (PO), estimated glomerular filtration rates (GFR), obtained by two formulas dependent on blood Cr and one on blood cystatin C values, and tubular enzymuria—alkaline phosphatase (AP), γ-glutamiltransferase (γ-GT)— were determined in well hydrated patients who underwent LC and analgesia with tramadol combined with either dipyrone (Dipyrone, n = 63) or ketorolac (Ketorolac, n = 63). Upon discharge from the post-anesthetic care unit (PACU), pain (through Verbal Numerical Scale—VNS) and need for rescue analgesia with morphine were evaluated. Results: There was hemodilution PO, which made GFR profile analysis more difficult—those dependent on Cr increased and statistically correlated, but those dependent on cystatin C did not change. There was a significant PO increase in AP in the Dipyrone and Ketorolac groups, and in the product of the both enzymes in the Ketorolac group. Upon PACU discharge, the Dipyrone group showed signifi cantly higher VNS scores than the Ketorolac group. All patients received morphine PO, and the total dose needed for pain control differed between groups, but without statistical significance. Conclusions: The association of tramadol with dipyrone or ketorolac in well hydrated patients submitted to LC had similar analgesic effectiveness in the PACU. Postoperatively, the effect on GFR may have been masked by hemodilution, and enzymuria was discreetly enhanced when ketorolac was used.

关键词： Kidney Function Tests Pneumoperitoneum Biological Markers Cystatin C Ketorolac Analgesia

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Genotyping and Antifungal Susceptibility Profile of Sequential Candida albicans Isolated from the Oral Cavity of HIV-Infected Individuals

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Journal of Pharmacy and Pharmacology 2018年第4期6卷 350-361页

作者： Daniela Vanessa Moris Joyce Marinho de Souza Marcia Souza carvalho Melhem Marilena dos Anjos Martins Caroline Lucio Moreira Lenice Rosario de Souza Gioconda San-Blas Maria Walderez Szeszs lidia raquel carvalho Marcus Vinicius Pimenta-Rodrigues Rinaldo Poncio Mendes Tropical Diseases Area--Faculdade de Medicina de Botucatu Universidade Estadual Paulista "Julio de Mesquita Filho "--UNESP Sao Paulo Botucatu 18600-000 Brazil Masters in Health Seience--Universidade do Oeste Paulista--UNOESTE Sao Paulo Presidente Prudente 19067-175 Brazil Department of Biomedical Sciences--Universidade do Oeste Paulista--UNOESTE Presidente Prudente 19050-920 Brazil Instituto Adolfo Lutz Sao Paulo 01246-000 Brazil Venezuelan Institute for Scientific Research Center for Microbiology and Cell Biology Caracas 11 01204 Venezuela Biostatistics Department Instituto de Biociencias Universidade Estadual Paulista "Julio de Mesquita Filho "--UNESP Sao Paulo Botueatu 18600-000 Brazil

Objective： The study aimed to evaluate the genotypic profiles of C. albicans （Candida albicans） sequentially isolated throughout the course of HIV infections, and to determine its MIC （minimal inhibitory concentrations） to AMB （amphotericin B）, FLC （fluconazole）, KTC （ketoconazole）, and ITC （itraconazole）. Design： samples were collected from the oral cavity of HIV-positive individuals during 4 years, with a sterilized swab. MIC was performed by using the microdilution method AFST/EUCAST. The genetic similarities within and between sequential clones of C. albicans were assessed by DNA fingerprinting using the random amplification ofpolymorphic DNA technique. Results： A total of 142 oral samples were isolated from 59 HIV-infected individuals who attempted up to five visits each, with or without symptoms of oropharyngeal candidiasis. Profile analysis revealed that yeasts isolated over sequential visits from symptomatic or asymptomatic individuals showed 78% or 87% relatedness, respectively. The degree of similarity among C. albicans was higher for isolates from colonization than for those from infection. Genetically identical C. albicans samples also formed connected subelusters in sequential visits. In regard to susceptibility profile, all isolates were susceptible to AMB, FLC, KTC, and ITC and maintained this pattern all along, no differences in MICs of any given antifungal compound were observed for sequential C. albicans isolates. Conclusions： These data suggest that genotype and susceptibility to antifimgal drugs were maintained over time in sequentially isolates of C. albicans colonization and a diverse evolutionary genetic trend in C. albicans sequentially isolated from the oral eandidiasis of HIV infected individuals.

关键词： Genotyping Candida albicans sequential HIV- positive individuals oral cavity.

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慢性腰痛的非盲安慰剂治疗:一项随机对照试验

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中国疼痛医学杂志 2018年第10期24卷 729-732页

作者：马冰洁(译) 马柯(校) Cláudia carvalho Joaquim Machado Caetano lidia Cunha 上海交通大学医学院附属新华医院疼痛科不详

这项随机对照试验目的是研究在常规治疗(treatment as usual, TAU)中加入非盲安慰剂治疗(open-label placebo, OLP)3周对慢性腰痛的影响在伦理上是否可以利用。在三个0至10分数字评分量表上评估疼痛严重程度,评分最大疼痛,最小疼痛和平... 详细信息

这项随机对照试验目的是研究在常规治疗(treatment as usual, TAU)中加入非盲安慰剂治疗(open-label placebo, OLP)3周对慢性腰痛的影响在伦理上是否可以利用。在三个0至10分数字评分量表上评估疼痛严重程度,评分最大疼痛,最小疼痛和平时疼痛,以及综合的、主要结局指标,总疼痛评分。我们其他的主要结局指标是与背部相关的功能障碍,它通过Roland-Morris功能障碍调查表评估。在探索性随访中,TAU的病人再额外服用安慰剂3周。我们将97名报告并由疼痛专家诊断的持续性腰痛超过3个月的病人随机分组。83名成年人完成了试验。与TAU组相比,OLP组在三个0到10点数字评分量表和0到10点复合疼痛量表中均疼痛减轻更多(P <0.001),并且具有中等到大的效应量。在OLP组中复合数字评估量表疼痛减少1.5(95%置信区间:1.0-2.0),在TAU组中减少0.2(-0.3至0.8)。与TAU组相比,非盲安慰剂治疗也减降低了功能障碍(P <0.001),效应量大。OLP组的功能障碍评分改善为2.9(1.7-4.0),TAU组为0.0(21.1-1.2)。转换为OLP后,TAU组疼痛(1.5,0.8-2.3)和功能障碍(3.4, 2.2-4.5)显著降低。本研究结果表明,OLP药物在积极的环境下呈现可能有助于慢性腰痛的治疗。

关键词：随机对照试验 Roland-Morris功能障碍调查表常规治疗慢性腰痛安慰剂疼痛评分评分量表盲

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6％的羟乙基淀粉-高渗盐水在失血性休克狗复苏时的作用

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麻醉与镇痛 2012年第5期8卷 19-30页

作者： Joao M. P. Barros Paulo do Nascimento Joao Luiz P. Marinello Leandro G. Braz lidia R. carvalho Luiz A. Vane Yara M. M. Castiglia Jose R. C. Braz Department of Anesthesiology Botucatu Medical School Universidade Estadual Paulista Department of Biostatistics Institute of Biosciences Universidade Estadual Paulista Botucatu Brazil

背景血流动力学和全身氧输送的变化无法反映内脏低灌注，从而导致无法认识到对失血性休克的处理不足。液体复苏后扩容对改善失血性休克时全身和局部的氧供是必不可少的。我们假设，与传统的代血浆相比，应用少量的扩容剂7．5氯化钠／6... 详细信息

背景血流动力学和全身氧输送的变化无法反映内脏低灌注，从而导致无法认识到对失血性休克的处理不足。液体复苏后扩容对改善失血性休克时全身和局部的氧供是必不可少的。我们假设，与传统的代血浆相比，应用少量的扩容剂7．5氯化钠／6％羟乙基淀粉（hydroxyethyl *** saline，HHES）溶液，可能提供较少的全身氧输送和胃血流灌注。我们为失血的狗进行临床上严重出血时常用的固定量液体单次输注，分别观察HHES、乳酸林格液（1actatedRinger，LR）和6％羟乙基淀粉（hydroxyethyl starch，HES）溶液对血管内扩容、早期全身氧合和胃灌注的影响。方法30只狗，出血30ml／kg，保持平均动脉压在40～50mmHg，持续45分钟后，分3组进行复苏：LR组（n=10），输注3倍出血量的液体；HES组（平均分子量130KDa，替代级0．4）（n=10），输注出血量等量的液体；HHES组（n=10），以4ml／kg的速度输注。测定血管内容量增加情况（用Evans蓝和血红蛋白稀释）、血流动力学、全身氧合、静动脉CO2分压差（Pv-aco2）和胃黏膜-动脉血CO2分压差（Pco2间隙）变化，测定时间点为基础值、出血45分钟后以及液体复苏5分钟、45分钟、90分钟时。结果由于HHES的高扩容效力增加了血容量，但它对血管内容量的扩张作用是各溶液中最小的（P〈0．05）。3种溶液对血流动力学影响相同，但相对于LR组和HES组，HHES组相混合静脉血Po，更低，全身氧合、Pv-aco2和胃黏膜Pco2间隙更大（P〈0．05）。结论对狗进行按血压调节的失血性休克和固定容量的复苏，尽管HHES有高效扩容作用，但相比LR和HES，由于输注量受限，它的血管内容量扩充能力较小，全身氧合和胃血流灌注较差。

关键词：失血性休克羟乙基淀粉复苏后高渗盐水血流动力学影液体复苏胃血流灌注平均动脉压

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