七氟醚复合顺式阿曲库铵对全麻患者术后苏醒质量的影响

目的观察七氟醚复合顺式阿曲库铵对全麻患者术后苏醒时间、自主呼吸恢复时间的影响及其不良反应。方法选择60例ASAⅠ～Ⅱ级成年择期全麻手术患者,随机均分为丙泊酚组（Ⅰ组）和七氟醚组（Ⅱ组）各30例。麻醉诱导后予以0.3mg／kg的顺式阿曲库铵插管;麻醉维持分别采用丙泊酚TCI-泵注瑞芬太尼-顺式阿曲库铵和吸入1～1．3倍最低肺泡有效浓度（MAC）七氟醚-泵注瑞芬太尼-顺式阿曲库铵。监测脑电双频指数（BIS）,用加速度仪进行肌松监测,观测T1恢复至25％、75％及四个成串刺激（TOF）比值（T4／T1）恢复至0．75的时间。结果两组患者的性别、年龄、体重指数、麻醉持续时间、血流动力学变化和恢复指数（T1从25％～75％时间）比较差异无统计学意义（P〉0.05）;两组苏醒时间I组比II组延长,差异有统计学意义（P〈0．05）。结论七氟醚不会延长患者苏醒时间,而且不延长顺式阿曲库铵的残余肌松作用,是理想的吸入麻醉药。     

不同浓度七氟醚对顺式阿曲库铵药效动力学的影响

目的观察不同浓度七氟醚对顺式阿曲库铵药效动力学的影响。方法选取择期腹部手术患者60例分成1MAC七氟醚组（Ⅰ组）、1.5MAC七氟醚组（Ⅱ组）、全凭静脉麻醉组（Ⅲ组）,每组20例。全部患者均靶控输注丙泊酚与瑞芬太尼行麻醉诱导,Ⅰ组与Ⅱ组在呼气末七氟醚浓度稳定于1MAC与1.5MAC 5min后5s内快速静脉注射顺式阿曲库铵0.15mg/kg;Ⅲ组静脉靶控输注丙泊酚与瑞芬太尼维持麻醉,稳定5min后,5s内快速静脉注射顺式阿曲库铵0.15mg/kg。三组患者调节异丙酚及瑞芬太尼靶控输注浓度维持麻醉,保持BIS值在40～60。采用HXD-Ⅰ型多功能监护仪中力-位移换能器刺激尺神经和测定拇内收肌收缩,监测神经肌肉传导功能。记录起效时间、临床作用时间、恢复指数、药理作用时间、TOFr恢复0.7时间、TOFr恢复0.9时间。结果组间比较临床作用时间、药理作用时间、TOFr恢复0.7时间、TOFr恢复0.9时间Ⅰ组、Ⅱ组较Ⅲ组均延长,差异有统计学意义（P〈0.05）;Ⅱ组较I组均延长,差异有统计学意义（P〈0.05）。一般资料、起效时间、恢复指数三组间差异无统计学意义（P〉0.05）。结论七氟醚可增强顺式阿曲库铵的肌松效应,其强化作用随浓度增加而加大,麻醉中应减少顺式阿曲库铵的用量。     

两种麻醉方式对持续输注顺式阿曲库铵肌松效应的影响

目的比较七氟烷吸入麻醉与丙泊酚-瑞芬太尼全凭静脉麻醉对持续输注顺式阿曲库铵肌松效应的影响。方法选择全麻下手术病人40例,随机分为七氟烷吸入麻醉组(Ⅰ组)和丙泊酚-瑞芬太尼组(Ⅱ组),各20例。静脉注射顺式阿曲库铵0.15mg/kg后气管插管,术中持续输注顺式阿曲库铵,调节输注速率维持T1≤5%。记录顺式阿曲库铵输注速率、3h时用药量,恢复指数、停药至TOF比值为0.9的时间。结果与初始输注速率比较,两组持续给药30～180min期间顺式阿曲库铵输注速率下降(P<0.05),且Ⅰ组输注速率显著低于Ⅱ组,总体平均输注速率较Ⅱ组减少28%。但120min后两组输注速率无明显变化。两组恢复指数、停药到TOF比值为0.9的时间差异均无统计学意义(P>0.05)。结论持续输注顺式阿曲库铵维持恒定肌松水平,七氟烷麻醉与丙泊酚-瑞芬太尼全凭静脉麻醉均能呈时间依赖性增强其肌松作用,输注120min时达最大程度,且前者的增强效应大于后者,但对肌松恢复的影响无明显差别。     

七氟醚对老年人顺式阿曲库铵肌松效应的影响

目的比较七氟醚复合瑞芬太尼靶控对于老年人顺式阿曲库铵肌松效应的影响。方法40例行择期手术的患者,ASAⅠ～Ⅱ级,按年龄分为老年组（≥65岁）和青年组（18岁〈年龄〈65岁）。麻醉诱导使用七氟醚、异丙酚、瑞芬太尼,麻醉诱导后所有患者经上肢静脉注0．15mg／kg顺式阿曲库铵。用TOFWATCH加速度仪进行肌松监测,采用4个成串刺激（TOF,频率2Hz,波宽0．2ms,串问间隔15S）。肌肉松弛效应观察指标包括：起效时间,T1恢复到25％、75％的时间,以及TOFr恢复至0．9的时间和恢复指数（T1恢复25％～75％的时间）。结果顺式阿曲库铵起效时间、恢复指数2组问差异无统计学意义（P〉0．05）;T1 25％、T175％、TOFr（T4／T1）恢复至0．9的时间2组问差异无统计学意义（P〉0．05）。结论在老年患者静吸复合全麻中顺式阿曲库铵肌松效果好、停药后肌松恢复较快,增龄对单次静脉注射顺式阿曲库铵的药效学无明显影响。     

七氟醚和异氟醚对顺式阿曲库铵肌松效应的影响

[摘要] 目的 观察七氟醚和异氟醚对顺式阿曲库铵肌松效应的影响。方法 30例择期行妇科腹腔镜手术的患者，ASAⅠ级，随机均分为七氟醚组（SEV组）和异氟醚组(ISO组)。麻醉诱导用咪唑安定、异丙酚、芬太尼，2%利多卡因3ml舌根部及咽喉部表面麻醉，3min后行气管插管。所有患者插管后均靶控输注3ng/ml瑞芬太尼（血浆靶控浓度），SEV组和ISO组分别吸入七氟醚和异氟醚维持麻醉，当呼气末浓度稳定为1.3MAC后继续维持40min，静脉注射总量为45ug/kg的顺式阿曲库铵，用TOF GUARD（丹麦）加速度仪进行肌松监测。顺式阿曲库铵45ug/kg分为3等份分次静注，记录每次注药（15ug/kg）后的起效时间及最大阻滞效应。用累积剂量法建立两组患者的剂量反应曲线。在最后一次注药后记录：T1恢复到25%、50%、75%的时间（T125%、T150% 、T175%）；TOF比值（T4/T1）恢复到70%的时间（TOFR 0.7）以及恢复指数（RI）。结果 1.3MAC七氟醚和异氟醚麻醉下顺式阿曲库铵的ED50、ED95分别为21（17～25）ug/kg、39（31～62）ug/kg和24（19～28）ug/kg、44（36～68）ug/kg，两组无显著性差异（P >0.05）；两组之间顺式阿曲库铵的起效时间、恢复至T175%、TOFR 0.7及RI无显著性差异（P >0.05）。SEV组顺式阿曲库铵的T125%、T150%较ISO组明显延长（P <0.05）。结论 1.3MAC七氟醚和异氟醚对顺式阿曲库铵量效关系的影响相似；但七氟醚对顺式阿曲库铵恢复至T125%、T150%的影响大于异氟醚。 [关键词] 顺式阿曲库铵 七氟醚 异氟醚 剂量-效应关系 ED50 ED95     

不同浓度七氟醚用于食道癌麻醉对肌松药的影响研究与实践

目的:对不同浓度的七氟醚用于食道癌麻醉对肌松药的影响进行分析探讨。方法:将120例食管癌患者随机分为4组,每组30例,依次静脉注射0.1 mg/kg咪唑地西泮、1~2 mg/kg异丙酚、2~4μg/kg芬太尼及0.3~0.6 mg/kg阿曲库铵,在肌松监测到4个成串刺激T1达到最大时,行双腔气管插管。麻醉维持:丙泊酚组30例患者静脉输注80~100μg/(kg·min),不同浓度的七氟醚组(Ⅰ组,Ⅱ组,Ⅲ组,n=30)分别吸入1 MAC、1.3 MAC及1.5MAC呼吸末浓度七氟醚。4组患者均经微泵输注0.1~0.2μg/(kg·min)瑞芬太尼,0.2 mg/kg阿曲库铵来维持镇痛剂肌松效果。对比各组的肌松起效时间、作用时间、恢复指数时间、阿曲库铵的诱导及维持用量。结果:不同浓度七氟醚组同丙泊酚组在肌松诱导用量、起效时间、恢复指数时间及T4/T1恢复70%的时间差异无统计学意义(P>0.05)。在麻醉诱导之后,不同浓度七氟醚组同丙泊酚组相比,肌松的作用时间显著延长,用量逐渐减少(P<0.05)。结论:不同浓度的七氟醚会随着浓度加大,对阿曲库铵肌松效应的明显加强,延长肌松作用时间、降低肌松维持的用量。     

七氟醚复合罗库溴铵对全麻患者术后苏醒的影响

目的 观察七氟醚复合罗库溴铵对全麻患者术后苏醒时间、自主呼吸恢复时间的影响及其不良反应.方法 选择60例ASAⅠ-Ⅱ级成年择期全麻手术患者,随机均分为丙泊酚组(Ⅰ组)和七氟醚组(Ⅱ组)各30例.麻醉诱导后予以0.6mg/kg的罗库溴铵插管;麻醉维持分别采用丙泊酚TCI-泵注瑞芬太尼-罗库溴铵和吸入1-1.3倍最低肺泡有效浓度(MAC)七氟醚-泵注瑞芬太尼-罗库溴铵.监测脑电双频指数(BIS),使用Biometer加速度观测T1恢复至25%、75%及四个成串刺激(TOF)比值(T4/T1)恢复至0.75的时间.结果 两组患者的性别、年龄、体重指数、麻醉持续时间、血流动力学变化和恢复指数(T1 从25%-75%时间)比较差异无统计学意义(P>0.05); 两组苏醒时间Ⅰ组比Ⅱ组延长,差异有统计学意义(P<0.05).结论 七氟醚不会延长患者苏醒时间,而且不延长罗库溴铵的残余肌松作用,是理想的吸入麻醉药.     

七氟醚对顺式阿曲库铵肌松效应的影响

目的观察七氟醚对顺式阿曲库铵肌松效应的影响。方法耳鼻喉科行全麻择期手术60例,随机分为A、B、C三组,每组20例。麻醉诱导进行气管插管呼吸机控制呼吸后,A组患者全凭静脉靶控(TCI)异丙酚麻醉,麻醉平稳后单次静脉推注顺式阿曲库铵0.02mg/kg;B、C组均以七氟醚吸入维持麻醉,监测呼气末麻醉气体浓度稳定在1MAC时,分别在15min及45min时单次静脉推注顺式阿曲库铵0.02mg/kg。记录各组顺式阿曲库铵的起效时间,完全肌松时间,T2、T3、T4出现的时间,TOFr恢复至25%、50%、75%的时间。结果 B、C组起效时间较A组缩短(P<0.05);B、C组完全肌松时间较A组延长(P<0.05),并且C组较B组延长(P<0.05);B、C组T2、T3、T4出现的时间均长于A组(P<0.05),并且C组较B组延长(P<0.05);B、C组的TOFr恢复至25%、50%、75%的时间较A组延长(P<0.05),并且C组较B组延长(P<0.05)。结论七氟醚能强化阿曲库铵肌松效应,并且强化效应对时间有依赖性。     

舒芬太尼对顺式阿曲库铵起效时间的临床观察

目的 采用单次注射法探讨舒芬太尼对全麻病人顺式阿曲库铵起效时间的影响. 方法 ASA I～II级择期全麻手术患者60例,随机分为 2组;单纯丙泊酚(A组),丙泊酚复合舒芬太尼(B组).A组麻醉诱导采用丙泊酚 2mg/kg;B组麻醉诱导采用丙泊酚2 mg/kg,舒芬太尼1ug/kg.A组和B组诱导时静注顺式阿曲库铵 0.15 mg/kg,待肌松抑制达到最大(T1=0)行气管插管,通过记录刺激尺神经时拇指内收肌的收缩加速度诱导期采用单个刺激(频率0.1Hz,持续0.2ms)监测肌松起效时间 (顺式阿曲库铵注药毕至肌颤搐抑制100%的时间).结果 顺式阿曲库铵起效时间在二组之间无显著差异P ＞0.05).结论 舒芬太尼并不影响全麻患者顺式阿曲库铵起效时间.     

七氟醚、异氟醚对国产顺式阿曲库铵强化作用的时间依赖性研究

目的观察1MAC七氟醚或异氟醚对国产顺式阿曲库铵强化作用的时间依赖性。方法30例择期头面部手术病人在咪唑安定—芬太尼—异丙酚麻醉期间持续输注国产顺式阿曲库铵,维持95%的肌松,达到稳态后,病人随机吸入呼气末浓度为1MAC的七氟醚或异氟醚,调整顺式阿曲库铵的注入速率,维持95%的肌松,观察吸入七氟醚或异氟醚后顺式阿曲库铵的注人速率随时间变化的趋势。结果七氟醚、异氟醚都显著降低了顺式阿曲库铵的注入速率,此效应随吸人七氟醚或异氟醚时间的延长逐渐增加,吸入七氟醚或异氟醚90min后达最大效应即顺式阿曲库铵的注人速率下降到最大值。最大下降率：七氟醚组为39.7%,异氟醚组为36.4%。结论七氟醚、异氟醚明显增强顺式阿曲库铵的肌松作用,其程度相近,且这种强化作用有显著的时间依赖性。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.