Zeus麻醉机自动控制全紧闭麻醉在乳腺癌根治术中的应用

目的：通过Zeus麻醉机自动控制全紧闭麻醉应用在乳腺癌根治术中,以评估Zeus麻醉机自动控制模式的麻醉效果。方法择期行乳腺癌根治术的病人60例,随机平均分为两组,每组30例。麻醉诱导,气管插管,A组采用自动控制紧闭麻醉模式,设置呼出七氟醚浓度为1．5,达到1．3MAC时减少呼出七氟醚浓度,维持1．3MAC;B组半紧闭麻醉组,氧流量2．0 L／min,七氟醚挥发罐刻度2％,通过调整挥发罐刻度,控制1．3MAC。手术结束后,A组设置呼出七氟醚浓度为“0”,B组关闭挥发罐,并将氧流量开为8 L／min。结果插管后3 min（T2）时A组MAP、HR降低较B组降低明显（P＜0．05）,睁眼时间、拔管时间A组早于B组。结论 Zeus自动控制模式麻醉取得了很好的麻醉效果。     

最低流量异氟醚吸入全麻或复合硬膜外阻滞用于老年上腹部手术

目的：比较异氟醚最低流量吸入麻醉复合硬膜外阻滞与单纯异氟醚吸入麻醉，为老年上腹部手术患提供一种合理的麻醉方法。方法：40例择期上腹部手术老年患，随机分成两组：I组20例仅吸入异氟醚：Ⅱ组20例吸入异氟醚并复合硬膜外阻滞。Ⅱ组患入室后先于T8－T10行硬膜外穿刺置管，用药为1％的利多卡因和0．15％的地卡因（加1：20万的肾上腺素），仅推试验量3－5ml，全麻诱导同I组。低流量麻醉实施前、两组患的异氟醚挥发罐浓度（Cv）均开至5％处，氧流量（FiO2)均设定为2L／min。在吸入5－8分钟后将两组Cv分别降至1．5％－2％和0．08％－1％。FiO2固定为0．5L／min。观察并比较两组患在诱导插管期，麻醉手术全过程中，拔管期的MAP、HR、ECG和SPO2变化。结果：Ⅱ组患在插管时MAP、HR比I组患上升幅度小（P＜0．05），两组患全部平稳完成手术，Ⅱ组比I组的清醒拔管时间显缩短（P＜0．05），且拔管期心血管系统比Ⅰ组平稳（P＜0．05）。结论：在吸入较低浓度，最低流量的异氟醚下复合硬膜外阻滞可以满足临床手术需要，用于老年患具有更多优点。     

采用宙斯麻醉机自动控制系统全紧闭麻醉七氟醚的消耗

目的本研究旨在研究采用宙斯(ZEUS)麻醉机自动控制系统全紧闭麻醉七氟醚的消耗。方法腹部外科手术病人60例,快速诱导、气管插管,实验组接宙斯(ZEUS)麻醉机全紧闭麻醉模式,设置呼出七氟醚浓度为1.5,通过调整,控制1.3MAC;对照组接Fabius GS麻醉机,氧流量2.0 L/min,3%七氟醚吸入,达到1.3MAC时,氧流量减至1.0 L/min,减小挥发灌刻度,控制在1.3MAC。分别记录吸入期(0～4 min)和维持期(4～64 min)两组七氟醚消耗量。结果实验组在吸入期七氟醚的消耗较对照组显著缩短(P<0.05),在维持期七氟醚的消耗与对照组比较有极显著差异(P<0.01)。结论采用宙斯麻醉机自动控制系统全紧闭麻醉能使七氟醚的消耗大幅减少。     

地氟醚在循环紧闭麻醉中的药代动力学

目的　了解地氟醚在最低流量循环紧闭麻醉中药代动力学的临床表现。　方法　５０例麻醉分级（ＡＳＡ） Ⅰ～Ⅱ级全麻下的择期手术病人。麻醉诱导采用咪唑安定、芬太尼、琥珀胆碱。气管插管后开始１０ ｍ ｉｎ 氧流量为４ Ｌ／ｍ ｉｎ,行间歇正压控制呼吸,地氟醚挥发罐浓度（ＦＤ）８％ 。此后关闭回路,氧流量０．２０～０．３５Ｌ／ｍ ｉｎ,地氟醚ＦＤ １０％ ～１２％ 。维持地氟醚的肺泡浓度（ＦＡ）在６％ ±０．１％ 。间断给予维库溴胺维持肌肉松弛。　结果　地氟醚ＦＡ 达６％ 和ＦＡ／ＦＩ（吸入浓度）达０．９,分别为４．９±０．８ ｍ ｉｎ 和１２．４±０．２ ｍ ｉｎ,并能维持在０．９０～０．９５。麻醉停止后,５．７±２．４ ｍ ｉｎ 恢复自主呼吸,拔管时间９．７±０．８ ｍ ｉｎ。麻醉中脉搏血氧饱和度均１００％ ,吸入氧浓度≥８０％ 。　结论　地氟醚的低组织溶解特性使其麻醉诱导和麻醉恢复快,麻醉调控性强。地氟醚的药代动力学特性使其能安全、有效地在最低流量循环紧闭麻醉中使用。     

The Sevoflurane Consumption in All Closed Anesthetic with Automatic Control System of Zeus Anesthesia Machine

目的 本研究旨在研究采用宙斯(ZEUS)麻醉机自动控制系统全紧闭麻醉七氟醚的消耗.方法 腹部外科手术病人60例,快速诱导、气管插管,实验组接宙斯(ZEUS)麻醉机全紧闭麻醉模式,设置呼出七氟醚浓度为1.5,通过调整,控制1.3MAC;对照组接Fabius GS麻醉机,氧流量2.0 L/min,3%七氟醚吸入,达到1.3MAC时,氧流量减至1.0 L/min,减小挥发灌刻度,控制在1.3MAC.分别记录吸入期(0~4 min)和维持期(4~64 min)两组七氟醚消耗量.结果 实验组在吸入期七氟醚的消耗较对照组显著缩短(P＜0.05),在维持期七氟醚的消耗与对照组比较有极显著差异(P＜0.01).结论 采用宙斯麻醉机自动控制系统全紧闭麻醉能使七氟醚的消耗大幅减少.     

低流量麻醉在颅脑手术中的应用

观察在颅脑外科手术中异氟醚低流量（O2流量0．8L／min）与中流量麻醉（O2流量2L／min）相比减少麻醉药消耗量、体温变化和术后寒战发生率的情况，选择ASAI－Ⅱ级颅脑外科手术患者30例，随机分为两组，每组15例，两组插管后均以2．0L／min氧流量吸入异氟醚，20min后I组改为0．8L/min氧流量吸入异氟醚作低流量麻醉，Ⅱ组氧流量不变。术中监测病人BP、SPO2、ECG、鼻咽体温（T）、VT、MV、PETCO2、FiO、FiISO、FETISO及新鲜气体流量，观察两组麻醉药消耗量（消耗ISO总量／麻醉时间）、术前和术毕体温、术后寒战发生率。结果：两组麻醉药消耗量、术毕体温变化及术后寒战发生率均有显著意义。提示，异氟醚低流量麻醉，能减少异氟醚45％的麻醉药消耗量，术毕体温变化轻微，寒战发生率低，在颅脑外科麻醉中值得推广应用。     

听觉诱发电位指数监测老年人地氟醚麻醉深度

目的：观察老年人地氟醚麻醉中听觉诱发电位指数（AEP指数）和血流动力学的变化,评估AEP指数监测老年人地氟醚麻醉深度的应用价值。方法：选择ASAⅠ-Ⅲ级,择期全麻气管插管下手术患者40例,按年龄分为2组：老年组（年龄≥65岁,n=20）和中青年组（年龄18～55岁,n=20）。异丙酚、维库溴铵诱导气管插管后行控制呼吸,吸入地氟醚维持麻醉,调整吸入浓度,使地氟醚呼气末浓度依次维持在0．6MAC,1．0MAC和1.3MAC,每一浓度均稳定20min。监测麻醉前（T1）、注射异丙酚后2min（T2）、气管插管时（T3）、气管插管后2min（T4）、地氟醚呼气末浓度为0.6MAC（T5）,1.0MAC（T6）和1．3MAC（T7）时的平均动脉压、心率和AEp指数。结果：地氟醚麻醉期2组患者平均动脉压均比麻醉前明显下降（P〈0.05）,老年组心率与麻醉前相比亦显著减慢（P〈0．05）。地氟醚呼气末浓度由0.6MAC～1．3MAC递增时,2组患者平均动脉压和心率无明显变化（P〉0．05）。地氟醚麻醉期2组患者AEP指数与麻醉前相比显著降低（P〈0．05）,老年组地氟醚呼气末浓度在1.0MAC和1．3MAC时AEP指数较0．6MAC时显著降低（P〈0．05）,但中青年组地氟醚呼气末浓度各浓度间AEP指数差异无统计学意义（P〉0．05）;在地氟醚各呼气末浓度时,老年组AEP指数均低于同时间点中青年组（P〈0．05）。AEP指数与地氟醚呼气末浓度在老年组和中青年组的相关系数分别为-0．983和-0．980（P〈0．05）。结论：听觉诱发电位指数与地氟醚呼气末浓度呈一定的剂量相关性,可监测老年人地氟醚麻醉深度变化并在一定程度上反映相同地氟醚呼气末浓度下老年人与中青年人麻醉深度的差异。     

腹腔镜胆囊切除手术患者吸入七氟醚与异氟醚麻醉恢复的比较

目的比较腹腔镜胆囊切除（LC）手术患者吸入七氟醚与异氟醚麻醉恢复的情况。方法将40例ASAⅠ-Ⅲ级择期行LC术患者随机分为2组,七氟醚组（A组20例）及异氟醚组（B组20例）。麻醉诱导后行气管插管,机械通气。诱导后吸入纯氧,氧流量2 L/min。麻醉维持：吸入七氟醚或异氟醚。维持血压和心率波动幅度不超过基础值30%。胆囊取出后停止吸入七氟醚或异氧醚,纯氧流量调整为8 L/min。记录睁眼时间（停止吸入麻醉药到睁眼的时间）、记录拨除气管导管时间（停止吸入麻醉药到拨除气管导管时间）、记录麻醉后恢复期评分达到9分时间（从停止吸入麻醉药计时）。结果与B组比较,A组睁眼时间、拨除气管导管时间、麻醉后恢得期评分达9分时间都较B组短。结论在LC手术中,与异氟醚比较,吸入七氟醚患者麻醉恢复较快,且麻醉恢复质量较好。     

七氟醚吸入在小儿口腔手术麻醉中的临床观察

目的观察七氟醚吸入用于小儿口腔手术麻醉的临床意义。方法78例口腔手术患儿,入室后面罩吸氧（5L／min）、常规静注盐酸阿托品0．01mg／kg,然后吸入8％七氟醚诱导,静注维库溴胺0．1mg/kg,芬太尼4μg／kg,2min后气管内插管。术中持续吸入2．5％-3．5％七氟醚维持麻醉,术毕即刻停吸七氟醚。术中观察并记录患儿睫毛反射消失时间;清醒时间;同时记录：吸入七氟醚前（基础值）、气管插管前、插管后1min、3min、5min、拔管后1min、3min的血压、心率值及可能出现的并发症。结果患儿吸入8％七氟醚后睫毛反射消失时间（41．2±10．8）s;停吸后清醒时间为（7．2±2．5）min;插管前血压和心率较基础明显降低（P〈0．05）。结论七氟醚用于口腔手术惠儿的麻醉,诱导苏醒迅速,循环稳定,并发症少,是一种安全的麻醉方法。     

麻醉气体吸附器的临床应用观察

目的：观察在吸入麻醉中，麻醉气体吸附器的吸附率及影响因素。方法：在基本相同的麻醉条件下，60例病人随机分为异氟醚组、安氟醚组，每组根据氧流量再分为a、b、c3个组，氧流量分别为0．5、1．2L／min。观察并记录麻醉气体吸附器对异氟醚、安氟醚的吸附率，同时观察病人性别、年龄、体重、身高等对吸附率的影响。结果：在呼出麻醉气体浓度基本一致时，氧流量越大，吸附器维持99％以上吸附率的时间越短，并随时间的延长吸附率逐步下降。同时，维持相同吸附率的时间和病人年龄呈反比，和体重呈正比，与病人的性别、身高无关。吸附器对异氟醚和安氟醚的吸附率无统计学差异（P＞0．05）。结论：在吸入麻醉中保持较小氧流量，应用麻醉气体吸附器时，维持高吸附率的时间较长。同时，可以根据氧流量、患者性别、身高等估计麻醉气体吸附器的更换时间，减少麻醉气体的污染。     

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.