心脏停搏与不停搏心内手术体外循环对凝血功能影响的研究

目的 观察体外循环心脏停搏与不停搏心内直视手术对机体凝血功能的影响.方法 50例体外循环心内手术患者随机分成心脏停搏(AH)组25例、心脏不停搏(BH)组25例,对比两组患者切皮前即刻(T1)、给予鱼精蛋白10 min后(T2)、关胸即刻(T3)、术后4 h(T4)血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APT...     

自体血逆行预充对体外循环期间血液有形成分影响的观察

目的观察自体血逆行预充(RAP)技术应用在体外循环(CPB)心脏手术中对血液有形成分的影响。方法选取单瓣膜置换术患者40例,随机分为RAP组20例;常规预充组(CP组)20例。RAP组于CPB开始前用患者自体血置换出部分预充液。对比两组患者肝素化10 min(T1)、CPB 30 min(T2)、鱼精蛋白中和后10 min(T3)、CPB终止1 h(T4)患者静脉血标本的红细胞(RBC)、白细胞(WBC)、血红蛋白(Hb)、血浆游离血红蛋白(FHb)、血小板(Plt)和纤维蛋白原(Fib)等含量以及红细胞比容(Hct)和D-二聚体(D-dimer)等指标的变化,并记录术中库存红细胞(悬红)用量。结果 RAP组平均置换预充液量为(663.2±167.4)ml。术中悬红用量RAP组少于CP组(P0.05)。RAP组患者T2、T3的Hct水平高于CP组(P0.05)。RAP组RBC计数和Hb含量在T2、T3比CP组高(P0.01,P0.05)。Plt计数、FHb含量、Fib和D-dimer水平在各时间点测定值两组间比较均无统计学差异。结论在CPB中采用RAP可减少CPB预充量,降低血液稀释度,减少异体血用量,对血液有形成分无显著损伤性改变。     

机血回输对体外循环心内手术患者凝血功能的影响

目的探讨机血直接回输对体外循环（CPB）心内手术患者凝血功能的影响。方法 60例体外循环心内手术患者随机分成两组,A组30例,机血全部直接回输;B组30例,机血全部丢弃。对比两组患者切皮前即刻（T1）、给鱼精蛋白10 min后（T2）、关胸即刻（T3）、术后4 h（T4）采血测定血小板计数（PLT）、血浆游离Ca2＋、血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、D-二聚体（D-D）含量、活化凝血酶原时间（ACT）、血红蛋白（Hb）等指标的变化,并记录术中、术后24 h库血的用量和术后24 h胸腔引流量等临床情况。结果 PLT计数、血浆游离Ca2＋、PT、APTT、TT、FIB、D-D、ACT、Hb在各时间点测定值两组间比较差异均无统计学意义（P〉0.05）。A组库血用量少于B组（P〈0.05）。术后24 h胸腔引流量两组间比较差异无统计学意义（P〉0.05）。结论体外循环后直接回输机血不加重凝血功能紊乱,体外循环后采用机血直接回输的方法,能明显减少异体输血量。     

心脏手术不停搏与停搏对心肌细胞因子表达的影响

目的探讨心脏不停搏和停搏心内直视手术对心肌肿瘤坏死因子α-mRNA的表达的影响。方法30例年龄5～10岁的先天性室间隔缺损患儿,随机等分为两组。组1在中低温体外循环心脏停搏下完成手术,组2在浅低温体外循环心脏跳动下完成手术。在打开与关闭右心房时取心肌组织检测TNF-αmRNA表达。分别于麻醉诱导后(T1),CPB转流20min(T2),CPB结束时(T3),停机后6h、12h、24h(T4-6)抽血检测血浆TNF-α浓度。结果两组患者心肌TNF-αmRNA表达水平在关闭右房时均明显升高(P<0.05),且组1明显高于组2(P<0.05)。组1血浆TNF-α浓度在T4～6时间点明显高于组2(P<0.05)。结论心脏不停搏心内直视手术较传统心脏停搏手术方式能减少的TNF-α表达与释放,有利于小儿体外循环期的心肌保护。     

先天性心脏病心脏停跳和不停跳心内直视手术围术期心律失常发生率比较

本研究总结了自2001年6月至2002年6月,我科对168例先天性心脏病患者,分别采取冷血心脏停跳液灌注心脏(心停跳组,AH)和浅低温体外循环心脏跳动(心不停跳组,BH)下心内直视手术围术期心电图变化情况,现报告如下.     

心脏不停跳或停跳体外循环对血浆电解质和酸碱平衡影响

目的：探讨心脏不停跳或心脏停跳体外循环对血浆电解质和酸碱平衡的影响。方法：随机选择93例瓣膜置换心内直视手术患者，47例采用心脏不停跳体外循环(BH组)，46例采用心脏停跳体外循环(AH组)，在CPB中监测平均动脉压、中心静脉压、尿量、鼻咽温，并在转前、转机10min、复温、停机时分别测定血气、血钾、血钙。结果：心跳组转机中流量、平均动脉压、转中尿量均较心停组高，而转流时间却较短，两组比较有显著性差异(P＜0．05)。BH组与AH组比较，pH值、PO2、BE值较转机前有显著升高，而PCO2却有显著下降(P＜0．05)，接近于正常生理值，两组Hct在转前、转中变化无明显差异，血钾、血钙在BH组中较稳定。结论：心脏不停跳体外循环比心脏停跳体外循环更接近正常生理状态，能保持良好的有氧代谢、酸碱平衡和电解质代谢。     

不同冠状动脉搭桥术式对血浆内皮素-1及左室收缩功能的影响

目的探讨体外循环心脏停跳下冠状动脉搭桥术(CPB-CABG)与非体外循环心脏不停跳冠状动脉搭桥术(OPCABG)对血浆内皮素-1(ET-1)及左室收缩功能的影响。方法选择62例首次择期行冠状动脉搭桥术的冠心病患者,按是否应用心肺转流(CPB)随机均分为体外循环组(G1,n=30)和非体外循环组(G2,n=32)。分别在麻醉诱导前(T1)、切皮前(T2)以及术后6h(T3)、24h(T4)采集血标本,放免法测定ET-1含量。计算并分析心排血指数(CI)、左室做功指数(LVSWI)。结果与T1时点相比,G1组T3、T4时点ET 1明显增加(P<0.05或P<0.01),G2组T2时点ET-1明显降低,T4时点明显升高(P<0.05)。与G1组相比,G2组T3、T4时点ET-1明显减低(P<0.05)。与T1时点相比,G1组T2、T3时点,G2组T2时点CI明显降低(P<0.05)。与T1时点相比,G1组T3、T4时点LVSWI明显降低(P<0.05)。与G1组相比,G2 组T3时点CI、LVSWI均显著性升高(P<0.05)。结论与体外循环心脏停跳下CABG相比,非体外循环心脏不停跳CABG可降低患者术后ET-1的产生，并且较少影响左室收缩功能。     

血常规参数在肺癌患者手术前后的变化和临床价值

目的:探讨血常规参数红细胞计数(RBC)、血红蛋白(Hb)、白细胞计数(WBC)、血小板与淋巴细胞比值(PLR)和中性粒细胞与淋巴细胞比值(NLR)在肺癌患者手术前后的变化和临床意义。方法:收集264例肺癌手术患者、109例健康体检者的一般临床资料信息,通过血常规计数仪检测RBC、WBC、Hb、PLR和NLR五项血常规参数。结果:肺癌患者的PLR、WBC、NLR三项参数显著高于健康组(P<0.05);男性肺癌患者RBC、Hb、WBC、NLR四项参数结果均明显高于女性患者(P<0.05);肺鳞癌组的PLR比值显著高于腺癌组,临床Ⅲ/Ⅳ期的PLR和NLR参数高于Ⅰ/Ⅱ期(P<0.05);TNM分期中T3和T4期的PLR、WBC和NLR结果均显著高于早期T1和T2期,而T4期的RBC和Hb含量小于T1和T2期(P<0.05);肺癌患者术后WBC、PLR和NLR各参数结果均显著高于手术前,而RBC和Hb水平明显小于术前(P<0.05)。结论:血常规参数RBC、Hb、WBC、PLR和NLR在肺癌中异常表达,与临床和病理分期具有一定相关性。且手术前后参数的变化对预防术后发生贫血、血栓和感染等并发症具有重要的临床价值,为精准治疗和病情监测提供依据,有助于提高患者术后生存率和生活质量。     

不停跳体外循环和停跳体外循环心内直视手术围术期使用库血比较及意义

目的 比较心脏不停跳(BH)和心脏停跳(AH)体外循环(CPB)期间及术后库血使用例数和库血使用量，并探讨其临床意义。方法 1997年1月～2002年1月，统计BH组患者2000例，AH组患者210例，观察CPB期间及术后库血的使用情况，并比较两组转流期间的各项指标。结果 BH组死亡52倒，死亡率2．6％，AH组死亡10倒，死亡率4．8％。两组存活患者术后恢复顺利。BH组围术期少用血或不用血明显少于AH组，放血例数明显多于AH组，机余血回输量明显多于AH组。结论 采取血液保护措施后CPB围术期BH较AH可明显减少库血使用量。     

乌司他丁对心脏不停跳心内直视术机体免疫功能的影响

目的:研究乌司他丁(UTI)对体外循环(CPB)心脏不停跳心内直视术所造成的机体免疫功能变化的影响.方法:将40例拟在体外循环下行心脏不停跳心内直视手术的患者随机分成对照组(C组)和UTI组(U组),其中C组20例,U组20例.U组给予UTI 100万U,C组给予同样容量的生理盐水.分别于麻醉后切皮前(T1);CPB 15 min(T2);停机时(T3);停机15 min(T4);停机30 min(T5);术毕(T6);术后2 h(T7)及术后24 h(T8)各时点收集外周静脉血测定下列各指标水平:淋巴细胞(LY)计数、肿瘤坏死因子(TNF-α)、白细胞介素-2,白细胞介素-6(IL-2,IL-6).结果:CPB心脏手术后两组TNF-α、IL-6水平均明显升高,在T4、T5时点U组TNF-α水平显著低于C组;U组的IL-6水平在T3~T7时显著低于C组.对照组的LY计数、IL-2水平呈现先升高后降低的趋势,术后24 h这两个指标均明显降低,而U组的这两个指标在术后24 h仍与术前相当.结论:UTI能够改善体外循环心不停跳手术造成的全身炎症反应和免疫抑制,从而保护机体的多种重要脏器功能,减少感染的风险.     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.