尼卡地平与拉贝洛尔控制腹腔镜手术中高血压的效果

目的:比较尼卡地平与拉贝洛尔对伴高血压的腹腔镜手术患者气腹期间的降压效果.方法:将30例择期行腹腔镜下胆囊切除术患者(均有高血压病史)随机分成3组,对照组仅接受麻醉药;尼卡地平组诱导前3 min静注尼卡地平20 μg·kg-1·min-1,随后持续静注0.5～1.5 μg·kg-1·min-1;拉贝洛尔组诱导前3 min静注拉贝洛尔0.3 mg·kg-1·min-1,之后持续静注10～20 μg·kg-1·min-1.观察给药前后患者心率、血压及心率收缩压乘积的变化.结果:尼卡地平组、拉贝洛尔组收缩压、舒张压、平均动脉压和心率与对照组比较均有显著性差异(P<0.05).结论:尼卡地平与拉贝洛尔均可控制高血压患者腹腔镜手术中因吸收CO2引起的血压升高, 且可控性良好.     

奥沙利铂静脉注射引发过敏反应3例报告

<正>2009年8—10月本文作者在药品临床反应检测中发现应用奥沙利铂静脉注射引发过敏反应3例,现报道如下。1临床资料[病例1]患者,女性,52岁。结肠癌术后进行化疗,给予奥沙利铂(深圳海王药业有限公司生产,批号20090801)200 mg加入5%葡萄糖注射液250 mL,静滴4 h。静滴结束后患者即出现喉痉挛、胸闷、寒战及出汗。查体:血压130/80 mmHg,呼吸未见异常,心率100 min-1。考虑为奥沙利铂过敏反应。立即给予地塞米松10 mg静注,异丙嗪25 mg肌注,肾上腺素0.5 mg肌注,2 min后喉痉挛及寒战症状加重,再次给予地塞米松10 mg静注,10 min后寒     

新型环糊精衍生物HPn-SBEm-β-CD动物血管给药的生物效应评价

目的:研究羟丙基-磺丁基-β-环糊精(HPn-SBEm-β-CD)对动物红细胞的溶血和 形态改变及对动物神经、呼吸及心血管系统的影响.方法:采用紫外分光光度法检测11种HPn-SBEm-β-CD对红细胞的溶血作用;扫描电镜观察HP3-SBE2-β-CD红细胞形态的变化;给小鼠分别静脉注射80、160及320 mg·kg-1的HP4-SBE3-β-CD后对小鼠一般行为和自主活动次数等进行观察;将Beagle犬麻醉后静脉注射40、80及160 mg·kg-1的HP4-SBE3-β-CD,检测其对呼吸频率、幅度及心电、心率和血压的影响.结果:11种HPn-SBEm-β-CD溶血性均明显低于β-CD,多数化合物溶血性显著低于HP-β-CD,其中HP2-SBE3-β-CD、HP1-SBE4-β-CD、HP3-SBE6-β-CD等化合物的溶血性低于SBE7-β-CD.10 mmol·L-1 HP3-SBE2-β-CD对红细胞形态无影响,而2.5 mmol·L-1 M-β-CD 能明显改变红细胞的形态;给定剂量条件下HP4-SBE3-β-CD不改变小鼠的一般行为和自主活动次数;对麻醉犬的呼吸频率、幅度及心电、心率和血压均无明显影响(P＞0.05).结论:HPn-SBEm-β-CD溶血性小,对小鼠神经精神系统无影响,对麻醉犬的呼吸系统及心血管系统均无明显的影响.     

萘哌地尔衍生物BWJ对麻醉大鼠及猫血压的影响

目的用麻醉的大鼠和家猫研究BWJ的降压效应.方法BWJ、NAF粉末用1%的吐温-20溶成混悬液,临用时配制.成年健康SD大鼠30只,随机分为5组(n=6),分别为1%吐温-20溶媒对照组、BWJ 10mg·kg-1组BWJ 20mg·kg-1组、BWJ 30mg·kg-1组、NAF 20 mg·kg-1组;成年健康市售家猫30只,随机分为5组(n=6),分别为1%吐温-20溶媒对照组、BWJ2.5mg·KG-1组、BWJ 5mg·kg-1组、BWJ 10mg·kg-1组、NAF 10mg·kg-1组.上述动物均用戊巴比妥30mg·kg-1腹腔注射麻醉,固定,颈动脉插管与计算机相连,十二指肠插管给药,BLE420-生物机能实验系统记录收缩压(SAP)、舒张压(DAP)和心率(HR).结果①BWJ 10mg·kg-1、20mg·kg-1、30mg·kg-1均可使麻醉SD大鼠的SAP、DAP明显下降,持续时间约为4.0-5.5h,三个剂量SAP下降最大幅度分别为13.5%、17.1%、21.3%;DAP下降最大幅度分别为15.3%和24.2%、26.7%;HR明显减慢,降低最大幅度分别为8.90%、10.9%、13.3%.NAF 20 mg·kg-1组SAP、DAP、HR下降最大幅度分别为21.6%、25.1%、2.3%.BWJ 20 mg·kg-1组与同剂量NAF相比SAP、DAP差别无显著性(P＞0.05),HR则差别显著(P＜0.05).②BWJ 2.5mg·kg-1、5mg·kg-1、10mg·kg-1均可使麻醉猫的SAP、DAP明显下降,持续时间约为3.5～4.5h.三个剂量SAP下降最大幅度分别为9.20%、22.7%、25.9%;DAP下降最大幅度分别为10.0%、19.2%、28.9%;HR明显加快,升高最大幅度分别为6.40%、8.90%、19.8%.NAF 10 mg·kg-1组使麻醉猫的SAP、DAP、HR下降,最大幅度分别为23.5%、23.6%、2.60%.BWJ与同剂量NAF相比SAP、DAP均无显著差异(P＞0.05),HR则差别显著(P＜0.05).结论①BWJ降低正常麻醉大鼠血压并减慢心率;②BWJ降低正常麻醉家猫血压并加快心率.     

穿琥宁不良反应4例

2004年1月～2005年1月我院门诊在静滴穿琥宁时发生不良反应4例,现分别报告如下. 过敏性休克1例:患者,女,34岁.因发热伴咽痛被诊断为急性上呼吸道感染,给予5%的葡萄糖液250ml和穿琥宁针(哈药集团三精加滨药业有限公司生产)0.4静滴,当滴注约30ml时,该患者感胸闷和气短,面色苍白,口唇发绀,四肢冰冷,P 120次/分,BP 70/40mmHg,考虑为穿琥宁引起的过敏反应,即停用穿琥宁,同时给予吸氧,地塞米松10mg静注,异丙嗪25mg肌注,约5分钟该患者上述症状渐减轻,30分钟后完全消失,同时血压和心率也恢复正常.观察2小时未再出现其他不适.     

芬太尼复合咪唑安定在辅助腰椎间盘突出手术中的应用

目的比较芬太尼复合咪唑安定与氟哌啶在腰椎间盘突出手术中的镇静作用及对呼吸、循环的影响。方法选择腰椎间盘突出手术患者48例,随机分为两组。A组静注咪唑安定0.04mg·kg-1与芬太尼0.1mg,然后以咪唑安定0.03～0.06mg·kg-1·h-1微量泵维持,B组静注氟哌啶2.5mg和芬太尼0.1mg,必要时单次追加芬太尼0.05mg维持。观察血压、心率、SpO2、呼吸、镇静程度、苏醒和遗忘情况。结果B组血压、SpO2下降较A组明显。两组镇静程度相仿,但遗忘程度A组优于B组。结论咪唑安定0.03～0.06mg·kg-1·h-1与芬太尼合用是安全有效的,并具有良好的遗忘作用。     

42种中药注射剂中吐温80定性定量测定

目的：测定42种中药注射剂中吐温80的含量.方法：硫氰酸钴铵和薄层层析两种方法结合定性判定中药注射剂是否含有吐温80,分光度度比色法测定吐温80的含量.结果：鱼腥草注射液等15种中药注射剂中含有吐温80,含量由（0.72±0.00）～（6.85±0.02）g/L,其他注射剂未检出吐温80.结论：中药注射剂中吐温80的添加有待加强监督与规范.     

艾司洛尔对围拔管期心血管反应的预防作用

目的　观察硝酸甘油和艾司洛尔对围拔管期心血管反应的影响。方法　 6 0例ASAⅠ～Ⅱ全麻病人随机分为三组 ,于术毕符合气管拔管指征时 ,Ⅰ组静注艾司洛尔 0 .5mg·kg-1,Ⅱ组静注硝酸甘油 10 μg·kg-1,Ⅲ组静注生理盐水 3ml,观察围拔管期血压、心率 ,并计算血压心率乘积 (RPP)。结果　Ⅲ组病人围拔管期血压、心率及RPP升高 (P <0 .0 5 ) ,Ⅰ组血液动力学趋平稳 ,Ⅱ组血压变化不明显 ,而心率及RPP则于拔管时及拔管后一分钟显著增高。结论　艾司洛尔比硝酸甘油更能有效预防围拔管期心血管反应。     

破伤风抗毒素皮试致过敏性休克1例

<正>患者女,27岁,手外伤后行破伤风抗毒素皮试0.1ml(含破抗毒素15IU),注射后5min局部皮肤开始发红,并逐渐扩大,15min时,患者感胸闷、气急、头昏、乏力,面色苍白,大汗淋漓,测心率130/分,血压10/4kpa,腹部出现红色斑丘疹,立即给予平卧、吸氧、肾上腺素1mg肌注,50％GS 20ml+10％葡萄糖酸钙10ml静注,5％GNS500ml+氟米松10mg静滴等处理,半小时后症状缓解,血压升至14/10kpa。72小时后症状全部消失。     

有机磷中毒合并甲亢患者死亡1例

1　病例介绍患者 ,女 ,3 5岁 ,半小时前自服有机磷农药 160 5约 15ml,被家人急送入院。查体 :神清 ,对答切题 ,双瞳孔直径 2mm ,光反射存在 ,皮肤微潮湿 ,无肌颤 ,双肺呼吸音粗 ,心率 90次 分 ,律齐 ,心音正常 ,血压 18 11Kpa,余未见明显异常。治疗 :立即给予洗胃 ,吸氧 ,静注阿托品 10mg ,解磷定 1.5g加入10 %葡萄糖溶液 5 0 0ml中静滴 ,并行其它综合治疗措施 ,10分钟后改用阿托品 5mg静脉注射 ,每 10分钟 1次。当用至2 0mg时 ,患者出现躁动不安 ,眼球突出明显并充血 ,瞳孔散大为 4mm ,口唇紫绀 ,呼吸急促 ,心率 2 0 0次 分 ,心律不齐 ,…     

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…     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.