老年妇科手术患者的临床特点及围术期处理

目的总结老年妇科手术患者的临床特点及围术期处理措施。方法选取2015年1~12月在该院进行妇科手术的56例老年患者作为老年组(年龄≥60岁),同时选取同一时期采取妇科手术治疗的62例非老年患者作为非老年组(年龄<60岁),并分析两组手术前后临床特点,同时总结老年妇科手术患者围术期处理措施。结果两组恶性肿瘤疾病和术后合并疾病发病率比较差异有统计学意义(P<0.05),两组并发症发生率比较差异无统计学意义(P>0.05)。结论老年患者以妇科恶性肿瘤疾病为主,且多数术后合并各种并发症,因此掌握老年妇科手术治疗的临床特点,围术期做好术前准备和术后护理干预,有助于提高患者对麻醉和手术的耐受力,减少术后并发症的发生以及死亡率。     

依托咪酯和丙泊酚在老年颅脑手术中的麻醉诱导效果

目的探究临床应用依托咪酯和丙泊酚在老年颅脑手术麻醉诱导中的效果。方法选取老年颅脑手术患者120例,采用随机分组法分为实验组和对照组,每组60例。实验组予以依托咪酯和丙泊酚联合麻醉,对照组予以依托咪酯联合七氟烷联合麻醉。检测两组手术麻醉前后灰质血流量、心率、血氧饱和度(SPO_2)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)变化情况。结果两组围术期灰质血流量、SPO_2无明显变化(P0.05);两组术前、术后心率、SBP、DBP差异无统计学意义(P0.05),而实验组术中心率、SBP、DBP均比对照组平稳,差异有统计学意义(P0.05);两组术前MAP差异无统计学意义(P0.05);两组手术中MAP差异有统计学意义(P0.05);两组术后2 h MAP差异有统计学意义(P0.05)。结论依托咪酯联合丙泊酚应用在老年颅脑手术麻醉诱导中的效果明显,安全性高,术后无严重不良反应的发生,也能保持各指标稳定,更适合用于老年颅脑手术麻醉诱导。     

术前饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响

目的 探讨术前2 h饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响。方法 选择择期行胸腔镜下肺叶切除术的老年病人60例，随机分为2组，每组30例。对照组术前常规禁食，试验组在麻醉诱导前2 h饮用5%葡萄糖水4 mL/kg,入室后采用超声检查2组病人的胃窦部，测量半卧位下胃窦部横截面积(cross-sectional area, CSA),计算胃容量(gastric volume, GV)、胃容量与体质量的比值(GV/W),评估2组病人反流误吸风险。行桡动脉有创动脉血压监测，记录T1(入室后5 min)、T2(麻醉诱导后3 min)、T3(手术开始时)、T4(手术进行1 h)、T5(手术结束时)、T6(术后2 h)及T7(术后6 h)的SBP、平均动脉压(MAP)及心率(HR),比较2组病人围术期SBP降幅>20%超过30 s的发生率，记录2组病人围术期麻黄碱和去甲肾上腺素的使用率、使用量及病人的术后情况。结果 2组病人麻醉诱导前半卧位下CSA、GV及反流误吸风险差异无统计学意义(P>0.05);试验组在T2和T5时刻的MAP高于对照组(P<0...     

瑞芬太尼复合丙泊酚靶控输注在老年妇科腹腔镜手术麻醉中的应用

目的探讨瑞芬太尼复合丙泊酚靶控输注在老年妇科腹腔镜手术麻醉中的应用效果及对患者血流动力学的影响。方法选取择期妇科腹腔镜手术的120例老年患者为研究对象,随机分为观察组和对照组,每组60例,观察组采用瑞芬太尼复合丙泊酚靶控输注麻醉,对照组采用芬太尼静脉复合麻醉,比较两组患者麻醉效果和血流动力学情况。结果 1观察组患者麻醉起效时间、睁眼时间、拔管时间均显著低于对照组(P<0.05);2对照组患者插管后1 min、气腹10 min HR、SBP、DBP明显增高(P<0.05),观察组患者麻醉诱导前、插管后麻醉诱导前、插管后1 min、气腹10 min、术中30 min、术毕30 min,HR、SBP、DBP组内比较差异均无统计学意义(均P>0.05),麻醉前、中、后血流动力学平稳。结论瑞芬太尼复合丙泊酚靶控输注在老年妇科腹腔镜手术麻醉中起效快,安全性高,有助于保证麻醉过程中血流动力学稳定。     

依托咪酯静脉泵注对腹腔镜胆囊切除术老年患者早期认知功能和血流动力学的影响

目的探讨依托咪酯静脉泵注对腹腔镜胆囊切除术老年患者早期认知功能和血流动力学的影响。方法拟全麻下行腹腔镜胆囊切除术的90例老年患者,随机分为对照组和试验组各45例。对照组给予右美托咪定进行麻醉维持,试验组静脉泵注给予依托咪酯进行麻醉维持。记录并比较两组麻醉时间、术中出血量、手术时间及拔管时间。于手术前1 d(T'0)、手术后第1天(T'1)、手术后第3天(T'2)及手术后第7天(T'3)时评价并比较两组MMSE评分。于入手术室后(T0)、麻醉诱导后(T1)、气管插管后即刻(T2)、气管插管后2 min(T3)、腹腔充气时(T4)、切除胆囊时(T5)及手术完毕时(T6)记录并比较两组心率(HR)、平均动脉压(MAP)、收缩压(SBP)及舒张压(DBP)。结果两组麻醉时间、术中出血量、手术时间及拔管时间比较,差异均无统计学意义(P0.05)。两组T'0、T'3时MMSE评分比较,差异均无统计学意义(P0.05);试验组T'1、T'2时MMSE评分均明显高于对照组(P0.05)。对照组T1时HR、MAP、SBP及DBP均明显高于T0时(P0.05),在T2、T3、T5及T6时的SBP、DBP均明显低于T1时(P0.05);试验组T0～T6各时间点的HR、MAP、SBP及DBP均保持较为稳定,与T0时比较差异均无统计学意义(P0.05)。试验组T1、T4时HR、MAP、SBP及DBP均明显低于对照组(P0.05);试验组T3时MAP、SBP、DBP,T5时HR、MAP、DBP,T6时SBP水平均显著低于对照组(均P0.05)。结论依托咪酯静脉泵注能够明显改善老年腹腔镜胆囊切除术患者的早期认知功能和血流动力学稳定性。     

神经阻滞麻醉对老年心脏患者下肢手术围术期心血管并发症的影响

目的:观察后路腰丛联合坐骨神经阻滞用于并发心脏病的老年患者行下肢手术的临床麻醉效果,探讨该方法是否能降低患者围术期心血管并发症的发生率。方法: 拟行择期膝关节镜手术并发心脏疾患的老年患者60例,随机分为两组,每组30例,其中A组采用常规腰硬联合麻醉;B组采用神经刺激器定位辅助后路腰丛联合坐骨神经阻滞。记录手术中不同时间点的平均动脉压（MAP）、心率（HR）变化,感觉、运动阻滞起效和维持时间,术后镇痛效果及术后72 h的心血管不良事件发生率。结果: 两组患者麻醉前后HR变化组间比较无明显统计学差异,A组患者麻醉后MAP呈下降趋势,在麻醉后10 min及15 min,MAP明显低于B组患者（P<0.05）,在其余时间点两组间无明显统计学差异。而B组患者各时间点的MAP无明显变化。A组患者术后心血管不良事件发生率为23%,明显高于B组（10%,P<0.05）。A组患者感觉、运动阻滞起效时间［(1.3±0.9) min和(4.1±2.3) min］均短于B组［(7.9±2.4) min和(15.2±4.1) min,P<0.05］。但B组患者感觉阻滞维持时间［(418±103) min］明显长于A组［(182±99) min,P<0.05］,且运动阻滞维持时间［(282±68) min］明显短于A组［(305±76) min,P<0.05］。术后6 h B组患者的VAS评分［(1.1±0.2)分］明显低于A组［(5.2±1.7)分,P<0.05］。结论: 对于并发心血管疾患的老年高危患者施行下肢手术,采用后路腰丛联合坐骨神经阻滞麻醉,更有利于术中维持稳定的血流动力学,并减少术后心血管并发症的发生率,术后镇痛时间更长,有利于患者的术后恢复。     

老年妇科腹腔镜手术麻醉中静吸复合麻醉与全凭静脉麻醉的效果对比

目的探讨静吸复合麻醉与全凭静脉麻醉对老年妇科腹腔镜手术患者麻醉效果、血流动力学、应激反应及短期认知功能等的影响。方法 80例于全身麻醉下行妇科腹腔镜手术的患者按照麻醉方法分为静吸复合麻醉组与全凭静脉麻醉组各40例,对比两组患者麻醉效果,麻醉诱导前(T0)、诱导后(T1)、气管插管(T1)、手术结束时(T3)、收缩压(SBP)、舒张压(DBP)、心率(HR)等血流动力学指标,去甲肾上腺素、肾上腺素等应激反应指标及短期认知功能。结果静吸复合麻醉组麻醉起效时间、睁眼时间、拔管时间明显长于全凭静脉组(P<0.05),静吸复合麻醉组T1、T2时SBP、DBP较T0均明显降低,全凭静脉麻醉组T1较T0明显降低,静吸复合麻醉组T1、T2、T3时HR较T0均明显提高,且T1、T2时均明显高于全凭静脉麻醉组(P<0.05)。两组去甲肾上腺素T3较T0明显提高,静吸复合麻醉组肾上腺素T3较T0明显升高,且高于全凭静脉组T3,全凭静脉麻醉组T1~2较T0降低,T3较T0升高(P<0.05)。麻醉诱导后24 h静吸复合麻醉组简易精神状况(MMS)评分低于全凭静脉组(P<0.05),余未见明显差异。静吸复合麻醉组麻醉后6、12 h认知功能障碍发生率明显高于全凭静脉组(均P<0.05)。结论静吸复合麻醉与全凭静脉麻醉应用于老年妇科腹腔镜术中均可获得显著效果,患者的血流动力学及生理指标稳定,其中全凭静脉麻醉的效果更好,生命体征更加平稳,应激反应更小,短期认知功能影响更小。     

全身麻醉和硬膜外麻醉对糖尿病患者围手术期血糖的影响

目的探讨分析全身麻醉和硬膜外麻醉对糖尿病患者围手术期血糖的影响。方法选取该院2017年1—8月收治的88例糖尿病围术期患者作为研究对象,分为对照组和观察组,对照组给予全身麻醉,观察组给予硬膜外麻醉。对比分析两组患者术后血糖指标变化。结果术前,两组患者血糖水平相差异无统计学意义(P0.05),手术切皮充CO_2、手术结束时、术后3 h、术后24 h 4个时间段,观察组患者的血糖水平低于对照组,差异有统计学意义(P0.05);观察组患者胰岛素使用剂量低于对照组,差异有统计学意义(P0.05);手术前,两组患者的收缩压(SBP)、舒张压(DBP)和心率(HR)相差不大,差异无统计学意义(P0.05),手术30 min、手术完成后,观察组患者的SBP、DBP和HR均低于对照组,差异有统计学意义(P0.05)。结论对糖尿病患者围手术期患者实施硬膜外麻醉,可有效降低患者术中、术后的血糖水平,减少患者术中胰岛素的使用量,且患者的血流动力学指标相对稳定,具有较高的临床推广价值。     

硬膜外阻滞与全身麻醉下老年患者乳酸钠林格液液体动力学比较

目的探讨硬膜外阻滞与全身麻醉老年患者乳酸钠林格液液体动力学的差别。方法择期手术病人89例,美国麻醉师协会(ASAI)-Ⅱ级老年病人,根据病情及手术所需均可选择硬膜外阻滞与全身麻醉的麻醉方法,随机分为硬膜外阻滞组43例和全身麻醉组46例。通过检测血红蛋白水平采用Matlab 6.5软件包计算扩容后一级和二级容量动力参数,采用CHMT3002型血流动力学监测仪检测扩容前后的血流动力学指标。结果两组扩容前平均动脉血压(MAP)、心率(HR)、心排量(CO)和心脏指数(CI)无显著差异(P>0.05),扩容前后的MAP、HR、CO和CI无显著变化(P>0.05),与硬膜外阻滞组比,全身麻醉组扩容后MAP、HR、CO、CI和尿量均明显降低(均P<0.05)。一级容量动力学结果显示,与硬膜外阻滞组比,全身麻醉的靶容量(V)较低,清除率较低(均P<0.05),二级容量动力学结果显示,与硬膜外阻滞组比,全身麻醉的V1、V2、K1和Kt明显降低,尿量也较低(P<0.05)。结论与硬膜外阻滞麻醉比,全麻后血浆稀释度增加,组织中的液体保留率增大,有益于老年手术患者血容量替代扩充,辅助手术顺利进行。     

腰丛复合坐骨神经阻滞麻醉对老年人股骨颈骨折患者术中血压和心率的影响

目的观察腰丛复合坐骨神经阻滞麻醉对老年股骨颈骨折手术患者术中血压和心率变化的影响。方法 96例老年股骨颈骨折患者,48例采用全髋关节置换术治疗（A组）,46例采用人工股骨头置换术治疗（B组）。记录两组患者麻醉前（T1）及阻滞完成后第5（T2）、10（T3）、20（T4）、30 min（T5）的动脉收缩压（SBP）、舒张压（DBP）、心率（HR）。结果阻滞完成后各时点A组患者SBP、DBP、HR和B组患者HR与T1相比P均〉0.05。B组患者T3、T4时SBP、DBP与T1、T2、T5相比P均〈0.05。结论采用全髋关节置换术治疗老年人股骨颈骨折时采用腰丛复合坐骨神经阻滞麻醉,术中麻醉诱导平稳,患者血压和心率稳定。采用人工股骨头置换术和治疗老年人股骨颈骨折时采用腰丛复合坐骨神经阻滞麻醉,术中麻醉诱导平稳,但患者血压和心率略有波动。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.