丙泊酚复合芬太尼用于微波子宫内膜消除术

目的 观察丙泊酚或丙泊酚复合芬太尼用于门诊微波子宫内膜消除术的麻醉效果。方法 ASA　Ⅰ～Ⅱ级门诊微波子宫内膜消除术患者60例,随机分为A组30例和B组30例,分别给予丙泊酚和丙泊酚复合芬太尼麻醉,记录麻醉诱导时间、苏醒时间、丙泊酚用量、平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO2)等的变化。结果 麻醉诱导时间A组为(6.0±2.8)s,B组为(5.7±3.1)s,两组差异无显著性。丙泊酚维持量B组为(0.5±0.4)mg/kg,显著低于A组(1.5±0.6)mg/kg。麻醉诱导后2min,A组MAP从(117.6±13.2)mmHg降至(93.1±8.9)mmHg,B组MAP从(119.2±12.7)mmHg降至(92.5±9.3)mmHg,2～3min后恢复正常。A组89％麻醉诱导后2min患者SpO2降至90％以下,显著高于B组(53％),给予辅助吸氧后两组SpO2均恢复正常。结论 丙泊酚或丙泊酚复合芬太尼均是门诊微波子宫内膜消除术安全有效的麻醉用药。     

吸毒者胃肠道金属异物取出术的麻醉处理

目的　研究吸毒者剖腹探查术的麻醉处理。方法　 1 0 8例吸毒患者分为两组 ,Ⅰ组 (92例 )静脉注射氟哌利多0 .1mg/kg、2 .5 %硫喷妥钠 5～ 6mg/kg、芬太尼 4 μg/kg、氯化琥珀胆碱 2mg/kg后气管插管 ,以 1 %～ 2 %异氟烷、1 .6 %普鲁卡因 +0 .1 %琥珀胆碱复合液维持麻醉 ,术中间断追加芬太尼 ;Ⅱ组 (1 6例 )术前 1h口服可乐定 5 μg/kg ,静脉注射氯胺酮2mg/kg、氯化琥珀胆碱 2mg/kg后气管插管 ,以 1 %～ 2 %异氟烷、1 %普鲁卡因 +0 .1 %氯胺酮 +0 .1 %琥珀胆碱复合液维持麻醉 ,术中适量追加芬太尼。连续监测无创血压、心电图、脉搏血氧饱和度 (SpO2 )和芬太尼用量。结果　与术前比较 ,Ⅰ组平均动脉压 (MAP)、心率 (HR)明显增高 (P <0 .0 5 ) ,SpO2 无显著变化 (P >0 .0 5 ) ;Ⅱ组MAP、HR、SpO2 均无显著性变化(P >0 .0 5 )。芬太尼用量Ⅰ组较Ⅱ组明显增多 (P <0 .0 5 )。结论　可乐定和氯胺酮联合用药不仅可以防治戒断反应 ,而且可以增强麻醉作用。术中要注意加强监护 ,维护循环系统的稳定     

静脉预注可塞风对子宫全切病人硬膜外术后自控镇痛的影响

目的探讨静脉预注可塞风对子宫全切病人硬膜外术后自控镇痛的影响。方法对60例择期子宫全切手术患者,随机单盲分为3组,每组20例,Ⅰ组为空白对照组,切皮前静脉输注生理盐水10mL。Ⅱ组手术结束时静脉输注可塞风8mg。Ⅲ组切皮前10min静脉输注可塞风8mg。所有患者均于两点连硬外麻醉下手术。3组患者均于手术结束后硬膜外自控镇痛(PCEA)。自控镇痛液为布比卡因和芬太尼的混合液(布比卡因0.125%,芬太尼2μg/mL)负荷剂量5mL,背景剂量2mL/h,单注剂量2mL,锁定时间15min,限量10mL/h,术后镇痛维持48h。结果第1个24h自控镇痛的视觉模拟(VAS)评分静息时Ⅰ组与Ⅱ组比较P<0.05,Ⅰ组与Ⅲ组比较P<0.01;咳嗽时Ⅰ组与Ⅲ组比较P<0.01。第1个24h镇痛药用量Ⅰ组为(99±15),Ⅱ组为(83±8)mL,Ⅲ组为(78±9)mL;每2个24h镇痛药用量Ⅰ组为(81±10)mL,Ⅱ组为(80±5)mL,Ⅰ组与Ⅲ组比较P<0.01,Ⅰ组与Ⅱ组比较P<0.05。Ⅰ组呕吐率大于Ⅲ组。结论静脉预注可塞风加强了子宫全切病人硬膜外术后自控镇痛的效果,减少了术后呕吐发生率。     

丙泊酚复合芬太尼用于微波子宫内膜消除术

目的观察丙泊酚或丙泊酚复合芬太尼用于门诊微波子宫内膜消除术的麻醉效果.方法 ASA Ⅰ～Ⅱ级门诊微波子宫内膜消除术患者60例,随机分为A组30例和B组30例,分别给予丙泊酚和丙泊酚复合芬太尼麻醉,记录麻醉诱导时间、苏醒时间、丙泊酚用量、平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO2)等的变化.结果麻醉诱导时间A组为(6.0±2.8)s,B组为(5.7±3.1)s,两组差异无显著性.丙泊酚维持量B组为(0.5±0.4)mg/kg,显著低于A组(1.5±0.6)mg/kg.麻醉诱导后2 min,A组MAP从(117.6±13.2)mmHg降至(93.1±8.9)mmHg,B组MAP从(119.2±12.7)mmHg降至(92.5±9.3)mmHg,2～3 min后恢复正常.A组89%麻醉诱导后2 min患者SpO2降至90%以下,显著高于B组(53%),给予辅助吸氧后两组SpO2均恢复正常.结论丙泊酚或丙泊酚复合芬太尼均是门诊微波子宫内膜消除术安全有效的麻醉用药.     

普鲁卡因静脉复合麻醉对鼻窦内镜手术的影响

目的观察1%普鲁卡因静脉复合麻醉与非普鲁卡因静脉复合麻醉对鼻窦内镜(FESS)手术的影响。方法将行FESS手术的60例患者随机分为普鲁卡因静脉复合麻醉(P组)和非普鲁卡因静脉复合麻醉(F组)两组,P组采用1%普鲁卡因250ml+芬太尼0.3mg静脉滴注维持麻醉,F组采用生理盐水250ml+异丙酚200mg+芬太尼0.3mg静脉滴注维持麻醉,两组均间断静脉注射万可松维持肌松。分别观察记录两组手术的出血情况和手术所需时间。结果P组平均出血量(1100±200)ml>F组(550±180)ml,P组手术所需时间(180±30)min>F组(140±35)min,均有显著性差异(P<0.05)。结论1%普鲁卡因静脉复合麻醉对FESS手术的出血量及手术时间有明显影响。     

感染性心内膜炎手术治疗的麻醉处理

①目的　探讨感染性心内膜炎病人手术治疗的麻醉处理方法。②方法　对 2 6例心功能Ⅱ～Ⅳ级的感染性心内膜炎病人均采用以芬太尼为主的低温低压体外循环静脉或静吸复合全麻。③结果　 2 6例病人平均麻醉时间 (330± 10 1)min ,芬太尼平均用量 (5 0± 7) μg/kg,潘库溴铵平均用量 (0 .30± 0 .0 6 )mg/kg ,安氟醚平均吸入体积分数 0 .134± 0 .0 0 4 ,地西泮平均用量 (0 .6 0± 0 .2 1)mg/kg。 2 6例病人中心脏自动复搏 18例 ,电击复搏 8例。除 1例因多器官功能障碍综合征死亡外 ,其余恢复顺利。④结论　缓慢的麻醉诱导 ,以芬太尼为主的静脉或静吸复合全麻 ,配合应用适当的血管活性药物 ,能保持围麻醉期循环稳定     

儿童先心病手术舒芬太尼麻醉效应的临床观察

目的:观察舒芬太尼应用于儿童先心病手术的麻醉效果。方法:48例拟于体外循环下行先心病矫正手术的患儿,随机分为两组(n=24),组Ⅰ阿片类药物用药为芬太尼,组Ⅱ为舒芬太尼,分别复合咪唑安定、依托咪脂和维库溴胺实施全凭静脉麻醉,除阿片用药不同外,两组其它用药相同。观察两组患儿麻醉效能、循环变化、阿片药用药量和术后麻醉恢复情况。结果:两组麻醉效果满意,诱导后组Ⅱ,HR减慢发生率高于组Ⅰ,两组MAP基本稳定。组Ⅰ芬太尼用量为(382.5±43.2μg),组Ⅱ舒芬太尼用量(33.4±9.7μg),组Ⅱ平均清醒时间和气管拨管时间为(3.2±0.8h)和(4.6±1.3h),较组Ⅰ(相应为4.3±1.1h和5.2±1.4h)为早(P<0.05)。结论:舒芬太尼作为先心病手术的麻醉用药具有一定的优势,可作为心脏手术麻醉用药的选择。     

亚甲蓝对体内过氧亚硝酸阴离子的清除作用

目的观察亚甲蓝（MB）对静脉普鲁卡因复合麻醉（IPA）期间患者体内过氧亚硝酸阴离子（ONOO^-）的清除作用。方法40例择期手术患者，根据麻醉方法不同随机分为对照组[芬太尼（F）组]和观察组[IPA（P）组]。分别观察麻醉诱导前（T0）、麻醉120min（T1）、180min（T2）及静脉注射MB（1～2mg·kg^-）后30min（T3）患者血内一氧化氮（NO）、氧自由基（OFR）、脂质过氧化物（LPO）、高铁血红蛋白（MHb）含量，红细胞超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、还原型辅酶Ⅰ-细胞色素b5还原酶（NADH—cyt b5-R）活性、IPA期间血浆普鲁卡因及对氨基苯甲酸（PABA）浓度变化。结果P组T1、T2与T0相比NO、OFR、LPO、MHb均有显著升高（P〈0．05或0、01），SOD、CAT、NADH—cyt b5-R均有显著降低（P〈0．05或0．01）。T3时NO等7项指标均恢复至正常水平（P〈0．01）。以MHb为因变量（Y）与其他8项自变量的多因素逐步回归分析显示，对MHb有显著影响的指标依次是：T1：PABA、OFR、NADH—cyt b5—R；T2：OFR、NADH—cyt b5—R。F组T0～T3诸指标无显著改变。结论临床治疗剂量的MB在人体内具有直接清除ONOO^-的特性。     

丙泊酚伍用芬太尼或氯胺酮用于腹腔镜检查术麻醉

目的　研究丙泊酚伍用芬太尼或氯胺酮在不孕妇女腹腔镜检查术中的麻醉作用。方法　ASAⅠ～Ⅱ级不孕妇女行腹腔镜检查术 15 0例 ,行静脉全麻 10 6例 ,随机分为 :丙泊酚芬太尼混合液 +局麻 (Ⅰ组 ) ,丙泊酚氯胺酮混合液 +局麻(Ⅱ组 ) ,单纯局麻 (Ⅲ组 )。观察手术时间、用药量、Bp、HR、SpO2 、副作用、恢复时间、术后满意度及Ⅲ组VAS的评分。结果　Ⅰ、Ⅱ两组手术时间比Ⅲ组短 (P <0 .0 5 ) ,平均动脉压下降 >2 0 % ,心率减慢 >2 0 % ,Ⅲ组分别为 17例 (38.6 % )、2 1例(47.7% ) ,Ⅰ、Ⅱ组分别为 4例 (3.8% )与 2例 (1.9% ) ,两者有极显著性差异 (P <0 .0 1)。Ⅲ组心悸 4 2例 (95 .4 % ) ,面色苍白、四肢发冷 4 0例 (90 .9% ) ,不自主运动 4 4例 (10 0 .0 % ) ,与Ⅰ、Ⅱ组对比有极显著性差异 (P <0 .0 1)。Ⅰ、Ⅱ组术后恶心呕吐 2例 (1.9% ) ,Ⅲ组VAS评分 (8.1± 1.6 ) ,恶心呕吐 19例 (43.1% )。Ⅱ组头低位时流涎 2 3例 (46 .0 % ) ,与Ⅰ、Ⅲ组对比有显著性差异 (P <0 .0 5 )。结论　丙泊酚伍用芬太尼或氯胺酮用于腹腔镜检查术麻醉作用可靠 ,并能减少检查术中的不良反应。丙泊酚伍用芬太尼 (1μg/kg)更有利于术中管理     

长时间显微神经外科手术麻醉管理

目的　结合长时间显微神经外科手术临床麻醉 ,探讨相关麻醉管理要点。方法　 2 0例择期脑肿瘤切除术患者 ,静注利多卡因、异丙酚、芬太尼、维库溴铵行麻醉诱导插管 ,麻醉维持 :静滴 (1～ 2 ) %普鲁卡因 ,吸入 (0 .5～ 3.0 ) %安氟醚 ,辅用维库溴铵 ,除常规监测ECG、SpO2 、CVP及有创血压外 ,持续监测肛温、血糖 1次 /小时。结果　 2 0例平均麻醉时间 (10± 2 )小时 ,芬太尼平均用量 (8± 4 ) μg/kg ,维库溴铵平均用量 (0 .80± 0 .30 )mg/kg ,安氟醚平均吸入 (2 .0± 0 .5 ) % ,术后均恢复自主呼吸 ,清醒拔管 ;手术开始后 7～ 10小时 ,血糖、肛温较术前明显降低 (P <0 .0 5 )。结论　长时间显微神经外科手术麻醉要加强有创监测 ,术中及时调整麻醉深度 ,根据CVP和尿量指导体液调节 ;麻醉后期应监测血糖、体温 ,防止低血糖及低体温     

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.     

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.     

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…     

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.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.