羟乙基淀粉130/0.4对非体外循环冠状动脉搭桥术患者肾功能的影响

目的比较非体外循环冠状动脉搭桥术(OPCAB)中临床剂量的羟乙基淀粉(HES)130/0.4和琥珀酰明胶(GEL)对肾功能的影响。方法选择24例美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级、择期行OPCAB的患者,随机均分为GEL组和HES组。分别于麻醉诱导前(T_0)、术毕即刻(T_1)和术后24h(T_2)测定血尿素氮(BUN)和肌酐清除率(Ccr)。记录T_1、T_2时间点尿量。结果两组间术中胶体或晶体补液量、术中出血量、24h胸管引流量以及T_1和T_2时间点尿量的差异均无统计学意义(P值均>0.05)。两组间及各组内T_0、T_1和T_2时间点的BUN和Ccr的差异均无统计学意义(P值均>0.05)。结论临床常规剂量的HES 130/0.4对OPCAB患者肾功能的影响与GEL相比无明显差异。     

不同胶体预充液对心肺转流术中患者凝血功能的影响

目的 :研究不同胶体预充液对心肺转流术 (CPB)下心脏直视手术病人凝血功能的影响。方法 :36例CPB下心脏直视手术病人随机分为 3组 ,每组 1 2例。分别以人血白蛋白 (A组 )、琥珀酰明胶 (G组 )和 6 %羟乙基淀粉 (H组 )预充 ,于麻醉前 (T0 )、转流中 (T1 )、转流毕 (T2 )、术后 6h(T3)、术后 2 4h(T4 )取静脉血测定凝血功能指标 :活化的部分凝血活酶时间 (APTT)、凝血酶原时间 (PT)、纤维蛋白原 (FIB)、D 二聚体 (D D)、血小板计数 (PLC)。结果 :(1 )A组和G组T1及T2时FIB均低于T0时 (P <0 0 1 ) ,G组T3时FIB仍低于T0时 (P <0 0 5 ) ,3组T3时PT均长于T0时 (P <0 0 1 ) ,H组T3时APTT长于T0时 (P <0 0 1 ) ,A组和G组T4时FIB均大于T0时 (P <0 0 1 ) ;(2 )H组T3时PT长于A组和G组 (P <0 0 5 ) ,且H组的APTT长于A组 (P <0 0 5 ) ,A组和G组T4时FIB均大于H组 (P <0 0 5 )。结论 :人血白蛋白和琥珀酰明胶预充液对机体凝血功能的影响小于羟乙基淀粉 ;各组术后数小时内机体凝血功能尚未完全恢复 ,且伴有相对高凝状态     

不同胶体液预充对冠状动脉旁路移植术患者凝血功能的影响

目的观察4%琥珀明胶（GEL）和6%羟乙基淀粉（130/0.4,HES）用于术中胶体补充和体外循环预充对体外循环下冠状动脉旁路移植（CABG）术患者凝血功能的影响。方法选择择期CABG手术患者44例,年龄42~85岁。随机分为明胶（G组）和羟乙基淀粉（V组）组,每组22例。4%琥珀明胶和6%羟乙基淀粉分别作为两组体外循环预充和麻醉诱导后单一类型胶体液补充。分别于患者麻醉诱导后（T0）、开胸后（T1）及鱼精蛋白中和肝素后10 min（T2）取静脉血用Sonoc lot凝血分析仪检测激活凝血时间（gbACT）、凝血速率（CR）、最大凝血标记值（MCS）和血小板功能（PF）,同时检测3个时点的常规凝血指标,包括活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）、纤维蛋白原（Fbg）和血小板计数（P lt）,记录术后24 h胸引量。分析各项检验结果的意义及其与术后24 h胸腔引流量的联系。对比分析使用不同胶体液对凝血功能的影响。结果 V组与G组相比在T2时间点APTT、gbACT、PF、MCS检测结果有统计学差异,V组对术后APTT、gbACT的影响相对较强,但血小板功能检测结果V组优于G组。两组术后24小时胸引量无统计学差异。结论 4%琥珀明胶与6%羟乙基淀粉用于液体预充时对CABG术患者凝血的影响略有差别,但对术后出血量无明显影响。     

羟乙基淀粉130/0.4和琥珀酰明胶对体外循环心内直视术患者血S100 β蛋白及炎性细胞因子的影响

目的:观察6%羟乙基淀粉130/0.4(HES130/0.4)对体外循环(CPB)心内直视术患者血清S100β蛋白水平及炎性细胞因子TNF-α、IL-6、IL-10的影响,探讨其在CPB心内直视术期间是否具有脑保护作用及其可能的作用机制.方法:选择浅低温CPB下行房间隔或室间隔缺损修补术患者40例,随机分为HES130/0.4组(H组)和琥珀酰明胶(明胶)组,每组20例.预充液胶体为:HES130/0.4组,6%HES130/0.4 20～25 ml·kg-1;明胶组,琥珀酰明胶20～25 ml·kg-1.分别于转机前(T0)、转机后20 min(T1)、停机即刻(T2)、停机后60 min(T3)、停机后24 h(T4)采中心静脉血液l0 ml离心,用ELISA法测定血清中S100β蛋白、TNF-α、IL-6和IL-10.结果:HES130/0.4组和明胶组S100 β蛋白均在转机后(T1)上升,停机即刻(T2)达到高峰,停机后回落.但在T1、T2、T3时点S100 β蛋白、TNF-α和IL-6HES130/0.4组明显低于明胶组(P＜0.05或P＜0.01),而IL-10HES130/0.4组明显高于明胶组.结论:HES130/0.4可通过抑制炎症反应、调节促炎因子/抗炎因子之间的平衡,从而降低转机过程中及停机后1 h血清S100β蛋白水平.     

不同分子量羟乙基淀粉溶液对非体外循环冠状动脉旁路移植术血流动力学及凝血功能的影响

目的:比较6%羟乙基淀粉130/0.4(万汶TM,Voluven)和6%羟乙基淀粉200/0.5(贺斯>,HAES-Steril)对非体外循环冠状动脉旁路移植术(OPCAB)血流动力学及凝血功能的影响。方法:60例拟行OPCAB手术患者,随机分为万汶TM(V组)和贺斯>(H组),每组30例。麻醉诱导后开始输注万汶或贺斯,二者术中最大量均为33ml/kg。监测麻醉前(T0)、术毕(T1)、术后6h(T2)及12h(T3)各时点血流动力学参数和APTT、PT、Ⅷ因子及VW因子,记录术中液体量、术后24h引流量、输血量。结果:于T1、T2及T3两组的CI、HR均明显高于T0(P<0.01);H组于T1、T2及T3所测APTT值均明显长于T0(P<0.01),且显著高于V组(P<0.05),而后者无明显变化;H组于T1、T2及T3所测Ⅷ因子、VW因子较T0显著降低(P<0.01)且明显低于V组(P<0.05),而V组患者无明显变化(P>0.05);术后24h引流量、输血量V组均显著低于H组(P<0.05)。结论:OPCAB术中输注万汶或贺斯均有利于血流动力学的稳定,但万汶对凝血功能无明显影响。     

不同液体急性高容量血液稀释对剖宫产产妇围术期血液流变学状态及凝血功能的影响

目的 评价不同液体急性高容量血液稀释（AHHD）对剖宫产产妇围术期血液流变学状态及凝血功能的影响。方法 选择在腰硬联合麻醉下行择期剖宫产足月单胎健康产妇120例,ASA分级Ⅰ或Ⅱ级,按不同液体AHHD分为4组,每组30例:对照组（C组）、聚明胶肽组（P组）、琥珀酰明胶组（G组）和6%羟乙基淀粉130/0.4组（H组）。C组、P组、G组和H组分别于麻醉前30min静脉输注乳酸钠林格液、聚明胶肽、4%琥珀酰明胶和6%羟乙基淀粉130/0.4进行AHHD,输液速度为20mL·kg-1·h-1。分别于AHHD前（T0）,AHHD后30min（T1）、1h（T2）和手术结束后2h（T3）时采集静脉血样,测定血红蛋白（Hb）含量、血红细胞比容（Hct）、血液流变学指标（全血高切黏度、全血低切黏度、血浆黏度值、红细胞聚集指数、血小板聚集指数和血沉）及凝血功能指标[血小板计数（PLT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和纤维蛋白（Fib）]。结果 与C组比较,P组、G组和H组T1—T3时Hb含量及Hct降低（P<0.05）,T1—T2时全血高切黏度、全血低切黏度、红细胞聚集指数、血小板聚集指数、PLT和Fib降低,APTT延长（P<0.05）,血浆黏度值、血沉及PT差异无统计学意义（P>0.05）;与H组比较,P组和G组T1—T2时红细胞聚集指数、血小板聚集指数及血沉升高（P<0.05）,余指标差异无统计学意义（P>0.05）。结论 术前应用聚明胶肽、4%琥珀酰明胶或6%羟乙基淀粉130/0.4行AHHD对剖宫产产妇凝血功能影响轻微,但可改善产妇围术期血液流变学状态,增加组织血液灌注,且6%羟乙基淀粉130/0.4相较其他液体对降低血液黏度时效更长。     

硬膜外阻滞对妇科腹腔镜手术患者凝血功能的影响

目的探讨硬膜外阻滞及硬膜外镇痛对妇科腹腔镜手术患者的凝血功能和术后深静脉血栓发生率的影响。方法将100例择期行妇科腹腔镜手术的患者随机平均分为全麻复合硬膜外阻滞组(GE组)和全麻组(G组)。分别测定两组患者麻醉前(T0)、气腹建立后30min(T1)、气腹停止后30min(T2)、术后24h(T3)、术后48h(T4)和术后72h(T5)等6个时间点的凝血酶原时间(PT)、部分激活凝血活酶时间(APTT)、纤维蛋白原含量(Fib)和D-二聚体(D-D);术后第3天行彩超检查双下肢血管,确定深静脉血栓发生情况。结果 PT于两组各时间点无差异(P>0.05);G组APTT缩短并维持到T4(P<0.05),GE组APTT各时点与T0比较无变化,与G组差异有统计学意义(P<0.05);G组Fib和D-D升高,与GE组差异有统计学意义(P<0.05)。结论妇科腹腔镜手术患者血液凝固性增高,硬膜外阻滞及镇痛可以抑制其凝血功能增强,从而降低妇科腹腔镜术后深静脉血栓发生率。     

早期使用超微量肝素治疗新生儿DIC倾向疗效观察

目的观察早期皮下注射超微量肝素对胎盘性产前出血新生儿和孕母外伤早产儿疗效。方法将54例胎盘性产前出血新生儿和孕母外伤早产儿有DIC倾向者随机分为A、B、C三组,分别是应用超微量肝素组、普通剂量肝素组及不用肝素组进行治疗。观察三组TT、APTT、PT、Fib、PLT及D-二聚体等出凝血指标和治愈率。结果A组用药24h后与用药前比较PT缩短、Fib升高、PLT无明显变化及D-二聚体降低,48h后PT、APTT、TT与用药前比较均缩短、Fib升高及D-二聚体降低。B组用药24h后PT较用药前延长,APTT、TT、Fib及D-二聚体无明显改变,用药48h后PT、TT均延长,与用药前比较差异有显著性。C组用药24h后PT较用药前延长,APTT、TT、Fib及D-二聚体无明显改变,用药48h后PT、TT均延长,与用药前比较差异有显著性。三者治愈率比较有显著性差异,A组治愈率最高。结论早期皮下注射超微量肝素对胎盘性产前出血新生儿和孕母外伤早产儿有疗效。     

中分子量羟乙基淀粉130/0.4电解质注射液作为体外循环预充液对凝血功能影响的临床研究

目的观察羟乙基淀粉130/0.4电解质注射液用于成人体外循环(ECC)管路预充对术后凝血功能的影响。方法采用双盲、随机对照研究方法,272例18岁以上于2019年5月至2019年11月于本院ECC下行心脏手术患者,分为羟乙基淀粉130/0.4电解质注射液组(20 ml/kg,A组)、羟乙基淀粉130/0.4电解质注射液组(40 ml/kg,B组)、琥珀酰明胶组(20 ml/kg,C组)、琥珀酰明胶组(40 ml/kg,D组),每组各68例。应用血栓弹力图测定检测转前(T1)、鱼精蛋白中和后15 min(T2)、转后4 h(T3)及术后24 h(T4)的凝血功能。结果四组患者年龄、身高、体重、性别、手术种类及术前心功能差异均无统计学意义(P0.05),ECC时间、主动脉阻断时间、术后呼吸机辅助通气时间、ICU监护时间、术中红细胞用量、术后24 h红细胞用量、24 h胸液引流量差异均无统计学意义(P0.05)。组间比较,B组血小板数量在T2时点组与A组、C组、D组有显著性差异(P=0.005);血栓弹力图最大幅度值在T2时点,B组与A组、C组和D组有显著性差异(P=0.009)。结论中分子量羟乙基淀粉130/0.4电解质注射液作为ECC预充液,当剂量小于40 ml/kg时对机体凝血功能不会造成明显影响。     

注射用血凝酶对髋关节置换术低分子肝素抗凝患者出血量及凝血功能的影响

目的观察注射用血凝酶对髋关节置换术低分子肝素抗凝患者术中出血量及凝血功能的影响。方法 161例全髋关节置换术患者分为观察组(83例)及对照组(78例),对照组术前予低分子肝素处理,观察组在对照组基础上予注射用血凝酶处理。术后对两组患者术中出血量、术后24 h引流量,术后24 h红细胞(RBC)、血红蛋白(Hb)、纤维蛋白原(Fib),术后24 h部分凝血活酶时间(APTT)、凝血酶原时间(PT)等指标进行分析。结果观察组术中出血量及术后24h引流量值均低于对照组(均<0.05)。两组术后24h RBC、Hb、Fib、APTT及PT差异均无统计学意义(均>0.05)。结论全髋关节置换术中使用注射用血凝酶不受低分子肝素的抑制,且安全有效,值得推广应用。     

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.