不同麻醉方法对围手术期应激反应的影响

目的 :探讨上腹部手术中三种不同麻醉方法对应激反应的影响。方法 :30例择期上腹部手术病人分为三组 :静脉复合全麻组 (Ⅰ组 ) ,静脉吸入复合全麻组 (Ⅱ组 )、静脉全麻复合硬膜外阻滞 (Ⅲ组 )。测定麻醉前 (T0 )、手术开始后 60min(T1)、手术后 2 4h(T2 )、手术后 4 8h(T3)、手术后 72h(T4 )血清免疫球蛋白 (lgG、lgA、lgM)、胰岛素 (INS)和血糖 (GLU)浓度 ,同时连续监测SBP、DBP、MAP、HR的变化。结果　Ⅰ、Ⅱ组lgG、lgA、lgM浓度显著升高 (p <0 .0 1) ,Ⅲ组lgG、lgA、lgM浓度显著降低 (p <0 .0 1) ,Ⅲ组GLU、INS各个时相与麻醉前相比变化幅度小 ,且手术后 72h基本恢复达到麻醉前水平 ;GLU浓度变化平稳 ,变化幅度比Ⅰ组低 5 8个百分点 ,INS值Ⅰ、Ⅱ组手术后 72h仍处在高值上 ,Ⅱ组是麻醉前的 3.6倍。本组试验组间比较 ,Ⅲ组静脉全麻复合硬外阻滞组 ,其lgG、lgA、lgM、INS和GLU的浓度变化明显小于Ⅰ组 (p <0 .0 1) ,三组患者lgG、lgA、lgM、INS和GLU浓度与SBP、DBP、MAP、HR无相关性。结论 :静脉全麻复合硬膜外阻滞麻醉方法用于上腹部手术 ,对血清免疫球蛋白 (lgG、lgA、lgM)、胰岛素 (INS)和血糖 (GLU)浓度的影响最小。控制术中应激反应效果显著 ,机体恢复较快 ,明显优于静脉复合全麻和静脉吸入复合全     

舒芬太尼用于婴幼儿先天性巨结肠Soave手术骶管阻滞的临床研究

目的 研究婴幼儿先天性巨结肠Soave手术时舒芬太尼用于骶管阻滞的麻醉及镇痛效果.方法 40例患儿随机分成对照组(C组:0.8％利多卡因+0.25％罗哌卡因)和舒芬太尼组(S组:0.8％利多卡因+0.25％罗哌卡因+舒芬太尼0.5μg/kg),气管插管后行单次骶管阻滞,异氟醚吸入维持.观察两组气管插管前(T0)、骶管阻滞后(T1)、扩张肛门(T2)、游离肠管(T3)及拔管后5 min(T,)患儿的心率(HR)和平均动脉压(MAP)变化,比较术中异氟醚维持值、肛门松驰程度及苏醒时间,术后2、4、8、16和24h镇痛、镇静评分及不良反应.结果 S组与C组比较:T2、T3、T4患儿HR、MAP低(P＜0.05),术中异氟醚维持值低(P＜0.05),苏醒时间短(P＜0.05),术后2、4、8 h' Ramsay镇静评分高(P＜0.05),FLACC镇痛评分各时点低(P＜0.05).两组术后尿潴留、皮肤瘙痒等不良反应的发生率无差异.结论 舒芬太尼配伍利多卡因、罗哌卡因骶管阻滞用于婴幼儿先天性巨结肠Soave 手术,可提供良好的术中麻醉及手术后镇痛、镇静效果.     

全身麻醉加颈丛阻滞在甲状腺手术的应用

目的 应用全身麻醉加颈丛阻滞观察全身麻醉加颈丛阻滞与单纯全麻,单纯颈丛阻滞在甲状腺手术的优缺点.方法 选择ASA Ⅰ-Ⅱ级甲状腺手术病人分三组以全麻加颈丛阻滞、单纯全麻、单纯颈丛阻滞实施手术.结果 Ⅰ组异丙酚一七氟醚用量较Ⅱ组明显减少(p＜0.01),气管拨管时间明显提前(p＜0.01).Ⅲ组病人多数需增加辅助用药.结论 全身麻醉加颈丛阻滞两者互补,减少全麻的用药量,可以维持呼吸道通畅,消除手术牵拉不适,增加手术麻醉安全性.     

全身麻醉联合骶管阻滞麻醉在小儿先天性巨结肠改良根治术的应用

目的 观察全身麻醉联合骶管阻滞麻醉在小儿先天性巨结肠症(HD)经肛门根治术中的麻醉效果及其安全性.方法 40例施行经肛门改良Soave根治术的HD小儿,随机分为全麻联合骶管阻滞麻醉组20例(A组)和全身麻醉组20例(B组).比较两组麻醉效果、静脉麻醉药用量,记录麻醉诱导前、气管插管后3 min、骶管阻滞后3 min、骶...     

两种不同麻醉方法用于小儿下腹部手术麻醉效果比较

目的探讨丙泊酚复合骶管阻滞麻醉与单纯静脉全麻用于小儿下腹部手术中的临床效果。方法选择择期行下腹部手术的患儿60例,随机分为丙泊酚复合骶管阻滞组(A组)和丙泊酚复合芬太尼单纯静脉全麻组(B组),每组30例。A组采用单次骶管阻滞复合静脉持续泵注丙泊酚麻醉,B组采用静脉持续泵注丙泊酚及间断追加芬太尼麻醉。记录入室时(T0)、切皮时(T1)、手术10min时(T2)、术毕时(T3)的平均动脉压(MAP)、心率(HR)、苏醒时间、SPO2<95%及术后恶心呕吐的发生情况。结果与T0相比,B组中MAP、HR均增高(P<0.05),A组MAP、HR均无明显变化(P>0.05);A组苏醒时间短于B组(P<0.05);B组SPO2<95%的发生率>A组(P<0.05);两组患儿均无术后恶心呕吐的发生。结论丙泊酚复合单次骶管阻滞能为小儿下腹部手术提供良好的麻醉效果,术后苏醒快,可推广应用于这类手术麻醉。     

麻醉深度指数调控下不同方式快通道麻醉的比较

目的 以麻醉深度指数(CSI)指导用药,探讨腹部手术不同方式快通道麻醉的差别.方法 择期行腹部手术的患者60例,ASAⅠ～Ⅱ级,随机分为静脉全麻(A组)和硬膜外复合静脉全麻组(B组),每组30例:A组为异丙酚静脉全麻,B组为硬膜外阻滞复合异丙酚静脉全麻.两组均行CSI监测,使CSI值维持在(55±5).记录麻醉诱导前(T0)、插管后5 min(T1) 、切皮时(T2)、术中探查时(T3)、手术结束时(T4)、拔管后10 min(T5)的循环指标(MAP、HR)、麻醉药用量、拔管时间、离室时间及术中知晓、术后躁动情况.结果 A组MAP、HR均高于B组,且均存在组间与时点的交互作用(P均＜0.01);两组患者T0、T4时点的MAP、HR差异无统计学意义(P＞0.05),A组T1、T2、T3、T5时点的MAP、HR均高于B组(P＜0.05).组内比较,A组T1、T2、T3、T5时点的MAP、HR均较T0时点明显地升高,而B组于上述时点则较平缓.B组的异丙酚、阿曲库铵、瑞芬太尼用量明显小于A组(P＜0.05);B组的拔管时间和离室时间早于A组(P＜0.05).两组患者均无术中知晓,B组的术后躁动率低于A组(P＜0.05).结论 CSI应用于快通道麻醉,可以避免术中知晓.CSI调控下,在腹部手术中,硬膜外复合静脉全麻比单纯静脉全麻可以使循环更稳定、术后躁动率更低,可以减少静脉麻醉药的用量、提早苏醒时间,在快通道麻醉中效果更优.     

不同浓度罗哌卡因骶管阻滞在成人肛肠手术应用的临床观察

目的 通过对比不同浓度罗哌卡因成人骶管阻滞的效果及其对机体循环功能和术后恢复的影响来评价罗哌卡因骶管阻滞的最佳浓度.方法 90例ASA Ⅰ～Ⅱ择期肛肠手术患者随机分为3组(n=30).患者入室后开放静脉,连续监测血压(Bp)、心率(HR)、血氧饱和度(SpO2),俯卧位行改良骶管阻滞,采用1%盐酸利多卡因5ml作为试验剂量,3min后无不良反应.分别给予0.375%、0.5%、0.75%罗哌卡因各20rnl.记录麻醉效果(感觉神经阻滞起效时间、最高平面、持续时间及运动神经阻滞程度),对循环功能的影响(Bp、HR、SpO2变化),不良反应及麻醉满意度.术后进行随访.结果 0.375%组麻醉起效时间[(9.5±4.5)min]显著长于0.5%组和0.75%组[(8.0±3.0)min,(6.0±2.3)min],而维持时间[(5.0±2.1)min]较0.5%组和0.75%组[(7.0±2.3)min,(8.9±3.21min]短,且麻醉效果差.0.75%组起效时间短且维持时间长,但术后运动阻滞程度重、尿潴留发生率较高.结论 0.5%的罗哌卡因应用于成人骶管阻滞起效快、作用维持时间长.术后并发症少.     

0．596％甲磺酸罗哌卡因骶管阻滞在肛肠手术中的效果

目的 探讨与0.5%盐酸罗哌卡因比较等摩尔甲磺酸罗哌卡因骶管阻滞用于肛肠手术的麻醉效果和安全性.方法 60例ASA Ⅰ～Ⅱ级择期肛肠手术患者随机分为两组:A组(甲磺酸罗哌卡因组)、B组(盐酸罗哌卡因组).入室开放静脉通路,连续监测BP、P、SpO2、ECG、RR.俯卧位行改良骶管阻滞,两组患者均以1%盐酸利多卡因5mL作为试验剂量,3min后无不良反应则分别给予0.596%甲磺酸罗哌卡因、0.5%盐酸罗哌卡因各20mL.记录麻醉效果(感觉神经阻滞起效时间、最高平面、持续时间及运动神经阻滞程度)、术中生命体征的变化情况、不良反应、麻醉满意度.术后进行随访.结果 甲磺酸罗哌卡因比盐酸罗哌卡因感觉阻滞起效时间短[(7.9±3.3)min VS(11.2±3.5min)],前者吸收快,易出现轻度局麻药毒性反应.两者感觉阻滞持续时间[6.4±1.3)hVS(6.5±1.1)h]、运动阻滞程度无明显差异,生命体征变化、麻醉满意度无明显差异.结论 0.596%甲磺酸罗哌卡因骶管阻滞下实施肛肠手术起效快,感觉阻滞完善.     

七氟醚复合骶管阻滞麻醉在小儿腹腔镜疝气手术麻醉中的临床应用

目的 探讨七氟醚复合骶管阻滞麻醉在小儿腹腔镜疝气手术中的可行性和安全性.方法 选择在腹腔镜下行单侧腹股沟斜疝修补术患儿60例,ASA Ⅰ～Ⅱ级,按随机方式分为A组(七氟醚复合骶管阻滞麻醉组)和B组(全麻插管组),每组30例,观察气腹效果、术后清醒时间,连续监测心率(HR)、平均动脉压(MAP)、呼气末二氧化碳分压(PetCO2)、血氧饱和度(SpO2).结果 两组患儿手术时间(min)差异无统计学意义(P＞0.05);两组患儿苏醒时间(min)A组短于B组,组间比较差异有统计学意义(P＜0.05).两组患儿气腹后HR、MAP、PetCO2比气腹前明显升高(P＜0.05),A组和B组间比较差异无统计学意义(P＞0.05).结论 七氟醚复合骶管阻滞麻醉用于小儿腹腔镜疝气手术是可行和安全有效的.     

新生儿腹腔镜幽门环肌切开术不同麻醉方法对比观察

目的对比观察单纯全麻及骶管阻滞复合全麻对新生儿腹腔镜幽门环肌切开术的麻醉效果。方法 36例新生儿腹腔镜幽门环肌切开术患儿随机分为Ⅰ组（全麻）和Ⅱ组（骶管＋全麻）,Ⅰ组患儿气管插管后吸入七氟醚维持麻醉,Ⅱ组患儿行骶管阻滞后吸入七氟醚维持麻醉,对比两组患儿气腹前后呼吸循环参数指标变化及气腹压力,拔管时间等。结果两组患儿手术时间,CO2气腹时间无显著性差异（P〉0.05）,Ⅱ组患儿气腹压力（10.2±1.7）mmHg小于Ⅰ组患儿气腹压力（13.2±2.1）mmHg,有显著性差异（P〈0.05）。Ⅱ组患儿拔管时间（4.5±1.1）min短于Ⅰ组（8.5±1.5）min,有显著性差异（P〈0.05）。Ⅰ组患儿气腹后10min PIP值（28.3±5.6）cm H2O显著高于Ⅱ组（24.7±4.6）cm H2O（P〈0.05）,Ⅰ组患儿气腹后20min PIP值（29.5±5.7）cm H2O显著高于Ⅱ组（25.5±4.9）cm H2O（P〈0.05）。HR、MAP、PetCO2、SpO2各时点组间比较无显著性差异（P〉0.05）。结论骶管阻滞复合全麻及单纯全麻均能为新生儿腹腔镜幽门环肌切开术提供满意,有效,合理的麻醉。     

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.