氟比洛芬酯减轻小儿全麻术后躁动临床观察

目的:观察并评价氟比洛芬酯减轻小儿全麻术后躁动的临床效果和安全性.方法:择期行眼科手术患儿60例,年龄2～10岁,随机分为氟比洛芬酯(F)组和对照(C)组.F组于麻醉后手术开始前静脉注射氟比洛芬酯lmg/kg,C组静脉注射等量生理盐水.所有患儿麻醉诱导均吸入5%七氟醚,意识消失后给予芬太尼2μg/kg,维库溴铵O.1mg/kg,直视下行气管插管.2组患儿术中麻醉吸入2%～3%七氟醚维持,持续静脉输注瑞芬太尼0.1～0.2μg/kg.监测拔管前5min、拔管即刻、拔管后5min、拔管后10min的平均动脉压(MAP)、心率(HR)及脉搏氧饱和度(SpO2).观察患儿苏醒期躁动发生率和躁动程度以及OAMS评分和不良反应.结果:F组患儿术后躁动发生率显著低于C组,躁动程度明显轻于C组(P<0.05).F组围拔管期各时点的MAP、HR均显著低于C组相应时点值(P<0.05).F组患儿在拔管后即刻、拔管后5min、拔管后15min的OAA/S评分与C组比较,差异无统计学意义(P>0.05).2组患儿术后未出现恶心、呕吐、呼吸抑制等不良反应.结论:术前静脉注射氟比洛芬酯作为镇痛可减少小儿术后躁动发生率.     

曲马多复合对乙酰氨基酚栓剂防治小儿七氟醚全麻苏醒期躁动的效果

目的：观察曲马多复合对乙酰氨基酚栓剂防治小儿七氟醚全麻苏醒期躁动的效果。方法：择期七氟醚全麻下手术患儿90例随机分为3组,每组各30例。3组均用8％七氟醚、芬太尼2μg/kg和维库溴铵0.1 mg/kg全麻诱导,术中以七氟醚（1～1.5 MAC）维持麻醉。 A组：术前10 min对乙酰氨基酚栓剂20 mg/kg塞肛＋手术结束前20 min静注曲马多1 mg/kg;B组：手术结束前20 min静注曲马多2 mg/kg;C组：手术结束前20 min静注等量生理盐水。观察3组手术时间,术后清醒时间、拔管时间、镇静评分、躁动发生情况及药物不良反应。结果：3组手术时间、清醒时间、拔管时间等指标比较,差异无统计学意义（P＞0.05）。 A组躁动发生率、恶心呕吐发生率和躁动评分明显低于B组和C组,而Remesay镇静评分明显高于B组和C组（ P＜0.05）,结论：曲马多1 mg/kg复合对乙酰氨基酚栓剂20 mg/kg用于防治小儿七氟醚全麻苏醒期躁动安全有效。     

全麻患者苏醒期静脉注射氟比洛芬酯预防躁动的观察

目的观察氟比洛芬酯预防患者全麻苏醒期躁动的效果。方法 90例ASA I或II级择期行腹部中小手术患者,随机分为A、B、C组（n=30）,术前常规禁食、禁饮8h,术前30min肌内注射地西泮10 mg、阿托品0.5 mg。3组患者麻醉诱导均用芬太尼、罗库溴铵、丙泊酚,气管插管后接麻醉机控制呼吸,麻醉中连续监护BP、HR、SpO2,术中麻醉维持以吸入七氟醚及氧化亚氮为主,间断静脉注射罗库溴铵,A组手术结束前30min,静脉注射氟比洛芬酯50 mg,3 min内注完;B组手术结束前30 min,芬太尼0.6 mg＋氟比洛芬酯150 mg＋生理盐水73 ml,总量100 ml,2ml/h持续静脉泵入;C组静脉注射生理盐水5 ml。手术结束前10 min停用麻醉药,以10 ml/min的氧流量开放式自主呼吸,拔管后观察15 min,患者平稳后送回病房。记录麻醉时间;分别在拔管后15、30、45、60 min随访患者;躁动评分;观察恶心呕吐、头晕头痛、畏寒发热、心悸、嗜睡、倦怠等不良反应情况。结果 3组患者的年龄、体质量、麻醉时间及术后呼之睁眼时间差异无统计学意义。A组拔管后15、30、45、60 min VAS评分均显著低于B、C组（P〈0.05）,B、C组差异无统计学意义;A组无或轻度躁动发生率明显高于B、C组,中度及重度躁动发生率明显低于B、C组（P〈0.05）;术后24 h内3组患者恶心呕吐、头晕头痛、畏寒发热、心悸、嗜睡、倦怠等不良反应发生率差异无统计学意义。结论静脉注射氟比洛芬酯可以有效预防全麻苏醒期躁动。     

右美托咪定复合七氟醚对妇科腹腔镜手术全麻苏醒质量的影响

正妇科腹腔镜手术虽然疼痛刺激小,但在全麻苏醒期时患者会因各种不适而发生躁动等不良反应。七氟醚是临床常用的吸入麻醉药,采用七氟醚全麻维持时,患者术后易发生躁动,且吸入时间越长,发生率越高~([1])。右美托咪定是一种高选择性的α2肾上腺素受体激动药,作用于中枢和外周神经系统,产生镇痛、镇静、抗焦虑和抑制交感神经兴奋作用~([2])。本研究拟在妇科腹腔镜手术中观察右美托咪定复合七氟醚用于全身麻醉能否减少七氟醚引起的不良反应,     

针刺辅助麻醉用于妇科腹腔镜手术的临床研究

目的观测针刺辅助静吸复合全麻在妇科腹腔镜手术中的麻醉效果。方法90例ASA评级Ⅰ~Ⅱ级择期妇科腹腔镜手术患者随机分为3组,每组30例。Ⅰ组单纯静吸复合全麻;Ⅱ组采用HANS仪行穴位刺激20~30min后再全麻;Ⅲ组则全麻后再行穴位刺激。术中调节七氟醚浓度,维持AAI值在15~25。记录术中七氟醚吸及浓度、心率和血压,观察术毕苏醒和拔管时间,以及苏醒期躁动、寒战和疼痛等反应,术后随访询问患者术中麻醉的舒适度、满意度及术中知晓等。结果术中七氟醚吸入浓度Ⅰ组最高,Ⅱ组最低,其中Ⅱ组比Ⅰ组降低减少33%,Ⅲ组比Ⅰ组减少21%(P<0.05);术中Ⅱ组和Ⅲ组的血压和心率较Ⅰ组更为稳定;术毕苏醒睁眼和拔管时间Ⅱ组最短,Ⅰ组最长,两组对比差异有显著性(P<0.05)。苏醒期躁动和疼痛的发生率Ⅰ组最多,Ⅱ组最少,两组对比差异有显著性(P<0.05)。术后随访3组均无术中知晓,Ⅱ组与Ⅲ组的满意度较Ⅰ组高(P<0.05)。结论妇科腹腔镜手术中穴位电刺激具有一定的麻醉作用,且以全麻前20~30min开始效果最佳,可减少复合全麻中七氟醚用量21%~33%并使术后苏醒更快、更平稳。     

氟比洛芬酯预防瑞芬太尼全麻术后躁动的临床观察

目的:探讨氟比洛芬酯超前镇痛预防瑞芬太尼全麻患者术后躁动的有效性与安全性。方法:选择全麻手术120例,分为氟比洛芬酯组(F组)和对照组(C组)各60例。F组于手术开始前静脉注射氟比洛芬酯50 mg,C组静脉注射脂肪乳剂5 ml。均选择气管内全麻,术中全部采用瑞芬太尼0.1～0.2μg.kg-1.min-1维持。分别观察2组患者的全麻苏醒时间,拔管时间以及苏醒期躁动情况,并采用视觉模拟评分评价术后镇痛情况。结果:术前使用氟比洛芬酯超前镇痛后,F组苏醒期躁动率为5.0%,明显低于C组的41.7%(P0.01)。结论:氟比洛芬酯超前镇痛对瑞芬太尼全麻后躁动有较好的预防作用。     

舒芬太尼与氟比洛芬酯复合曲马多对雷米芬太尼复合麻醉苏醒期的影响比较

目的:比较超前使用舒芬太尼与氟比洛芬酯联合曲马多对雷米芬太尼复合全麻苏醒期的影响。方法:将40例择期腹腔镜胆囊切除术患者随机分为舒芬太尼组(A组)和氟比洛芬酯复合曲马多组(B组),每组20例。A组手术结束前5 min,静脉注射舒芬太尼0.15μg/kg;B组手术开始前10 min,静脉注射氟比洛芬酯50 mg,手术结束前10 min,静脉注射氟比洛芬酯50 mg和曲马多2 mg/kg。记录并比较2组苏醒时间、苏醒后的镇痛评分(VRS)和不良事件发生例数。结果:A组苏醒时间长于B组(P0.01);B组苏醒拔管后10、20、30 min的VRS均明显高于A组(P0.01);2组拔管后2 h期间不良事件发生率差异无统计学意义(P0.05)。结论:舒芬太尼在雷米芬太尼复合麻醉苏醒早期的镇痛效果较氟比洛芬酯复合曲马多更佳。     

七氟醚低流量紧闭麻醉在腹腔镜胆囊切除术的应用

目的对比观察雷米芬太尼和七氟醚全身麻醉在腹腔镜胆囊切除手术时,对患者循环功能的影响及苏醒时的不良反应。方法将70例腹腔镜下胆囊切除手术患者,随机分为雷米芬太尼组（R组）和七氟醚组（S组）,每组35例,R组以雷米芬太尼、丙泊酚维持麻醉;S组应用七氟醚低流量紧闭循环吸入维持麻醉,观察两组患者气腹前、气腹后,气管拔管前、气管拔管后的血压和心率;观察苏醒时间,拔除气管导管时的不良反应,术中疼痛及术后恶心、呕吐发生率。结果两组患者的苏醒时间,拔除气管导管时的不良反应,术后恶心、呕吐发生率比较差异无统计学意义;两组患者收缩压在气腹前及气腹后5、10min均较麻醉前显著降低,但R组下降更明显;R组的心率在气腹前及气腹后5、10min均较麻醉前显著降低（P〈0．01）。结论雷米芬太尼和七氟醚均适用于腹腔镜胆囊切除手术,但七氟醚对循环的抑制小,更安全。     

高乌甲素复合丙泊酚预防全身麻醉苏醒期躁动的效果观察

目的:观察高乌甲素与丙泊酚联合应用预防全麻苏醒期躁动的临床效果。方法:选择耳鼻喉科全麻患者80例,随机分为两组(A组和B组),A组采用以异氟醚+芬太尼为主的静吸复合全麻;B组采用高乌甲素+丙泊酚+低浓度异氟醚静吸复合全麻,在手术结束前30min停异氟醚改用丙泊酚维持麻醉。观察两组的睁眼时间、拔管时间、躁动评分、术毕及拔管时的血压、心率、血氧饱和度及血糖值。结果:两组的麻醉过程均平稳,苏醒时间及拔管时间差异无统计学意义,A组苏醒期躁动的发生率明显高于B组(P<0.01),A组苏醒期应激水平的增高比B组明显(P<0.05)。结论:高乌甲素与丙泊酚复合预防全麻苏醒期躁动安全、效果好。     

盐酸右美托咪定联合麻醉苏醒护理对七氟醚全麻苏醒期躁动的影响

目的探讨盐酸右美托咪定联合麻醉苏醒护理对七氟醚全麻苏醒期躁动的影响。方法选取2013-06—2016-08间接受七氟醚全麻的160例患者,将其随机分为对照组和干预组,每组各80例,对照组于麻醉前15min予生理盐水持续静脉泵注并接受常规护理,干预组于麻醉前15 min予盐酸右美托咪定持续静脉泵注并接受综合的麻醉苏醒护理。比较两组血压、心率基线值、苏醒期值,苏醒期躁动发生情况。结果两组的血压、心率基线值差异无统计学意义(P>0.05),至苏醒期干预组明显优于对照组(P<0.05);干预组苏醒期躁动分级明显优于对照组(P<0.05)。结论对七氟醚全麻患者予以盐酸右美托咪定进行超前镇痛,同时联合有效的护理措施,有助于维持患者麻醉苏醒期的血流动力学稳定,减轻患者躁动发生情况。     

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…     

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     

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.     

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.