小剂量丙泊酚在全麻拔管期中的应用

目的:观察小剂量丙泊酚在全麻拔管期对患者的影响。方法:将40例ASAⅠ～Ⅱ级全麻手术后患者,随机分为两组:丙泊酚组(Ⅰ组)于手术结束达到拔管条件,静脉注射丙泊酚1mg·kg-1,2min后吸痰拔管;对照组(Ⅱ组)达到拔管条件,不予镇静,吸痰后拔除气管导管。观察各组拔管前5min、拔管即刻、拔管后5min时的心率(HR)、平均动脉压(MAP)、呛咳反应、拔管后清醒时间、拔管知晓率。结果:Ⅰ组拔管期MAP、HR值较稳定,与拔管前比较差异无统计学意义(P>0.05);Ⅱ组拔管即刻、拔管后5min时MAP、HR较拔管前均明显增加(P<0.01或P<0.05)。Ⅰ组患者术后清醒时间明显长于Ⅱ组(P<0.05),Ⅱ组重度呛咳反应发生率、拔管知晓率较Ⅰ组明显增高(P<0.01或P<0.05)。结论:小剂量丙泊酚可用于抑制全麻拔管期反应。     

小剂量曲马多和丙泊酚预防全麻拔管时心血管反应的临床研究

目的观察小剂量曲马多和丙泊酚在全麻拔管时预防心血管反应的效应。方法选择上腹部及普胸手术全麻患者67例，随机分为观察组（n=34）和对照组（n=33）。待患者意识恢复，咳嗽、吞咽等反射恢复，BP、FIR稳定。观察组静脉缓慢推注曲马多30mg、丙泊酚0．5mg／kg（稀释到10ml），3—5min后吸痰拔出气管导管。对照组静脉推注生理盐水10ml，吸痰后拔出气管导管。连续监测ECG、FIR、MAP、SpO2，记录用药前、用药后5min，拔管前、拔管时及拔管后5min、10min时HR、SBP、DBP、MAP、SpO2，苏醒时间、镇静程度和恶心呕吐情况。结果与用药前相比，观察组各时点FIR、MAP下降（P〈0．05）；SpO2略有降低但差异无显著性，拔管后lOrnin反而有所上升；苏醒时间为6—8min。与拔管前比较，对照组拔管时及拔管后5min时FIR、MAP均明显升高（P〈0．05）；SpO2在拔管时、拔管后5min下降（P〈0．05），拔管后10min回升。镇静评分观察组高于对照组，而恶心呕吐发生率观察组明显低于对照组，两组间差异有显著性。结论小剂量曲马多和丙泊酚联合应用能有效地预防全麻拔管时的心血管反应，且副作用明显减少。     

航海刺激对瑞芬太尼复合丙泊酚靶控输注麻醉深度及苏醒质量的影响☆简

目的探讨航海刺激对瑞芬太尼复合丙泊酚靶浓度控制输注（target controlled infusion,TCI）麻醉深度及苏醒质量的影响。方法40例择期全身麻醉手术患者随机分成旋转组（rotation group,R组,20例）和对照组（control group,C组,20例）。R组采用旋椅试验制备运动病临床模型,C组不行旋转刺激。麻醉诱导采用以血浆药物浓度为靶目标进行丙泊酚TCI,靶浓度（Ct）为4μg／ml,同时静脉泵注瑞芬太尼1μg／kg,待患者意识消失后静注罗库溴铵0．6mg／kg,吸纯氧3min后气管内插管。术中以瑞芬太尼0．2μg／（kg·min）维持麻醉,调节丙泊酚TCI的Ct值,使状态熵（state entropy,SE）维持在（50±3）。记录入室各指标基础值（T0）,麻醉诱导前（T1）,气管插管后5min（T2）,手术开始即刻（T3）,手术开始后10min（T4）、30min（T5）、60min（T6）、90min（T7）的反应熵（response entropy,RE）、SE、平均动脉压（mean artery pressure,MAP）、心率（heart rate,HR）及丙泊酚Ct值。观察患者麻醉清醒时间、拔管时间、拔管时和拔管后10min的MAP、HR以及疼痛评分、镇静-躁动评分、全麻后身体舒适度评分、术后恶心呕吐（postoperative nausea and vomiting,PONV）发生率等。结果R组T2～T7时Ct值均明显低于C组（P〈0．01）,降幅为11．68％～15．28％;HR明显减慢并于T4～L时显著低于C组（P〈0．01）,有2例需用阿托品纠正。R组拔管时和拔管后10min的MAP、HR以及视觉模拟评分法（visual analogue scale,VAS）评分均明显低于C组（P〈0．01）,但清醒时间和拔管时间明显长于C组（P〈0．01或P〈0．05）,镇静-躁动评分为（2．56±1．76）,明显低于C组（P〈0．01）。结论航海刺激可增加患者瑞芬太尼复合丙泊酚TCI麻醉的敏感性,减轻苏醒期的疼痛及血流动力学波动,但可降低苏醒质量（清醒程度）。     

异丙酚、咪唑安定用于后颅窝术后保留气管插管患者镇静的临床观察

目的观察异丙酚和咪唑安定用于后颅窝肿瘤术后保留气管插管患者镇静的临床效果和对呼吸循环的影响。方法将60例择期全麻后颅窝肿瘤手术后保留气管插管躁动的患者随机分为异丙酚组（P组）和咪唑安定组（M组）,每组30例。首先分别给予异丙酚0.5mg/kg或咪唑安定0.05mg/kg静脉推注,再给予异丙酚0.5～3mg/（kg.h）或咪唑安定0.05～0.2mg/（kg.h）微量泵泵入,维持Ramsay镇静评分2～3级,于镇静前及镇静后10min、30min、1h、2h、4h、8h记录Ramsay镇静评分、用药量、心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、呼吸频率（RR）、脉搏血氧饱和度（SpO2）。结果起效时间P组为（28±11）s,M组为（45±13）s,两组有显著性差异;苏醒时间M组为（37±16）min,较P组的（24±7）min长,有显著性差异（P〈0.05）。镇静期间两组患者HR、RR均较镇静前显著下降（P〈0.05）,而SBP、DBP、MAP、SpO2均无明显变化,组间比较无显著性差异。结论异丙酚起效时间明显快于咪唑安定,苏醒时间明显短于咪唑安定,二者在镇静剂量下对呼吸和循环的抑制轻微,用于后颅窝术后带气管插管患者镇静是安全有效的。     

丙泊酚在肿瘤患者全麻气管拔管期的临床应用

目的研究有效剂量丙泊酚用于防治肿瘤患者全麻气管拔管期并发症的临床疗效。方法选择择期行胸、腹及头颈部肿瘤手术的患者114例,ASAⅠ～Ⅱ级,随机分为治疗组（A）和对照组（B）。手术结束后送入麻醉复苏室。符合拔管条件时A组患者给予丙泊酚0.4～0.8mgk/g静脉注射,5分钟后拔管;B组患者不予以药物即行拔管。观察记录2组患者的平均动脉压（MAP）、心率（HR）及血氧饱和度（SpO2）的变化,记录拔管时间、呛咳反应、屏气反应、恶心、呕吐情况及镇静程度。结果A组患者拔管即刻MAP、HR与拔管前相比均升高,但无显著性差异;B组患者在拔管即刻、拔管后5分钟MAP、HR均较拔管前及A组明显升高（P〈0.05）,A组患者拔管即刻镇静程度良好,而B组患者镇静程度下降,2组比较有显著性差异（P〈0.05）;2组患者拔管时间无显著性差异（P〉0.05）;B组患者呛咳反应、屏气反应等并发症的发生率高于A组,有显著性差异（P〈0.05）。结论丙泊酚0.4～0.8mgk/g于拔管前静脉注射可有效减轻肿瘤全麻术后患者拔管期的不良反应,使循环、呼吸更为平稳,且不影响拔管时间。     

椎管内麻醉前肌注咪唑安定对术中镇静以及术后遗忘的影响

目的：探讨椎管内麻醉前肌注咪唑安定对术中的镇静作用和对术后遗忘的影响。方法：选择ASA1～2级择期在腰硬联合阻滞下行下肢手术的患者180例,随机分为咪唑安定组和苯巴比妥钠组,咪唑安定组患者入室后（实施麻醉前10min）肌内注射咪唑安定0．1mg／kg,苯巴比妥钠组患者入室前30min肌内注射苯巴比妥钠0．1g。采用Ramsay镇静评分法评价两组入室前、入室后、麻醉时的平均动脉压（MAP）和心率（HR）,术后24h评价患者对麻醉操作及手术操作的遗忘程度。结果：两组患者入室前、后MAP、HR无明显变化（P〉0．05）,苯巴比妥钠组麻醉时MAP、HR较入室前及咪唑安定组明显升高（P〈0．05～0．01）;咪唑安定的镇静作用优于苯巴比妥钠（P〈0．05）;咪唑安定组对麻醉和手术操作的完全遗忘率为43．3％,不全遗忘率为56．7％,而苯巴比妥钠组的不全遗忘率为24．4％,无遗忘率为75．6％,两组差异有统计学意义（P〈0．01）。结论：麻醉前10min肌内注射咪唑安定0．1mg／kg,可使患者消除焦虑、恐惧心理,既安静又能配合麻醉和手术体位,对麻醉和手术操作有很好的镇静和记忆遗忘作用。     

瑞芬太尼用于支撑喉镜下声带息肉摘除术的临床观察

目的：观察比较瑞芬太尼或芬太尼复合丙泊酚用于支撑喉镜下声带息肉摘除术的心血管反应、丙泊酚用量及苏醒时间。方法：30例支撑喉镜下声带息肉摘除患者，随机分为A、B、C三组，每组10例。A组以咪唑安定、丙泊酚、瑞芬太尼麻醉诱导，以丙泊酚、瑞芬太尼麻醉维持。B组以咪唑安定、丙泊酚、芬太尼麻醉诱导，以丙泊酚、芬太尼麻醉维持。C组麻醉诱导同B组，麻醉维持同A组。观察记录三组不同时点的BP、HR、SpO2和丙泊酚用量、手术时间、苏醒拔管时间、拔管后10min的VAS评分。结果：SBP在插管后lrainB、C组明显高于A组（P〈0．05），置入支撑喉镜时A、C组明显低于B组（P〈0．05）。丙泊酚用量和苏醒拔管时间A、C组明显少于B组（P〈0．05），拔管后VAS评分B、C组明显低于A组（P〈0．01）。结论：瑞芬太尼复合丙泊酚用于支撑喉镜下声带息肉摘除术较芬太尼抑制心血管反应更有效且丙泊酚用量少、苏醒快。     

咪唑安定静脉麻醉对气管内插管/拔管反应的影响

目的　探讨咪唑安定用于全麻诱导与维持对诱导期气管插管及苏醒期拔管反应的影响。方法　 42例行上腹部择期手术患者 ,随机分为 2组 (M组 2 1例 ,P组 2 1例 ) ,经T8～ 9间隙穿刺置入硬膜外导管维持术中麻醉。麻醉诱导药M组加用 0 .0 5～ 0 .1mg/kg咪唑安定 ,余用药 2组相同 ,气管插管。术中M组间断静脉注射咪唑安定2mg ,P组以 2mg·kg- 1·h- 1异丙酚静脉注射维持麻醉。分别记录用药前、插管前、插管即刻、拔管前各时刻的平均动脉压 (MAP)、心率 (HR)、脉搏氧饱合度 (SpO2 ) ,并进行比较。结果　诱导后 2组MAP均有所下降 ,但无显著差异 ;气管拔管前P组MAP及HR均较用药前显著升高 ,10例出现苏醒期躁动 ;M组MAP维持稳定 ,2例苏醒延迟 ;HR无显著变化。结论　适量的咪唑安定用于全麻诱导与维持可有效抑制其气管插管与拔管期的心血管反应 ,并具有良好的镇静作用。     

右美托咪啶或丙泊酚联合瑞芬太尼用于后腹腔镜手术效果比较

目的：比较右美托咪啶或丙泊酚联合瑞芬太尼用于后腹腔镜手术效果。方法：将60例ASAⅠ～Ⅱ级后腹腔镜手术的患者随机分为2组,每组30例。D组予盐酸右美托咪啶负荷剂量0.5μg/（kg·h）静脉泵注10 min,术中继续泵注右美托咪啶0.3μg/（kg·h）,瑞芬太尼20μg/（kg·h）。 P 组予丙泊酚5 mg/（kg·h）静脉泵注10 min,术中继续以丙泊酚4 mg/（kg·h）,瑞芬太尼20μg/（kg·h）微泵维持。观察麻醉诱导前（T0）、气管插管后1 min（T1）、气腹后即刻（T2）、气腹后30 min（T3）、气腹结束时（T4）、拔管后即刻（T5）患者心率（heart rate,HR）、平均动脉压（mean arterial blood pressure,MAP）,苏醒时间、镇痛、镇静评分及唤醒期间的呛咳、躁动等相关不良反应。结果：二组比较T0、T5点HR、MAP 差异有统计学意义（均P〈0.05）;D组唤醒时间长于P组,但差异无统计学意义（P〉0.05）;镇痛评分效果D组明显优于P组（均P〈0.05）;苏醒时躁动、呛咳发生率P组高于D组（均P〈0.05）;拔管后D 组患者术后镇静优于P组（均P〈0.05）。结论：右美托咪啶联合瑞芬太尼用于后腹腔镜手术,效果优于丙泊酚联合瑞芬太尼。     

Proseal喉罩通气-靶控输注丙泊酚和瑞芬太尼在妇科腹腔镜手术中的临床应用

目的探讨丙泊酚和瑞芬太尼靶控输注时Proseal喉罩在妇科腹腔镜手术中的临床应用。方法选择ASAⅠ～Ⅱ级、年龄18～60岁、择期行妇科腹腔镜手术的患者60例,随机分为两组：靶控输注喉罩（PLMA）组30例,静吸复合气管插管（ET）组30例。观测两组患者诱导前、诱导后、插管（罩）即刻、插管（罩）后1min、插管（罩）后3min、拔管（罩）后1min和拔管（罩）后3min时的平均动脉压（MAP）和心率（HR）变化。记录两组患者苏醒时间、拔管（罩）时间、置管（罩）成功率,以及拔管（罩）时呛咳反应、术后24h咽痛、声音嘶哑、咳嗽的发生率。结果PLMA组患者插喉罩即刻、插喉罩后1min及拔喉罩后1min和3min患者的HR、MAP无明显变化,与诱导前相比差异无统计学意义（P〉0．05）;ET组插管即刻、插管后1min及拔管后1min和3min患者的HR、MAP显著升高,与诱导前相比差异有统计学意义（P〈0．01）。PLMA组患者的苏醒时间、拔管（罩）时间明显短于ET组,差异有统计学意义;ET组拔管时患者呛咳反应显著高于PLMA组（P〈0．01）;ET组术后24h咽痛、声音嘶哑、咳嗽的发生率也明显高于PLMA组。结论靶控输注丙泊酚和瑞芬太尼时Proseal喉罩用于妇科腹腔镜手术操作简单、插管刺激小、血流动力学平稳、术毕清醒快、拔管早、术后并发症少,是妇科腹腔镜手术比较理想的麻醉选择。     

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.