罗哌卡因在高位硬膜外麻醉中的效果观察

目的探讨罗哌卡因在高位硬膜外麻醉中对呼吸循环系统的影响以及临床效果。方法选择ASAⅠ-Ⅱ级乳腺手术患者40例，随机分为两组，每组20例，常规于T3-4间隙行硬膜外穿刺向头端置管。A组用0．25％罗哌卡因行硬膜外麻醉，B组用0．25％布比卡因行硬膜外麻醉。分别于麻醉前（T0）、麻醉后10min（T1）、30min（T2）、60min（T3）及术毕（T4），测定心率、血压、潮气量、呼吸频率、分钟通气量、阻滞时间和镇痛效果等指标。结果40例麻醉效果均佳，两组在T2、T3时心率、血压较麻醉前均有下降（P〈0．05），各项呼吸指标与术前比较差异无统计学意义。组间比较，在T2、T3时A组HR下降幅度小于B组，呼吸频率较B组变化更小（P〈0．05）。结论罗哌卡因能明显缩短阻滞起效时间，对感觉神经阻滞完善，镇痛效果好，对循环、呼吸功能影响小，用于高位硬膜外麻醉安全、有效。     

罗哌卡因与布比卡因颈段硬膜外阻滞对循环呼吸功能的影响

目的比较罗哌卡因与布比卡因用于颈段硬膜外阻滞对循环呼吸功能的影响。方法选择甲状腺手术女性患者60例，ASAⅠ～Ⅱ级，年龄18～58岁，随机分为罗哌卡因组（R组）和布比卡因组（B组），每组n=30例；R组选用0．5％罗哌卡因，B组选用0．375％布比卡因，选择C4～5或C5～6行硬膜外穿刺，向头置管3cm，两药的首量6～10ml；分别测定并记录麻醉前，麻醉后各时点BP、HR、RR、SpO2、VT、MV、PETCO2的变化。结果两组病例麻醉效果均满意，阻滞范围C2～T2，麻醉后血压和心率较麻醉前有所下降，但无统计学意义（P〉0．05）；术中两组SBP值明显高于麻醉前值（P〈0．05）。两组病例麻醉后PETCO2有不同程度的升高，R组（P〈0．05）、B组（P〈0．01），R与B组间比较（P〈0．01）。结论0．5％罗哌卡因和0．375％布比卡因用于颈段硬膜外阻滞麻醉效果均满意，对循环功能的影响两者相似，对呼吸功能（PETCO2）的影响罗哌卡因比布比卡因明显轻。     

等效剂量罗哌卡因和左布比卡因腰麻-硬膜外联合麻醉用于Misgave-Ladach-Method剖宫产术的比较

目的探讨等效剂量罗哌卡因、左布比卡因腰麻-硬膜外联合麻醉用于Misgave—Ladach—Method剖宫产术的临床效能及安全性。方法选择ASAⅠ～Ⅱ级足月妊娠初产妇60例,随机双盲法分为两组,每组各50例。罗哌卡因组（R组）：0.75％罗哌卡因2ml回吸脑脊液至2．5ml;左布比卡因组（L组）：0．5％左布比卡因2ml回吸脑脊液至2．5ml。术中麻醉效应不足时经硬膜外导管补充2％利多卡因。术中连续监测呼吸和循环状况,评估麻醉效能,观察围手术期不良反应的发生和新生儿情况。结果两组麻醉效能、最高阻滞平面、新生儿Apgar评分及不良反应相似（p〉0．05）,但R组感觉阻滞起效慢,维持时间短（P〈0．05）;下肢运动阻滞程度R组显著低于L组（p〈0.05或p〈0.01）。结论等效剂量的罗哌卡因和左布比卡因腰麻-硬膜外联合麻醉用于剖宫产术安全有效,与左布比卡因相比,罗哌卡因对下肢运动阻滞弱且恢复迅速。     

0．75％罗哌卡因在高龄患者下肢手术中连续腰麻的应用观察

目的研究小剂量0．75％罗哌卡因连续腰麻用于高龄患者下肢手术的安全性和有效性。方法择期高龄下肢手术患者32例,年龄70～82岁,ASAⅡ-Ⅲ级,用随机数字表法分为罗哌卡因组和布比卡因组。两组分别以0．1ml／s在蛛网膜下腔分次小剂量注入0．75％罗哌卡因1ml或0．75％布比卡因1ml直至麻醉平面满意,比较两组患者痛觉阻滞程度、最高阻滞平面,运动阻滞程度（改良Bromage分级法）,并且记录麻醉前（T0）、麻醉满意时（T1）、切皮后1．5h（T2）和术毕（B）HR、MAP的变化同时观察不良反应和并发症。结果两组患者均可达到完善的镇痛效果,但罗哌卡因组的镇痛起效时间、运动阻滞起效时间、最大运动阻滞时间均比布比卡因组显著延长（P〈0．05）;最高阻滞平面低于布比卡因组（P〈0．05）;而痛觉恢复时间、运动恢复时间比布比卡因组显著缩短（P〈0．05）;罗哌卡因组最大Bromage评分明显优于布比卡因组（P〈0．05）。结论小剂量0．75％罗哌卡因连续腰麻用于高龄老年患者下肢手术具有麻醉效果确切,对血流动力学影响小,不良反应少。临床上安全可行。     

罗哌卡因单侧腰麻用于股骨头置换术的临床观察

目的观察老年病人股骨头置换术小剂量罗哌卡因单侧腰麻的镇痛效果和不良反应。方法选择股骨头置换术老年病人66例，年龄60～80岁，ASAⅠ～Ⅱ级，随机分成单侧腰麻组（Ⅰ组）和连续硬膜外阻滞组（Ⅱ组），每组33例。Ⅰ组病人侧卧于水平位手术台上，患肢在上，选择L2、3行蛛网膜下腔穿刺，26G腰穿针单侧孔垂直向上，注入0．375％罗哌卡因轻比重液1．6ml。Ⅱ组选择L2、3行硬膜外穿刺，向头侧置管，注入1．6％利多卡因3ml试探量，5分钟后追加注入0．5％罗哌卡因8ml。观察两组感觉神经阻滞起效时间、平面扩散范围、运动神经阻滞程度，呕吐、头痛、神经并发症等情况，监测比较两组麻醉前（T0）和给予首剂局麻药后1min（T1）、3mln（T2）、5min（T3）、10min（T4）、15min（T5）、30min（T6）、60min（T7）、术毕（T8）及术后15min（T9）MPA、HR、SPO2等指标。结果与Ⅱ组相比，Ⅰ组感觉神经阻滞起效时间明显缩短，改良Bmmage评分升高（p〈0．05），神经阻滞平面仅限于手术单侧，术中低血压、心动过缓、呕吐发生率降低（p〈0．01或p〈0．05），MPA在T5、T7升高，SPO2在T4、T6升高（p〈0．01或P〈0．05）。结论小剂量罗哌卡因单侧腰麻起效迅速，阻滞完善，副作用少，是老年病人股骨头置换术较好的麻醉方法。     

罗哌卡因高位硬膜外阻滞实施乳腺癌根治术

目的 :观察罗哌卡因高位硬膜外阻滞用于乳腺癌根治术的效果。方法 :将择期行乳腺癌根治术的患者 ,随机分为 0 .2 5 %罗哌卡因组 (R组 )和 1%利多卡因 0 .1%的卡因 (L组 )。均选择T2～ 3或T3～ 4 行一点硬膜外穿刺 ,先注入 5ml试验量 ,5min后无异常R组注入 2 0～ 2 5ml,L组注入 10～ 15ml,测定阻滞平面 ,麻醉平面满意后开始手术。监测指标包括HR、SP、DP、MAP、ECG、SpO2 、感觉阻滞平面、麻醉起效时间、麻醉质量评定和麻醉期间的不良反应。结果 :两组一般情况、ASA分级、手术时间均无明显差异。感觉阻滞平面范围、脊神经阻滞节段数有明显差异。麻醉起效时间R组明显慢于L组。结论 :罗哌卡因高位硬膜外阻滞能完全满足乳腺癌根治术的麻醉要求     

罗哌卡因混合舒芬太尼用于剖宫产手术硬膜外麻醉的效果观察

目的比较0．75％罗哌卡因混合舒芬太尼与0．75％罗哌卡因用于剖宫产手术患者硬膜外麻醉的临床效果。方法择期剖宫产手术患者40例,ASAⅠ级,随机分为两组（n=20）：S组（舒芬太尼15μg＋0．75％罗哌卡因15ml）和R组（0．75％罗哌卡因15ml）。选择L2-3间隙穿刺,将上述药液注入硬膜外腔。记录感觉阻滞的起效时间、持续时间、最高阻滞平面及达最高阻滞平面的时间、运动阻滞的起效时间和持续时间、术中疼痛程度、腹肌松弛程度、牵拉反应程度及不良反应的发生和处理。结果S组感觉阻滞起效时间及达最高平面的时间短于R组,持续时间延长,最高平面升高,两组下肢运动阻滞的起效时间和持续时间及Bromage评分比较差异无统计学意义（P〉0．05）,S组牵拉反应程度低于R组。结论剖宫产手术患者混合舒芬太尼可增强0．75％罗哌卡因硬膜外麻醉的效果。     

0.5%盐酸罗哌卡因与布比卡因用于胃癌根治术的比较

目的探讨0.5%罗哌卡因用于胃癌根治术的麻醉效果及对呼吸、循环功能的影响并与布比卡因进行比较。方法选择ASAⅠ～Ⅱ级拟行胃癌根治术患者30例,其中女13例,男17例,年龄34岁～58岁,随机分为0.5%布比卡因组（A组）和0.5%罗哌卡因组（B组）,每组各15例。T8～9间隙行硬膜外穿刺,向头端置管,分别注入0.5%布比卡因和0.5%罗哌卡因,观察麻醉效果及对呼吸、循环功能的变化。结果2组硬膜外阻滞效果均满意,注入局麻药后A组RR、BP、ECG下降幅度大于B组（P〈0.05或P〈0.01）,硬膜外阻滞后A组出现轻度呼吸困难1例,B组SpO2维持在95%～97%,无呼吸困难发生。结论0.5%罗哌卡因组麻醉效果满意,对呼吸、循环功能的抑制比0.5%布比卡因轻。     

腰麻—硬膜外联合阻滞应用罗哌卡因和布匹卡因的比较

目的：探讨罗哌卡因在腰麻－硬膜外联合阻滞中应用的安全性和有效性。方法：拟行下肢或下腹部手术病人40例，22－58岁，心功能Ⅰ－Ⅱ级，随机分成两组。用Durasafe TM型联合阻滞针行腰2－3间隙穿刺，0．75％罗哌卡因或0．75％布匹卡因2ml双盲法注入蛛网膜下腔，2％利多卡因5－10ml从硬膜外腔给予，满足手术麻醉平面的需要。比较两组感觉、运动阻滞和恢复上的差异，并观察术后不良反应。结果：罗哌卡因感觉阻滞起效时间、维持时间与布匹卡因比较无明显差异；运动阻滞起效时间、最大运动阻滞时间明显长于布匹卡因（P＜0．05），两组不良反应相似，均无神经系统并发症。结论：罗哌卡因用于腰麻一硬膜外联合阻滞是安全有效的。     

腰-硬联合麻醉在高龄患者髋关节手术中的应用

目的：观察高龄患者髋关节手术用小剂量罗哌卡因腰-硬联合麻醉（CSEA）的效果及对循环呼吸功能的影响。方法：ASA（美国麻醉医师协会制定的手术危险性分级）Ⅱ级或Ⅲ级髋关节手术40例,随机分为两组,各组20例。A组腰麻用轻比重0.2%罗哌卡因（2.5～3.5）mL,硬膜外阻滞用0.2%罗哌卡因;B组腰麻用重比重0.5%布比卡因（1.6～2.0）mL,硬膜外阻滞用0.375%布比卡因硬膜外阻滞。记录两组麻醉效果和术中BP（血压）、HR（心率）变化。结果：A组麻醉平面可达T8～T10,患侧,术中各时点BP、HR平稳,改良法Bromage[1]评分患肢（1～2）分;B组麻醉平面可达T6～T8,双侧,术中各时点BP明显下降,HR明显减慢（P〈0.01）,Bromage评分双下肢（3～4）分为主。结论：轻比重罗哌卡因腰-硬联合麻醉更适用于高龄髋关节手术患者。     

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.