心脏跳动下心脏手术心肌保护效果的临床观察

目的　探讨心脏不停跳心内直视手术的临床应用效果和心肌保护效果。方法　临床随机对照前瞻性研究 ,4 0例单纯简单先心病患者随机分为两组 ,每组各 2 0例。对照组 (A组 )在常规心脏停跳下行心内直视手术 ;实验组 (B组 )不阻断升主动脉 ,在浅低温体外循环、心脏跳动下完成心内直视手术。两组分别于术前、停机即刻、术后 6h、12h、2 4h和 4 8h 6个时点取外周静脉血测定心肌酶 (CK)、肌钙蛋白I(cTnI)、丙二醛 (MDA)的血浆浓度 ,同时监测心功能各项指标。结果　停机即刻、术后 6h和 12h ,A组较B组CK显著升高 (P <0 .0 1) ;cTnIA组停机即刻至 4 8h均高于B组 ;A组MDA停机即刻和术后 6h高于B组 (P <0 .0 5 )。不停跳组平均体外循环时间 (5 2 .4± 17.5 )min ,明显低于停跳组 (84 .8± 16 .6 )min(P <0 .0 1)。循环和血气分析指标两组无明显差别 (P >0 .0 5 )。B组无空气栓塞并发症。结论　浅低温不停跳心内直视手术避免了低温和缺血再灌注引起的心肌损害 ,具有明确的心肌保护作用 ,但仍存在一定的心肌损伤。另外这种手术方法存在血液成分破坏较严重的不足。     

不同剂量异丙酚对心内直视手术患者心肌酶谱的影响

目的 :比较不同剂量异丙酚对心内直视手术患者心肌酶谱的影响。方法 :30例心内直视手术病人 ,麻醉诱导后给予持续输注异丙酚A组 2mg·kg- 1 ·h- 1 ,B组 5mg·kg- 1 ·h- 1 ,C组 8mg·kg- 1 ·h- 1 ,并监测诱导后、停体外循环 (CPB)即刻、CPB后30min、6 0min、3h五个时间点心肌酶AST、LDH、α -HBDH、CK -MB浓度变化。结果 :三组患者体外循环 (CPB)后心肌酶指标与诱导后相比均有不同程度升高。与A组相比 ,B组患者不同时间点AST、CK -MB、LDH值较低 (P <0 0 5或P <0 0 1) ,α -HB DH无明显差异 (P >0 0 5 )。A组与C组相比无明显差异 (P >0 0 5 )。结论 :术中 5mg·kg- 1 ·h- 1 异丙酚是较为理想的具心肌损伤保护作用的临床维持用药剂量     

胸腔引流管引流时间对纵隔肿瘤胸腔镜切除术后患者恢复的影响

目的探讨胸腔引流管不同引流时间对纵隔肿瘤胸腔镜切除术后患者恢复的作用。方法收集2010年1月至2014年1月南宁市第二人民医院72例纵隔肿瘤患者,依据随机数字表法分为A、B和C三组。A组患者24例,接受胸腔镜切除术,术后患者引流管置管时间为3 d;B组患者25例,接受胸腔镜切除术,当存在引流管拔管指征时拔管;C组患者23例,接受传统开胸手术;当存在引流管拔管指征时拔管。分别观察B和C组患者所需的拔管时间,三组患者的住院时间和发生感染、呼吸衰竭、二次返院及死亡的患者比例。结果 A组、B组、C组三组患者的引流管时间分别为(4.22±1.04)d、(4.75±1.18)d、(8.13±2.05)d,差异有统计学意义(P<0.05),以C组手术引流时间最长;A组和B组患者住院时间、感染的发生率、呼吸衰竭发生率和二次返院率均要显著低于C组[(7.16±1.24)d、(9.07±2.48)d比(12.14±3.23)d;12.5%(3/24)、8.0%(2/25)比34.8%(8/23);0%、0%比13.0%(3/23);0%、0%比17.4%(4/23)](P<0.05);A组和B组患者的感染发生率、呼吸衰竭发生率和二次返院率差异无统计学意义(P>0.05),而两组的住院时间差异有统计学意义(P<0.05),三组患者的病死率差异无统计学意义(P>0.05)。结论胸腔镜下切除纵隔肿瘤比传统开胸手术更利于患者术后的恢复,同时胸腔镜手术能早期拔除引流管,缩短患者的住院时间。     

乌司他丁预处理对术中心脏瓣膜置换患者心电图的影响

目的研究乌司他丁预处理对术中心脏瓣膜置换患者心电图的影响,探讨其对体外循环(CPB)心内直视手术缺血再灌注损伤的心肌保护作用。方法选择接受心内直视手术行瓣膜置换患者45例,随机分为3组:A组于术前3d静脉滴注乌司他丁2万u/(kg.d),用至术前1d,连续用药3d;B组患者进入手术室后即开始静脉滴注乌司他丁2万u/kg,维持至升主动脉阻断前10min;C组为对照组,不用乌司他丁预处理。记录各组麻醉后(T1)、主动脉插管时(T2)、心脏复跳时(T3)、主动脉开放10～15min(T4)、主动脉开放30min(T5)、主动脉开放45min(T6)、主动脉开放1～2h(T7)、术后24h(T8)时心电图的改变,记录各组主动脉开放后血管活性药物的使用剂量。结果A组与B组体外循环再灌注后5～10min室颤发生率分别为27%、7%,C组60%(P0.05);A组、B组T3、T4、T5、T6等时点再灌注心律失常评分显著小于C组(P0.05,P0.01),B组显著小于A组(P0.05);A组、B组T3、T4、T5、T6、T7、T8时心电图中∑ST-T抬高或下移显著小于C组(P0.05,P0.01),B组显著小于A组(P0.05);A组、B组CPB后心脏自动复跳率(73%、93%)明显高于C组(40%),A组、B组多巴胺[5μg/(kg.min)]的使用(40%、20%)明显低于C组(87%),且平均使用时间A组、B组显著短于C组(P0.05,P0.01);A组、B组肾上腺素使用率(6%、0%)明显低于C组(40%),且A组、B组使用时间和最大剂量均显著降低(P0.05)。结论乌司他丁预处理减轻体外循环心内直视手术缺血再灌注心律失常,产生心肌保护作用,既有早期保护作用(earlyprotection,EP),亦有延迟保护作用(delayedprotection,DP),但早期保护效应较强。     

乌司他丁预处理对心脏瓣膜置换术患者心电图的影响

目的 研究乌司他丁预处理对术中心脏瓣膜置换患者心电图的影响,探讨其对体外循环心内直视手术缺血再灌注损伤的心肌保护作用。方法 选择接受心内直视手术行瓣膜置换患者45例,随机分为三组：A组于术前3 d 静脉滴注乌司他丁2 万u/(kg·d),用至术前1 d,连续用药3 d;B组患者进入手术室后即开始静脉滴注乌司他丁2 万u /kg,维持至升主动脉阻断前10 min;C组为对照组,不用乌司他丁预处理。记录各组麻醉后(T1)、主动脉插管时（T2)、心脏复跳时（T3）、主动脉开放10~15 min（T4）、主动脉开放30 min（T5）、主动脉开放45 min（T6）、主动脉开放1～2 h（T7）、术后24 h (T8)等时点心电图的改变,各组主动脉开放后血管活性药物的使用剂量。结果 A组与B组体外循环再灌注后5～10 min室颤发生率分别为27％、7％,C组60％（p<0.05）;A组、B组T3、T4、T5、T6等时点再灌注心律失常评分显著小于C组（p<0.05 ～p<0.01）,B组显著小于A组（p<0.05）;A组、B组T3、T4、T5、T6、T7、T8等时点心电图中∑ST-T抬高或下移显著小于C组（p<0.05 or p<0.01）,B组显著小于A组（p<0.05）;A组、B组CPB后心脏自动复跳率（73%、93%）明显高于C组（40%）,A组、B组多巴胺 (﹥5μg/kg. min)的使用（40%、20%）明显低于C组（87%）,且平均使用时间A组、B组显著短于C组（p<0.05or p<0.01）; A组、B组肾上腺素使用率（6%、0%）明显低于C组（40%）,且A组、B组使用时间和最大剂量均显著降低（p<0.05）。结论：乌司他丁预处理减轻体外循环心内直视手术缺血再灌注心律失常,产生心肌保护作用,既有早期保护作用（early protection, EP）,亦有延迟保护作用（delayed protection, DP）,但早期保护效应较强。     

电视胸腔镜微创体外循环心脏手术与常规手术方法比较

【目的】探讨电视胸腔镜微创体外循心内直视术治疗先天性心脏病房间隔缺损的手术方法和效果。【方法】将80例房间隔缺损的先心病患者分成2组,电视胸腔镜组（A组）：40例,采用胸壁打孔股动脉、股静脉和上腔静脉插管,建立体外循环。常规组（B组）：40例,采用正中纵劈胸骨,经主动脉、上下腔静脉插管建立体外循环。【结果】胸腔镜组较常规组创伤小,术后24h胸腔引流量小（P〈0．01）,手术辅助呼吸时间短（P〈0．05）,手术应用库血量少（P〈0．05）,ICU停留时间短（P〈0．01）。【结论】电视胸腔镜微创体外循环下心内直视术创伤小,恢复快,手术并发症少,安全可行。     

胸腔镜手术切口下应用常规器械行部分肺切除术的临床分析

目的比较胸腔镜手术切口下应用常规器械与一次性昂贵耗材行部分肺切除术的临床疗效及成本。方法 46例行肺部分切除手术的患者,其中肺大疱12例,肺挫裂伤18例,肺曲菌球病3例,支气管扩张3例,肺良性肿瘤6例,肺转移瘤2例,肺癌2例。根据手术应用器械的不同分为两组,A组(n=22)应用常规手术器械行部分肺切除术,B组(n=24)应用一次性耗材行部分肺切除术。结果两组手术均顺利完成,手术切口大小、术后胸腔引流时间、术后并发症和住院时间比较,差异均无统计学意义(P0.05)。A组手术时间、术中高值耗材费用分别为(41.27±9.92)min和(2 612.86±1 600.08)元,B组分别为(26.12±6.52)min和(6 977.46±2 646.84)元,两组比较,差异有统计学意义(P0.01)。结论胸腔镜切口下应用常规手术器械行部分肺切除术安全可靠,医疗成本较低,但操作时间较长,可作为经济欠发达地区和基层医院开展胸腔镜手术的一种有效的补充方式。     

不同定位方案在行胸腔镜手术孤立性肺小结节患者中的应用效果比较

目的探讨医用胶和Hook-wire定位用于行胸腔镜手术孤立性肺小结节患者临床效果差异。方法选取该院2017年1月至2018年12月收治行胸腔镜手术孤立性肺小结节患者共150例,随机分为A组(75例)和B组(75例),分别在CT引导下行Hook-wire和医用胶定位;比较两组操作时间和术后并发症发生率。结果 A组衔接期和楔形切除时间分别为(3.84±0.61) h、(18.93±4.55) min;B组衔接期和楔形切除时间分别为(12.57±1.77) h、(20.05±4.91) min;B组衔接期时间显著长于A组(P0.05);两组楔形切除时间比较差异无统计学意义(P0.05);A组术后气胸、肺部出血、咳嗽及胸痛不适发生率分别为24.00%(18/75)、60.00%(45/75)、4.00%(3/75)、5.33%(4/75);B组术后气胸、肺部出血、咳嗽及胸痛不适发生率分别为21.33%(16/75)、9.33%(7/75)、6.67%(5/75)、2.67%(2/75);两组气胸、咳嗽及胸痛不适发生率比较差异无统计学意义(P0.05);B组肺部出血发生率显著低于A组(P0.05)。结论相较于Hook-wire,医用胶定位用于行胸腔镜手术孤立性肺小结节患者可有效缩短操作时间,降低术后并发症发生风险,更具临床应用价值。     

婴幼儿体外循环后血糖变化的初步研究

目的初步分析婴幼儿在体外循环术后血糖水平的变化规律及其影响因素。方法选择行心内直视手术患儿60例,按年龄、体重、体外循环时间分组。分为幼儿组(1~3岁)、婴儿组(≤1岁),体重≤10kg(A组)、体重>10kg组(B组),体外循环时间<60min(C组)、体外循环时间≥60min(D组)。观察患儿手术前(t0),手术结束时(t1),手术结束后1h(t2)、3h(t3)、5h(t4)血糖变化。结果体外循环术后各组血糖水平较转流前均明显升高;婴儿组与幼儿组相比手术结束时和术后1h血糖水平升高更明显;A组手术结束时和术后1、3h的血糖水平明显高于B组同时点血糖水平;D组手术结束和术后1h血糖水平明显高于C组同时点血糖水平。结论体外循环对小儿糖代谢有明显影响,体外循环期间糖代谢紊乱,血糖明显升高,且体外循环术对低龄、低体重、体外循环时间长的患儿血糖水平影响更大。     

地氟烷预适应对心脏直视手术围术期心肌肌钙蛋白I的影响

目的研究地氟烷预适应对心内直视手术中缺血/再灌注对心肌损伤的保护作用及可能机制.方法择期行先天性心脏病矫正术的患者40例,随机分为地氟烷预适应组(A组,n=20)和对照组(B组,n=20).两组患者均采用相同剂量芬太尼麻醉(30 μg/kg),其中A组在主动脉阻断前吸入10 min 1 MAC的地氟烷,随后继以5 min的洗脱期;而B组只给予15 min的纯氧吸入.观察麻醉前(T0),主动脉开放后即刻(T1)、2 h(T2)、6 h(T3)、24 h(T4)、48 h(T5)、各时点的血浆肌酸激酶同工酶(CK-MB),心肌肌钙蛋白I(cTnI)水平以及主动脉开放后心脏自主复跳率.结果 A组在主动脉开放后血浆CK-MB(T2、T3)及cTnI(T1～T5)浓度与B组相比有显著降低(P《0.05),并且心脏自主复跳率有显著增高.结论在临床心内直视手术中,由缺血/再灌注造成的损伤,地氟烷预适应可以产生和缺血预适应相似的心肌保护作用.     

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.