人工气道方式对心脏骤停模型复苏的影响

目的观察人工气道建立方式对大鼠心跳骤停模型自主循环恢复后呼吸功能、存活率的影响及改良经口气管插管法的可行性。方法建立窒息法大鼠心跳骤停模型;30只SD大鼠随机分成经口气管插管组（n=15）和气管切开插管组（n=15）两组。观察复苏后大鼠在机械通气与自主呼吸状况下动脉血气值的变化,比较复苏后6、24、72h生存率。结果经口气管插管组在机械通气与自主呼吸状态下的pH值比较,差异无统计学意义（P〉0.05）,而气管切开组在机械通气与自主呼吸状态下的pH、PaCO2比较,差异均有高度统计学意义（均P〈0.001）;同期两组间pH、Pa-CO2、PaO2比较,差异均有高度统计学意义（均P〈0.001）;气管切开组6、24h存活率有明显下降趋势,72h存活率比较差异有统计学意义（P〈0.05）。结论对于观察时间长、需要脱机或撤除人工气道的大鼠心跳骤停模型,经口气管插管法建立人工气道优于气管切开插管法;且改良经口气管插管法是值得推荐的一种大鼠气管插管方法。     

Shikani喉镜与Macintosh喉镜在双腔气管导管插管中的比较

目的：比较Shikani喉镜和Macintosh喉镜在双腔气管导管插管中的有效性和安全性。方法：60例择期行胸外科手术的患者随机分为Shikani喉镜组（S组,n=30）和Macintosh喉镜组（M组,n=30）,在全麻诱导后分别采用Shikani喉镜和Macintosh喉镜插入双腔气管导管,记录患者插管时间,插管次数,是否发生导管套囊破裂及口唇、牙齿损伤,患者基础(T0)血压和心率,以及插管开始时(T1)、插管完成后1 min(T2)、插管完成后3 min(T3) 、插管完成后5 min(T4)的血压和心率,评估术后24 h患者有无声音嘶哑及咽喉疼痛。结果：S组患者插管时间少于M组［(37.4±9.7) s vs. (43.9±13.7) s, P=0.039］,两组一次插管成功率差异无统计学意义(87% vs. 80%, P=0.488);两组均未发生套囊破损;S组发生口唇及牙齿损伤者少于M组（8例vs. 2例,P=0.038）;两组患者之间T0、T1、T2、T3、T4的血压、心率差异无统计学意义(P＜0.05);两组患者术后24 h咽痛（7例vs. 10例,P=0.390）及声嘶（5例vs. 7例,P=0.519）发生率差异无统计学意义(P＜0.05)。结论：与Macintosh喉镜相比,Shikani喉镜插管花费时间短,口唇及牙齿损伤发生率更小     

乌拉地尔防止气管插管引起的心血管反应的临床观察

目的　观察乌拉地尔用于防止气管插管心血管反应的效果。方法　 4 0例全麻择期病人 ,随机分为 2组 (n =2 0 ) ,麻醉诱导用 2 .5 %硫喷妥钠 5～ 8mg/kg ,琥珀胆碱 2mg/kg ,进行快速气管内插管。对照组不用乌拉地尔 ,实验组诱导前静注乌拉地尔 0 .6mg/kg。分别记录诱导前 ,用乌拉地尔后 1、3、5min ,用硫贲妥钠、琥珀胆碱后 1min及插管时 ,插管后 2、5min时的HR、SBP、MAP及RPP值。结果　对照组插管时 ,插管后 2min的HR、SBP、MAP及RPP值明显升高 (P <0 .0 5 )。乌拉地尔组插管时 ,插管后 2min的HR及RPP值明显升高 ,SBP和MAP恢复到诱导前水平。两组之间比较乌拉地尔组HR、SBP、MAP及RPP值升高相对较低 ,组间比较有显著性差异 (P <0 .0 5 )。结论　诱导前使用乌拉地尔可以减轻气管插管心血管反应。     

全麻诱导时力月西合适剂量的初步探讨

目的　探讨力月西在全麻诱导时的合适剂量。方法　男性食管癌择期手术 75例 ,ASA 1～ 2级 ,均采用硬膜外麻醉复合气管插管全麻。随机分为A(n =2 5 )、B(n =2 4 )、C(n =2 6 )组 ,分别静注力月西 0 .0 4mg kg、0 .0 8mg kg和 0 .12mg kg ,其它药物剂量相同。观测术毕唤醒人数和术毕至清醒时间。 结果　A、B、C三组术毕唤醒人数和术毕至清醒时间分别为 2 0 (80 % )、(3.2 4± 2 .87)min ;12 (5 0 % )、(8.37± 3.2 6 )min ;3(11.5 4% )、(15 .4 2± 3.2 9)min ,A组与B、C组相比P <0 .0 1,B组与C组相比P <0 .0 1,有非常显著性差异。结论　力月西合适诱导剂量为 0 .0 4mg kg～ 0 .0 8mg kg ,不宜刻求临床上推荐的诱导剂量 0 .15mg kg～ 0 .3mg kg。     

PENTAX AWS-S200视频喉镜与传统普通喉镜对气管插管患者的血流动力学影响比较

目的 观察PENTAX AWS-S200视频喉镜与传统普通喉镜对全麻下气管插管患者的血流动力学和安全性与有效性的影响.方法 选取接受全麻下进行气管插管的患者176例(ASA Ⅰ~Ⅱ级),随机将其分为两组,观察组(P组,n=88)采用PENTAX AWS-S200视频喉镜插管,对照组(C组,n=88)行传统普通喉镜插管.观察两组患者麻醉前(基础值T0),气管插管前(T1),气管插管即刻(T2),气管插管后1 min(T3)、3 min(T4)、5 min(T5)时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO2)值;记录两组患者声门暴露时间、插管时间和插管后并发症发生率.结果 P组一次完成气管插管88例(100%),C组则为68例(77.3%),20例(22.7%)需要2~3次气管插管, 组间比较差异有统计学意义(P<0.05).与C组比较,P组患者T2、T3、T4、T5时SBP、DBP、MAP和HR 值明显低于C组(P<0.05);两组各时间点SpO2的变化相似,组间比较差异无统计学意义(P>0.05);P组声门暴露时间和插管时间明显低于C组(P<0.05),插管后并发症发生率P组低于C组(P<0.05).结论 PENTAX视频喉镜操作简单,使用方便;快速准确,屏幕具有声门准星定位引导,安全性与有效性高,在全麻气管插管过程中应激反应较小,患者血流动力学稳定,适合在临床麻醉中推广选用.     

异丙酚和咪唑安定对颅脑手术患者颅内压的影响

目的　比较异丙酚和咪唑安定麻醉在脑肿瘤患者的手术中对颅内压的影响。方法　选择 2 0例开颅手术的脑肿瘤患者随机分成异丙酚组 (Ⅰ组 ,n =10 )和对照组咪唑安定组 (Ⅱ组 ,n =10 ) ,两组患者均取左侧卧位选择L3～ 4间隙穿刺 ,监测颅内压 (ICP) ;并监测记录ICP、收缩压 (SBP)、舒张压 (DBP)。在麻醉前 ,麻醉诱导后 2、4min ,插管后 2、4、6、8、10min ,切皮及钻颅等时点的数值进行对比分析。结果　两组患者之间在诱导后 2min时ICP差异有显著性 (P <0 0 5 ) ,其他时点的ICP比较差异无显著性 ;两组患者之间SBP、DBP比较差异无显著性 (P >0 0 5 )。Ⅰ组诱导后 4minSBP和DBP与基础比差异有显著性 (P <0 0 5 ) ,ICP与基础比差异无显著性 (P >0 0 5 )。Ⅱ组诱导后 4min和插管后 6min的SBP、DBP与基础比差异有显著性 (P <0 0 5 ) ,ICP与基础比差异无显著性 (P >0 0 5 )。结论　异丙酚和咪唑安定用于脑肿瘤患者的麻醉 ,都能维持稳定的颅内压 ,但咪唑安定对血压的影响较异丙酚大 ,因此异丙酚更安全有利。     

阿拉明预防咪达唑仑-异丙酚-芬太尼全麻诱导时的低血压反应

目的　观察预防性应用阿拉明对咪达唑仑 -异丙酚 -芬太尼全麻诱导期间血流动力学稳定性的影响。方法　选择全麻气管或支气管插管病人 2 0例 ,随机分成阿拉明 (A)组 (n =10 )和对照 (C)组 (n =10 )。所有病例采用咪达唑仑 0 .1mg·kg-1,异丙酚 1.0mg·kg-1,维库溴铵 0 .1～ 0 .15mg·kg-1,芬太尼 5～ 6mcg·kg-1,顺序静脉全麻诱导 ,于维库溴铵用药后 3min插管。A组连续静注诱导药物 ,并于芬太尼后静注阿拉明 10mcg·kg-1;C组在维库溴铵用药后等待 2min再静注芬太尼 ,并在芬太尼后 1min插管。每例分别于诱导前 ,插管前 1min ,插管前即刻 ,插管后 1、3、5、10min测量SBP ,HR和RPP。结果　两组年龄 ,体重无统计学差异 ;C组SBP ,HR和RPP在插管前后波动较大 ,波幅为 2 4 .3%,17.3%和 4 0 .9%,而A组的波动较小 ,波幅分别为 10 .3%,15 .8%和 2 3.9%,组间差异显著 ,P <0 .0 5。结论　在咪达唑仑 -异丙酚 -芬太尼顺序静脉诱导中 ,适时适量地应用阿拉明可以对抗诱导期的低血压反应 ,并能起到稳定诱导插管期间血流动力的作用。     

尼卡地平在全麻气管插管和手术切皮刺激时维持血流动力学稳定的最适剂量

目的　研究麻醉诱导后静脉给予尼卡地平以维持气管插管和切开皮肤时血流动力学稳定的最适剂量。方法　 6 0例美国麻醉医师协会 (ASA)体验标准评估为Ⅰ～Ⅱ级的成年患者 ,随机均分为 4组 :生理盐水组 (Ⅰ组 ) ,尼卡地平 0 .5mg组 (Ⅱ组 ) ,尼卡地平 1.0mg组 (Ⅲ组 ) ,尼卡地平 2mg组 (Ⅳ组 )。不同剂量的尼卡地平均用生理盐水稀释至 5ml,在实施气管插管前 2min ,于 30s内静脉推注 ;气管插管后 15min和切皮后 5min内 ,定时记录平均动脉压 (MAP)和心率 (HR)。结果　气管插管后 ,Ⅰ、Ⅱ组的MAP峰值较诱导前的基础值升高18.95 %和 10 .10 % ;Ⅲ组的MAP峰值与基础值的差异无显著性 ;Ⅳ组的MAP较基础值显著降低 10 .6 4 % (P<0 .0 5 )。气管插管后Ⅲ组的心率最高 ,与其他 3组的差异有显著性 (P <0 .0 5 )。但Ⅳ组皮肤切开后MAP的增加最少。结论　尼卡地平预防气管插管和皮肤切开所致高血压反应的最适剂量为 1.0mg。     

绑带式胸廓挤压仪在心跳骤停小型猪心肺复苏中的作用

目的 观察新型绑带式胸廓挤压仪在心跳骤停小型猪心肺复苏(CPR)中的效果,并与传统人工按压的CPR结果进行比较.方法 26只小型猪随机分为机械按压组(n=13)和传统人工按压组(n=13),在电击诱发心室颤动(室颤)致心跳骤停4 min后分别实施机械胸外按压和人工胸外按压.比较两组动物CPR后的存活率;测定并比较两组动物诱导室颤前和恢复自主循环(ROSC)后1 min、5 min和1h时间点的血流动力学指标、主动脉血气参数和乳酸浓度;X线摄片观察CPR成功后动物肋骨的损伤情况.结果 两组动物在ROSC时和CPR后1h的存活率比较差异无统计学意义(P＞0.05).人工按压组在ROSC 1 min时的主动脉收缩压(AOS)、主动脉舒张压(AOD)和平均动脉压(MAP)均显著高于机械按压组(P＜0.05),而各时间点的冠状动脉灌注压(CPP)比较差异均无统计学意义(P＞0.05);机械按压组在ROSC 1 min、15 min及1h时间点的血液乳酸浓度均明显低于人工按压组(P＜0.05).X线胸片显示,机械按压组的肋骨损伤发生率与人工按压组比较差异无统计学意义(33.3％和45.5％)(P＞0.05).结论 绑带式胸廓挤压仪在小型猪CPR中的效果与传统人工按压效果相似,可以作为代替CPR中人工按压的一种方法.     

早期气管插管在心肺复苏中的应用

目的　探讨院前 (含急诊科内 )心肺复苏 (CPR)时早期行气管插管对复苏成功率的影响。方法　对在院前 (含急诊科内 )发生的心跳呼吸骤停患者 98例随机分为 3组 ,A组 3 5例 ,在常规CPR时即行气管内插管术 ;B组 3 2例 ,先行胸外按压 (CAB方法 ) 5min无效时即刻气管内插管 ;C组 3 1例 ,行常规CPR或CAB方法 5min以后无效时 ,再行气管内插管。结果　A组复苏成功 2 3例 ,成功率 65 7% ;B组复苏成功 12例 ,成功率 3 7 5 % ;C组复苏成功 4例 ,成功率 12 9% ;3组间比较差异有显著性 (P <0 0 5 )。结论　在院前心肺复苏时 ,早期气管插管能明显提高抢救成功率     

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…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.