丙泊酚复合硝普钠控制性降压对机体应激反应的影响

目的研究丙泊酚和硝普钠控制性降压对机体应激反应的影响.方法 ASAⅠ～Ⅱ级择期耳鼻喉显微外科手术病人30例,随机分两组,Ⅰ组为硝普钠组,Ⅱ组为丙泊酚复合硝普钠组.分别在控制性降压前(T1),降压后10 min(T2)、40 min(T3)及停降压后10 min(T4),记录降压期间血流动力学参数,采集颈内静脉血样测内皮素、血管紧张素Ⅱ和醛固酮浓度.记录硝普钠总用量和控制性降压时间,计算硝普钠输注速度;记录动脉血糖(BGa),颈内静脉球部血糖(BGjv), 计算动脉-颈内静脉球部血糖差(D(a-jv)BG)和脑葡萄糖摄取率(BGER).结果Ⅰ组降压期间心率增快(P<0.05),Ⅱ组无心率增快,T4时刻MAP显著低于Ⅰ组(P<0.05); 血管紧张素和内皮素在T3、T4时刻Ⅰ组均显著高于Ⅱ组(P<0.05或P<0.01).Ⅰ、Ⅱ组动、静脉血糖与降压前相比逐渐升高(P<0.05);Ⅰ组D(a-jv)BG和BGER降压后进一步下降(P<0.05).结论丙泊酚复合硝普钠控制性降压期间可减少硝普钠用量、降低快速耐药及反跳性高血压的发生,能有效抑制应激反应及与应激反应有关激素水平的增加,对降压期间糖代谢无明显影响.     

压宁定对硝普钠控制性降压效应及内分泌激素影响的研究

目的：观察压宁定对硝普钠控制性降压效应及血浆内分泌激素的影响，探讨两药复合应用的可行性，为临床合理选用降压药提供参考。方法：择期全麻下颌脑手术病人２８例，ＡＳＡⅠ～Ⅱ级，随机分为硝普钠（Ⅰ组，１４例）和压宁定复合硝普钠（Ⅱ组，１４例）两组。两组病人麻醉诱导和维持方法相同，平均动脉压均降低３０％￣４０％，分别于降压前即刻降压达预计值时、维持降压３０ｍｉｎ、停降压１０ｍｉｎ时观察降压诱导时间和降压药的     

鼻内镜手术中硝普钠复合艾司络尔和单纯硝普钠控制性降压的比较

目的 观察鼻内镜手术中，硝普钠复合艾司洛尔与单纯硝普钠控制性降压的比较。方法 40例ASAⅠ～Ⅱ级进行功能性鼻内镜手术的病人被随机分成两组，每组20例。Ⅰ组病人接受硝普钠和艾司络尔进行控制性降压，Ⅱ组只接受硝普钠进行控制性降压。麻醉诱导用咪唑安定、芬太尼、异丙酚、万可松，用1％～2％异氟醚 50％N2O维持。两组病人术中平均动脉压保持在60～65mmHg之间，Ⅰ组病人通过调整艾司络尔用量将心率维持在80～90次／min，根据Fromme术野质量评分表在手术开始后5、15、30、45min由同一术者进行术野质量评分。结果 Ⅰ组病人的术野质量评分明显低于Ⅱ组，其手术持续时间也少于Ⅱ组。结论 单纯应用硝普钠轻度控制性降压并不能改善鼻内镜手术术野质量、缩短手术时间，硝普钠复合艾司络尔是较理想的降压方法。     

丙泊酚复合硝普钠控制性降压对机体应激反应的影响

目的研究丙泊酚和硝普钠控制性降压对机体应激反应的影响。方法ASAⅠ～Ⅱ级择期耳鼻喉显微外科手术病人 30例 ,随机分两组 ,Ⅰ组为硝普钠组 ,Ⅱ组为丙泊酚复合硝普钠组。分别在控制性降压前 (T1) ,降压后 10min(T2 )、4 0min(T3 )及停降压后 10min(T4) ,记录降压期间血流动力学参数 ,采集颈内静脉血样测内皮素、血管紧张素Ⅱ和醛固酮浓度。记录硝普钠总用量和控制性降压时间 ,计算硝普钠输注速度 ;记录动脉血糖 (BGa) ,颈内静脉球部血糖 (BGjv) ,计算动脉 -颈内静脉球部血糖差(D(a jv) BG)和脑葡萄糖摄取率 (BGER)。结果Ⅰ组降压期间心率增快 (P <0 .0 5 ) ,Ⅱ组无心率增快 ,T4时刻MAP显著低于Ⅰ组 (P<0 .0 5 ) ;血管紧张素和内皮素在T3 、T4时刻Ⅰ组均显著高于Ⅱ组 (P <0 .0 5或P <0 .0 1)。Ⅰ、Ⅱ组动、静脉血糖与降压前相比逐渐升高 (P <0 .0 5 ) ;Ⅰ组D(a jv) BG和BGER降压后进一步下降 (P <0 .0 5 )。结论丙泊酚复合硝普钠控制性降压期间可减少硝普钠用量、降低快速耐药及反跳性高血压的发生 ,能有效抑制应激反应及与应激反应有关激素水平的增加 ,对降压期间糖代谢无明显影响     

硝普钠复合艾司洛尔控制性降压用于腹主动脉瘤腔内修复术的临床观察

目的:观察硝普钠复合艾司洛尔控制性降压对腹主动脉瘤腔内修复术患者血流动力学的影响.方法:20例择期腹主动脉瘤腔内修复术患者随机分为两组,Ⅰ组采用单纯硝普钠控制降压;Ⅱ组用硝普钠复合艾司洛尔控制降压.观察降压前、降压后5,10,15min及停药后5,10,15min,患者的SBP、RPP、HR及CVP值,同时记录两组降压开始至降到目标血压时间.结果:Ⅰ组和Ⅱ组从降压开始至目标血压的时间分别为(4.9±1.1)min和(3.7±0.8)min(P<0.05),Ⅱ组患者HR在降压后5,10,15min及停止降压后5min均低于I组(P<0.05).结论:硝普钠复合艾司洛尔复合使用行控制性降压在腹主动脉瘤腔内修复术中降压平稳,降压中HR无明显增快.     

艾司洛尔复合硝普钠控制性降压用于腹主动脉瘤腔内支架隔绝术

目的:观察艾司洛尔复合硝普钠控制性降压对腹主动脉瘤腔内支架隔绝术患者血流动力学的影响。方法:24例择期腹主动脉瘤腔内支架隔绝术病人随机分为2组,Ⅰ组采用单纯硝普钠控制性降压,Ⅱ组硝普钠联用艾司洛尔控制性降压。观察降压前、降压后5,10,15 min以及停止降压后5,15 min的SBP、HR、RPP、CI、SVR、PCWP及CVP值,记录2组从降压开始到降到目标血压所需的时间。结果:Ⅰ组与Ⅱ组从降压开始到达目标血压的时间分别为(5.3±1.5)min和(3.6±0.9)min(P<0.05)。Ⅱ组HR、RPP值在降压后5,10,15 min及停止降压后5 min时均低于Ⅰ组对应值(P<0.05)。结论:艾司洛尔复合硝普钠控制性降压可以降低腹主动脉瘤腔内支架隔绝术患者的HR与RPP、减少硝普钠的用量、降压迅速、复压平稳。     

异丙酚复合硝普钠在小儿动脉导管未闭结扎术中控制性降压作用的探讨

目的比较异丙酚复合硝普钠和异氟醚复合硝普钠在动脉导管未闭(PDA)结扎术中控制性降压的效果及血流动力学变化。方法将78例患儿随机分成2组,Ⅰ组硝普钠 异丙酚(n=40),Ⅱ组硝普钠 异氟醚(n=38)。观察两组在降压期间血压、心率变化,并计算血压最低时心率-收缩血压输出(RPP)值。结果Ⅰ组降压后心率变化不大(P>0.05);Ⅱ组降压后心率明显增快,与降压前比较差异有非常显著性意义(P<0.01);两组心率差比较差异有非常显著性意义(P<0.01)。结论异丙酚复合硝普钠控制性降压有协同作用,降压期间心率平稳,不增加心肌氧耗。     

右美托咪定复合硝普钠控制性降压对脊柱手术患者肾素-血管紧张素-醛固酮系统的影响

目的观察右美托咪定复合硝普钠在脊柱手术中行控制性降压的效果。方法择期行控制性降压的脊柱手术患者40例,按降压方法将患者随机分成硝普钠(N组)和右美托咪定复合硝普钠(D组),每组20例,使MAP较术前基础值下降30%,但不低于55mmHg。在基础值(T1)、控制性降压前即刻(T2)、控制性降压后10min(T3)、30min(T4)及控制性降压结束20min(T5)记录HR、MAP、CVP,同时测定血浆中肾素、血管紧张素Ⅱ、醛固酮浓度。由术者评估术野质量。结果 N组T3～5的HR较T1和T2明显增加(P<0.05),D组的HR无明显变化(P>0.05);N组T5的MAP、CVP高于T1,高于D组T5MAP、CVP(P<0.05),D组T5的MAP、CVP低于T1(P<0.05);肾素、血管紧张素Ⅱ、醛固酮含量两组T3～5较T1和T2增加(P<0.05或P<0.01),N组T3～5高于D组相应时点(P<0.05)。D组术野质量优于N组(P<0.05)。结论右美托咪定复合硝普钠控制性降压过程心率平稳,无反跳性高血压,为手术提供更清晰的术野,在控制性降压期间抑制RAAS的激活程度。     

硝普钠复合异氟醚控制性降压用于鼻内窥镜手术的临床研究

目的探讨硝普钠复合异氟醚控制性降压用于鼻内窥镜手术的可行性、安全性。方法将Ⅱ型Ⅱ期—Ⅲ型慢性鼻窦炎、鼻息肉病人50例随机分为对照组(A组)和全麻控制性降压组(B组),每组25例,两组病人均为ASAⅠ－Ⅱ级,控制性降压组采用气管内插管全麻下以硝普钠1ug／(kg．min)微量泵泵入及1．5～2％异氟醚持续吸入控制性降压,对照组采用局麻下手术。比较两组术中出血量、输液量、手术时间、平均动脉压 (MAP)、心率(HR)。结果与对照组比较两组术中出血量、输液量、手术时间、平均动脉压(MAP)、心率 (HR)有显著性差异(p＜0．05)。结论硝普钠复合异氟醚控制性降压用于鼻内窥镜手术效果显著、安全可靠,无单用硝普钠降压的副作用,出血量减少,手术时间缩短。     

舒芬太尼在鼻内镜手术中控制性降压的临床观察

目的:观察舒芬太尼用于静吸复合全麻时在鼻内镜手术中行控制性降压的效果。方法:42例ASAⅠ-Ⅱ级择期鼻内镜手术患者随机分为舒芬太尼组(以舒芬太尼为镇痛药诱导且在术中复合异氟醚、丙泊酚维持麻醉并调控BP)和硝普钠组(以芬太尼为镇痛药诱导且在术中以丙泊酚、异氟醚维持并加用硝普钠调控BP),每组21例。记录两组不同时间点的收缩压、平均动脉压、HR、呼气末异氟醚浓度、皮质醇浓度及术野质量。结果:两组控制性降压期间收缩压、平均动脉压均低于麻醉前(P<0.01)。舒芬太尼组控制性降压期间收缩压、平均动脉压、HR均低于硝普钠组(P<0.05),术野质量明显好于硝普钠组(P<0.01)。皮质醇浓度在控制性降压期间明显低于麻醉前(P<0.01),组间同时间点比无统计学意义。结论:鼻内镜手术中以舒芬太尼用于静吸复合全麻时控制性降压可达理想的降压效果,术野质量高,可有效抑制术中应激反应。     

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.     

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.     

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…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.