老年病人围术期呼吸力学变化与术后低氧血症的关系

目的观察老年病人上腹部手术围术期呼吸力学的变化及低氧血症的发生情况,并探讨二者的关系.方法 60例上腹部手术病人按年龄分三组,每组20例,ASA Ⅰ～Ⅲ级.Ⅰ组75 ～ 89岁,Ⅱ组60 ～ 74岁,对照组45 ～ 59岁.监测食管内压、肺顺应性、呼吸功、P0.1等,监测的时间点为术前、拔管前、拔管后20 min、术后6 h和24 h.并用24 h脉搏氧饱和度仪记录术后低氧血症发生情况.结果三组病人拔管后20 min呼吸力学改变最明显,以后逐渐恢复,恢复速度为Ⅰ组＜Ⅱ组＜对照组.Ⅰ组及Ⅱ组术后24 h内共发生低氧血症9例,对照组无低氧血症发生.低氧血症组肺顺应性在术前、拔管后20 min、术后6 h和24 h明显低于无低氧血症组.结论上腹部手术病人在拔管后20 min呼吸力学变化最明显,老年人术后24 h呼吸力学仍不能恢复至术前水平.术前肺顺应性可作为评估老年病人上腹部手术后发生低氧血症或呼吸功能不全的重要监测指标.     

鼻面罩无创通气在上腹部手术全麻恢复期应用的临床研究

目的探讨上腹部手术全麻恢复期应用鼻面罩无创通气的临床意义。方法将择期行上腹部手术全麻恢复期患者80例气管拔管后随机分为鼻面罩无创通气组(A组)及面罩吸氧组(B组)进行对照观察。所有患者自主呼吸恢复,吸空气5min,脉搏血氧饱和度(SpO2)≥90%后拔除气管插管,拔管后吸氧3～5min,然后呼吸空气5min,动态监测SpO2情况,观察术后早期低氧血症、气道梗阻和呼吸抑制情况。A组行鼻面罩无创通气支持呼吸1h,B组拔管后给予面罩吸氧。所有患者拔管后即刻及拔管后1h抽取动脉血进行血气分析。结果两组患者气管拔管后吸空气时SpO2下降明显,低氧血症发生率A组为50%,B组为45%,差异无统计学意义(χ2=0.201,P=0.654),其中严重低氧血症发生率分别为30%、23%,差异无统计学意义(χ2=0.581,P=0.446);气管拔管后发生气道梗阻A组为25%,B组为18%,差异无统计学意义(χ2=0.672,P=0.412);两组患者拔管后即刻血气分析无明显差异,1h后A组二氧化碳分压和氧分压均优于B组。结论上腹部手术全麻恢复期应用鼻面罩无创通气有积极的临床意义,能预防全麻恢复期低氧血症、气道梗阻等并发症,增加...     

舒氧康静脉给氧预防术后低氧血症

目的探讨舒氧康静脉给氧对老年病人术后早期低氧血症的防治效果.方法40例行腹部手术的老年患者,随机分为对照组(Ⅰ组)20例和实验组(Ⅱ组)20例.Ⅰ组病人从离开手术室到转送回病房共20分钟不吸氧;Ⅱ组病人离开手术室即开始在平衡盐液中使用舒氧康以6ml/kg,输注速度为0.3ml/(kg@min)进行输液给氧.两组病人均应用脉搏血氧饱和度监测仪连续动态监测SpO2.比较两组的脉搏血氧饱和度(SpO2)、血压(BP)、心率(HR)并进行统计学分析.结果对照组(Ⅰ组)脉搏血氧饱和度(SpO2)明显低于实验组(Ⅱ组)(P＜0.05),两组生命体征比较无显著性差异(P＞0.05).结论在手术后转送病房途中,由于不具备吸氧条件,老年病人容易发生低氧血症,舒氧康可以维持SpO2值,预防转送途中低氧血症的发生.     

气管插管全麻术后拔管时机的观察

目的掌握术后拔管时机，减轻苏醒期心血管应激反应。方法选择40例ASAⅠ～Ⅱ级，择期上腹部手术全麻患者随机分成两组，各20例。Ⅰ组为呼吸恢复，出现吞咽反射后拔管；Ⅱ组为清醒配合医生指令时拔管。记录麻醉前、吞咽时、拔管时、拔管后1min、5min时，收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏血氧饱和度（SpO2）的变化，以及两组病例拔管后不用给氧时SpO2〉95％所需的时间（M）。结果Ⅱ组拔管时SBP、DBP、HR显著高于本组和Ⅰ组各观察时段及Ⅰ组拔管时（P〈0．05）；Ⅰ组各时段SBP、DBP、HR无明显变化，拔管后1min、5minSpO2显著低于麻醉时及拔管前（P〈0．05）；Ⅰ组拔管后需要面罩给氧的时间显著长于Ⅱ组（P〈0．05）。结论全麻患者术后，出现吞咽反射拔管较清醒拔管的心血管应激反应小，但SpO2较清醒拔管时低，需面罩给氧。     

老年人腹部手术后低氧血症的监测及意义

目的　探讨老年患者腹部手术后低氧血症的监测及意义。方法　选择 62例施行腹部手术的老年患者 ,于术前及术后 1～ 4d ,在晨间停止吸氧 3 0min后抽取动脉血进行血气分析。结果　术后低氧血症发生率为 5 0 .0 0 % ,术后 1～ 4d动脉血氧分压较术前明显降低 (P均 <0 .0 1)。术后并发症发生率为 5 6.45 %。结论　老年患者腹部手术后容易发生低氧血症 ,必须采取有效措施预防处理 ,并防止并发症的发生。     

开颅和腹部手术患者苏醒期脑过度灌注现象的比较

目的使用颈静脉球部血氧饱和度和经颅多普勒监测,研究手术苏醒期患者脑血流动力学的变化。方法随机选择择期在全麻下行开颅脑肿瘤切除术和腹部手术的患者,分为开颅手术组(Ⅰ组)(n=50)和腹部手术组(Ⅱ组)(n=50)。Ⅰ组患者术前行颈静脉球部置管,分别测术前,术后拔管即刻,拔管后30,60,90和120min时大脑中动脉平均血流速度(mean velocity of middle cerebral artery,MCA Vm),平均动脉压(mean arterialpressure,MAP)及颈静脉球部血氧饱和度(blood oxygen saturation of jugular vein bulb,SjvO2)。Ⅱ组分别测量术前,术后拔管即刻,拔管后30,60,90和120 min时的MCA Vm和MAP。结果Ⅰ组患者MCA Vm从术后拔管即刻到拔管后2 h间均较术前明显升高(P<0.05),Ⅱ组患者术后MCA Vm无明显升高,两组MCA Vm在各时点差异有统计学意义(P<0.05)。Ⅰ组患者术后SjvO2较术前显著升高,并维持至拔管后2 h(P<0.05)。Ⅰ组MCA Vm和同时点MAP值均不存在线性相关,和同时点SjvO2值在术后各点均存在正相关关系(P<0.05)。结论仅Ⅰ组术后发生脑过度灌注,脑过度灌注程度与血压无线性相关关系。     

低潮气量对单肺通气患者动脉氧合及肺顺应性的影响

目的探讨低潮气量对单肺通气(OLV)患者动脉氧合及肺顺应性的影响。方法择期接受开胸手术患者90例,年龄(50±10)岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,随机分为3组(n=30):A组:大潮气量10 mL/kg;B组:低潮气量6 mL/kg;C组:低潮气量6 mL/kg+呼气末正压(PEEP)3 cm H2O。分别于OLV前(T0)、OLV后10 min(T1)、30 min(T2)、60 min(T3)和90 min(T4)监测血流动力学、动脉血气分析及气道压力平台压(Paw plat),并计算肺顺应性。结果与A组比较,B组和C组患者PaO2均降低(P<0.05),而B组和C组患者低氧血症发生率均明显升高(P<0.05)。结论单肺通气时,与大潮气量相比,小潮气量伴或不伴PEEP均更易引起低氧血症的发生。     

七氟醚与异丙酚对老年人腹部手术术后认知功能的影响

目的探讨七氟醚与异丙酚对老年人腹部手术术后认知功能的影响及S100β蛋白与术后认知功能障碍(POCD)的相关性。方法选择择期行腹腔镜下腹部手术的ASAⅠ~Ⅱ级老年患者40例,随机分为七氟醚组(S组)和异丙酚组(P组),每组20例。麻醉诱导后分别予1~1.3 MAC七氟醚(S组)和靶控输注2~4μg/mL异丙酚(P组)麻醉维持。记录手术结束后自主呼吸恢复时间、轻唤睁眼时间及拔管时间,于麻醉前、术后1、3、6、12、244、8 h采用简易智力状态检查表(MMSE)评价认知功能,并测定术前及术后1、62、4 h的血清S100β蛋白。结果两组患者术后自主呼吸恢复时间、睁眼时间、拔管时间及术前MMSE评分比较均差异无统计学意义(P>0.05)。与术前基础值比较,P组患者术后13、h和S组术后1、36、h MMSE评分均有明显下降(P<0.05),且S组术后13、h MMSE评分较P组低(P<0.05)。P组患者术后12 h已恢复至术前水平。S组术后24 h仍有1例患者存在POCD。两组患者术前S100β比较无差异。与术前基础值比较,P组和S组术后1 h S100β蛋白测定值均有明显升高(P<0.01),且S组术后16、...     

充气式止血带对下肢手术患者围术期肺换气功能的影响

目的 探讨充气式止血带对下肢手术患者围术期肺换气功能的影响.方法 选择美国麻醉医师协会(ASA)Ⅰ～Ⅱ级择期行单侧下肢手术上止血带时间超过60 min的患者11例(止血带组)和不上止血带下肢手术患者10例(对照组).分别于上止血带前或术前(T0)、松开后或手术结束后1/2 h(T1)、2 h(T2)、6 h(T3)、24 h(T4),取桡动脉血行血气分析,计算肺泡动脉氧分压差(PaA-aDO2)、呼吸指数(RI).结果 止血带组T3时刻氧分压(PaO2)较对照组明显降低,差异有统计学意义(P＜0.05).止血带组各时刻二氧化碳分压(PaCO2)与对照组比较,差异均无统计学意义(P＞0.05).止血带组T3PaA-aDO2较对照组明显升高,差异有统计学意义(P＜0.05).止血带组T3、T4 RI较对照组明显升高,差异有统计学意义(P＜0.05).结论 使用止血带时间超过60 min的下肢手术患者,在止血带松开后1 d内可发生肺换气功能损害,产生低氧血症,加强围手术期护理或常规给予吸氧极为重要.     

氟比洛芬酯用于妇科腹腔镜的临床观察

目的观察氟比洛芬酯用于腹腔镜术后全麻病人拔管的临床观察。方法 60例择期手术的患者随机分为两组,Ⅰ组病例于手术结束时静脉注入氟比洛芬酯注射液50mg（5mL）,Ⅱ组则注入5mL生理盐水。术中连续监测SpO2、ECG、HR、Bp和RR,并记录,手术结束时（T1）、拔管时（T2）、拔管后1min（T3）、5min（T4）和15min（T5）的SpO2、HR、MAP以及自主呼吸时的呼吸频率（RR）、潮气量值（VT）和呼气末二氧化碳分压（PET-CO2）以及从停药至患者自主呼吸恢复,呼之睁眼,抬头和手可指鼻的时间,并观察术后谵妄躁动的例数。结果Ⅰ组的生命体征较Ⅱ组更为平稳（P〈0.05）。Ⅰ组和Ⅱ组患者术后苏醒及意识恢复时间无显著差异（P〉0.01）,Ⅰ组谵妄发生例数明显少于Ⅱ组。结论氟比洛芬酯不会使全麻患者的苏醒时间延长,使患者在拔管时和苏醒期的生命体征更加平稳。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.