小剂量多巴胺对肾移植患者围术期β_2微球蛋白的影响

目的观察小剂量多巴胺对肾移植患者围术期β_2微球蛋白(β_2-MG)的影响。方法对40例肾移植术患者随机分为多巴胺组和对照组,各20例。术中分别以多巴胺和0.9%氯化钠微泵持续静推,速度为2μg/kg·min~(-1)。观察出尿时间、移植肾血管开放后1h总尿量、移植肾血管开放后6h总尿量;手术开始(T_1)、移植肾动脉开放前10min(T_2)、移植肾动脉开放后10min(T_3)、移植肾动脉开放后1h(T_4)、移植肾动脉开放后6h(T_5)等5个时间点的静脉血中β_2-MG结果。结果多巴胺组出尿时间显著快于对照组(P<0.05);多巴胺组移植肾动脉开放后1h总尿量、移植肾动脉开放后6h总尿量显著高于对照组(P均<0.01)。移植肾血管开放后10min、移植肾血管开放后1h、移植肾血管开放后6h的血中β_2-MG水平,与手术开始的血中β_2-MG水平对比并无变化(P>0.05)。而且移植肾血管开放后6h总尿量与静脉血中β_2-MG结果无直线相关关系(r=-0.0839,P>0.05)。结论术中使用多巴胺以2μg/kg·min~(-1)的速度微泵持续静推,对围术期(手术开始至移植肾血管开放后6h)血中β_2-MG水平并无影响。     

小剂量多巴胺在肾缺血-再灌注损伤中的抗损伤作用

目的 探讨多巴胺在抗肾缺血-再灌注中损伤中的作用及其可能的作用机制.方法 选取体质量(2.1±0.2)kg的日本大耳白兔23只,随机分为生理盐水对照组(n=11)和多巴胺组(n=12),采用双盲法,通过夹闭家兔肾动脉的方式建立肾缺血模型,两组家兔在实验过程中分别持续静滴生理盐水或多巴胺1.5～2μg/(kg·min).分别于夹闭肾动脉前和缺血50 min再灌注30 min后取家兔肾静脉血,检测血肌酐(Scr)、血尿素氮(BUN)和丙二醛(MDA),并记录缺血再灌注前后的尿量.结果 两组血肌酐、血尿素氮和丙二醛在再灌注后较夹闭前均明显升高(P<0.05);再灌注30 min后对照组各指标升高更明显(P<0.05),而尿量无明显统计学差异(P>0.05).结论 小剂量多巴胺对肾缺血-再灌注损伤具有抗损伤保护作用,其作用机制可能与抗氧化作用有关.     

小剂量阿斯匹林对受体大鼠慢性移植肾肾病的治疗作用

目的观察小剂量阿斯匹林对同种异基因移植受体大鼠慢性移植肾肾病的作用并探讨可能的作用机制。方法建立大鼠肾移植慢性排斥反应模型,移植受体大鼠随机分为2组(n=10),均自术前1d开始每日以环孢素A5mg/kg灌胃,治疗组每日给予阿斯匹林5mg/kg灌胃,对照组每日给予生理盐水2ml灌胃,术后8周采静脉血测定血清肌酐、尿素氮水平;处死动物取移植肾组织进行H-E染色及免疫组化染色(测定TGF-β1表达)。结果阿斯匹林治疗组大鼠血肌酐、尿素氮升高程度,组织病理损害及TGF-β1表达程度均较生理盐水对照组轻(P<0.05)。结论肾移植术后在常规抗排斥治疗基础上使用小剂量阿斯匹林对慢性移植肾肾病有治疗作用,其机制可能与致纤维化因子TGF-β1的表达减少有关。     

氯胺酮抗肾移植术中脂质过氧化的临床研究

目的：观察氯胺酮抗肾移植术中脂质过氧化及对术后早期肾功能的影响。方法：选择26例肾移植患者分为两组，每组各13例。实验组于血管吻合开始后加氯胺酮0．2mg／kg静脉注射，对照组同时点加生理盐水2ml。分别于血管吻合开始前（T1）、动脉开放后5min（T2）、动脉开放后30min（T3）、动脉开放后60min（T4）取血测定丙二醛（MDA）、超氧化物歧化酶（SOD）。并记录术后第1天、第2天、第3天、第6天的肌酐和尿素氮值及尿量。结果：随动脉开放，MDA、SOD上升，T4最高。组间T2、T3、T4三个时间点MDA和SOD差异均有显著性（P〈0．05）。术后血肌酐、尿素氮和尿量：组间术后第6天差异有显著性（P〈0．05）。结论：亚麻醉剂量氯胺酮可通过抗肾移植术中脂质过氧化，改善肾移植术后早期肾功能。     

硬膜外麻醉用于同种异体肾移植术的管理

目的　探讨同种异体肾移植手术患者应用硬膜外麻醉一点法围术期血流动力学的变化和麻醉管理方法。方法　观察 5 0例同种异体肾移植患者麻醉前 (T1)、肾动静脉血流开放前 (T2 )、血流开放后 10min(T3 )和手术结束时 (T4)各时点平均动脉压 (MAP)、中心静脉压 (CVP)和心率 (HR)的变化。结果　T2 、T3 和T1相比 ,MAP有显著降低 (P <0 .0 5 ) ,经扩容及小剂量多巴胺 (2～ 5 μg·kg-1·min-1)持续泵入 ,MAP波动小于麻醉前的 2 0 %。T3 与T1相比 ,CVP、HR显著升高 (P <0 .0 5 ) ;T2 、T4与T1比较无显著差异。结论　连续硬膜外麻醉用于同种异体肾移植术的过程中 ,阻滞平面易于调控 ,血流动力学波动较小 ,是肾移植术较为理想的麻醉方法     

全麻和腰-硬联合麻醉对肾移植术后患者早期肾功能的影响

目的:探讨全麻(GA)和腰-硬联合麻醉(CSEA)对肾移植术后患者肾功能的影响是否存在差异。方法:择期行肾移植手术的尿毒症患者80例,随机分为2组(GA组和CSEA组),每组40例。记录移植肾血流开放后24h内每组患者的总尿量和血肌酐下降百分比。结果:GA组开放后24h内尿量为(10320±3640)ml,血肌酐下降百分比为(40±13)%;CSEA组开放后24h内尿量为(9850±3470)ml,血肌酐下降百分比为(41±12)%。组间比较差异没有统计学意义(P>0.05)。结论:全麻和腰-硬联合麻醉2种麻醉方法对肾移植术后患者肾功能的影响无差别。     

硬膜外自控镇痛对同种异体肾移植术后肾功能的影响

目的 观察硬膜外自控镇痛(PCEA)在同种异体肾移植患者术后镇痛效果及对移植肾功能恢复的影响.方法 同种异体肾移植手术病人80例,ASAⅡ～Ⅲ级,采用腰-硬联合麻醉完成手术,术后随机分为2组,每组40例).PECA组选择负荷剂量 持续剂量 PCA给药模式,镇痛药为0.75%罗哌卡因30mL,曲马多600mg,用生理盐水配置成150ml的混合液;对照组不给术后镇痛.两组分别于麻醉前、手术后24h、48h、72h抽取静脉血采用放射免疫法测定血内皮素及尿素氮、肌酐及尿酸,观察记录术后1h、4h、8h、12h、24h、48h、72h的心率、血压、SpO2、尿量及VAS评分.结果 PCEA组镇痛效果满意,副作用少.两组术前血压较高,自控镇痛组平均动脉压(MAP)术后迅速下降,术后72h接近正常(P＜0.01);非自控镇痛组此变化不明显;组间比较差异显著(P＜0.01),两组术后24h血浆内皮素、尿素氮、肌酐及尿素含量明显下降;手术后72h均达到各自的最低水平,但非自控镇痛组各时点测定值明显高于同时点自控镇痛组(P＜0.01).结论 硬膜外自控镇痛有利于减轻同种异体肾移植术后疼痛刺激对生理功能的扰乱,有利于移植肾功能的恢复.     

前列腺素E_1应用于肾移植受者的实验及临床观察

为探讨前列腺素E1(PGE1)应用于肾移植患者的免疫抑制机制 ,及其对肾移植受者的影响 ,进行 :1 )基础实验 :选取正常人 1 6例及尿毒症患者 1 0例 ,取其外周血淋巴细胞 ,体外用植物血凝素 (PHA)刺激 ,检测PGE1对淋巴细胞增生的抑制能力。 2 )临床观察 :对 1 4例 (A组 )肾移植受者术后持续应用PGE12 0 μg/d ,与同期 1 1例 (B组 )未使用PGE1的肾移植受者相比 ,比较 2组术后血肌酐、尿素氮、血流变学以及 2组急性排斥反应的发生率。结果 :体外实验显示PGE1可以抑制PHA刺激的T淋巴细胞增生 ;术后 5dA组的尿量比B组明显增多 (P <0 .0 5 ) ;术后 1 4dA组的肌酐、尿素氮比B组明显减少 (P <0 .0 5 ) ;术后A组的血黏度、红细胞刚性指数、血小板聚集率等血流变学参数明显好于B组 (P <0 .0 5 ) ;术后A组的急性排斥反应发生率 (1 4.3 % )低于B组 (3 6.4% )。提示 :PGE1在体外可以抑制PHA刺激的T淋巴细胞增生 ,且呈剂量依赖关系 ;肾移植患者术后应用PGE1可以明显改善移植肾功能 ,对降低急性排斥反应的发生率可能有一定的作用     

多巴胺对体外循环下冠状动脉旁路移植术患者肝脏血流量的影响

目的:观察体外循环期间持续输注多巴胺对患者肝静脉血流动力学的影响?方法:选择20例择期行冠状动脉旁路移植术(CABG)患者,随机分成多巴胺组和对照组,多巴胺组在体外循环开始时泵注2 μg/(kg?min)多巴胺,分别于全麻诱导后(T0)?体外循环开始后5 min(T1)?体外循环后30 min(T2)及体外循环停机后30 min(T3),记录血流动力学变化(心率?血压等)及肝静脉血流相关指标(肝静脉直径?流速等)?比较术前与术后第1天肝肾功能的变化?结果:两组体外循环后血压均下降,多巴胺组停机后心率较对照组增快(P < 0.05);多巴胺组体外循环期间肝静脉血流量较术前有所上升(P < 0.05),但与对照组比较差异无统计学意义?与对照组相比,多巴胺组肌酐及尿素氮下降?结论:持续泵注2 μg/(kg?min)小剂量泵注多巴胺可能增加肝静脉血流,但仍需进一步研究合适的多巴胺剂量使其达到更好的临床效果?     

围体外循环期应用小剂量多巴胺对肾脏的作用

目的:探讨围体外循环(CPB)期应用小剂量多巴胺对肾脏功能的影响.方法:选取48例无肾脏疾病行CPB心内直视手术的病人,将其随机分成两组,两组均采用静-吸全麻外,A组术始即以小剂量多巴胺持续泵注,余处理与B组相同.观察术前、术毕及术后24小时两组患者血尿素氮(BUN)、血肌酐(Cr)、尿蛋白及尿量等肾功能指标,了解肾损害情况.结果:应用小剂量多巴胺组与对照组的BUN、Cr、尿蛋白在术前、术毕及术后24小时比较差异均无统计学意义,而两组患者的尿量术毕及术后24小时差异有统计学意义,应用多巴胺组的尿量较对照组明显增加.结论:围体外循环期应用小剂量多巴胺对肾脏功能无保护作用.     

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…     

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.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.