依达拉奉预处理对老年患者全麻控制性降压手术后认知功能的影响

目的观察自由基清除剂依达拉奉预处理对老年患者全麻控制性降压手术后认知功能(POCD)的影响。方法选择行髋关节置换术的老年患者50例,年龄≥65岁,ASAⅠ～Ⅱ级,简易智能状态检查(MMSE)评分24分,随机分为E组和C组。全麻后采用硝酸甘油和瑞芬太尼行控制性降压。E组在控制性降压实施前按0.5 mg/kg预注依达拉奉,C组为对照组。分别于术前1 d、术后1、3和7 d通过MMSE对认知功能进行评估。结果 E组和C组术后1、3 d MMSE评分均较术前降低(P0.05),但E组术后1、3 d MMSE评分均高于C组(P0.05)。POCD发生例数E组低于C组。结论依达拉奉预处理可降低老年患者全麻控制性降压手术后MMSE评分,减少术后早期POCD的发生。     

临床用药研究依达拉奉在心脏不停跳手术中对心肌的保护作用

目的 探讨依达拉奉在心脏不停跳手术中对心肌的保护作用.方法 将60例需行二尖瓣置换术(MVR)的风湿性心脏病患者随机分成依达拉奉组(E组)30例,对照组(C组)30例.E组于预充液中按0.5 mg/kg加入依达拉奉,C组加入等量生理盐水.分别于术前(T1)、转机30 min(T2)、停机(T3)、术毕(T4)、术后24...     

经皮穴位电刺激治疗老年患者全麻腹部手术后认知功能障碍临床观察

<正>术后认知功能障碍(postoperative cognitive dysfunction,POCD)是麻醉手术后常见的中枢神经系统并发症,多见于老年患者,主要表现为精神错乱、焦虑、人格改变以及记忆受损,社交能力及认知能力的减退,严重影响患者术后康复[1]。老年患者全麻腹部手术后POCD发生率较高,研究[2]表明,电针刺治疗能够有效预防和治疗老年患者全麻腹部手术后     

依达拉奉对老年患者髋关节置换术术后谵妄的影响

目的术后谵妄(postoperative delirium,POD)是老年患者术后常见的中枢神经系统并发症,文中评价依达拉奉对髋关节置换术老年患者术后谵妄的作用。方法 2012年6月至2014年3月间在南京军区南京总医院蛛网膜下腔麻醉下行单侧髋关节置换术的老年患者246例,随机数字表法分为依达拉奉组和对照组。依达拉奉组于麻醉诱导前静脉给予依达拉奉30 mg,对照组给予等量等渗盐水。术前1 d及术后1 d采用意识混乱评估法对患者进行评估,记录患者一般临床资料并观察患者住院时间、术后急性肺栓塞、心肌梗死、脑梗死及POD发生率;于术前1 d及术后1 d测定血浆丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、神经原特异性烯醇化酶(neuron-specific enolase,NSE)及S100β蛋白(S100β)表达水平。结果 2组患者住院时间与围术期急性肺栓塞、心肌梗死及脑梗死发生率比较结果差异无统计学意义(P>0.05);依达拉奉组POD发生率明显低于对照组(17.7%vs 30.3%,P<0.05)。2组患者术前血浆MDA、SOD、NSE及S100β比较差异无统计学意义(P>0.05)。依达拉奉组术后1 d血浆MDA及NSE均明显低于对照组,分别为[(2.2±0.5)nmol/L vs(3.6±0.7)nmol/L,P<0.05]和[(6.3±2.2)μg/L vs(8.6±2.8)μg/L,P<0.05]。结论依达拉奉可降低髋关节置换术老年患者POD的发生率,在临床应用中具有促进神经功能康复的作用。     

氧化应激反应对老年患者炎症反应及术后认知功能障碍的影响

目的观察氧化应激反应对全身麻醉术后炎症反应及认知功能障碍(POCD)的影响。方法选择择期腹部手术行全身麻醉的患者60例,年龄60-75岁,随机分为2组:依达拉奉组(n=30)和对照组(生理盐水组,n=30),两组麻醉方法相同。依达拉奉组麻醉前静脉注射依达拉奉30 mg。对照组则于依达拉奉组相对应时间和途径注入相同容积的生理盐水。分别于麻醉后手术前(T1)、手术结束后即刻(T2)、手术结束后24 h(T3)抽取静脉血测定血浆IL-6含量及外周血中性粒细胞NF-κB表达水平。术前1或2 d以及术后第1,3,7天用《简易智能量表》测定认知功能,使用《简易精神测定表》评定术后谵妄。结果 14例患者出现认知功能障碍(23.33%),其中依达拉奉组4例,对照组10例;两组间差异有显著性(P<0.05)。两组T2、T3时点外周血中性粒细胞NF-κB表达均较T1增加(P<0.05),但依达拉奉组表达水平低于对照组(P<0.05)。两组T2时点血浆IL-6水平均较T1明显升高(P<0.01),且对照组血浆IL-6水平显著高于依达拉奉组(P<0.01);两组T3时点血浆IL-6水平较T2时点明显下降,但仍高于T1(P<0.05);T3时点两组间差异没有统计学意义(P>0.05)。依达拉奉组外周血中性粒细胞NF-κB表达水平与血浆IL-6有良好的相关性(r=0.69,P<0.01)。结论 POCD的发生与氧化应激反应有关,抑制NF-κB的激活可减少术后炎症反应及POCD的发生。     

术后认知功能障碍研究进展

正术后认知功能障碍(postoperative cognitive dysfunction,POCD)是手术麻醉清醒后常见的中枢神经系统并发症。本文对POCD的概念、发病机制以及影响因素等研究进展作一综述。1概念和诊断POCD亦称术后认知功能损伤、术后认知功能缺     

依达拉奉对行控制性降压后老年患者认知功能的影响

目的观察和分析依达拉奉对行控制性降压后老年患者认知功能的影响。方法对60例全麻下行髋部手术中行控制性降压的老年患者随机分为2组,各30例,麻醉诱导前E组通过微量泵输注30mg依达拉奉,C组输注生理盐水,给予观察两组相关指标。结果组间手术时间、出血量、术中控压时间、术后拔管时间差异无统计学意义(P0.05);S100-β、TNF-a、IL-6、IL-10、MDA和SOD水平差异有统计学意义(P0.05);MMSE评分中术前术后差异有统计学意义(P0.05)。结论依达拉奉对行控制性降压后老年患者认知功能具有降低发生率和改善发病程度的作用。     

下肢神经阻滞复合喉罩全身麻醉对老年单膝关节置换术患者术后认知功能的影响

目的:研究下肢神经阻滞复合喉罩全身麻醉法对老年单膝关节置换术患者术后认知功能的影响。方法:将86例择期行单膝关节置换术的老年患者随机分为观察组和对照组,每组各43例。观察组患者采用下肢神经阻滞复合喉罩全身麻醉法;对照组患者采用气管插管全身麻醉法。对比两组患者围手术期平均动脉压(MAP)和简易精神状态量表(MMSE)评分。结果:在麻醉前(T0)及术后6 h(T5)两个时间点上,两组患者的MAP值无明显差异(P>0.05);观察组患者的MAP值在置入喉罩或气管插管成功后1 min(T1)、使用止血带60 min(T2)及拔出喉罩或气管导管后1 min(T4)均明显低于对照组(P<0.01),而在松开止血带5 min(T3)明显高于对照组(P<0.01);在术后6 h及术后12 h,观察组患者的MMSE分值均明显高于对照组(P<0.01);观察组的POCD发生率为9.30%,对照组为25.58%,观察组患者的POCD发生率低于对照组(P<0.05)。结论:在老年单膝关节置换术患者中采用下肢神经阻滞复合喉罩全身麻醉,相较于气管插管全身麻醉对其围手术期生理指标影响更小,同时对术后认知功能影响更小,有助于降低患者术后POCD发生。     

依达拉奉对心脏瓣膜置换术患者脑保护作用的临床观察

目的:探讨自由基清除剂依达拉奉对心脏瓣膜置换术患者围心肺转流(CPB)期对脑保护作用。方法:选择行二尖瓣或主动脉瓣置换术患者30例随机分为试验(E)组和对照(C)组,每组15例。E组采用依达拉奉30 mg,加入生理盐水100 mL中,于CPB前30 min内静脉输注;C组输入等量生理盐水。分别于手术开始时(T1)、CPB结束时(T2)、结束后6(T3)、24(T4)、48(T5)和72 h(T6)测量血清神经元特异性烯醇化酶(NSE)(T1~T6)、S-100BB(T1~T5)水平。记录术后神经系统并发症的发生情况。结果:C组NSE在T2、T3和T4均显著升高(P<0.01)且明显高于E组(P<0.05),48 h后降至正常范围。E组在T2和T3显著升高(P<0.01),24 h后降到正常范围。2组血清S-100BB蛋白峰值均出现在CPB结束时(T2),且明显升高(P<0.01)。C组CPB结束时血清S-100BB蛋白明显高于E组(P<0.05),C组CPB结束后6、24h较E组高,但无显著性差异。E组术后谵妄1例,认知功能障碍7例;C组术后谵妄3例,认知功能异常9例。结论:依达拉奉可减少脑损伤蛋白S-100BB、NSE在围CPB期的表达,对心脏瓣膜手术患者有一定脑保护作用。     

老年患者术后认知功能障碍病因的研究进展

术后认知功能障碍(postoperative cognitive dysfunction,POCD)是老年患者手术后常见的中枢神经系统并发症。目前病因尚不清楚,该病可持续数月或数年,甚至发生永久性认知功能障碍,严重影响患者生活质量并对家庭和社会造成严重的负担。本文就POCD病因方面研究进展进行综述。     

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.     

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.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…