三药联合诱导对气管插管心血管反应的预防作用

目的: 比较静脉麻醉药三药联合诱导对气管插管心血管反应的预防作用。方法: 60例随机分为3组,分别以硫喷妥钠、丙泊酚和依托咪酯为主药,各以咪达唑仑和芬太尼为辅药的三药联合麻醉诱导,观察对气管插管前后血压和心率变化。结果: 气管插管时,硫喷妥钠组心率较基础值略有增快(P>0。05),而丙泊酚和依托咪酯组无明显变化;硫喷妥钠和依托咪酯组血压无明显变化,丙泊酚组则显著低于基础值(P<0。05)。诱导及插管后,丙泊酚组低血压和心动过缓发生例数稍高于硫喷妥钠组,而依托咪酯组无低血压发生。结论: 三药联合诱导时,丙泊酚可完全消除气管插管心血管反应,但易引起低血压和心动过缓,而硫喷妥钠和依托咪酯则只能分别消除血压升高和心率加快。     

分析丙泊酚联合依托咪酯诱导在老年人麻醉的临床效果

目的:分析丙泊酚联合依托咪酯诱导在老年人麻醉的临床效果.方法:选择我院2014年1月至2015年1月收治的老年患者100例 ,对照组患者给予丙泊酚诱导 ,实验组患者采用丙泊酚联合依托咪酯诱导.结果:两组患者在诱导麻醉后心率、血压均降低 ,但是实验组患者诱导后插管前和诱导前相比差异无统计学意义(P>0.05) ,和对照组患者诱导后对比 ,差异有统计学意义(P<0.05) ,对照组患者诱导后插管前与诱导前相比差异有统计学意义(P<0.05);气管插管后2分钟 ,两组患者的各项指标均增加 ,但是比较差异无统计学意义(P>0.05);实验组患者的不良反应发生率显著低于对照组患者 ,两者比较差异有统计学意义(P<0.05).结论:在老年患者麻醉中 ,应用丙泊酚联合依托咪酯进行麻醉诱导 ,具有较高的有效性和安全性 ,能让患者的血流动力学保持稳定 ,让不良反应发生率降低 ,值得临床推广和应用.     

老年人麻醉中丙泊酚与依托咪酯联合诱导作用分析

目的：：探讨丙泊酚联合依托咪酯对老年人实施麻醉时的诱导作用。方法：研究组给予丙泊酚联合依托咪酯诱导;对照组给予单纯丙泊酚诱导。记录2组患者不同时间段血流动力学变化情况及不良反应发生率,给予统计学分析后得出结论。结果：2组患者经不同方式诱导麻醉后血压、心率均较麻醉前有所下降,但研究组诱导后插管前与诱导前无显著变化,与对照组诱导后对比结果具有统计学意义(P<0.05),对照组诱导后插管前与诱导前具有显著差异(P<0.05),但气管插管后2分钟2组各项指标均上升(P>0.05);研究组不良反应发生率仅为5.71%,显著低于对照组不良反应发生率25.71%(P<0.05)。结论：使用丙泊酚联合依托咪酯对老年患者进行诱导麻醉安全性及有效性较高,在维持其血流动力学稳定基础上降低不良反应发生率,保障患者疗效及预后。     

全麻气管插管期间依托咪酯或丙泊酚对心率变异性的影响

目的:研究依托咪酯和丙泊酚在全麻诱导气管插管期间对自主神经系统功能的影响. 方法:利用心率变异功率谱分析(HRPSA)技术对90例择期腹部手术患者麻醉前、麻醉诱导后及气管插管后的心率变异性(HRV)改变进行研究. 结果:麻醉诱导后,依托咪酯组HRV总功率频段(TP)和其中低频段(LF),丙泊酚组LF、高频段(HF)、LF/HF(低频/高频比)及TP均显著降低(P<0.05),组间比较显示丙泊酚组LF与LF/HF降低程度显著大于依托咪酯组(P<0.05);气管插管后,两组LF,LF/HF及TP均显著升高(P<0.01),HF亦均显著升高(P<0.05),组间比较两组插管前后HRV各指标差值无显著性差异(P>0.05). 结论:丙泊酚在麻醉诱导时对自主神经功能的抑制作用强于依托咪酯;就控制插管引起的心血管反应而言,依托咪酯和丙泊酚的临床意义没有显著性差异.     

丙泊酚或依托咪酯在联合全麻诱导中预防气管插管心血管反应的临床观察

目的　评价丙泊酚或依托咪酯在联合全麻诱导中预防气管插管心血管反应的效果。方法　将 45例择期手术全麻气管插管病人随机分为三组 :Ⅰ组 (对照组 )、Ⅱ组 (丙泊酚 1.5mg/kg)及Ⅲ组 (依托咪酯 0 .3mg/kg)各 15例。Ⅰ组采用咪唑安定 0 .1mg/kg、芬太尼 5 μg/kg及维库溴铵 0 .1mg/kg诱导气管插管 ,Ⅱ和Ⅲ组诱导用药在Ⅰ组的基础上加用丙泊酚或依托咪酯 ,然后气管插管。监测BP和HR ,分别记录三组诱导前、后、气管插管后即刻及插管后 1、3、5min的BP和HR。结果　诱导后三组BP、HR均明显下降 ,与诱导前比较 ,P <0 .0 1或 0 .0 5 ,气管插管后即刻和插管后 1min ,Ⅰ组BP和HR超过诱导前水平 ,P <0 .0 5。而Ⅱ、Ⅲ组与诱导前比较差异无显著性 (P >0 .0 5 )。与Ⅰ组比较差异有显著性 (P <0 .0 5 )。结论　联合全麻诱导中辅助一定量的丙泊酚或依托咪酯均能较好地抑制气管插管的心血管反应。     

依托咪酯、瑞芬太尼在高血压患者全麻诱导气管插管中的应用观察

目的观察依托咪酯、丙泊酚分别与瑞芬太尼联合应用在高血压患者全麻诱导插管时的血流动力学影响的比较。方法60例行择期手术的高血压患者随机分成两组:依托咪酯 瑞芬太尼(A)组;丙泊酚 瑞芬太尼(B)组,每组各30例。观察并记录用药前后的各项指标。结果两组SBP、DBP、MAP在诱导后均下降(P<0.05),插管后上升(P<0.05)。A组发生低血压、心动过缓的例数明显少于B组;B组血压下降较A组幅度大。结论依托咪酯代替丙泊酚与瑞芬太尼行全麻诱导,可以使循环更趋稳定。     

无肌松药气管插管预防急性颅内血肿清除术患者反流误吸的效果

目的观察小剂量利多卡因-丙泊酚-瑞芬太尼无肌松药气管插管预防急性颅内血肿清除术患者麻醉诱导期反流误吸的效果。方法 60例急性颅内血肿清除术患者随机分为试验组和对照组各30例,试验组依次缓慢静脉注射小剂量利多卡因-丙泊酚-瑞芬太尼完成麻醉诱导气管插管,不用肌松药及面罩加压给氧去氮;对照组常规全麻诱导气管插管。观察2组气管插管条件满意情况、气管插管前后血流动力学变化情况和反流误吸发生情况。结果 2组气管插管条件满意情况差异无统计学意义（P〉0.05）;试验组气管插管前即刻和气管插管后即刻平均动脉压（MAP）和心率（HR）与麻醉诱导前及与对照组比较均降低（P〈0.05）,但均在临床允许范围,无需处理;2组各时点指脉血氧饱和度（SpO2）比较差异无统计学意义（P〉0.05）,但对照组中发生误吸者气管插管前即刻和气管插管后即刻均降至90%以下;试验组1例反流,无误吸,对照组8例反流,3例误吸,2组比较差异有统计学意义（P〈0.05）。结论小剂量利多卡因-丙泊酚-瑞芬太尼无肌松药气管插管可有效预防急性颅内血肿清除术患者麻醉诱导期反流误吸,气管插管条件满意,血流动力学变化在临床允许范围,值得推广。     

瑞芬太尼联合丙泊酚与依托咪酯靶控输注(TCI) 在全麻诱导中的临床观察

目的 观察瑞芬太尼联合丙泊酚与依托咪酯靶控输注(TCI)在全麻诱导中的应用.方法 选择择期全麻手术ASAⅠ～Ⅱ级病人40例,随机分为丙泊酚联合瑞芬太尼组(P组n=20);依托咪酯联合瑞芬太尼组(E组n=20).两组诱导均采用血浆靶控静脉输注,复合咪达唑仑0.05mg/kg,维库溴胺0.1mg/kg,选择BIS在40～60之间做气管插管,分别观察并记录两组病人麻醉前、气管插管前1min、气管插管后1min、气管插管后5min时收缩压(SBP)舒张压(DBP)心率(HR)的变化.结果 P组病人麻醉前MAP明显高于气管插管前后1min 和插管后5min,E组病人前管插管前后1min和插管后5minMAP较麻醉前轻度降低(p>0.05) 结论 瑞芬太尼联合丙泊酚与依托咪酯靶控输注(TCI)在全麻诱导中对血流动力学变化影响较小,而瑞芬太尼联合依托咪酯靶控输注(TCI)在全麻诱导中更能保持患者血流动力学的稳定.     

依托咪酯与丙泊酚对老年患者全麻诱导期间血流动力学影响的比较

目的 探讨依托咪酯和丙泊酚全麻诱导气管插管期间血流动力学的影响.方法 选择ASAⅡ～Ⅲ级择期全麻手术病人6O例,随机分为依托咪酯组(Ⅰ组,n=30)和丙泊酚组(Ⅱ组,n=30).麻醉诱导Ⅰ组给予瑞芬太尼、依托咪酯乳剂、罗库溴铵;Ⅱ组给予瑞芬太尼、丙泊酚、罗库溴铵.记录入室、插管前及插管后1分钟、3分钟时的血流动力学变化.结果 Ⅰ组平均动脉压(MAP)无明显变化,Ⅱ组 MAP 明显降低,组间比较 T1～T3 时间点两组间差异有显著性;两组间心率诱导后均较诱导前基础值相比稍减慢,但组间、组内比较差异无显著性.结论 麻醉诱导插管期间依托咪酯对血流动力学影响显著低于丙泊酚,因而老年患者麻醉诱导插管依托咪酯优于丙泊酚.     

依托咪酯和丙泊酚用于困难气道诱导插管的效果比较

目的比较依托咪酯和丙泊酚用于困难气道诱导插管的安全性和有效性。方法将40例择期腹部手术患者（ASA分级Ⅰ～Ⅱ级）随机分为依托咪酯组和丙泊酚组,进行诱导气管插管。记录入室后、插管前即刻、插管后1min、插管后5min的平均动脉压（MAP）和心率（HR）,血氧饱和度（SpO2）从100%下降到90%的时间、意识消失时间和自主呼吸恢复时间。结果与基础值相比,依托咪酯组插管前即刻MAP的变化幅度（%）小于丙泊酚组（P〈0.01）。依托咪酯组SpO2从100%下降到90%的时间和自主呼吸恢复时间短于丙泊酚组（P〈0.01）。结论在困难气道患者诱导插管中,依托咪酯对循环系统影响小,自主呼吸恢复快,安全性较好。     

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…     

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.     

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.