艾司洛尔复合异丙酚缓解气管插管时应激反应的剂量水平的调查分析

目的探讨非心脏手术患者应用艾司洛尔预防气管插管引起血流动力学变化的合理剂量水平。方法 33例患者随机分为3组。T_0组为对照组(11例),T_1组为0.5 mg/kg艾司洛尔组(11例),T_2组为1 mg/kg艾司洛尔组(11例)。静注异丙酚和维库溴铵诱导气管内捅管。监测插管后1 min、3 min、5 min及10 min收缩压、舒张压和心率(HR);并抽取不同时间血标本用高压液相色谱仪测血浆中去甲肾上腺素(NE),肾上腺素(E)和多巴胺(DA)浓度。结果与基础值比,T_0组插管后1 min时血压和心率显著升高(p0.05或P0.01)。T_1组插管后3 min、5 min及10 min时血压和心率显著降低(P0.01或P0.05);3 min及5 min时去甲肾上腺以及肾上腺素水平显著升高(P0.01或P0.05)。T_2组心率、血压、去甲肾上腺素及肾上腺素水平显著降低(P0.01或P0.05),与T_1组比较,插管后1 min和3 min时肾上腺素水平显著降低(P0.01)。结论 1.0 mg/kg艾司洛尔复合异丙酚可缓解插管时循环反应及儿茶酚胺反应。     

全身麻醉复合硬膜外阻滞麻醉与单纯全身麻醉在腹腔镜手术中的应用

目的:观察全身麻醉复合硬膜外阻滞麻醉和单纯全身麻醉应用于腹腔镜手术中。CO2气腹对血流动力学和血浆儿茶酚胺浓度的影响及术后苏醒认知功能的影响。方法:60例腹腔镜手术患者(其中胆囊切除40例,腹股沟疝修补10例,子宫肌瘤和卵巢肿切除10例),随机分为全身麻醉复合硬膜外麻醉组(A组,30例),用高效液相色谱-电化学检测气腹前后血浆肾上腺素(E)和去甲上腺浓度(NE)。结果:血浆NE、E浓度变化:气腹时A组无明显变化(P>0.05),B组增加明显(P>0.05)。血流动力学变化:气腹时A组除CVP明显上升外,其余备指株无明显变化,B组HR、MAP、CVP均明显增加。苏醒24 h时,A组认知功能恢复到术前水平,B组仍低于术前水平。结论:全身麻醉复合硬膜外阻滞麻醉施行腹腔镜下手术,能减轻应激反应,稳定血流动力学,术后苏醒及认知功能恢复较快。     

依那普利的血液动力学作用及其对激素代谢的影响

本文旨在研究口服单剂(5 mg及10mg)依那普利后动脉血压、心指数(CT)、外周血管阻力(PVR)、肺毛细血管嵌楔压(PCWP)的变化及其对血浆肾素活性(PRA)、血管紧张素Ⅰ,Ⅱ(AⅠ,AⅡ)水平,转换酶活性(ACEA)和血浆醛固酮(PA)、去甲肾上腺素(NE)、肾上腺素(E)浓度的影响。结果表明:(1)服药后12 h,血压、PVR,PCWP显著降低,CI 显著升高;(2)治疗后 PRA 及 AI 水平升高,AⅡ,PA,ACEA,NE,E 浓度均显著降低,说明典血液动力学作用与抑制肾素-儿茶酚胺的代谢有关,与剂量无明显相关。     

检测脐血及羊水中儿茶酚胺水平诊断胎儿窘迫

吉林医学院附属医院张菊青等,应用高效液相色谱技术对足月正常分娩儿(11例),胎儿窘迫儿(30例)的脐动脉血浆及足月后羊水(36例)中儿茶酚胺水平进行了测定。 结果表明:胎儿窘迫时,儿茶酚胺水平升高,以去甲肾上腺素(NE)、肾上腺素(E)为主,其增高的程度与新生儿窒息发生率有关,并与Apgar     

中药复方拮抗小鼠运动应激时血中儿茶酚胺升高

目的：观察人参、麦冬、葛根等提取物以及速效救心丸对小鼠运动应激时血中儿茶酚胺水平的影响。方法健康ICR小鼠置跑步机上跑10min造成运动应激，用高效液相色谱－电化学联合检测法测定运动应激动物血浆中儿茶酚胺水平。结果：运动应激小鼠血浆中去甲肾上腺素和肾上腺素显著增加（P＜0．01），小鼠ig人参、麦冬、葛根等提取物以及速效救心丸1h后再运动应激可拮抗血心中去甲肾上腺素升高（P＜0．01）。结论：小鼠运动应激可使交感神经激活，导致血中去甲肾上腺素释放增加，人参、麦冬、葛根提取物和速效救心丸可拮抗抗之。     

丙泊酚复合瑞芬太尼麻醉对外科手术患者orexin A水平的影响

目的：通过检测丙泊酚复合瑞芬太尼全麻外科手术患者血浆中orexin A及去甲肾上腺素水平,研究全麻是否会引起血浆中ORX-A和去甲肾上腺素浓度发生变化。方法选取大庆龙南医院30例ASAI～I级择期外科手术患者,采用丙泊酚复合瑞芬太尼全身麻醉。分别于诱导前、诱导后1 h、诱导后2 h及拔管后15 min采桡动脉血测定血浆中ORX-A、丙泊酚及儿茶酚胺浓度。结果麻醉期间血浆ORX-A无明显变化,拔管后15 min后明显增加。麻醉期间血浆去甲肾上腺素浓度无明显变化,拔管后15 min后显著增加。与麻醉前比较,血浆肾上腺素浓度在麻醉期间及麻醉后无显著变化。血浆ORX-A浓度与血浆去甲肾上腺素浓度有明显的相关性（P＜0.05）,血浆中丙泊酚浓度与血浆中ORX-A浓度也明显相关联（P＜0.05）,与血浆中去甲肾上腺素浓度显著相关（P＜0.01）。BIS值随丙泊酚浓度增加而降低（P＜0.01）,而随ORX-A浓度及去甲肾上腺素浓度增加而升高（P＜0.05）和（P＜0.01）。血糖浓度在麻醉前（113±6）mg/dL及拔管后15 min（121±7）mg/dL无明显改变。结论血浆中ORX-A和去甲肾上腺素在丙泊酚-芬太尼全麻拔管后15 min明显增加。     

单纯硬膜外阻滞对腹腔镜腹股沟疝修补术应激反应的影响

目的：观察硬膜外阻滞麻醉用于腹腔镜腹股沟疝修补术对血浆肾上腺素、去甲肾上腺素及血流动力学的影响。方法：拟行腹腔镜经腹腔腹膜前网片腹股沟疝修补术患者行硬膜外麻醉。监测麻醉前，手术开始前即刻，气腹后5min、30min,术毕30min各时点血浆NE、E浓度，并记录HR、MAP值。结果：各时点浓度无明显改变，手术开始前即刻及气腹后E明显增高（P〈0．05），术后30min基本恢复；手术开始前即刻HR略有升高，气腹后HR、MAP基本正常。结论：硬膜外麻醉能较好地抑制腹腔镜腹股沟疝修补术的应激反应。     

艾司洛尔抑制气管插管反应机制的探讨——血浆儿茶酚胺水平与脑电双频指数的关系

目的:观察艾司洛尔对丙泊酚麻醉诱导气管插管时血浆儿茶酚胺水平与脑电双频指数(BIS)变化的关系,探讨艾司洛尔抑制气管插管反应的机制.方法:30例患者随机分为两组即对照组及用药组.对照组静脉注射生理盐水10 mL负荷量后静脉滴注生理盐水;用药组将艾司洛尔1 mg/kg稀释于生理盐水10 mL中静脉注射后以250 μg/(kg·min)微量泵输入,然后行全麻诱导气管插管.两组分别于麻醉诱导后气管插管前和插管后3 min时记录患者脑电双频指数(BIS)、收缩压(SP)、舒张压(DP)和心率(HR),同时分别抽取8 mL动脉血标本用于测定血浆肾上腺素(E)和去甲肾上腺素(NE)浓度.结果:插管后3[KG*2]min,对照组BIS(63.53±3.11)、NE(2.02±0.68)和E(0.58±0.07)分别高于插管前水平的BIS(42.6±3.46)、NE(1.63±0.38)和E(0.54±0.04),P均＜0.05,用药组BIS、NE、E水平无明显改变.插管后3 min,对照组NE(2.02±0.68)和E(0.58±0.07)高于用药组NE(1.84±0.43)和E(0.53±0.04)(P＜0.05),对照组BIS(63.53±3.11)和△BIS(20.93±4.57)明显高于用药组的BIS(43.13±3.16)和△BIS(7.53±3.0)(P＜0.01),对照组插管后SP(148±20)和HR(89±180)高于插管前水平(P＜0.05);用药组插管后SP、DP和HR与插管前相比无明显改变.结论:艾司洛尔通过抑制气管插管时外周交感神经的兴奋,直接减少血浆中NE和E的释放,推论其可能间接减少中枢NE和E的浓度,而抑制气管插管后BIS的反应性增加.     

不同分泌类型嗜铬细胞瘤的围手术期血流动力学变化

目的 分析分泌不同类型儿茶酚胺的嗜铬细胞瘤围术期血流动力学变化特点.方法 回顾分析1997年1月至2007年7月北京协和医院收治的202例经手术治疗的嗜铬细胞患者的临床资料.按24 h尿儿茶酚胺含量对患者进行分组,分为.肾上腺素高分泌组(高E)和低分泌组(低E),去甲肾上腺素高分泌组(高NE)和低分泌组(低NE)及多巴胺高分泌组(高DA)和低分泌组(低DA),分析肿瘤分泌类型与围术期血流动力学变化特点之间的关系.结果 术前最高收缩压,高E[(201±40)mm Hg]及高NE组[(205±38)mm Hg]显著高于低E[(183±43)mm Hg,P=0.003]及低NE组[(181±43)mm Hg,P=0.000].高E组术中收缩压波动显著高于低E组[(108±39)mm Hg vs(91±33)mm Hg,P=0.001];术后顽固低血压的发生率高NE(23.3%,20/86)及高DA组(32.7%,17/52)显著高于低NE组(2.6%,3/116,P=0.000)及低DA组(4.0%,6/150,P=0.000).结论 肾上腺素高分泌的患者术中易发生较大的血压波动;去甲肾上腺素或多巴胺高分泌的患者术后易发生顽固低血压.     

两种麻醉方法对腹腔镜气腹的应激反应变化的作用

目的　观察全身麻醉和全麻复合硬膜外麻醉用于腹腔镜胆囊切除术 (LC)中CO2 气腹对血浆儿茶酚胺浓度的影响。方法　 18例行腹腔镜胆囊切除患者 ,随机分成全麻组 (A组 ,10例 )和硬膜外 全麻组 (B组 ,8例 ) ,采用高效液相色谱测定气腹前后血浆肾上腺素 (E)和去甲肾上腺素 (NE)浓度。结果　气腹时血浆肾上腺素 (E)和去甲肾上腺素 (NE)浓度A组均明显增加 (P <0 0 5 ) ,B组无明显变化 (P >0 0 5 )。结论　全麻复合硬膜外麻醉下施行腹腔镜胆囊切除术能减轻患者术中应激反应。     

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…