半椎板切除在椎管内占位病变手术中的应用(附7例分析)

1 对象与方法 1.1 临床资料 2005年4月～2005年12月，我们采用完全或部分半椎板切除入路手术治疗7例椎管内占位病变，其中男3例，女4例；平均年龄55.2岁。     

小剂量阿斯匹林致61例上消化道出血临床分析

阿斯匹林是一种临床常用的非甾体类抗炎药物,具有解热、镇痛、消炎、抗风湿等作用.近年来研究发现阿斯匹林具有降低血小板聚集性的作用.随着社会老龄人口的增长,心、脑血管疾病发病率的显著增加,小剂量肠溶阿斯匹林广泛用于防治心、脑血管缺血性疾病,取得了较好的疗效,但阿斯匹林的胃肠道副作用也随之增多,特别是引起上消化道出血病例,严重威胁中老年病人健康.     

硬膜外复合吸入全麻用于肝叶切除3 858例总结

目的：考察硬膜外复合吸入全麻用于肝叶切除手术的优缺点，以探讨较为理想的肝脏手术麻醉方法。方法：比较硬膜外复合吸入全身麻醉（n=3858)，单纯硬膜外麻醉（n=100)及单纯全麻（n=100)患者行肝叶切除术中生命体征，麻醉药用量及术后苏醒情况的差异。结果：硬膜外复合全麻组在诱导期对心率，血压影响较大，但一定量的麻黄素即可纠正，该法可明显减少阿曲库铵，芬太尼及吸入麻醉药的用量，硬膜外复合全麻组早期清醒拔管，很少发生烦躁，术后较长时间内无切口痛，结论：持续硬膜外复合吸入全麻用于肝吸切除手术优于单纯硬膜外麻醉及单 纯全麻，是肝脏手术麻醉比较理想的方法。     

高渗氯化钠羟乙基淀粉40注射液高容量血液稀释对大鼠肝脏缺血再灌注损伤的影响

Objective To investigate the effects of hypervolemic hemodilution (HH) with hypertonic saline plus hetastarch solution 40 injectio on hepatic ischemia-reperfusion (I/R) injury in rats. Methods Thirty male Wistar rats weighing 300-350 g were randomly divided into 3 groups ( n = 10 each): group I sham operation (group S); group II I/R and group Ⅲ HH. Partial liver ischemia was produced by clamping hepatic portal vein and left arteria hepatica for 30 min with atraumatic mini-clamp, followed by 2 h of reperfusion in I/R group and HH group. In HH group the animals were infused hypertonic saline plus hetastarch solution 40 injectio 10 ml/kg through vena caudalis over 30 min and then hepatic I/R was performed IS min after the infusion.The animals were killed at 2 h of reperfusion. The left liver was removed and blood sample was taken from inferior caval vein for determination of (1) serum alanine amino transferase (ALT) and aspartate amino transferase (AST) activities; (2) superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content in the liver; ( 3 ) microscopic examination. Results The serum ALT and AST activities and MDA content in the liver were significantly higher, SOD activity in the liver significantly lower after hepatic I/R and pathological changes in the liver severer in group I/R and HH than in group S. The serum ALT and AST activities and MDA content in the liver were significantly lower, SOD activity in the liver significantly higher after hepatic I/R and pathological changes in the liver milder in group HH than in group I/R. Conclusion Hypervolemic hemodilution with hypertonic saline plus hetastarch solution 40 injectio can ameliorate hepatic I/R injury by decreasing oxygen free radical production in rats.     

稀释血液关节腔内注射致血肿并3周固定构建家兔损伤后期膝关节功能障碍模型

目的:应用关节注射致血肿并3周固定法,观察是否可呈现关节损伤后期关节功能障碍的理想动物模型。方法:实验于1997-10/1998-04在南京中医药大学附属医院临床医学研究所完成。健康日本大耳白兔20只,雄性16只,雌性4只,兔龄为5个月。雄兔随机分为4组,正常对照组:不作任何处理;单纯固定组:将兔双膝关节完全屈曲固定3周;血肿不固定组:心脏取血1.2m L,稀释成2m L注入兔两膝关节各1m L,不作外固定;血肿固定雄兔组:注射致血肿方法同血肿不固定组,注射完毕后,膝关节完全屈曲位以绷带外固定3周。雌兔4只为1组,血肿固定雌兔组:以与血肿固定雄兔组同样方法造模。造模3周后观察关节活动度、大体变化及光镜进行组织学观察。结果:实验兔20只均进入结果分析。①兔膝关节活动度正常对照组为(183.1±1.73)°,单纯固定组为(146.0±4.24)°,血肿不固定组为(174.0±2.83)°,血肿固定雄兔组为(100.3±5.93)°,血肿固定雌兔组(116.4±13.80)°,血肿固定雄兔组膝关节功能障碍最严重。②大体观察见血肿固定组兔膝关节囊内大块瘀血,光镜下组织学观察见此组关节腔内充满红细胞,膝周软组织充血水肿,骨小梁菲薄排列紊乱,肌肉轻度萎缩。结论:雄性兔膝关节注射形成血肿加固定法,能较好地复制损伤后期膝关节功能障碍模型。     

6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.     

布比卡因和芬太尼浓度与容量匹配对肝脏术后硬膜外镇痛效应的影响

目的:研究布比卡因和芬太尼联合用药的浓度与容量匹配对肝脏术后硬膜外镇痛效应的影响.方法:对125例肝脏手术患者(ASA Ⅰ～Ⅱ)采用布比卡因(3.75 mg/h)和芬太尼(12 μg/h)联合用药行术后硬膜外镇痛,将该两药等剂量的浓度与容量的匹配关系随机分成5组(n=25),G1组为0.375％布比卡因和12 μg/ml芬太尼混合液以1 ml/h速率持续硬膜外输注;G2组为0.187 5％布比卡因和6 μg/ml芬太尼(2 ml/h);G3组为0.125％布比卡因和4 μg/ml芬太尼(3 ml/h);G4组为0.093 75％布比卡因和3 μg/ml芬太尼(4 ml/h);G5组为0.075％布比卡因和2.4 μg/ml芬太尼(5 ml/h).选择负荷量+持续输注量+PCA给药模式,计算术后48 h的用药总量,观察镇痛效果及相应的不良反应.结果:(1)药物用量:术后48 h各组的布比卡因和芬太尼用药总量、按压总数/按压实进数比值(D/D值)均无明显差异(P>0.05);但G4组的按压实进数明显低于G1和G5组(P<0.05).(2)镇痛效果:各组的有效镇痛率依次为G4>G3>G2>G5>G1.组间比较G3和G4组的静息痛视觉模拟评分(VAS)明显低于G1和G5组(P<0.05),但G3和G4组的咳嗽痛VAS评分仅低于G1组(P<0.05).(3)不良反应:G1组的恶心、呕吐和瘙痒发生率最高,分别为24％和32％,但组间比较未见明显差异.结论:肝脏术后联合应用等剂量布比卡因和芬太尼行硬膜外镇痛,其浓度与容量的匹配关系对镇痛效应有明显的影响.     

吸入麻醉药全麻敏感基因的研究现状

利用分子遗传学研究手段,在生物整体水平探索影响吸入麻醉药全麻敏感性的相关基因及其表达产物,是近年来开展的全麻机制研究的新方法和新策略.目前已在酵母类、线虫类、果蝇类、哺乳类等生物模型中筛选到许多吸入麻醉药的全麻敏感基因,并进行了初步的定位、克隆和功能鉴定,为进一步阐明特异性的全麻分子靶位作出了有益的探索.     

六磨汤加减治疗胸腰椎压缩性骨折后胃肠功能障碍

目的：观察六磨汤加减治疗胸腰椎压缩性骨折后腹胀和便秘的临床疗效。方法将142例患者按双盲法分为2组,治疗组75例用六磨汤加减治疗,对照组67例采用常规西医治疗。结果治疗组和对照组通气正常率分别为84.3℅,55.2℅,总有效率分别为92.0℅,62.7℅,组间比较,差异均有统计学意义（P ﹤0.05）。结论六磨汤可明显改善胸腰椎压缩性骨折后腹胀、便秘患者的临床症状,临床疗效优于单纯西药治疗。     

肱骨外科颈骨折的手术治疗

肱骨外科颈骨折常发生于解剖颈下2—3cm,相当于大、小结节下缘于肱骨干的交界处,此为松质骨与致密骨质接壤,占肩部骨折的26％。外科颈骨折远端由于胸大肌和近端肩袖牵拉而向前成角。临床上根据移位情况可分为内收型和外展型骨折。根据陆裕朴等提出的分型：外展型骨折和内收型骨折两种。肱骨外科颈骨折也可归为肱骨上端骨折的分型,