硝酸甘油联合多巴酚丁胺、多巴胺治疗急性心肌梗死早期并急性左心衰竭

目的　探讨硝酸甘油与多巴酚丁胺、多巴胺合用治疗急性心肌梗死早期 (2 4h内 )并急性左心衰竭的效果及安全性。方法　 31例急性心肌梗死早期并急性左心衰竭患者 ,随机分为A ,B组 ,A组为硝酸甘油治疗组 ,在常规吸氧、镇静、止痛、溶栓、抗凝、解痉、利尿等治疗的基础上加用硝酸甘油 2 0～ 4 0 μg/min 静脉滴注 ;B组为联合治疗组 ,在A组治疗基础上 ,加用多巴酚丁胺 6～ 10 μg/ (kg·min) ,多巴胺 6～ 10μg/ (kg·min) ,用微量输液泵分开静脉滴注。结果　A组显效 4例 ,有效 7例 ,无效 4例 ,总有效率为 73% ;B组显效 11例 ,有效 3例 ,无效 2例 ,总有效率为 88%。两组总有效率比较差异有显著性 (P <0 0 1)。结论　在常规治疗基础上 ,硝酸甘油与多巴酚丁胺、多巴胺合用治疗急性心肌梗死早期并急性左心衰竭比单独加用硝酸甘油疗效更为显著 ,更加安全。     

大剂量甲基强的松龙冲击疗法治疗急性视神经炎临床疗效观察

目的：评估大剂量甲基强的松龙冲击疗法治疗急性视神经炎的疗效． 方法：应用大剂量甲基强的松龙冲击疗法治疗急性视神经炎30例．并与常量地塞米松疗法进行了病例对照观察。 结果：治疗组与对照组比较篷异有显著性(P<0.01)，治疗组见效快、副作用少、安全可靠。 结论：大剂量甲基强的松龙冲击疗法是治疗急性视神经炎的更为有效方法． （中华眼底病杂志，1996，12：186-187）     

Propofol and Sevoflurane in Subanesthetic Concentrations Act Preferentially on the Spinal Cord: Evidence from Multimodal Electrophysiological Assessment

Background: Animal experiments in recent years have shown that attenuation of motor responses by general anesthetics is mediated at least partly by spinal mechanisms. Less is known about the relative potency of anesthetic drugs in suppressing cortical and spinal electrophysiological responses in vivo in humans, particularly those, but not only those, connected with motor responses. Therefore, we studied the effects of sevoflurane and propofol in humans using multimodal electrophysiological assessment.

Methods: We studied nine healthy volunteers in two sessions during steady state sedation with 0.5, 1.0, and 1.5 [mu]g/l (targeted plasma concentration) propofol or 0.2 and 0.4 vol% (end-tidal) sevoflurane. Following a 15-min equilibration period, motor responses to transcranial magnetic stimulation and peripheral (H-reflex, F-wave) stimulation were recorded, while electroencephalography and auditory evoked responses were recorded in parallel.

Results: At concentrations corresponding to two thirds of C50 awake, motor responses to transcranial magnetic stimulation were reduced by approximately 50%, H-reflex amplitude was reduced by 22%, F-wave amplitude was reduced by 40%, and F-wave persistence was reduced by 25%. No significant differences between sevoflurane and propofol were found. At this concentration, the Bispectral Index was reduced by 7%, and the middle-latency auditory evoked responses were attenuated only mildly (Nb latency increased by 11%, amplitude PaNb did not change). In contrast, the postauricular reflex was suppressed by 77%.     

Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery: Smokers versus Nonsmokers

Background: Smoking is considered to be a risk factor for patients undergoing surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing ambulatory surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers.

Methods: The authors studied a random selection of 489 adult patients undergoing ambulatory surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge +/- positive microbial culture, requiring antibiotic therapy) in smokers versus nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of surgery.

Results: Most smokers continued to smoke up until the day of surgery. Smokers had a higher rate of respiratory complications (32.8%vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.84;P = 0.038) and wound infection (3.6%vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58-175;P = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications.     

Dual Exposure to Sevoflurane Improves Anesthetic Preconditioning in Intact Hearts

Background: Anesthetic preconditioning (APC) with sevoflurane reduces myocardial ischemia-reperfusion injury. The authors tested whether two brief exposures to sevoflurane would lead to a better preconditioning state than would a single longer exposure and whether dual exposure to a lower (L) concentration of sevoflurane would achieve an outcome similar to that associated with a single exposure to a higher (H) concentration.

Methods: Langendorff-prepared guinea pig hearts were exposed to 0.4 mm sevoflurane once for 15 min (H1-15; n = 8) or 0.4 mm (H2-5; n = 8) or 0.2 mm sevoflurane (L2-5; n = 8) twice for 5 min, with a 5-min washout period interspersed. Sevoflurane was then washed out for 20 min before 30 min of global no-flow ischemia and 120 min of reperfusion. Control hearts (n = 8) were not subjected to APC. Left ventricular pressure was measured isovolumetrically. Ventricular infarct size was determined by tetrazolium staining and cumulative planimetry. Values are expressed as mean +/- SD.

Results: The authors found a better functional return and a lesser percentage of infarction on reperfusion in H2-5 (28 +/- 9%) than in H1-15 (36 +/- 8%; P < 0.05), L2-5 (43 +/- 6%; P < 0.05), or control hearts (52 +/- 7%; P < 0.05).     

双眼视差视觉诱发电位与立体视觉的关系初探

作者采用双眼视差视觉诱发电位（VEP）记录了18名正常人和9名斜视患者（立体盲），结果正常人视觉刺激VEP P₁₀₀振幅明显高于非视差刺激者；斜视患者视差刺激与非视差刺激VEP P₁₀₀振幅差异无显著性；正常人视差刺激VEP P₁₀₀振幅增加的幅度值[（DSA-NDA）/NDA]明显高于斜视患者。 （中华眼底病杂志，1992，8：10-13）