穿刺针导引技术在超声引导下臂丛神经阻滞中的应用

目的设计超声引导下臂丛神经阻滞时的穿刺针导引器,并在体外和临床上验证其效果。方法自制一个穿刺针导引器,其主要部分是一个双层的扇形不锈钢薄片。选择80例在臂丛神经阻滞下行上肢手术的患者,随机分为自由手组和导引组,每组40人。由四位麻醉医师实施在超声引导下臂丛神经阻滞(锁骨上入路),每位医师完成20例,10例用自由手技术,10例用穿刺针导引器引导技术。记录穿刺针的主观可视性、阻滞完成时间、临床效果以及麻醉医师和患者对臂丛神经阻滞的满意度。结果导引组的针的主观可视性显著优于自由手组(P<0.05);导引组的阻滞完成时间明显短于自由手组(P<0.01);麻醉医师使用导引技术的满意度高于使用自由手技术(P<0.05)。结论使用穿刺针引导技术更容易完成超声引导下臂丛神经阻滞。     

成人肌间沟臂丛神经阻滞运动反应终点的研究

目的研究胸大肌、三角肌运动反应作为外周神经刺激器(PNS)定位下成人经肌间沟臂丛神经阻滞终点的可行性。方法择期成人上肢手术240例,PNS定位下行经肌间沟臂丛神经阻滞,随机均分为四组:胸大肌运动反应终点组(A组)、三角肌运动反应终点组(B组)、肱二头肌运动反应终点组(C组)和胸大肌、三角肌或肱二头肌运动反应终点组(D组)。比较组间刺激域电流、获得终点时间、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果。结果D组获得终点时间短于A、B、C组(P<0.05),组间刺激域电流、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果差异无统计学意义。神经阻滞综合优良率90.8%。结论胸大肌、三角肌运动反应终点可作为PNS定位下成人经肌间沟臂丛神经阻滞穿刺针正确定位的满意、安全标志。     

Three-dimensional magnetic resonance myocardial motion tracking from a single image plane.

Three-dimensional imaging for the quantification of myocardial motion is a key step in the evaluation of cardiac disease. A tagged magnetic resonance imaging method that automatically tracks myocardial displacement in three dimensions is presented. Unlike other techniques, this method tracks both in-plane and through-plane motion from a single image plane without affecting the duration of image acquisition. A small z-encoding gradient is subsequently added to the refocusing lobe of the slice-selection gradient pulse in a slice following CSPAMM acquisition. An opposite polarity z-encoding gradient is added to the orthogonal tag direction. The additional z-gradients encode the instantaneous through plane position of the slice. The vertical and horizontal tags are used to resolve in-plane motion, while the added z-gradients is used to resolve through-plane motion. Postprocessing automatically decodes the acquired data and tracks the three-dimensional displacement of every material point within the image plane for each cine frame. Experiments include both a phantom and in vivo human validation. These studies demonstrate that the simultaneous extraction of both in-plane and through-plane displacements and pathlines from tagged images is achievable. This capability should open up new avenues for the automatic quantification of cardiac motion and strain for scientific and clinical purposes.     

Intercostal catheterization

Twenty-one patients scheduled to undergo thoracotomy or median sternotomy had intercostal catheters inserted pre-operatively. During thoracotomy, under direct vision, the spread of 20 ml of a solution containing bupivacaine and methylene blue was followed. In most cases the spread involved one or two intercostal spaces. However, in all but one patient, dye spread medially to the paravertebral space where it then spread in both caudad and cephalad directions to reach between two and five vertebrae. In three cases, dye was seen crossing the anterior surface of the vertebrae to reach the contralateral aspect. It is concluded that a major component of dermatomal block during intercostal catheterisations may be secondary to paravertebral spread.     

缬沙坦与苯那普利拉对SHR肾小球系膜细胞的保护作用

目的：观察ARB－valsartan及ACEI－benazeprilat能否抑制由AngⅡ、PDGF引起的SHR肾小球系膜细胞的增殖与肥大。且比较单用时作用孰强孰弱，联合应用后有无协同效应。方法；采用经典SHR系膜细胞培养技术，细胞中加入各种因子和（或）药物，以^3H-leucine或^3H-thymidine掺入后的cpm值反映蛋白或DNA合成。采用t test检验差异的显著性。结果：1、系膜细胞在AngⅡ、PDGF刺激后引起的增殖与肥大，均可被valsartan及benazeprilat抑制。2、比较发现单一用药在同一浓度下，valsartan较benazeprilat能更有效地抑制细胞的增殖与肥大。3、联合用药在同一浓度valsartan benazeprilat均比单用valsartan或benazeprilat效果明显。结论：1、valsartan与benazeprilat均能抑制SHR系膜细胞的增殖与肥大。2、valsartan在抗系膜细胞增殖与肥大作用稍强于benazeprilat。3、在一定浓度条件下联合用药对抗系膜细胞的增殖与肥大作用，较单一用药效果明显。     

Accessory atrioventricular pathway, supra-, and infrahisian conduction impaired due to mitral annulus calcification

Disorders of conduction occurring simultaneously in both normal and accessory pathways of patients with Wolff-Parkinson-White (WPW) syndrome have only rarely been observed. To our knowledge this is the first report of impaired conduction in both pathways in WPW syndrome due to mitral annulus calcification (MAC). This case of WPW syndrome type A presented the following conduction abnormalities: (1) right bundle-branch block; (2) transient second-degree AV block with prolonged PR interval of the conducted beats; (3) during electrophysiological study, induction of tachycardia, dependent (phase 3) second-degree AV block, and occasionally conduction of two consecutive beats, the second showing an increased H-V interval (from 25 to 60 ms) and left bundle-branch block (LBBB) pattern, due to (4) infrahisian conduction abnormality.     

完全性左束支传导阻滞合并显著电轴左偏32例分析

本文对32例完全性左束支传导阻滞(CLBBB)合并显著电轴左偏超过(-30°)和20例CLBBB电轴正常两组病人进行对比观察。结果无论在心脏形态大小或心电图改变方面电轴左偏病人比电轴正常者病情严重。CLBBB合并电轴明显左偏的发病机制可以有五种情况解释。     

局部浸润和神经阻滞麻醉在会阴切开中的应用分析

目的 探讨会阴切开时不同麻醉方式对产妇的影响.方法 将100例产妇随机分为左侧阴部神经阻滞麻醉组(阻滞组)和局部组织浸润麻醉组(浸润组),每组50例,比较两组产妇镇痛效果、缝合时间、第四产程出血量及产后72h活动的情况.结果 浸润组在镇痛效果、缝合时间、出血量及产后的活动方面均优于阻滞组.结论 在会阴切开缝合术中应用小剂量利多卡因作阴部浸润麻醉有效减轻了产妇的切口疼痛,缩短缝合时间,减少第四产程出血量.