氨基酸负荷对梗阻肾的肾功能和肾储备功能的影响

为寻求预测梗阻肾肾功能的新方法，用氨基酸负荷（ＡＬ）对２５例双肾积水患者进行肾储备功能测定，并对负荷前后肾小球滤过率（ＧＦＲ）、有效肾血浆流量（ＥＲＰＦ）、肌酐清除率（Ｃｃｒ）、滤过分数（ＦＦ）、ＧＦＲ百分比上升率（％ＧＦＲ）进行比较性研究，以求预测肾功能恢复的客观指标。结果表明：ＡＬ能提高ＧＦＲ、ＥＲＰＦ值，通过Ｃｃｒ对比研究，进一步表明ＧＦＲ增值能反映肾储备功能的变化，增值越高恢复越快，反之亦然。结果认为：肾储备功能的测定可预测肾功能恢复情况，并对肾积水疾病的手术方式选择有一定的指导作用     

Alfentanil or fentanyl during isoflurane–based anaesthesia for day–care knee arthroscopy?

Forty patients agreed to participate in a study to compare whether fentanyl or alfentanil used as analgesic is associated with quicker recovery following anaesthesia for outpatient arthroscopy procedure. Psychomotor tests including choice reaction time (CRT), perceptive accuracy test (PAT) and finger tapping test (FTT) were done prior to induction of anaesthesia with propofol (2–3 mg–kg^-1). Patients were then divided into two groups: Group F (fentanyl) received 0.1 mg fentanyl prior to start of surgery and thereafter 0.05 mg every 30 min during the procedure. Group A (alfentanil) received 0.5 mg alfentanil prior to the onset of surgery and 0.25 mg every 15 min thereafter. Anaesthesia was then maintained using isoflurane (0.5–2%) in oxygen and air (Fio₂ 0.33) during spontaneous respiration with a face mask in a Bain's system. Psychomotor tests were repeated every 45 min postoperatively. Clinical recovery, visual analogue pain intensity score (VAS) and time to discharge home were also assessed by a nurse blind to the method used. Patients in Group A returned to baseline values on the FTT after 90 min while those in Group F did not return to baseline values until 135 min after the end of the operation. Clinical recovery and time to discharge home ("home ready") were also significantly longer in Group F. There was no difference in recovery as seen in the PAT and CRT between the groups. Also, there was no difference in the incidence of side effects and the pain intensity (VAS) scores were similar in the two groups at all time periods. We conclude that recovery following alfentanil is quicker compared to fentanyl when anaesthesia is based on isoflurane.     

肾小管泌氢功能试验在肾移植监测中的价值

对36例肾移植患者肾移植前与术后8周内的肾小管泌氢功能，包括尿pH、可滴定酸（TA）、NH4＋、酸净排出量（NAC）及HCO3-浓度进行动态监测，以探讨该试验在术后监测中的价值。结果发现，移植前pH及HCO3-明显高于正常，TA、NH4＋及NAC明显低于正常。移植后肾功能稳定恢复组的五个参数均逐渐恢复，其中完全恢复正常者占62．5％；排斥组出现排斥反应时TA、NH4＋及NAC合量下降，随排斥逆转而有所恢复，完全达正常者占37．5％；肾失功组患者TA、NH4＋及NAC始终波动于低水平，而pH与HCO3-增高。结果表明，肾移植术活动态监测肾小管泌氢功能对了解移植肾功能状态、预测排斥反应的发生以及判断疗效和预后具有一定参考价值。     

多巴酚丁胺负荷及运动试验~(99m)Tc-MIBI心肌断层显像与冠状动脉造影的对比研究

比较６９例冠心病患者多巴酚丁胺负荷９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与８２例运动试验９９ｍＴｃＭＩＢＩ心肌断层显像的结果，以探讨它们对冠心病的诊断价值。结果表明：以冠状动脉造影结果为标准，多巴酚丁胺负荷诊断冠心病的敏感性和特异性分别为９１２％和８００％，运动试验分别为８９４％和８２９％。多巴酚丁胺负荷检出冠状动脉病变的敏感性和特异性：左前降支为７８１％和９１３％，回旋支为６６７％和９８２％，右冠状动脉为１００％和８３７％；运动试验分别为７８３％和９１１％，６００％和９６８％，９０９％和８５０％，差异均无显著性（Ｐ＞００５）。提示两者结果相近，对于不能进行运动试验的病人，多巴酚丁胺试验是一种有价值的诊断冠心病的方法。     

Pre- and post-transplant assessment of liver function in paediatric liver transplantation

The pre-operative risk of paediatric liver transplantation candidates (n=41) was assessed in a prospective study by means of clinical symptoms, conventional static and liver blood flow dependent dynamic liver function tests. Nine patients died during the 365-day waiting period. The data were subjected as covariates to a survival analysis in the Cox proportional hazards model. There was a significant relationsship between the results of mono-ethylglycinexylidide (MEGX) formation and ICG test and the 365-day survival rate. In the stepwise analysis, none of the remaining parameters improved the predictive ability when added to the dynamic liver function test results. The assessment of post-transplantation liver function was studied in 27 patients during the first 28 postoperative-day period. In addition, liver function was studied in a cross-sectional study 1–7 years after successful liver transplantation in children with complete or partial rehabilitation. In the early postoperative period severe organ damage was indicated by both static and dynamic liver function tests. In the later course after transplantation no deterioration of liver function measured with MEGX formation was to be observed. These findings demonstrate the usefulness of dynamic liver function tests in the pre- and post-transplant assessment of liver function.     

饮用水中过量铁和锰对蚕豆根尖细胞微核率的影响

目的 探讨饮用水中过量的铁和锰的致突变作用。方法 采用蚕豆根尖细胞微核技术。结果 当水中铁含量超过饮用水卫生标准3～10倍时，蚕豆根尖细胞微核率升高，且微核率与铁剂量间存在着明显的剂量-反应关系。锰对蚕豆根尖细胞微核率升高的作用不明显，只有在剂量高达卫生标准1000倍时，才会使蚕豆根尖细胞微核率有所增加。结论 过量的铁有致突变作用。     

Demonstration of dilatation of peripheral airways

Summary. To investigate the ability of various lung-function tests to demonstrate dilatation of peripheral airways, ten asthmatics inhaled increasing doses of a f2-agonist by two different and controlled techniques. Low inspiratory flow with a long post-inspi-ratory pause favoured peripheral deposition, and a high inspiratory flow with a short post-inspiratory pause favoured central deposition of drug in the airways. Ordinary spirometry, maximum expiratory flow rates after breathing air as well as a helium-oxygen mixture, a single breath N₂-test and resistance of the respiratory system were obtained before and after each of five terbutaline doses with both inhalation techniques. By using a double-dummy technique, the study could be performed double blinded. Effects were compared at doses giving equal effects on PEF, assumed to represent equal deposition of bronchodilator and effects on central airways. At such ‘iso A PEF doses’, particularly FVC and the slope of phase III of the N₂-test improved more following the slow inhalation technique. It is concluded that changes in those tests reflect dilatation in peripheral airways in asthmatics.,     

8～12岁单纯性肥胖儿童心功能研究

利用多导生理仪，同步记录心电图、心音图、颈动脉搏动图和心阻抗微分图，测试８～１２岁肥胖儿童９４名，对照组儿童７６名，分析比较有关心功能数据。结果显示肥胖儿童收缩压、舒张压、平均动脉压、左室射血时间和心搏出量高于对照组儿童，心输出量与对照组比较差异无显著性，心功能指数低于对照组儿童。提示肥胖儿童由于回心血量增加，血压增高，而使心脏前、后负荷加重，心肌收缩力代偿性增强，单位体表面积心输出量下降，部分心功能指标已受到影响。     

适量饮酒对健康成年男性血浆TXB2,6-Keto-PGF2a及血小板聚集功能的影响

①目的　观察适量饮酒对健康成年男性的血小板聚集功能及血浆血栓素B2 (TXB2 ) ,6 酮 前列腺素F2a(6 Keto PGF2a)的影响。②方法　将 80例健康成年男性随机分成 4组 ,分别空腹饮用矿泉水、啤酒、干红葡萄酒各 2 0 0mL ,白酒 50mL加矿泉水至 2 0 0mL .于饮前及饮后 2h分别测定血小板的聚集率及解聚率 ,并采血测定血浆TXB2 ,6 Keto PGF2a.③结果　矿泉水组饮后上述指标无变化 (t=0 .0 3～ 0 .84,P >0 .0 5) ;白酒、啤酒、红葡萄酒组饮后血小板聚集率减低 (t=8.1 2～ 2 4 .39,P <0 .0 1 ) ,解聚率升高 (t=2 8.48～ 35 .2 2 ,P <0 .0 1 ) ,血浆TXB2 降低 (t=2 5 .69～ 89.83 ,P <0 .0 1 ) ,而血浆 6 Keto PGF2a升高 (t=2 1 .0 6～ 2 3 .2 9,P <0 .0 1 )。④结论　健康成年男性适量饮酒可减低其血小板聚集功能 ,降低其血浆TXB2 ,提高其血浆 6 Keto PGF2a水平