电针加激光血管内照射治疗颅脑损伤功能障碍

目的 观察电针加激光血管内照射治疗颅脑损伤导致的功能障碍患者的疗效。方法 颅脑损伤患者170例，随机分为治疗组（84例）和对照组（86例），对照组给予常规治疗，治疗组在常规治疗的基础上进行电针加激光血管内照射治疗。结果 治疗后两组在格拉斯哥预后评估（GOS），运动障碍评估（DS）。远期生活质量评估（KPS）方面差异均有显著性。结论 电针加激光血管内照射治疗可以改善颅脑损伤患者的预后。帮助恢复运动功能。提高远期生活质量。     

Immunoglobulin administration to fetuses with anemia due to alloimmunization to D

BACKGROUND: The purpose of this study was to examine fetal tolerance of high-dose intravenous immunoglobulin (IVIG), given directly at the time of intravascular transfusion, and its effects on fetal hemolysis and pregnancy outcome in the setting of alloimmunization to D. STUDY DESIGN AND METHODS: Thirteen consecutive D+ fetuses requiring transfusion for maternal alloimmunization received high-dose IVIG (1.0 g/kg) and red cell transfusions. Twenty-four previous, consecutive fetuses with maternal anti-D served as controls. The schedules for subsequent transfusions were the same in the two groups. RESULTS: High-dose IVIG was well tolerated by all fetuses. In the IVIG group, daily decreases in hematocrit were smaller than those in controls after the second administration of IVIG (mean hematocrit decrease, 0.72 percent/day vs. 1.45 percent/day; p = 0.007). No significant difference was found in the total number of fetal transfusions, the gestational age at delivery, the duration of neonatal intensive care, the number of neonates requiring postnatal transfusion therapy, and perinatal mortality. CONCLUSION: In this small pilot study, direct administration to fetuses of IVIG with red cell transfusions was well tolerated and appeared to have a beneficial effect on fetal hemolysis.     

Evaluation of EuII‐based positive contrast enhancement after intravenous,intraperitoneal, and subcutaneous injections

Eu^II‐based contrast agents offer physiologically relevant, metal‐based redox sensing that is unachievable with Gd^III‐based contrast agents. To evaluate the in vivo contrast enhancement of Eu^II as a function of injection type, we performed intravenous, intraperitoneal, and subcutaneous injections in mice. Our data reveal a correlation between reported oxygen content and expected rates of diffusion with the persistence of Eu^II‐based contrast enhancement. Biodistribution studies revealed europium clearance through the liver and kidneys for intravenous and intraperitoneal injections, but no contrast enhancement was observed in organs associated with clearance. These data represent a step toward understanding the behavior of Eu^II‐based complexes in vivo. Copyright © 2016 John Wiley & Sons, Ltd.     

胰岛素瘤切除术围手术期血糖监测的临床意义

【摘要】 目的 探讨胰岛素瘤切除术的围术期管理。方法 回顾性分析本院5年来通过手术治疗胰岛素瘤患者的临床资料。结果 18例患者中男6例,女12例,均有典型的Whipple三联征。15例行开放性肿瘤切除术,3例行腹腔镜下肿瘤切除术。开腹手术采用硬膜外麻醉复合气管内全麻,腹腔镜手术采用单纯气管内全麻。根据术中不同的血糖管理方式将患者分为两组:持续泵注组(C组,n=10)术中静脉泵注50%葡萄糖溶液,根据血糖调节输注速度,维持血糖在3.0~6.0 mmol·L-1;非持续泵注组(NC组,n=8)未予持续泵注葡萄糖,仅在血糖低于2.8 mmol·L-1时才静脉推注50%葡萄糖50 mL。术中每隔15分钟监测一次血糖,肿瘤切除前30 min停止给糖。所有患者术中患者生命体征平稳。持续泵注葡萄糖组肿瘤切除前后血糖控制较非持续泵注稳定(P<0.05)。结论 胰岛素瘤手术时采用持续泵注葡萄糖能够稳定手术过程中血糖水平,肿瘤切除前静脉泵注50%葡萄糖可以避免肿瘤切除前后血糖急剧波动。     

注射贴在静脉输液中的应用观察

[目的 ]观察注射贴在同一病人静脉输液中扩张局部血管和减轻局部疼痛的效果。 [方法 ]观察比较 40例静脉输液病人使用注射贴前后局部血管外径值、局部疼痛的变化。 [结果 ]使用注射贴后局部血管外径大于使用注射贴前 ,两组比较有统计学意义(P <0 .0 0 1) ;使用注射贴后局部疼痛程度也明显轻于使用前 ,两组比较有统计学意义 (P <0 .0 0 1)。 [结论 ]静脉输液前使用注射贴可有效扩张局部血管和局部镇痛。     

Effects of cold pressor test on circulating atrial natriuretic peptide 99–126 (ANP) in patients with Raynaud's phenomenon and influence of treatment with magnesium sulphate and nifedipine

Summary. The effect of a standardized cold pressure test (CPT) on the venous concentration of immunoreactive atrial natriuretic peptide (ir ANP) was studied in 12 females with primary Raynaud's phenomenon (PRP) and 12 female age-matched controls. The test was performed at the end of three stages. During the first stage no medication was given. During the second stage a magnesium infusion was given. After fourteen days of medication with a calcium antagonist (Nifedipine) the third stage of the study was performed. The venous irANP increased significantly (P < 0.05) 10 min after the start of the CPT both in the PRP group and in the control group (136±39 to 159±54 and 153±45 to 179±40 pg ml^-1, given as mean and SD). Baseline irANP did not change in the PRP group after treatment with magnesium or nifedipine. In the control group nifedipine treatment significantly (P < 0 01) lowered venous irANP compared to the no treatment or magnesium sulphate infusion stages (128±31 vs. 153±45 and 160±41 pg ml^-1). After the CPT in both PRP group and control group the venous irANP did not increase either during magnesium sulphate infusion or nifedipine treatment. In conclusion the study has demonstrated that a standardized CPT results in a delayed increase in irANP in venous plasma and that magnesium sulphate infusion and nifedipine treatment prevent this increase. Furthermore, our data do not suggest a role for irANP in the symptomatology of primary Raynaud's phenomenon.     

老年病人术前靶控输注异丙酚镇静不同监测指标的比较

目的:观察在无手术刺激状态下,老年患者靶控输注异丙酚不同镇静程度与效应部位血药浓度(CE)、脑电双频指数(BIS)、平均动脉压(MAP)及心率(HR)的相关性。方法:择期老年手术患者18例,年龄65~78岁,ASAⅠ~Ⅱ级,所行手术不限。全麻诱导前行异丙酚靶控输注(TCI)镇静,靶浓度由0.5 mg/L开始,递增梯度为0.5 mg/L,间隔时间为5 min,直至镇静评分(OAA/S)为0后5 min停止。试验中,监测并记录患者的BIS、MAP、HR值,间隔20 s行OAA/S镇静评分。记录靶控输注系统预测的效应部位浓度值(CE),每变化0.5 mg/L时的数值及时间。结果:①镇静深度的变化与CE、BIS、MAP呈线性回归关系:与CE呈负相关(r=-0.925,P<0.01),与BIS、MAP呈正相关(r=0.858,r=0.564;P均<0.01)。相关性的程度依次为CE>BIS>MAP。HR与OAA/S的变化无显著相关性(P>0.05)。②BIS能很好反映患者镇静深度的变化,可作为其监测的敏感指标。结论:效应部位的异丙酚浓度决定镇静程度的深浅及OAA/S评分的大小,作为新的麻醉镇静深度监测指标,BIS可很好地反映靶控输注异丙酚对老年患者的镇静程度,而作为传统的监测指标,MAP、HR受各种因素的影响较大,灵敏度较差。     

钠盐稀释对静滴氯化钾所致疼痛及补钾效果的影响

目的探讨使用氯化钠稀释对缓解静滴氯化钾所致疼痛及补钾效果的影响。方法将60例血钾偏低需静脉补钾病人随机分为两组各30例,钠盐组将10%氯化钾15ml加入生理盐水500ml中进行静脉滴注,葡萄糖组将10%氯化钾15ml加入5%葡萄糖液500ml中进行静脉滴注,2次/d,观察局部疼痛发生情况,补钾2d后观察血钾升高值。结果两组疼痛程度比较有显著性差异(P<0.05);钠盐组血钾升高(0.57±0.14)mmol/L,葡萄糖组血钾升高(0.89±0.39)mmol/L,有显著性差异(P<0.05)。结论钠盐可缓解静滴氯化钾所致的局部疼痛,同时钠盐亦会减慢补钾的过程。     

喉罩通气并全凭静脉麻醉在老年冠心病患者腹腔镜胆囊手术中的应用

[目的]观察老年冠心病患者在行腹腔镜胆囊切除术(LC)时运用喉罩 瑞芬太尼、丙泊酚或喉罩 异氟醚、丙泊酚的麻醉效果.[方法]择期全麻LC老年冠心病患者32例,ASA Ⅱ～Ⅲ级,随机分为两组.两组患者麻醉诱导后置入LMA-ProSealTM喉罩.麻醉维持RP组以瑞芬太尼0.2～O.4μg/(kg·min),丙泊酚4～6 mg/(kg.h),静脉泵入维持麻醉.IP组以丙泊酚4～6 mg/(kg·h)静脉泵静脉入,异氟醚2%～3%维持麻醉.记录血流动力学变化、Sp()2、术后麻醉恢复情况、术后OAAS评分.[结果]停药后5 min,患者心率、MAP呈上升趋势均高于停药前水平(P＜0.05);自主呼吸恢复时间、睁眼时间、拔除喉罩时间、定向力恢复时间和离开PACU时间RP组早于IP组(P＜0.05);RP组在拔喉罩后即刻、离开PACU、拔喉罩后30min、1 h OAAS评分高于1Pfit(P＜0.05).[结论]喉罩通气、瑞芬太尼、丙泊酚全凭静脉麻醉对冠心病患者LC循环抑制轻,患者有更好的麻醉恢复.     

肌松药微量输注法在喉显微外科手术中的应用

目的观察微量泵输注琥珀胆碱与普通静脉滴注法用于全麻下喉显微外科手术的效果。方法择期行全麻下喉显微手术患者40例，分为微量泵注组与普通静脉滴注组。对比2组术中肌松效果、用药量、术毕自主呼吸和意识恢复时间。结果与通静脉滴注组相比，微量泵注组的术中肌松效果好，用药量少，术毕自主呼吸和意识恢复时间明显缩短（P〈0．05）。结论琥珀胆碱微量泵输注法便于术中调控，利于术后自主呼吸恢复。