右美托咪定对急性脑损伤患者内酯素和高敏C反应蛋白的影响

目的 探讨右美托咪定对急性脑损伤患者内酯素和高敏C反应蛋白(hs-CRP)的影响。 方法 将76例急性脑损伤患者按照麻醉方式的不同分为研究组(36例)和对照组(40例)。全部患者行开颅术及血肿清除术,采用全身复合麻醉。麻醉诱导前,研究组静脉泵注右美托咪定,对照组给予等量的生理盐水。于入室后(T0)、手术60 min(T1)、手术结束(T2)、术后24 h(T3)、术后3 d(T4)、术后5 d(T5),检测2组血清内脂素、hs-CRP、神经元特异性烯醇化酶(NSE)、S-100β水平变化。随访6个月,采用格拉斯哥预后量表(GOS)评估患者预后情况。 结果 2组内脂素、hs-CRP在T2~T5时的水平显著高于同组在T0时的水平,差异有统计学意义(P<0.05);在T2~T5时,研究组内脂素、hs-CRP显著高于对照组,差异有统计学意义(P<0.05);2组NSE、S-100β在T1~T5时的水平显著高于同组在T0时的水平,差异有统计学意义(P<0.05);在T3~T5时,研究组NSE、S-100β显著高于对照组,差异有统计学意义(P<0.05);随访6个月后,研究组的预后显著优于对照组,差异有统计学意义(P<0.05)。 结论 右美托咪定用于急性脑损伤患者手术麻醉,有助于减轻炎症反应,降低脑组织损伤,改善患者预后。      

右美托咪定对脑损伤老年患者术后认知功能障碍的影响

目的探讨右美托咪定对老年脑损伤患者术后认知功能障碍的影响。方法按照随机字母表法将我院老年患者(60例)分为安慰剂组(n=30)和右美托咪定组(n=30)。安慰剂组给予生理盐水,右美托咪定组给予右美托咪定。比较两组术前1d,术后3 d、7 d、30 d简易智力状态检查表(MMSE)评分,以及麻醉诱导前至术后24 h(T1~T7)各时段血清S100β蛋白及NSE水平,记录手术及并发症发生情况。结果术前,两组MMSE评分、血清S100β蛋白及神经元特异性烯醇化酶(NSE)水平差异均无显著性(P>0.05)。术后3 d,两组MMSE评分明显降低(P<0.05),T1~T7时血浆S100β蛋白及血清NSE水平呈先升后降趋势,均在T4时达高峰。与安慰剂组比较,右美托咪定组T3~T6时血清S100β蛋白、NSE水平均明显降低(P<0.05)。此外,右美托咪定组患者苏醒和拔管期间躁动发生率、术后并发症发生率也明显低于安慰剂组(P<0.05)。结论右美托咪定可显著降低老年患者术后血清S100β蛋白、NSE水平以及认知功能障碍发生率。     

右美托咪定对老年患者下肢手术中止血带所致氧化应激及炎症反应的影响

目的探讨右美托咪定对老年患者下肢手术中止血带所致氧化应激及炎症反应的影响。方法将168例行下肢手术平均年龄(67.6±6.4)岁(60~84岁)的老年患者,分为右美托咪定组(n=62)、丙泊酚组(n=52)和对照组(n=54),均采用蛛网膜下腔阻滞麻醉联合硬膜外麻醉。完成穿刺后,右美托咪定组患者10min内给予负荷量1μg/kg右美托咪定静脉输注,后采用0.5μg/(kg·h)维持至术毕;丙泊酚组患者给予丙泊酚靶控静脉输注,起始靶浓度1.0μg/mL,与效应室浓度平衡3min后,以0.2μg/mL递增;对照组患者给予与右美托咪定组同剂量、同速率生理盐水输注。分别于使用止血带前(T0),松开止血带后10min(T1),30min(T2)和60min(T3)时,采用ELISA法检测血清超氧化物歧化酶(SOD)、丙二醛(MDA)、C-反应蛋白(CRP)、白细胞介素-8(IL-8)和人肿瘤坏死因子-α(TNF-α)。结果 T1~T3时点,右美托咪定组和丙泊酚组患者血清SOD含量均高于对照组,MDA和CRP含量均低于对照组(均P<0.05);T2、T3时点,右美托咪定组患者SOD含量高于丙泊酚组,MDA和CRP含量低于丙泊酚组(均P<0.05);T1~T3时点,右美托咪定组和丙泊酚组患者血清IL-8和TNF-α含量均低于对照组(均P<0.05),右美托咪定组患者血清IL-8和TNF-α含量均低于丙泊酚组(均P<0.05)。结论右美托咪定应用于下肢手术老年患者,可有效减少由于使用止血带所导致的氧化应激及炎症反应。     

右美托咪定对食管癌患者术中脑血氧饱和度及术后认知功能障碍的影响

目的 探讨右美托咪定对食管癌患者术中脑血氧饱和度及术后认知功能障碍风险的影响。方法 纳入2020年2月至2021年12月新疆医科大学附属肿瘤医院拟行食管癌根治术的70例患者,采用随机数字表法分为右美托咪定组和对照组,每组35例。对照组予以常规麻醉,右美托咪定组在对照组的基础上予以右美托咪定麻醉。比较两组患者术中患者脑血氧饱和度、麻醉深度,记录两组患者术中阿片类药物需求量情况,比较两组患者术后认知功能评分及认知功能障碍发生率情况。结果 右美托咪定组患者T1、T2、T3及T4时脑血氧饱和度均高于对照组(P<0.05);右美托咪定组患者T1、T2、T3及T4时双频指数(BIS)低于对照组(P<0.05);右美托咪定组患者T4、T5、T8及T7时认知功能评分均高于对照组(P<0.05);右美托咪定组术中瑞芬太尼、舒芬太尼累积剂量低于对照组(P<0.05);两组认知功能障碍发生率差异无统计学意义(P>0.05)。结论 右美托咪定可有效维持食管癌患者术中脑血氧饱和度,提高麻醉深度,降低患者术中阿片类药物需求量,对患者认知功能损伤小。     

右美托咪定对行腹腔镜恶性肿瘤根治术患者术后肾功能的影响

目的 观察右美托咪定对行腹腔镜下恶性肿瘤根治术的患者术后肾功能的影响.方法 选择择期行腹腔镜恶性肿瘤根治术的患者44例,按随机数字表法分为右美托咪定组和对照组,每组22例.两组患者麻醉诱导、麻醉维持用药相同,右美托咪定组在麻醉诱导时静脉泵注右美托咪定而对照组给予等容量的生理盐水.观察两组患者术前(T1)、术毕(T2)、术后第1天(T3)、术后第3天(T4)血肌酐(SCr)、尿素氮(BUN)、胱抑素C(Cys-C)水平.结果 两组SCr、BUN水平比较,差异无统计学意义(P>0.05);各组内各时点SCr水平比较差异无统计学意义(P均>0.05),但各组内各时点BUN水平比较,差异有统计学意义(P<0.05),其中T3时BUN水平低于其他时点.与T1时比较,T2~T4时两组的Cys-C水平明显增高(P<0.05);T2~T4时右美托咪定组Cys-C水平明显低于对照组(P<0.05).结论 麻醉时静脉泵注右美托咪定对腹腔镜恶性肿瘤根治术患者术后肾功能具有一定的保护作用.     

盐酸右美托咪定对食管癌根治术患者围术期血糖、β-内啡肽、TNF-α及IL-6表达的影响

\[摘要\]目的观察全麻期间持续应用盐酸右美托咪定对食管癌根治术患者围术期血糖、β-内啡肽(β-EP)、肿瘤坏死因子α (TNF-α)和白细胞介素6(IL-6)表达水平的影响。方法40例择期行食管癌根治术的患者,所有患者均采用全凭静脉麻醉,随机分为盐酸右美托咪定组和对照组(n=20)。两组分别于麻醉诱导前(T0)、拔管(T1)即刻、术后l d(T2)和术后2 d(T3)晨抽取静脉血,测定血糖、血浆β-EP、血清TNF-α和IL-6水平。结果与T0点相比,对照组在T1时点MAP和HR显著升高(P<0.05),T1～T3时点血糖、血浆β-EP浓度显著升高(P<0.05),T1～T2时点血清TNF-α和IL-6的浓度明显上升(P<0.05);盐酸右美托咪定组在各时点均无明显变化,两组各时间点差异有统计学意义(P<0.05)。结论全麻期间持续应用盐酸右美托咪定可有效降低食管癌根治术患者围术期血糖、血浆β-EP、血清TNF-α和IL-6水平,抑制围术期应激反应。     

右美托咪定在间接暴力致颅脑损伤手术麻醉中的脑保护作用及对患者预后的影响

目的 探讨右美托咪定在间接暴力致颅脑损伤手术麻醉中的脑保护作用及其对患者预后的影响。方法 选取2015 年11 月～2017 年9 月于我院就诊的间接暴力致颅脑损伤患者150 例,按随机数字表法分为对照组和观察组。观察组在麻醉诱导前给予右美托咪定静脉滴注,对照组给予等剂量的生理盐水。观察并比较两组患者脑损伤、血糖相关指标及患者预后。结果 组内比较结果显示,两组患者在麻醉诱导前的神经元特异性烯醇化酶（NSE）、酸性钙结合蛋白（S-100β）表达水平均低于术后24 h（P<0.05）;对照组患者在麻醉诱导前的血糖、空腹胰岛素水平低于麻醉后60 min（P<0.05）。组间比较结果显示,观察组在术后24 h 的NSE、S-100β 指标表达水平均低于对照组（P<0.05）;观察组在麻醉后60 min 的血糖、空腹胰岛素水平低于对照组（P<0.05）;观察组患者GOS、ADL 评分高于对照组（P<0.05）。结论 右美托咪定应用于间接暴力致颅脑损伤手术麻醉中,可有效缓解患者脑损伤并改善患者预后。     

右美托咪定对颅脑损伤患者血清S100β蛋白及神经元特异烯醇化酶的影响

目的 探讨在全身麻醉下使用右美托咪定对颅脑损伤患者血清S100β蛋白及神经元特异性烯醇化酶(NSE)水平的影响.方法 80例在全身麻醉下行开颅血肿清除去骨瓣减压术患者,随机分为右美托咪定组(观察组,n=40)和0.9％氯化钠注射液组(对照组,n=40)分别于麻醉诱导即刻(T1)、术毕即刻(T2)、术毕6h(T3)、术毕12h(T4)、术毕24 h(T5)抽取患者静脉血,用酶联免疫吸附(ELISA)测定S100β蛋白及NSE值.结果 两组血清S100β蛋白、NSE浓度T2、T3、T4及T5较T1均显著升高(均P＜0.05);与对照组比较,观察组T2、T3、T4及T5时点的S100β蛋白、NSE浓度均明显降低,差异均有统计学意义(均P＜0.05).结论 使用右美托咪定可使颅脑损伤患者血清S100β蛋白及NSE浓度下降,具有脑保护作用.     

右美托咪定预处理对单肺通气后肺损伤的保护作用

目的 探讨右美托咪定预先给药对单肺通气后肺损伤的保护作用。方法选择择期行全麻单肺通气的食管癌病人56例,随机分为右美托咪定组和对照组各28例,分别于麻醉诱导后单肺通气前(T1)、单肺通气6Omin(T2)、120min(T3)、单肺通气结束前(T4)、出室前(T5)及术后24h(T6)时间点记录患者平均动脉压、心率、氧合指数、气道峰压和脑电双频指数值,并测定血清超氧化物歧化酶(SOD)、白介素(IL)-6、丙二醛(MDA)浓度。结果两组术中监测氧合指数在T2~T4时间点,右美托咪定组低于对照组(P<0.05);除T1时间点外,T2~T6时间点血清IL-6、MDA浓度,右美托咪定组明显低于对照组(P<0.05),而SOD右美托咪定组明显高于对照组(P<0.05);其余指标两组无差异。结论右美托咪定可显著减低单肺通气期间的炎症因子表达,改善术中的氧合指数,对单肺通气肺损伤有保护作用。     

右美托咪定预处理对老年腹腔镜手术患者术后氧化应激水平及肠屏障功能的影响

目的 分析右美托咪定预处理对老年腹腔镜患者术后氧化应激水平及肠屏障功能的影响。 方法 将2018年1—12月于杭州市西溪医院行腹腔镜治疗的74例患者,依据是否接受右美托咪定预处理将其分为右美托咪定组(37例)及对照组(37例),对2组患者一般资料及麻醉前、麻醉后1 min、麻醉后5 min及麻醉后30 min的心率、血压进行比较,并对患者术后24 h氧化应激及肠屏障功能进行比较。 结果 2组患者的血压、心率、不良反应及术前氧化应激、肠屏障功能差异无统计学意义(均P>0.05);右美托咪定组患者的镇静起效及停药后苏醒时间均明显低于对照组(均P<0.05),术后1 h及2 h的Ramsay评分明显高于对照组(均P<0.05),且右美托咪定组芬太尼用量明显少于对照组(P=0.001);术后2组患者的MDA较前升高,SOD、GSH-Px、TAS、I-FABP、内毒素、DAO及D-乳酸较前降低,右美托咪定组患者的MDA、I-FABP、内毒素、DAO及D-乳酸明显低于对照组(均P<0.05),SOD、TAS、GSH-Px明显高于对照组(均P<0.05)。 结论 右美托咪定预处理可有效缩短镇静起效及手术后苏醒时间,能有效改善患者术后肠道受损情况,减轻患者的氧化应激发生。      

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.