全麻期间并发急性肺水肿(附5例报告)

目的　探讨全麻期间急性肺水肿的发病、诊断、治疗和预后。方法　临床资料的回顾性分析。结果　全身麻醉期间发生急性肺水肿5例,发病机理可能为心源性肺水肿、负压性肺水肿和通透性肺水肿。预防及处理意见是①严格控制输血输液量;②有胸水的病人在抽胸水时,首次量应控制在800ml左右;③胸科手术中,特别是双侧开胸手术者,避免单肺通气或对肺组织挤压、牵拉时间过长。结论　急性肺水肿是全身麻醉的严重并发症,须及时诊断和治疗     

开胸术后复张性肺水肿的探讨

目的：探讨开胸手术中单侧肺萎陷,术后肺复张导致急性肺水肿的发病机理、诊断治疗及预防。方法：对5例开胸术后复张性肺水肿患者进行总结,3例为胸腔镜辅助下胸膜固定术后,2周为食管癌根治术后,结果：常规单侧肺萎陷的开胸手术均可能发生轻重不一的复张性肺水肿。结论：可通过术中定期（以间隔30min为宜）肺复张以及术后渐进性肺复张等措施来减低复张性肺水肿的发生率。     

麻醉中急性肺水肿原因及处理体会

分析临床麻醉中并发 5例急性肺水肿的原因及处理 ,合理治疗降低麻醉并发症发生率及麻醉死亡率。方法 :通过对麻醉中并发 5例肺水肿病人的麻醉前准备、麻醉选择、麻醉中的管理及出现并发症后的治疗进行全程分析 ,找出发生急性肺水肿的原因及治疗体会。结果 :治愈 4例 ,死亡 1例。急性肺水肿发生的原因是由于麻醉前未详细检查病人 ;麻醉中单位时间内输液相对过量 ;麻醉处理不当而引起呼吸抑制、缺氧 ;诊断有误、未被认识的疾病所致。讨论 :认真检查病人 ,明确诊断 ;正确的麻醉选择和处理是减少乃至杜绝麻醉中急性肺水肿发生的有利措施。急性肺…     

不同麻醉方法对胸腔镜手术单肺通气时应激状态的影响

目的：讨论两种不同麻醉方法对胸腔镜手术单肺通气时应激状态以及炎症介质间的作用。方法：选择施行胸腔镜手术患者30例平均分为两组（n=15）,即单纯全身麻醉组（D组）和全麻复合胸段硬膜外阻滞组（S组）,测定两组患者术前（T0）,侧卧位后的单肺通气15min（T1）,单肺通气30min（T2）,单肺通气60min（T3）四个时间点的血清中IL-8,IL-10浓度。结果：对比两组,全麻复合胸段硬膜外阻滞组IL-8表达明显降低（P〈0.01）,IL-10表达明显增加（P〈0.01）。结论：全麻复合胸段硬膜外阻滞对比单纯全身麻醉显示出了良好的安全性,在应激反应的控制方面显著优于后者,尤其是对于胸腔镜这类微创手术患者,能够起到保持机体稳定,改善预后等作用,值得临床广泛推广应用。     

21例麻醉期间急性肺水肿的诊治分析

目的探讨麻醉期间急性肺水肿发生的原因和诊治措施.方法总结我科近年来21例不同病种病人麻醉手术期间急性肺水肿的临床资料,并对其发生原因以及诊治措施进行分析.结果所有病人均出现心率增快、脉搏氧饱和度下降,双肺听诊满布湿罗音和哮鸣音.气管插管全麻病人气道阻力明显增加,8例病人有粉红色泡沫痰从气管导管溢出.非气管插管全麻病人均出现烦躁和呼吸困难,经抢救插管后4例病人可见粉红色泡沫痰从气管导管溢出.部分病人出现代谢性酸中毒和低氧血症.结论麻醉手术期间急性肺水肿发生突然,病情变化快,快速正确的诊断和有针对性的治疗措施是挽救病人生命的关键.     

人工液胸辅助高强度聚焦超声治疗儿童肝母细胞瘤安全性的观察

目的：评估在全身麻醉下人工液胸辅助高强度聚焦超声（high-intensity focused ultrasound,HIFU）治疗儿童肝母细胞瘤的有效性及安全性。方法：回顾性分析在全身麻醉气管插管下,18例肝母细胞瘤患儿,在其右侧胸腔注入200~300 ml生理盐水建立人工液胸。分别于气管插管后5 min（T0）、人工液胸建立后10 min（T1）、HIFU治疗30 min（T2）、1 h（T3）、2 h（T4）及治疗结束时（T5）记录有创血压（invasive arterial pressure,IABP）、心率（heart rate,HR）、气道峰压（peak airway pressure,Ppeak）、胸肺顺应性（compliance of lung,Cmpl）、呼末二氧化碳（end-tidal carbon dioxide partial press,PETCO2）、血氧饱和度（oxygen saturation,SpO2）;并在以上各时点及HIFU治疗后24 h（T6）作动脉血气分析。HIFU治疗后第1天及第7天行胸部X线摄片,观察双肺和胸水转归,治疗前后行彩超及增强 MRI 对比治疗效果。结果：在HIFU治疗过程中,患儿各血流动力学指标均保持稳定。Ppeak在建立人工液胸后较建立人工液胸前明显升高（P＜0.05）,且持续维持在一个较高水平。Cmpl在建立人工液胸后较建立人工液胸前降低（P＜0.05）。PETCO2在HIFU治疗30 min以后较注入胸水前明显升高（P＜0.05）;动脉血气分析中PO2及PCO2均较建立人工液胸前增高（P＜0.05）,但pH在各个时间点差异无统计学意义（P ＞0.05）,且以上呼吸参数改变均在临床安全范围内。胸片提示所有患儿胸水在术后7 d内全部吸收,且均未出现气胸、血胸等严重并发症。术后影像学检查（MRI或者增强CT）提示所有患儿病灶均达到预定消融效果。结论：全身麻醉下建立人工液胸辅助HIFU治疗儿童肝母细胞瘤是有效、安全的。     

复张性肺水肿的诊断和治疗分析

目的：探讨复张性肺水肿的发病因素、诊断及治疗措施。方法：回顾性分析在我科诊治的12例复张性肺水肿的病例资料。结果：全部病例得以及时诊断，经积极抢救治疗痊愈，无死亡病例。结论：大量气胸液胸行胸腔闭式引流术是发生复张性肺水肿的主要原因，但历时较长的开胸术也是其发病的另一好发因素；及时的诊断是治疗成功的关键I在治疗中应缓慢减压使肺复张，历时较长的开胸术术中应间隔每小时缓慢膨肺1次，以预防复张性肺水肿的发生。     

肺切除与胸改术并发肺水肿的护理

肺水肿是指过量的液体在肺血管外的潴留状态．是肺切除和胸改术的严重并发症。由于手术麻醉刺激，使肺流量和肺毛细血管压力较术前增加，肺毛细血管通透性增强，术后容易出现肺水肿，造成严重缺氧和二氧化碳潴留。我院医务人员通过对1984年-2003年间施行肺切除和胸改术563例患者术后护理的严密观察，及时发现，及时治疗，积极采取有效的护理措施，使并发肺水肿患者得到满意疗效，现将护理体会报告如下：     

硬膜外阻滞复合全身麻醉对单肺通气期间气体交换影响的临床研究

目的 观察胸段硬膜外阻滞复合全身麻醉对单肺通气期间气体交换的影响.方法 随机将病人随机分为两组,全身麻醉复合硬膜外麻醉组（A组）和全身麻醉组（B组）,每组40例.两组患者在开胸前双肺通气20min（T1）时及开胸后单肺通气（OLV）30min（T2）、60min（T3）、120min（T4）时,分别采动脉血及混合静脉血,观察患者动静脉血气情况并计算肺内分流率（Qs/Qt）值、肺泡-动脉血氧分压差（A-aDO2）和无效腔量/潮气量（Vd/Vt）值.结果 与T1相比,两组T2-4时Paw均升高（P〈0.01）,T2-4时Qs/Qt均增加（P〈0.01）,A-aD02增加（P〈0.01）,PaO2降低（P〈0.01）.结论 单肺通气期间硬膜外阻滞复合全身麻醉对肺换气功能有影响,使Qs/Qt增加,PaO2下降,A-aDO2增大;对肺泡通气功能标Vd/Vt影响甚微.     

22例复张性肺水肿的临床诊治体会

目的探讨复张性肺水肿（RPE）的发病机制和诊治措施。方法回顾性分析22例复张性肺水肿患者的临床资料。结果治愈20例,死亡2例,死亡原因为急性呼吸窘迫综合征（ARDS）并发全身多器官功能衰竭。结论RPE的诊断治疗并不复杂,重在预防。做到早发现、早诊断、早治疗,可明显降低发病率及病死率。     

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.