术中应用不同剂量曲马多对雷米芬太尼复合麻醉苏醒期镇痛的影响

目的:探讨术中应用不同剂量的曲马多对雷米芬太尼复合全麻苏醒期镇痛的影响。方法:60例ASAⅡ￣Ⅲ级静吸复合全麻下行下腹部肿瘤手术(包括结肠癌、直肠癌)的患者随机分为3组:Ⅰ组曲马多1.0mg/kg、Ⅱ组曲马多2.0mg/kg、Ⅲ组曲马多3.0mg/kg。各组分别于术毕前40min静注给药。手术结束后滞留30min,观察患者苏醒恢复期的清醒时间、拔管时间和拔管后0min、20min的平均动脉压、心率及镇痛(VAS)评分和并发症(恶心、呕吐、嗜睡、呼吸抑制等)。结果:Ⅱ组和Ⅲ组的VAS评分显著低于Ⅰ组(P<0.01)。清醒时间、拔管时间和拔管后平均动脉压、心率的差异无显著性(P>0.05)。Ⅲ组的恶心、呕吐发生率较高。结论:雷米芬太尼复合全身麻醉术中,曲马多应用剂量以2.0mg/kg为好。     

超前应用氟比洛芬酯、曲马多和芬太尼对雷米芬太尼复合麻醉苏醒期的影响

目的 探讨超前应用氟比洛芬酯、曲马多和芬太尼对雷米芬太尼复合全麻苏醒期的影响.方法 60例ASA Ⅱ～Ⅲ级、静吸复合全麻下行下腹部肿瘤(包括结肠癌、直肠癌)手术的患者随机分为3组,患者分别于术毕前30 min静脉推注氟比洛芬酯50 mg(Ⅰ组)、曲马多2.0 mg/kg(Ⅱ组)、芬太尼1μg/kg(Ⅲ组).手术结束后滞留30 min,观察患者苏醒恢复期的清醒时间、拔管时间、拔管后0 min和20 min的平均动脉压、心率及镇痛评分、并发症(皮肤搔痒、嗜睡、呼吸抑制).结果 Ⅱ组和Ⅲ组的镇痛评分显著低于Ⅰ组(P<0.05 o 3组的清醒时间、拔管时间、拔管后平均动脉压和心率的差异无显著性(P>0.05).Ⅲ组的呼吸抑制发生率为20%,与Ⅰ组、Ⅱ组相比无统计学意义.结论 雷米芬太尼复合全身麻醉的下腹部肿瘤术中,曲马多的超前应用不但使苏醒期的镇痛效果好,而且并发症发生率低.     

术中氟比洛芬酯与曲马多复合应用对全麻苏醒期镇痛的影响

目的：探讨氟比洛芬酯和曲马多复合给药对手术全麻苏醒期患者的镇痛影响。方法：研究组75例应用氟比洛芬酯1mg/kg和曲马多1 mg/kg,对照组75例单纯应用曲马多2mg/kg。比较两组镇痛VAS效果和拔管时间、清醒时间、拔管后血压、心率变化情况。结果：研究组患者手术结束时VAS评分明显低于对照组（P＜0．05）,术后4h、8h、12h、24h和术后48h的VAS评分明显低于对照组（P＜0．01）。研究组患者拔管时间、清醒时间、血压有心率与对照组比较无统计学差异（ P＞0．05）。结论：全麻手术中氟比洛芬酯与曲马多复合应用有利于全麻苏醒期的镇痛,其镇痛效果优于单纯应用曲马多,且安全性高。     

舒芬太尼与氟比洛芬酯复合曲马多对雷米芬太尼复合麻醉苏醒期的影响比较

目的:比较超前使用舒芬太尼与氟比洛芬酯联合曲马多对雷米芬太尼复合全麻苏醒期的影响。方法:将40例择期腹腔镜胆囊切除术患者随机分为舒芬太尼组(A组)和氟比洛芬酯复合曲马多组(B组),每组20例。A组手术结束前5 min,静脉注射舒芬太尼0.15μg/kg;B组手术开始前10 min,静脉注射氟比洛芬酯50 mg,手术结束前10 min,静脉注射氟比洛芬酯50 mg和曲马多2 mg/kg。记录并比较2组苏醒时间、苏醒后的镇痛评分(VRS)和不良事件发生例数。结果:A组苏醒时间长于B组(P0.01);B组苏醒拔管后10、20、30 min的VRS均明显高于A组(P0.01);2组拔管后2 h期间不良事件发生率差异无统计学意义(P0.05)。结论:舒芬太尼在雷米芬太尼复合麻醉苏醒早期的镇痛效果较氟比洛芬酯复合曲马多更佳。     

氟比洛芬酯复合曲马多用于开胸患者全麻苏醒期镇痛效果研究

目的 探讨氟比洛芬酯复合曲马多用于开胸患者全麻苏醒期的镇痛效果与安全性.方法 选择30例ASAⅠ-Ⅲ级在静吸复合全麻下行开胸手术患者,随机分为3组:曲马多组(Ⅰ组)、氟比洛芬酯组(Ⅱ组)、曲马多复合氟比洛芬酯组(Ⅲ组),每组10例.3组分别于术毕前30 min静注给药.手术结束后送恢复室,比较3组患者睁眼时间、拔管时间、手术时间、拔管即刻疼痛评分(VRS评分)、不良反应发生情况及术前术后血压(BP)、心率(HR)的变化.结果 Ⅲ组VRS评分显著低于Ⅰ、Ⅱ组(均P<0.01).Ⅰ、Ⅲ组睁眼时间、拔管时间较Ⅱ组延长,差异均有统计学意义(均P<0.05);3组手术时间相比,差异均无统计学意义(均P＞0.05).Ⅰ、Ⅱ组患者拔管即刻、拔管后 5 min BP、HR明显升高,与基础水平相比,差异均有统计学意义(均P＜0.05);而Ⅲ组患者BP、HR仅轻度升高,与基础水平相比,差异均无统计学意义(均P＞0.05);3组均无明显呼吸抑制.结论 复合应用氟比洛芬酯与曲马多不但全麻苏醒期镇痛效果好,且不增加不良反应的发生.     

不同剂量的氟比洛芬酯用于甲状腺手术超前镇痛

目的观察不同剂量的氟比洛芬酯对甲状腺手术病人的超前镇痛效果。方法对80例双侧甲状腺次全切除术的病人随机双盲分为4组,在静脉诱导前5 min静脉注射。Ⅰ组给予氟比洛芬酯1.25 mg/kg;Ⅱ组氟比洛芬酯1.0 mg/kg;Ⅲ组氟比洛芬酯0.75 mg/kg,Ⅳ组空白对照。术后2、4、8、16、24、48 h,用视觉模拟评分(VAS)评价吞咽时疼痛,舒适评分(BCS)评价咳嗽时疼痛,并记录不良反应。结果 VAS:2、4、8、16 h时,Ⅰ、Ⅱ、Ⅲ组显著低于Ⅳ组(P<0.01),24、48 h时,Ⅰ、Ⅱ组显著低于Ⅳ组(P<0.01),Ⅲ组与Ⅳ组无显著差异(P>0.05)。BCS2、4、8、16 h时,Ⅰ、Ⅱ、Ⅲ组显著优于Ⅳ组(P<0.05)。本文4组不良反应无显著差异(P>0.05)。结论 1.0 mg/kg、1.25 mg/kg组氟比洛芬酯用于甲状腺手术超前镇痛安全有效,且1.0 mg/kg、1.25 mg/kg组氟比洛芬酯可延长镇痛时间。     

心理干预联合氟比洛芬酯对七氟醚全麻腹腔镜手术苏醒期的影响

目的探讨心理干预联合氟比洛芬酯对七氟醚全麻下腹腔镜手术苏醒期的影响。方法 120例七氟醚全麻腹腔镜子宫切除术患者分为三组:对照组(Ⅰ组);氟比洛芬酯组(Ⅱ组);心理干预联合氟比洛芬酯组(Ⅲ组)。三组患者诱导方法、术中维持相同,都采用七氟醚+异丙酚+瑞芬太尼维持麻醉。Ⅱ组术前10min静脉注射2mg/kg氟比洛芬酯,Ⅲ组术前心理干预联合手术开始前10min静脉注射2mg/kg氟比洛芬酯。对比观察三组患者拔管前、拔管后即刻和拔管后5min时躁动发生率及其强度、心率,平均动脉压、Ramsay镇静评分及不良反应。结果Ⅲ组患者各时段的躁动发生率及其强度明显低于前两组,血流动力学更平稳,镇静评分更好,恶心呕吐等不良反应的发生率少。结论心理干预联合氟比洛芬酯能很好维持苏醒期循环呼吸稳定,减轻疼痛,减少不良反应,是七氟醚全麻腹腔镜手术可靠易行的方法。     

丙泊酚复合不同剂量氟比洛芬酯用于无痛人流的临床疗效观察

目的:观察丙泊酚配伍不同剂量氟比洛芬酯在无痛人流中的镇痛效果和安全性。方法:将100例ASAⅠ～Ⅱ要求进行无痛人工流产的患者随机分为4组,Ⅰ组先缓慢静注芬太尼1μg/kg,10 min后静脉注射丙泊酚2 mg/kg。Ⅱ组先静脉注射氟比洛芬酯100 mg,10 min后静脉注射丙泊酚2 mg/kg。Ⅲ组先静脉注射氟比洛芬酯150 mg,10 min后静脉注射丙泊酚2 mg/kg。Ⅳ组静脉注射丙泊酚2 mg/kg。观察各组诱导及苏醒时间、用药总量,记录术中呼吸、循环参数改变和术中、术后不良反应。术后由手术医生评定麻醉效果。结果:手术全程丙泊酚给药量及术毕至唤醒时间对照组高于其他各组,Ⅲ组丙泊酚用量最小。各组SBP、DBP、HR及SpO2较手术前均有下降,但都在正常范围之内。Ⅱ、Ⅲ组麻醉效果明显优于Ⅰ、Ⅳ组(P<0.05)。Ⅱ、Ⅲ组麻醉效果明显优于Ⅰ、Ⅳ组(P<0.05),而术后下腹痛VAS评:分Ⅰ、Ⅱ、Ⅲ组明显优于Ⅳ组(P<0.05)。Ⅱ、Ⅲ组术中舌根后坠,呼吸暂停不良反应发生例数明显低于Ⅰ和Ⅳ组,术后兴奋躁动、恶心、呕吐、头晕等不良反应Ⅱ、Ⅲ组发生例数也明显低于Ⅰ和Ⅳ组(P<0.05)。结论:丙泊酚复合氟比洛芬酯注射液药物不良反应少,对术后下腹痛也表现出更好的镇痛效应,是一种较为安全有效的配伍方法。     

氟比洛芬酯复合曲马多抑制全麻苏醒期不良反应的临床观察

[摘要] 目的 观察氟比洛芬酯复合曲马多抑制全麻苏醒期不良反应的效果。方法 选择90例择期在全麻下行乳腺癌根治术的患者,随机分为3组,每组30例,F组：气管插管后切皮前10 min静脉注射氟比洛芬酯50 mg, 术毕前20 min静脉追加氟比洛芬酯50 mg;T组：术毕前10 min静脉注射曲马多100 mg;C组：气管插管后切皮前10 min静脉注射氟比洛芬酯50 mg, 术毕前10 min静脉注射曲马多100 mg并于术毕前20 min追加氟比洛芬酯50 mg。观察苏醒期燥动、寒战、疼痛和恶心呕吐的出现及程度;观察患者术毕至拔除气管导管的时间、呼之睁眼的时间。结果 C组燥动、寒战和疼痛出现明显减少且程度较轻。结论 氟比洛芬酯复合曲马多可较好抑制全麻苏醒期不良反应,苏醒质量高。     

氟比洛芬酯复合曲马多用于术后静脉镇痛

目的探讨氟比洛芬酯复合小剂量曲马多与单纯曲马多术后静脉镇痛的临床效应。方法选取全髋关节置换术的患者80例，随机分为4组：Ⅰ组，曲马多600mg＋0．9％生理盐水＋昂丹司琼16mg；Ⅱ组，曲马多400mg＋0．9％生理盐水＋昂丹司琼16mg；Ⅲ组，氟比洛芬酯50mg＋曲马多400mg＋0．9％生理盐水＋昂丹司琼16mg；Ⅳ组，氟比洛芬酯100mg＋曲马多200mg＋0．9％生理盐水＋昂丹司琼16mg。每组总量均为100mL。镇痛模式：背景流量2mL／h，自控剂量0．5mL／次，锁定时间15min。观察24h内的镇痛评分（VAS），PCIA术后镇痛效果及不良反应的发生情况。结果术后1h时Ⅱ组的VAS显著高于Ⅰ，Ⅲ和Ⅳ组（P〈0．05），而1h后的VAS4组间差异无显著性（P〉0．05）。Ⅱ，Ⅲ和Ⅳ组恶心、呕吐的发生率显著低于Ⅰ组（P〈0．05）。镇痛期间无呼吸抑制及异常出血等并发症发生。结论氟比洛芬酯复合曲马多术后静脉镇痛效果良好，可明显减少曲马多的用量和不良反应的发生率。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.