右美托咪定在老年颈椎间盘突出症患者术中的唤醒试验效果

目的比较右美托咪定复合瑞芬太尼与丙泊酚复合瑞芬太尼麻醉在老年颈椎间盘突出症患者术中的唤醒试验效果。方法将择期行手术治疗的颈椎间盘突出症患者27例,随机分为丙泊酚复合瑞芬太尼组（P组）和右美托咪定复合瑞芬太尼组（s组）。唤醒试验分别记录麻醉开始（T0）,气管插管时（T1）,插管后5min（T2）,暂停输注丙泊酚及右美托咪定减量时（L）及唤醒成功时（T4）的MAP和HR;记录两组患者唤醒成功的时间间隔（Tx）;术后回访患者发生术中知晓情况。结果与Tn时相比,P组患者的血压和心率在唤醒后有显著的升高（P〈0．05）;P组患者在T2、T3、T4时的心率和血压高于s组患者（P〈0．05）;与P组相比,s组的唤醒时间较P组短,差异有统计学意义（P〈0．05）,两组患者均无术中知晓情况发生。结论右美托咪定复合瑞芬太尼麻醉方法用于老年颈椎间盘突出症患者的术中唤醒试验,唤醒时间短,唤醒期间血流动力学稳定,是一种适合于老年颈椎病患者术中需要进行唤醒试验的麻醉方法。     

右美托咪定或丙泊酚复合瑞芬太尼用于功能神经外科术中唤醒的比较

目的比较右美托咪定或丙泊酚复合瑞芬太尼用于功能神经外科术中唤醒的效果。方法收集行功能外科手术治疗、术中唤醒患者100例,采用抽签法将患者分为右美托咪定组和丙泊酚组,每组50例。右美托咪定组采用右美托咪定复合瑞芬太尼进行麻醉唤醒,丙泊酚组采用丙泊酚复合瑞芬太尼进行麻醉唤醒。比较两组入室时(T_0)、切皮结束即刻(T_1)、试验药物使用后5 min(T_2)、试验药物使用后15 min(T_3)、唤醒即刻(T_4)、唤醒后5 min(T_5)、唤醒后15 min(T_6)的平均动脉压(MAP)、心率(HR)。记录患者不良事件(呛咳、躁动)及术中知晓发生情况。结果两组在T_0、T_1、T_2、T_4、T_5及T_6时比较差异无统计学意义(P0.05),T_3时右美托咪定组患者MAP明显高于丙泊酚组,HR明显低于丙泊酚组(P0.05)。右美托咪定组苏醒时间、自主呼吸恢复时间明显短于丙泊酚组(P0.05),右美托咪定组呛咳、躁动发生率明显低于丙泊酚组(P0.05)。结论右美托咪定复合瑞芬太尼靶控输注镇痛,易于唤醒,安全性较高,较少发生呛咳、躁动等不良事件,值得临床借鉴。     

瑞芬太尼分别复合丙泊酚与右美托咪定对全麻保留自主呼吸患儿气道异物取出术镇静效果及安全性

目的 探究瑞芬太尼分别复合丙泊酚与右美托咪定对全麻保留自主呼吸患儿气道异物取出术镇静效果及安全性.方法 选取2019年1月-2020年5月期间收入我院治疗的86例气道异物患儿为研究对象,根据患儿入院的先后顺序分为对照组与观察组各43例.对照组实施瑞芬太尼复合丙泊酚麻醉,观察组实施瑞芬太尼复合右美托咪定麻醉,分别记录患儿...     

右美托咪定对瑞芬太尼复合丙泊酚靶控输注全麻的影响

目的探讨右美托咪定对瑞芬太尼复合丙泊酚靶控输注全麻的影响。方法选择全麻腹腔镜手术患者280例,根据其入院时间,将其分为观察组与对照组,对照组给予常规麻醉诱导,观察组在其基础上,给予右美托咪定0.8g/kg静脉泵注,分别记录其用药前后不同时期MAP、BIS、HR水平,分析瑞芬太尼与丙泊酚用量与麻醉恢复情况。结果观察组T_1、T_2、T_3时期MAP、BIS、HR水平均显著优于对照组,瑞芬太尼与丙泊酚用量显著低于对照组P0.05,有统计学意义。结论右美托咪定对瑞芬太尼复合丙泊酚靶控输注全麻临床可控性高,值得推广。     

右美托咪定对老年腹腔镜手术患者苏醒期谵妄的影响

目的:评价右美托咪定对老年腹腔镜手术患者苏醒期谵妄的影响。方法:择期行腹腔镜手术老年患者80例,性别不限,年龄60~80岁,BMI 19~30,ASA分级Ⅰ或Ⅱ级。采用随机数字表法,将患者分为两组(n=40):七氟醚-瑞芬太尼组(A组)和右美托咪定-七氟醚-瑞芬太尼组(B组)。B组麻醉诱导前15min静脉持续泵注右美托咪定负荷量0.6μg/kg,随后以0.3ng/(kg·min)的速率静脉持续输注至术毕前20min;A组诱导前给予等容量生理盐水。负荷量输注完毕后3min麻醉诱导,两组均静脉注射芬太尼2~5μg/kg、丙泊酚1~2mg/kg和顺阿曲库铵0.2mg/kg,气管插管后行机械通气。麻醉维持:七氟醚(呼气末靶浓度1%~3%)吸入,静脉泵注瑞芬太尼0.05~0.1ng/(kg·min),术中维持BIS值40~60。根据BIS值来调节七氟醚和瑞芬太尼的用量,记录丙泊酚、瑞芬太尼和七氟醚的用量及苏醒期躁动和术后6h内谵妄发生情况。结果:与A组比较,B组丙泊酚、瑞芬太尼和七氟醚的用量减少,苏醒期躁动发生率及术后6h内谵妄的发生率降低(P<0.05)。结论:右美托咪定可降低老年腹腔镜手术患者术后苏醒期谵妄的发生,对术后认知功能障碍的发生有一定的防治效果。     

不同剂量右美托咪定复合丙泊酚、瑞芬太尼麻醉在超低位直肠癌患者麻醉中的效果比较

目的:分析不同剂量右美托咪定复合丙泊酚、瑞芬太尼麻醉在超低位直肠癌患者麻醉中的效果.方法:选取2018年6月—2020年4月平顶山市第二人民医院收治的55例超低位直肠癌患者作为研究对象,均以右美托咪定复合丙泊酚-瑞芬太尼麻醉进行手术,根据右美托咪定剂量不同分为A组28例和B组27例.A组给予右美托咪定0.6μg/(kg...     

右美托咪定对靶控输注丙泊酚复合瑞芬太尼在脑胶质瘤切除术中唤醒麻醉的效果观察

目的 观察右美托咪定对靶控输注丙泊酚复合瑞芬太尼在脑胶质瘤切除术中唤醒麻醉的应用效果。方法 选取2018年1月～2023年3月我院收治的40例脑胶质瘤切除手术患者，按照随机数字表法分为两组，每组20例。分别为右美托咪定组与对照组。两组均采用丙泊酚复合瑞芬太尼维持麻醉，其中对照组静脉泵注生理盐水，右美托咪定组静脉泵注右美托咪定，比较两组术中唤醒麻醉效果：不良反应，麻醉唤醒时脑电双频指数，苏醒时间和拔管时间，数字评价量表(numerical rating scale, NRS),血流动力学(平均动脉压和心率),动脉血气指标(动脉血二氧化碳分压和动脉氧分压)。结果 右美托咪定组术中麻醉唤醒时的动脉血二氧化碳分压(arterial carbon dioxide tension, PaCO₂)、血流动力学指标与麻醉唤醒不良反应发生率均低于对照组，且麻醉质量、脑电双频指数(bispectral index, BIS)与动脉氧分压(arterial oxygen tension, PaO₂)高于对照组，麻醉结束后的苏醒质量也高于对照组，差异有统计学意义(P...     

右美托咪定对功能性鼻内镜鼻窦手术出血及术野质量的影响

目的 观察右美托咪定对功能性鼻内镜鼻窦手术(FESS)术中出血及术野的影响.方法 择期行FESS患者60例,分为对照组和观察组,每组30例,所有患者均采用丙泊酚与瑞芬太尼靶控输注气管插管全麻,观察组麻醉诱导前15 min,静脉输注右美托咪定0.6μg/kg,后以0.6μg/(kg·h)维持至手术结束,对照组静脉输注等剂量生理盐水.记录手术时间、拔管时间及丙泊酚、瑞芬太尼总用量,手术开始前、开始后15、30、45 min的MAP、HR、术中出血量、Boezaart评分及手术医师对术野质量的满意度,术中心动过缓、低血压的发生率.结果 观察组丙泊酚和瑞芬太尼用量及术中出血量少于对照组(P＜0.05),术中Boezaart评分和手术医师满意度优于对照组(P＜0.05),术中心动过缓发生率高于对照组(P＜0.05).结论 右美托咪定用于FESS,可减少术中出血,提高手术视野质量,减少麻醉药物用量,但需注意防治心动过缓.     

肺灌洗术的两种麻醉方法的比较

目的:比较BIS监测与丙泊酚联合瑞芬太尼靶控输注(Target Controlled Infusion,TCI)麻醉与丙泊酚恒速输注全凭静脉麻醉下肺灌洗术的临床麻醉效果.方法:65例ASA Ⅰ～Ⅲ级行肺灌洗术的患者随机分为TCI组(T)组和恒速输注组(H)组:T组予丙泊酚与瑞芬太尼TCI,血浆靶浓度基值分别为3μg/mL、3ng/mL,调整靶浓度以保持BIS值在40～60之间;H组予丙泊酚与芬太尼,负荷量分别是1.5 mg/kg、5ug/kg,丙泊酚维持量5mg·kg·h,根据血压、心率的变化趋势同向调整丙泊酚与芬太尼的剂量,两组均复合维库溴铵.记录两组患者围麻醉期心血管血流动力学变化、术毕苏醒时间及术中知晓等不良反应.结果:T组围麻醉期血流动力学平稳,苏醒时间与术中知晓等不良反应均少.结论:BIS监测与丙泊酚联合瑞芬太尼TCI全凭静脉麻醉术中平稳,术中知晓等不良反应少,不失为肺灌洗术麻醉的优先选择.     

观察右美托咪定、丙泊酚复合瑞芬太尼用于小儿麻醉中维持喉罩通气的临床效果

目的探讨右美托咪定、丙泊酚复合瑞芬太尼用于小儿麻醉中维持喉罩通气的临床效果。方法将我院于2014年3月15日至2017年6月12日收治的60例手术患儿分为两组,对照组30例,应用右美托咪定复合瑞芬太尼麻醉;观察组30例,应用丙泊酚复合瑞芬太尼麻醉,比较两组患儿在手术各时间点的心率变化情况。结果进入手术室时,两组患儿的心率无明显差异(P0.05),但在麻醉诱导后、喉罩置入、手术结束时、喉罩取出时、面罩取出30 min各时间点中,观察组患儿的心率变化明显小于对照组(P0.05)。结论丙泊酚复合瑞芬太尼在小儿麻醉维持喉罩通气中的效果要优于右美托咪定复合瑞芬太尼。     

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.