中度低温低流量体外循环的初步报告

采用中度低温低流量体外循环对１０例先天性心脏病患儿作手术纠治，降温至肛温（２５．９±０．７４）℃，鼓膜温（２４．３±１．３７）℃，维持流量（１．２４±０．１１）Ｌ·ｍｉｎ－１／ｍ２。灌注压力５～６．７ｋＰａ，低流量时间（３２．２±１１．９）ｍｉｎ。体外循环各时限血气分析各项指标均在正常范围，血液乳酸值未升高，静脉血氧饱和度均在８０％以上，提示中度低温低流量灌注是临床可以选择的一种体外循环方法。     

不同诱导剂量异丙酚辅助硬膜外阻滞麻醉的临床比较

目的：探讨异丙酚辅助硬膜外阻滞麻醉行上腹部手术时最佳的诱导剂量、注入时间及镇静、抑制内脏牵拉反应的临床效果。方法：６４例病人分为两组：组１异丙酚诱导量１．５ｍｇ·ｋｇ－１、１ｍｉｎ静脉注入，３ｍｉｎ后接维持量２～３ｍｇ·ｋｇ－１ｈ－１；组２诱导量０．７～１ｍｇ·ｋｇ－１，２ｍｉｎ注入。即接同组１的维持量，均以微量药物注射泵（Ｇｒａｓｂｙ３１００）持续注药，用药时间４０～２５０ｍｉｎ。结果：组２诱导后血压下降幅度小，无呼吸暂停和ＳｐＯ２严重降低，Ｒａｍｓａｙ均值低于组１，两组间有统计学意义（Ｐ＜０．０５）。在异丙酚注药后１０ｍｉｎ内，两组血压、心率、ＳｐＯ２均达到用药前水平（Ｐ＞０．０５）。结论：以异丙酚低诱导剂量０．７～１ｍｇ·ｋｇ－１，２ｍｉｎ注入，维持量２～３ｍｇ·ｋｇ－１·ｈ－１微量泵持续静注方式给药，抑制内脏牵拉反应的效果确切，对呼吸、循环抑制轻，比较安全。     

癫痫手术的麻醉处理

本文报道静吸复合麻醉行脑皮层癫痫灶切除术２０例。用ｒ－ＯＨ５０－６０ｍｇ／ｋｇ、２．５％ＳＰ６－８ｍｇ／ｋｇ、芬太尼０．２－０．３ｍｇ、司可林１－２ｍｇ／ｋｇ静脉注射诱导，气管插管后２％普鲁卡因１００ｍｌ内加芬太尼０．２ｍｇ静脉点滴，普鲁卡因滴速０．４－０．６ｍｇ／ｋｇ／ｍｉｎ；同时间断吸入小剂量氨氟醚或异氟醚，吸入浓度〈１ＭＡＣ；１７例加肌松剂用机械呼吸维持。普鲁卡因、芬太尼为主，间断吸入小剂量     

不同剂量5%苏打对脑膜炎双球菌感染性休克家兔心功能的影响

目的：研究输注５ ％ 苏打对感染性休克家兔心功能的影响。方法：将新西兰家兔制成脑膜炎双球菌感染动物模型,６０ ｍｉｎ 后随机分成对照组、 Ｓｂ ５ ．０ 组（５ ％ 苏打５ ．０ ｍｌ·ｋｇ － １） 、 Ｓｂ ３ ．３ 组（５ ％ 苏打３ ．３ ｍｌ·ｋｇ － １） 、 Ｈｓ５ ．０ 组（３ ．５ ％ 氯化钠溶液５ ．０ ｍｌ·ｋｇ － １） 及 Ｈｓ３ ．３ 组（３ ．５ ％ 氯化钠溶液３ ．３ ｍｌ·ｋｇ － １） ,观察左心室峰压、平均动脉压、左室压最大变化速率。以治疗前所测值为基础,比较给药后３０ 、６０ ｍｉｎ 上述指标变化百分率。记录结束后取心肌作超微结构检查。结果：输液治疗后３０ ｍｉｎ 和６０ ｍｉｎ , Ｓｂ ５ ．０ 组和 Ｈｓ５ ．０ 组上述观察指标比对照组显著降低,而 Ｓｂ ３ ．３ 和 Ｈｓ３ ．３ 组与对照组相比无差别。治疗后６０ ｍｉｎ Ｓｂ５ ．０ 组、 Ｈｓ ５ ．０ 组动物全部死亡,而另外３ 组全部存活。所有动物都可见相似的心肌损伤。结论：５ ％ 苏打及３ ．５ ％ 氯化钠高渗液体,５ ｍｌ·ｋｇ － １ 剂量均可加重脑膜炎双球菌感染性休克家兔的心功能损伤,故在感染性休克治疗中,使用５ ％ 苏打应谨慎。     

普鲁卡因静脉复合与静吸互补麻醉的血流动力学改变

择期２４例ＡＳＡⅠ～Ⅱ级胸内手术患者，随机分为两组（静脉组１３例，静吸组１１例），于麻醉后５ｍｉｎ、１５ｍｉｎ、３０ｍｉｎ、６０ｍｉｎ测定ＰＲ、ＳＶ、ＣＯ、ＳＩ、ＣＩ、ＶＰＥ、ＭＡＰ、ＴＰＲ分析比较。结果表明：静脉组ＰＲ前３０ｍｉｎ稳定，６０ｍｉｎ增快（Ｐ＜０．０１），ＭＡＰ下降４％（ｐ＞０．０５），ＳＶ、ＣＯ、ＳＩ、ＣＩ、ＶＰＥ进行性下降（ｐ＜０．０１）；静吸组ＰＲ前３０ｍｉｎ增快７％（Ｐ＞０．０５），６０ｍｉｎ时正常，ＭＡＰ稳定，其他指标前３０ｍｉｎ呈下降趋势（Ｐ＜０．０５），６０ｍｉｎ恢复正常。两组ＴＰＲ增高幅度近似（６７．２％～７０．１％）。     

急性冷暴大鼠ACTH分泌及锌代谢的变化

目的：观察急性冷暴过程中大鼠ＡＣＴＨ分泌及锌代谢的变化情况。方法：雄性ＳＤ大鼠３２只，随机分为４组，１组为室温对照组（２０℃±１℃）２，３组分别于－１５℃冷暴１５ｍｉｎ和６０ｍｉｎ４组－１５℃冷暴６０ｍｉｎ后室温１５ｍｉｎ，动物处理后立即宰杀，测定血浆ＡＣＴＨ，血清，肝脏和骨骼肌锌含量。结果：大鼠冷暴１５ｍｉｎ时，血浆ＡＣＴＨ即明显升高，冷暴６０ｍｉｎ及恢复１５ｍｉｎ后仍于较高水平（Ｐ〈０．０５）     

亚硒酸钠对HL—60细胞生长,分化和环核苷酸水平的影响

研究亚硒酸钠对人急性白血病细胞（ＨＬ－６０细胞，ＡＭＬ－Ｍ２型白血病细胞）生长、分化及胞内环核苷酸水平的影响。方法ＨＬ－６０细胞用ＲＰＭＩ１６４０培养液培养，对比研究加与不加亚硒酸钠的差别，环磷酸腺苷（ｃＡＭＰ）、环磷酸鸟苷（ｃＧＭＰ）水平的测定用放射免疫分析法。结果１．５×１０－５ｍｏｌ／Ｌ或３．０×１０－５ｍｏｌ／Ｌ的亚硒酸钠能显著抑制ＨＬ－６０细胞的生长，且呈剂量依赖性，１．５×１０－５ｍｏｌ／Ｌ的亚硒酸钠能促进ＨＬ－６０细胞的分化，对静息的胞内ｃＧＭＰ水平有明显的降低作用，对照组（０．０７±０．０２９）ｐｍｏｌ／１０６ｃｅｌｓ，３０ｍｉｎ，亚硒酸钠组（０．０６±０．０１７）ｐｍｏｌ／１０６ｃｅｌｓ，３０ｍｉｎ（Ｐ＜０．０５）。对肾上腺素刺激的胞内ｃＧＭＰ水平也有明显的降低作用，对照组（０．０７±０．０１８）ｐｍｏｌ／１０６ｃｅｌｓ，３０ｍｉｎ，亚硒酸钠组（０．０５±０．０１４）ｐｍｏｌ／１０６ｃｅｌｓ，３０ｍｉｎ（Ｐ＜０．０５）。结论亚硒酸钠的抑瘤作用可能与降低细胞内ｃＧＭＰ水平有关。     

消除Ia阳性细胞及短程应用CyA诱导大鼠甲状腺同种异体移…

本实验采用单抗加补体方法消除大鼠甲状旁腺（ＰＴＧ）移植物中的Ｉａ阳性细胞，处理后移植物分泌功能保存良好，将其移植到同种受体肾包膜下，移植物平均存活时间达６０ｄ，与未处理移植组（１４ｄ）相比，Ｐ〈０．０１。若受鼠接受移植前应用环孢素（ＣｙＡ）３ｄ（２．５ｍｇ．ｋｇ＾－１／ｄ）则可使６０％经处理的ＰＴＧ同种异体移植存活期大于１５０ｄ；与未处理短程应用ＣｙＡ组（７０ｄ）相比，Ｐ〈０．０１。说明消除Ｉａ抗     

亚剂量氯胺酮静脉麻醉应用儿童斜视矫正术临床观察

氯胺酮镇静痛术用于儿童眼病斜视矫正术，２０例使用亚剂量静脉注入与静脉滴入方法，配合局部麻醉，首次静脉注入０．５－０．６ｍｇ／ｋｇ，患儿安静入睡５－６分钟静脉滴入０．１％氯胺酮０．８－１．５ｍｇ／ｋｇ，术中儿童意识消失，维持镇静镇痛Ⅳ级，停药２－３分钟，和能唤醒顺利观察眼位。     

异丙酚全凭静脉麻醉用于腹腔镜胆囊切除术的临床观察

为观察异丙酚全凭静脉麻醉用于腹腔镜胆囊切除术的麻醉经过及苏醒情况,重点观察麻醉诱导插管及ＣＯ２ 人工气腹过程呼吸循环功能的变化,以探讨其优点和实用性。对３０ 例ＡＳＡ Ⅰ～Ⅱ级择期腹腔镜胆囊切除术病人,以芬太尼２ ～４μｇ·ｋｇ －１ 及异丙酚２ ～２ ．５ ｍｇ·ｋｇ － １、卡肌宁０ ．５ ｍｇ／ｋｇ － １静注快速诱导气管插管,用微量泵持续静脉泵注异丙酚１０ ～１２ ｍ ｇ·ｋｇ －１·ｈ －１ 、２０ ～３０ ｍｉｎ 间断静注卡肌宁０ ．２５ ～０ ．５ ｍｇ／ｋｇ － １ 维持麻醉及肌松,连续监测Ｆｉｏ２、ＳｐＯ２ 、ＰＥＴＣＯ２ 、ＴＶ、Ｐｐｅａｋ 、ｍ Ｐａｗ 、ＨＲ、ＳＢＰ、ＤＢＰ、ＭＡＰ、ＥＣＧ 的变化。结果本组平均麻醉时间为７９ ．５ ±５ ．２ ｍｉｎ ,异丙酚平均总用量为６０５ ±１３５ ｍｇ ,诱导后插管前ＳＢＰ、ＭＡＰ、ＨＲ 分别下降３ ．６３ｋＰａ 、１ ．９８ｋＰａ 、１７ 次／ ｍｉｎ（ Ｐ ＜ ０ ．０１） ,ＤＢＰ 也下降１ ．２５ｋＰａ（ Ｐ ＜ ０ ．０５） ,完成插管后迅速回升;ＰＥＴＣＯ２ 、Ｐｐｅａｋ 、ｍ Ｐａｗ 在ＣＯ２ 气腹后１０ ～１５ ｍｉｎ 上升到最高值（ Ｐ ＜ ０ ．０１） ,并在气腹期维持在较高水平。全部病例均于拔管后     

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.