异丙酚—安氟醚复合麻醉在食管癌根治术中的应用

目的；观察异丙酚安氟醚复合全麻在食管癌根治手术中的麻醉效果。方法：２０例食管癌患者在异丙酚，芬太尼诱导，异丙酚，安氟醚，维库溴铵麻醉维持下施根治术。观察诱导前，后及麻醉中的血流动力学变化，术毕患者清情况及不良反应。结果：诱导前后血压变化有显著差异，诱导后血压一过性下降，术中血压平稳。     

七氟醚静吸复合麻醉在小儿腹腔镜胆囊切除术中的应用

目的：探讨七氟醚静吸复合麻醉在小儿腹腔镜胆囊切除术的临床效果。方法：5例4～7岁ASAI级择期行腹腔镜胆囊切除术,七氟醚麻醉诱导,七氟醚麻醉维持。记录术中血流动力学变化,术后麻醉恢复情况。结果：七氟醚麻醉诱导平稳,术中循环稳定,术后清醒迅速,安全。结论：七氟醚可安全有效地应用于小儿腹腔镜胆囊切除手术。     

瑞芬太尼复合异丙酚或地氟醚对麻醉手术中血流动力学的影响

比较支撑喉镜手术中瑞芬太尼复合异丙酚和地氟醚对患者术中血流动力学变化的影响.麻醉诱导采用异丙酚1.5 mg·kg-1,瑞芬太尼1 μg·kg-1不能完全抑制气管插管反应;麻醉维持阶段瑞芬太尼0.2μg·kg-1·min-1的输注速度不能完全消除置支撑喉镜时引起的血压升高;瑞芬太尼复合地氟醚麻醉在手术开始前血压下降的程度小于复合异丙酚组;麻醉诱导期瑞芬太尼复合地氟醚要比复合异丙酚的血流动力学更加稳定.     

七氟醚吸入对上腹部手术麻醉效果和苏醒的影响

目的比较七氟醚吸人复合舒芬太尼麻醉与丙泊酚复合舒芬太尼麻醉对上腹部手术麻醉诱导和苏醒的影响。方法80例择期上腹部手术患者随机均分为七氟醚组（A组）和丙泊酚组（B组）,记录各时点的血流动力学、脑电双频指数、麻醉恢复期时间及不良反应。结果两组血流动力学平稳,A组麻醉恢复较B组迅速（P〈0．05）。结论七氟醚复合舒芬太尼麻醉,患者术中血流动力学稳定,麻醉维持平稳,术毕苏醒早,是一种安全的麻醉方法。     

异丙酚安氟醚静吸复合麻醉的应用

为观察异丙酚、安氟醚静吸复合麻醉的可取性,选择了26例手术病人行异丙酚(2.5mg/kg)诱导,异丙酚(0.08％)—安氟醚(1％～1.5％)静吸复合维持麻醉。观察并记录诱导前后5分钟BP、HR;维持期间的BP、HR、拔管时间和术后不良反应,结果:诱导后5分钟SBP、DBP明显下降,HR改变不明显,维持期SBP、DBP基本稳定在诱导前水平,波动小于基础值20％,心率无明显改变,恢复期拔管时间为22.69±11.83分钟,术后无不良反应,提示:异丙酚—安氟醚静吸复合麻醉是一项可取的麻醉方法。     

安氟醚复合异丙酚麻醉对肺内分流及肺顺应性影响的研究

目的 研究安氟醚复合异丙酚麻醉对肺动态顺应性和肺内分流的影响。方法 １４例ＡＳＡⅠ￣Ⅱ级上腹部手术病人分别在麻醉诱导、气管插管后３０ｍｉｎ，复合安氟醚和异丙酚用药后３０ｍｉｎ、６０ｍｉｎ测定肺内分流率及肺顺应性。结果 使用安氟醚复合异丙酚麻醉后各时刻肺内分流率及肺动态顺应性无显著变化。结论 安氟醚复合异丙酚麻醉对肺内分流及肺顺应性无显著影响。     

非体外循环下冠状动脉搭桥术的麻醉管理

目的:探讨非体外循环下冠状动脉搭桥的麻醉管理方法。方法:16例冠状动脉狭窄病人分别在全麻下采用体外循环(CCABG组)和非体外循环(OPCAB组)下行冠状动脉搭桥术,麻醉方法采用咪唑安定、芬太尼、异丙酚、安氟醚静吸复合麻醉,术中通过心血管活性药物控制血压、心率。对OPCAB搭桥前后血流动力学变化进行比较,并对OPCAB和CCABG手术时间,术后恢复情况,输血情况进行比较。结果:OPCAB术的麻醉能够维持病人的血流动力学平稳,手术时间(120±32min),术后呼吸支持时间(6.5±3.6h),ICU停留时间(24.3±8.5h)及输血量(2.5±0.5u)均小于CCABG组。结论:OPCAB手术的麻醉效果满意,血流动力学稳定,能够满足手术要求,并相对于体外循环下手术的病人更早恢复,更省费用,具有明显的优势。     

七氟醚复合异丙酚在无痛胃镜检查中的应用

目的:观察七氟醚复合异丙酚用于无痛胃镜检查术的安全性与有效性。方法:60例择期手术患者随机分为SP组(七氟醚异丙酚组)和P组(异丙酚组),SP组用面罩法吸入8%七氟醚-O25L/min,麻醉后鼻导管吸入2%七氟醚-O2,检查开始前静注异丙酚0.5mg/kg,检查结束前1min停止吸入七氟醚,吸入纯O2。P组静注异丙酚2mg/kg诱导,术中持续泵注异丙酚3～5μg/kg.min,手术结束时停止输注。观察麻醉期间的MAP、HR、SpO2。记录诱导至麻醉的时间、苏醒时间及不良反应情况。结果:SP组术中SpO2、HR与P组差异有显著性。SP组和P组诱导至麻醉的时间分别是72±16s和34±11s,差异有显著性。苏醒时间分别是2.6±1.3min和2.2±1.4min,差异无显著性。结论:七氟醚复合异丙酚麻醉,诱导平稳,苏醒迅速,可安全的应用于无痛胃镜检查。     

异丙酚与安氟醚在神经外科手术麻醉中的应用

目的 :比较异丙酚与安氟醚在神经外科手术中麻醉诱导和维持阶段对血流动力学影响和病人术毕苏醒时间长短。方法 :34例幕上肿瘤切除病例随机分为A、B两组 ,两组均以异丙酚、芬太尼、司可林麻醉诱导。A组以异丙酚维持 ,B组以安氟醚吸入维持 ,术中连续监测HR、MAP、SpO2 值。结果 :苏醒时间、术后恶心、呕吐的发生率A组明显低于B组 ,且A组血流动力学平稳。结论 :1%普鲁卡因 +0 .6‰琥珀胆碱辅以小剂量异丙酚微泵静推适用于神经外科手术的麻醉     

异丙酚——氯胺酮复合麻醉对颅脑手术患者颅内压的影响

目的研究异丙酚-氯胺酮复合麻醉对颅脑手术患者颅内压、血流动力学及麻醉苏醒期的影响.方法选择30例颅脑手术病人,麻醉前于L3～4椎间隙穿刺,蛛网膜下腔置管测压,异丙酚、芬太尼及潘可罗宁常规诱导,随机将病人分成2组I组术中维持以异丙酚4mg@mg@kg-1、氯胺酮2mg@kg-1@h-1持续微泵静脉滴注,Ⅱ组术中维持以同等剂量异丙酚复合1%～2%异氟醚,观察术前、切皮、钻颅骨、打开硬膜时颅内压的变化,Datex监护仪持续监测ECG、脉搏氧饱和度(SpO2)及有创监测动脉血压、中心静脉压(CVP)的变化;同时观察麻醉苏醒期病人血流动力学变化和恢复期的不良反应.结果异丙酚-氯胺酮复合麻醉术中循环稳定,颅内压降低的同时可维持满意的脑灌注,苏醒过程平稳,呛咳、屏气及躁动等不良反应发生少;而异丙酚复合异氟醚吸入麻醉在降低血压的同时使颅内压下降,并伴随明显的脑灌注减少.结论异丙酚-氯胺酮复合麻醉可安全用于颅脑外科手术病人.     

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.