全髋置换术后认知功能障碍的临床研究

目的分析可能引起全髋关节置换术后认知功能障碍(POCD)的原因、临床表现及不同麻醉方式对术后认知功能障碍的影响。方法选择2011年1月-2012年6月桃江县人民医院收治的全髋关节置换手术患者46例,硬膜外麻醉组及全麻组各23例。回顾性分析患者在行后全髋关节置换术后出现认知功能障碍的原因、临床表现,不同麻醉方式术后采用MMSE量表对比评估两组患者术后24h、48h的认知功能障碍。结果高龄、睡眠紊乱、手术打击、内环境紊乱等是全髋关节置换术后认知功能障碍发病的相关因素。两组患者MMSE量表评分均有不同程度的降低,但全麻组下降更明显,全麻组POCD发生率高于硬膜外组,两组比较差异有统计学意义(P<0.05)。结论术后认知功能障碍是多种因素协同作用的结果,硬膜外麻醉较全身麻醉对老年患者术后认知功能影响轻,POCD发生率低,是一适合老年患者手术的麻醉方法。     

不同全麻方法对正颌手术后早期认知功能的影响

目的:观察和比较两种不同全麻方法对青年患者正颌手术后早期认知功能的影响。方法:选取2010年1～9月中国医科大学附属口腔医院择期行正颌手术青年患者(18～39岁)60例,随机分为两组,I组为丙泊酚复合瑞芬太尼全凭静脉麻醉,II组为七氟烷复合瑞芬太尼静吸复合麻醉,每组各30例,记录两组患者术后苏醒情况。采用简易精神状态量表(MMSE)对术前1天以及术后1、3、7天的认知功能进行测试评估。结果:I组患者听从指令时间与定向力恢复时间均早于II组患者,差异均有统计学意义(P<0.05),I、II组患者术后第1天发生术后认知功能障碍(POCD)各有1例。结论:采用MMSE评估,全凭静脉麻醉和静吸复合麻醉对青年患者正颌手术后早期认知功能均有不同程度的影响,可引起一过性POCD。     

两种不同麻醉方式对老年人工股骨头置换术患者术后认知功能影响

目的:探讨不同麻醉方式对老年人工股骨头置换术病人术后认知功能的影响。方法:拟择期行人工股骨头置换手术的患者236例,年龄≥65岁,随机分为静吸复合全麻组和硬腰联合椎管内麻醉组,每组118例。分别采用静脉吸入复合全身麻醉和腰硬联合椎管内麻醉方式下行人工股骨头置换手术。于手术前1d,术后1、3、7d及3月用MMSE量表进行认知功能评分,并判断记录术后认知功能障碍(POCD)发生率。结果:静吸复合全麻组术后MMSE量表评分明显降低,并可以导致POCD,且近期发生率高于远期,分别为21.5%~23.7%,4.3%。腰硬联合椎管内麻醉组术后MMSE评分有降低,POCD仍有发生,近期与远期发生率相似,约3.4%。和椎管内麻醉组相比全麻组术后近期POCD发生率明显增高(P<0.05),但远期差异无统计学意义(P>0.05)。结论:静吸全身麻醉比腰硬联合椎管内麻醉在近期更容易引起人工股骨头置换术术后POCD发生,但远期发生率相似。     

不同麻醉方式对老年患者术后麻醉恢复期的影响

目的探讨不同麻醉方式对老年患者术后麻醉恢复期内认知功能的影响。方法选取老年手术患者108例,根据麻醉方法分为局麻组、全麻组和硬麻组各36例,手术前后评估患者的简易智能精神状态检查量表(MMSE)得分,并据此判定术后患者认知功能障碍(POCD)发生率。结果 3组手术前后各个时间点的MMSE得分均无明显差异(P>0.05),仅全麻组术后1 d及3 d MMSE得分较术前下降明显(P<0.05)。本文POCD发生率为9.3%,局麻组、硬麻组、全麻组分别占2.8%,8.3%,16.7%,全麻组明显高于局麻组(P<0.05)。结论不同麻醉方法对老年患者术后MMSE影响并不大,但全麻术后POSD发生率较高,局麻和硬麻相对更为安全,科学的麻醉方法必须以具体术式为依据。     

老年患者上腹部手术后认知功能障碍的临床观察

目的 观察老年患者上腹部全麻术后认知功能障碍(POCD)的发生率,了解和分析其相关可能的危险因素和独立危险因素.方法 选择行上腹部手术的65岁以上老年患者312例,分别于手术前及手术后1d、3d,由同一试验者采用简易智能量表(MMSE)评估患者的认知功能,以是否发生POCD将患者分为2组,对312例患者术前一般情况...     

丙泊酚和异氟烷对老年患者术中应激反应和术后认知功能恢复的影响

目的 探讨丙泊酚和异氟烷麻醉对老年患者术中应激反应及术后认知功能恢复的影响.方法 上腹部手术老年患者60例,分别接受丙泊酚(30例)和异氟烷(30例)麻醉,比较两组术中应激反应、术后简易精神状态量表评分、术后认知功能障碍发生率.结果 丙泊酚组应激反应较异氟烷组平稳,术后简易精神状态量表评分恢复较异氟烷组快,术后认知功能障碍发生率较异氟烷组低.结论 丙泊酚能有效抑制全麻术中应激反应,对患者术后认知功能影响小,适用于老年患者麻醉.     

麻醉深度对老年患者术后认知功能的影响

目的:研究不同的麻醉深度的静吸复合麻醉对老年患者术后认知功能(POCD)的影响。方法:选取采用静吸复合麻醉的65岁以上老年患者150例,随机将患者分为L组(术中BIS值维持50~60)、M组(术中BIS值维持40~50)和D组(术中BIS值维持30~40),每组50例。分别在术前1 d、术后3、5 d对患者进行精神状态量表(MMSE)评分,在术前1 d和术后3 d进行痕迹连线测试(TMT)和数字广度测验。对比分析不同时间点的评分差异。结果:L组和D组患者术后三项评分与术前比较差异均有统计学意义(P0.05),两组术后评分与M组比较差异均有统计学意义(P0.05)。结论:静吸复合全麻麻醉深度对老年患者术后认知功能有影响,术中BIS值维持在40~50时对老年患者术后认知功能影响较小。     

不同麻醉方式对老年腔隙性梗死患者术后认知功能的影响

目的 探讨不同麻醉方式对老年腔隙性梗死患者术后认知功能的影响.方法 选择接受手术治疗的腔隙性脑梗死患者46例作为研究对象,按照手术麻醉方式分为硬膜外麻醉组与全身麻醉组.观察并比较两组患者术后认知功能障碍(POCD)的发生率、采用MMSE(简易智能状态检测法)评分以及中文版蒙特利尔认知估量表(MoCA)对患者术后短期认知功能进行评估.结果 与术前相比,两组患者MMSE及MoCA评分均显著降低,且具有统计学意义(P＜0.05);与接受静吸复合全身麻醉的患者相比,接受硬膜外麻醉患者的术后6h、1d以及3d的POCD发生率、MMSE及MoCA评分均显著改善.结论 手术麻醉对老年腔梗患者认知功能会造成一定程度的损伤,但硬膜外麻醉方式较静吸复合麻醉带来的损伤小,可作为需进行手术治疗的老年腔梗患者的首选麻醉方式.     

不同麻醉方法对老年患者术后早期认知功能的影响

目的探讨不同麻醉方法对老年患者术后早期认知功能的影响。方法240例老年患者依据不同麻醉方法分为局麻组80例、硬麻组80例、全麻组80例,分别于术前和术后1、3、5d应用简易智能量表（MMSE）评定其认知功能,并对另外5个可能影响老年患者术后认知功能的因素（年龄、性别、受教育程度、手术时间、术前认知功能评分）进行Logistic分析。结果全麻组术后1、3dMMSE评分降低明显（P〈0．05）,但全麻组与硬麻组和局麻组相比无统计学意义（P〉0．05）。单因素分析有统计学意义的危险因素是年龄、手术时间和术前MMSE评分（P〈0．05）,多因素非条件Logistic回归分析发现,患者的年龄是一个独立危险因素（P〈0．05）.结论老年患者全麻手术后早期认知功能下降明显,但不同麻醉方法对老年患者术后早期发生认知功能障碍的影响无统计学差异。年龄是老年患者术后早期发生认知功能障碍的一个有显著性意义的危险因素。     

麻醉对认知功能的影响

目的探讨麻醉对患者术后认知功能的影响。方法该研究将150例骨科患者分为局麻、硬麻和全麻3组,利用MMSE量表分别对3组患者在术前和术后1d、3d、5d进行认知功能测评。结果不同麻醉方法对患者术后发生认知功能障碍的影响,经比较,差异无统计学意义(P>0.05)。结论年龄是影响患者术后发生认知功能障碍的一个显著性因素。     

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.