纳布啡联合舒芬太尼用于老年单侧全髋关节置换术后静脉自控镇痛的效果

目的 观察纳布啡联合舒芬太尼用于老年单侧全髋关节置换术后静脉自控镇痛的效果。方法 选取2020年1月-2022年1月在我院接受单侧全髋关节置换术治疗的老年患者60例,随机分为对照组和实验组,每组各30例。术后给予对照组患者舒芬太尼静脉自控镇痛,实验组患者联合纳布啡进行静脉自控镇痛。对比分析两组患者术后镇痛效果（视觉模拟评分法,visual analogue scale,VAS）、镇静效果（Ramsay镇静评分,ramsay sedation score,RSS）以及苏醒期治质量。结果 手术完成后,VAS、RSS评分组间比较,差异无统计学意义（P>0.05）;术后2、12、24 h,实验组VAS、RSS评分均明显低于对照组,差异显著（P<0.05）。结论 老年单侧全髋关节置换术后静脉自控镇痛应用纳布啡联合舒芬太尼可获得理想的镇痛、镇静效果,并且可以缩短患者苏醒时间以及降低躁动程度。     

老年患者全髋置换术后多模式镇痛的探讨

目的:探讨多模式镇痛用于老年全髋关节置换术后的效果及不良反应。方法:选择择期在连续硬膜外麻醉下行全髋关节置换术的老年患者90例,随机分为三组(n=30)。A组单纯使用静脉自控镇痛(PCIA);B组经硬膜外单次注射吗啡后,再实行PCIA;C组在B组方法的基础上,使用帕瑞昔布钠静脉分次注射。三组患者的镇痛泵配方均为0.2 g/L地佐辛,于手术结束后开启,以LCP模式进行镇痛。观察各组患者术后不同时间点的NRS评分、Ramsay镇静评分、不良反应以及有效PCA按压次数。结果:A组患者术后4 h与8 h的NRS评分和有效PCA按压次数高于B、C组(P<0.05),各时间点的Ramsay镇静评分A组均高于B组和C组(P<0.05);而B、C组NRS、Ramsay评分及有效PCA按压次数差异均无统计学意义。C组不良反应发生率明显低于A、B组。结论:硬膜外联合静脉多模式镇痛,用于老年全髋关节置换术后,镇痛效果好且不良反应少,是一种值得推荐的术后镇痛方式。     

硬膜外自控镇痛对老年患者人工全髋关节置换术后应激反应的影响

目的 观察硬膜外镇痛对老年患者人工全髋关节置换术后应激反应的影响.方法 择期人工全髋关节置换术手术患者40例,年龄70～90岁,采用腰麻-硬膜外阻滞联合麻醉,随机分为两组:硬膜外镇痛组20例,术后给予硬膜外自控镇痛(PCEA);对照组20例,术后不给予硬膜外自控镇痛.患者于麻醉开始前、术毕即刻、术后6 h、术后24 h经中心静脉抽取静脉血,测定肾上腺素、去甲肾上腺素、多巴胺的含量并进行比较.结果 硬膜外镇痛组术后镇痛效果满意,视觉模拟评分法评分VAS<2分.镇痛组患者血浆多巴胺在术后6 h和24 h明显下降,下降幅度与术前比较差异有显著性(P<0.05),与对照组相应时段比较亦差异有显著性(P<0.05).镇痛组患者血浆肾上腺素在术后24 h明显下降,下降幅度与术前比较差异有显著性(P<0.05),与对照组相应时段比较亦差异有显著性(P<0.05). 结论人工全髋关节置换术后硬膜外自控镇痛能显著减少老年患者血浆儿茶酚胺的含量,能显著减轻术后患者的应激反应.     

氢吗啡酮硬膜外镇痛联合静脉自控镇痛在老年髋关节置换术中的应用效果研究

目的 探讨氢吗啡酮硬膜外镇痛联合静脉自控镇痛在老年患者髋关节置换术中的应用效果。方法 选取本院120例老年髋关节置换术患者。按随机数字表法分组，对照组(n=60)实施静脉自控镇痛，试验组(n=60)实施氢吗啡酮硬膜外镇痛联合静脉自控镇痛。比较2组术后镇痛效果及应激反应、认知功能。结果 术后4 h、8 h、12 h、24 h、48 h试验组视觉模拟评分(VAS)低于对照组(P<0.05);术后12 h、24 h时试验组皮质醇(Cor)、去甲肾上腺素(NE)低于对照组(P<0.05);术后1 d、3 d、7 d时试验组简易精神状态量表(MMSE)评分高于对照组(P<0.05);试验组术后认知功能障碍发生率为3.33%,低于对照组15.00%(P<0.05)。结论 老年髋关节置换术患者中应用氢吗啡酮硬膜外镇痛联合静脉自控镇痛可获得理想镇痛效果，减轻应激反应，改善术后认知功能。     

地佐辛镇痛对老年骨科手术患者术后谵妄发生率的影响

目的：观察地佐辛术后静脉镇痛对老年骨科患者术后谵妄发生率的影响。方法：择期行髋关节置换术患者70例,年龄〉60岁,随机均分为地佐辛术后镇痛组（ DA组）和吗啡术后镇痛组（ MA组）,各组35例。术后行患者静脉自控镇痛,并随访统计术后即刻（T1）、24 h（T2）和48 h（T3）3个时间点的谵妄发生率（CAM-CR法）、VAS评分以及术后不良反应。结果：DA组在T1的术后谵妄发生率与MA组差异无统计学意义（P〉0.05）;DA组患者术后恶心呕吐与呼吸抑制发生率与MA组的差异均无统计学意义（P〉0.05）。2组患者在T1、T2和T3三个时间点VAS评分差异均无统计学意义（P〉0.05）。结论：对于老年骨科手术患者而言,地佐辛术后静脉自控镇痛具有与吗啡相当的镇痛效果,并不增加术后谵妄的危险性,不良反应较少。     

超声引导下连续髂筋膜阻滞对老年患者全髋关节置换术后早期恢复质量的影响

目的 探讨超声引导下连续髂筋膜阻滞（continuous fascia iliac compartment block,CFICB）对老年患者全髋关节置换术后早期恢复质量的影响。方法 选取2022年1月至7月于嘉兴学院附属第二医院行全髋关节置换术的老年患者,根据随机数字表法将患者分为CFICB组和患者静脉自控镇痛（patient-controlled intravenous analgesia,PCIA）组,每组各34例。采用15项恢复质量量表（15-item quality of recovery questionnaire,QoR-15）评估两组患者术后24h和48h的恢复情况。记录两组患者术后1h、3h、6h、12h、24h和48h静息和运动时疼痛数字评分量表（numerical rating scale,NRS）评分和曲线下面积（area under the curve,AUC）及首次镇痛补救时间、镇痛补救发生率、首次下床活动时间、术后住院时间及不良反应发生情况。结果 术后24h和48h,CFICB组患者的QoR-15总分及身体舒适度、情绪状态、心理支持、疼痛评分均显著高于同期PCIA组（P<0.05）,但两组患者的身体独立评分比较差异均无统计学意义（P>0.05）。术后1h、3h、6h、12h和24h,CFICB组患者的静息和运动时NRS评分均显著低于PCIA组（P<0.05）;术后48h,CFICB组患者的运动时NRS评分显著低于PCIA组（P<0.05）,但两组患者的静息时NRS评分比较差异无统计学意义（P>0.05）。CFICB组患者术后静息和运动时NRS评分的AUC均显著小于PCIA组,首次镇痛补救时间长于PCIA组,镇痛补救发生率、术后恶心呕吐发生率低于PCIA组（P<0.05）。结论 超声引导下CFICB能够提高老年患者全髋关节置换术后早期的恢复质量,并提供良好的镇痛效果。     

无线镇痛泵对于老年患者髋关节置换术后镇痛的效果观察

目的 探讨无线镇痛泵用于老年患者髋关节置换术后镇痛的可行性及有效性。方法 将100例我院2016年5月~2017年5月需术后镇痛的老年髋关节置换术后患者随机分为两组,试验组50例,采用无线镇痛泵;对照组50例,采用传统电子镇痛泵。观察应用数字疼痛评分法（NRS）分别于术后出PACU、24h、48h、72h的评价患者的疼痛程度;患者对自控键的总按压次数、有效按压次数、麻醉医生的有效处理时间、测评患者总体满意度及不良反应的发生情况、评估两组患者的术后认知功能。结果 两组患者术后各时点的NRS评分比较无统计学差异（P>0.05）;两组患者按压自控键的总次数、有效按压次数比较无统计学差异（P>0.05）;麻醉医生有效处理时间院试验组为（11.0±2.53）min,对照组为（18.0±3.11）min,有统计学差异（P<0.05）;试验组患者的总体满意度高于对照组,差异有统计学意义（P<0.05）;两组患者不良反应发生率无明显差异（P>0.05）;两组患者术后简易精神状态量表评分及术后认知功能障碍的发生率比较均无差异（P>0.05）。结论 无线镇痛泵系统用于老年患者髋关节置换术后的镇痛管理安全可行,利于患者术后快速康复。     

舒芬太尼在老年全髋关节置换术后静脉自控镇痛的临床应用

目的 观察老年患者全髋关节置换术后舒芬太尼脉自控镇痛的临床效果和安全性,并和芬太尼静脉自控镇痛比较.方法 硬膜外麻醉下全髋关节置换术后老年患者60例,随机分为研究组（n=30）和对照组（n=30）,前者使用舒芬太尼,对照组使用芬太尼,两组均加昂丹司琼4 mg,均以0.9%生理盐水稀释至100 ml.观察术后镇痛效果与不良反应.结果 研究组VAS在术后48h内低于对照组（P〈0.05）;收缩压对照组明显高于研究组（P〈0.05）,不良反应的发生率亦较研究组高（P〈0.05）.结论 舒芬太尼可安全有效地用于老年全髋关节置换术后静脉自控镇痛,效果优于芬太尼,且不良反应减少.     

剖宫产术后不同PCA镇痛方法对应激的影响

目的 探讨不同PCA镇痛方法用于剖宫产术后对应激的影响.方法 40例择期硬膜外麻醉下剖宫产术需术后镇痛产妇.术毕随机分硬膜外自控镇痛（PCEA）组和静脉自控镇痛（PCIA）组.记录手术后6h、24h、48h视觉模拟评分（VAS）及患者术后镇痛满意度.测术前、术毕、术后6h、术后24h、术后48h血浆葡萄糖值并同时记录MAP、HR.结果 术后6h时点PCEA组VAS评分比PCIA组VAS评分低（P＜0.05）,其余各时点VAS评分无显著性差异（P＞0.05）.PCEA组在6h、24h血糖值显著比PCIA组低（P＜0.05）;术毕、术后6h、术后24h、术后48h血糖值比术前较高（P＜0.05）;两组MAP、HR各时点无显著性差异（P＞0.05）;患者术后镇痛满意度无显著性差异（P＞0.05）.结论 剖宫产术后采用硬膜外自控镇痛比静脉自控镇痛更好地减轻手术后应激反应,有利于术后恢复.     

重症胸外伤患者术后静脉自控镇痛的临床效果观察

目的：观察静脉自控镇痛用于重症胸外伤（ STT）患者术后镇痛效果。方法将STT患者90例,按随机数字表法分为观察组和对照组,每组45例。两组患者入院后均按通气、输液、搏动、控制出血、手术的程序进行救治,观察组术后给予芬太尼、格拉司琼和氯胺酮行静脉自控镇痛,对照组术后给予芬太尼、格拉司琼和右美托咪定行静脉自控镇痛。比较两组患者术后1 h、6 h、12 h及24 h视觉模拟（ VAS）评分、Ramsay镇静（ RSS）评分及不良反应发生率。结果观察组患者术后VAS评分低于对照组（P＜0．05）,两组VAS评分随着时间延长而降低（P＜0．05）;两组RSS比较,差异无统计学意义（P＞0．05）。观察组并发症发生率低于对照组（P＜0．05）。结论重症胸外伤患者术后静脉自控镇痛加用氯胺酮能增强镇痛效果,并且未增加并发症的发生率,安全可靠。     

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.