硬膜外阻滞手术中输液加温器的应用效果分析

目的:探寻输液加温器在硬膜外阻滞手术中的应用。方法:采用试验性研究法,选择硬膜外麻醉的手术患者300例,随机分为观察组和对照组各150例,观察组输液时使用输液加温器,对照组常规输液,比较两组患者术中、术毕时肢体寒战,疼痛,麻木,血管痉挛等现象的发生率及肢体舒适度。结果:观察组输液时肢体寒战、疼痛、麻木、血管痉挛的发生率均明显低于对照组,差异有统计学意义(P<0.05),术中、术后患者肢体舒适度评分观察组均高于对照组,差异有统计学意义(P<0.01)。结论:硬膜外麻醉的手术患者使用输液加温器输液时能有效减少寒战、疼痛、麻木、血管痉挛等情况的发生,提高患者的舒适度。     

硬膜外阻滞手术中输液加温器的应用效果分析

目的 :探寻输液加温器在硬膜外阻滞手术中的应用.方法 :采用试验性研究法,选择硬膜外麻醉的手术患者400例,随机分为观察组和对照组各200例,观察组输液时使用输液加温器,对照组常规输液,比较两组患者术中、术毕时肢体寒战,疼痛,麻木,血管痉挛等现象的发生率及肢体舒适度.结果 :观察组输液时肢体寒战、疼痛、麻木、血管痉挛的发生率均明显低于对照组,差异有统计学意义(P<0.05),术中、术后患者肢体舒适度评分观察组均高于对照组,差异有统计学意义(P<0.01).结论 :硬膜外麻醉的手术患者使用输液加温器输液时能有效减少寒战、疼痛、麻木、血管痉挛等情况的发生,提高患者的舒适度.     

加温输液对冬天剖宫产患者术中的影响

目的:探讨加温(37℃)输液在冬天剖宫产术中应用的意义。方法:将90例在冬天剖宫产手术患者随机分为非加温输液组与加温输液组各45例,及时记录患者对寒战的自觉症状及出现时间、持续时间。结果:加温组寒战发生率明显低于室温组,而且加温组发生寒战持续时间明显少于室温组,统计学处理差异有显著性(P<0.01),2组患者输液总量、输液速度之间差异无显著性(P>0.05)。结论:在冬天剖宫产术中患者应用加温液体输注可以有效减少寒战发生。     

硬膜外试验量产生广泛阻滞4例

硬膜外试验量产生广泛阻滞４例王建（青岛市第三人民医院麻醉科山东青岛２６６０４１）１９８８年～１９９７年间，我们在硬膜外麻醉中，常规试验剂量注入１．５％～２％利多卡因４～５ｍｌ产生广泛神经阻滞４例，报告如下。１临床资料４例患者均常规硬膜外穿刺，置管顺利...     

单管低浓度局麻药连续硬膜外麻醉用于乳腺癌根治术

乳腺癌１１０例随机分为２组，单管阻滞组５７例，双管阻滞组５３例，单管阻滞组采用Ｔ２￣Ｔ３硬膜外阻滞，０．６７％利多卡因。双管阻滞组采用Ｃ７￣Ｔ１和Ｔ４￣５两点硬膜外阻滞，年老体弱和肥胖者要严密观察呼吸循环改变，动态监测ＳＰＯ２，常规给氧以防低氧血症。     

经尿道前列腺电切术的术中保温效果观察

目的观察术中保温对预防经尿道前列腺电切术患者低温性寒战的效果。方法将60例经尿道前列腺电切术（TURP）患者随机分为保温组和对照组，每组各30例。对照组患者术中不采用任何升温措施，使用室温灌洗液进行膀胱冲洗；保温组患者术中采用输液加温及上身加盖毛毯保温，选用加温至37℃的灌洗液进行膀胱冲洗。测定术前和术后核心温度，比较两组患者术中发生寒战情况。结果保温组患者术中体温稳定，手术前后体温无明显变化；对照组患者术中体温显著下降。保温组寒战发生率显著低于对照组。结论TURP采用术中保温措施可维持体温恒定、降低寒战发生率。     

输液加温法预防术中、术后寒战的观察

目的：观察术中输入加温液体对术中、术后寒战的预防作用。方法：60例外科手术患者随机分为实验组（30例）及对照组(30例），两组患者手术种类、麻醉方法及ASA分级无差异，输入液体的量与速度无差异。实验组输入的液体和库血，均通过八达输液加温仪将输出端的液体加温至32－36℃，对照组输入室温的液体和未经加温处理的库血。分别于麻醉前，麻醉后30min、60min、120min，术终、术后30min、60min记录患者的鼻咽温及寒战的发生情况。结果：两组患者在麻醉后60min至术后60min各个时段的鼻咽温均有显著差异（P＜0．01），而各个时段寒战的发生也有显著差异（P＜0．01）。结论：术中使用输液加温法可预防术中体温的降低，从而减少寒战的发生。     

液体输入对术中寒战发生率的影响

目的：探讨术中输入液体对术中寒战发生率的影响。方法：选择硬腰联合麻醉、腹部手术患者600例,随机分为观察组（输入32℃-36℃加温液体）和对照组（输入常温下液体）,每组各300例。观察两组患者输液后30 min、输液后60 min和输液后120 min寒战发生情况,并记录结果进行统计学处理。结果：对照组术中寒战发生率受输入液体量与速度的影响非常明显,相同时间输入液体量越多,寒战率越高,相同液体量输入时间越短寒战率越高;手术时间越长,输入液体量越大寒战发生率越高;观察组在相同条件下寒战率明显降低,两组差异有统计学意义（P均〈0.01）。结论：术中寒战与输入常温液体的时-量关系非常明显,输入加温液体可显著降低术中寒战的发生率,是一种安全有效的预防寒战的方法。     

快速输液在高血压患者硬膜外阻滞中的应用

快速输液在高血压患者硬膜外阻滞中的应用黄松山，黄少泉洛阳铜加工厂医院麻醉科洛阳４７１００３关键词快速输液；高血压；硬膜外阻滞硬膜外阻滞中血压下降是高血压患者（ｐＳＢ≥２１．３ｋＰａ，ｐＤＢ≥１２．７ｋＰａ）常见的、也是危险的并发症之一［１］。一旦下降...     

曲马多＋加温液降低老龄硬膜外麻术中寒战发生的观察

目的 观察曲马多＋ 输注加温液体降低老龄硬膜外麻醉手术寒战发生的效果.方法 将126 例全麻下老年手术患者,随机分为研究组（ 曲马多＋ 输注加温液体）、对照1 组（ 输入常温液体）、对照2 组（曲马多＋ 输入常温液体）.记录3 组患者麻醉后至手术结束时寒战出现情况（ 时间与分级）,并进行比较分析.结果 对照2 组寒战发生率低于对照1 组,研究组寒战发生率明显低于对照1 组和对照2 组,3 组比较差异有统计学意义（P 〈0.05）.结论 采用曲马多＋ 输注加温液体可有效地降低老龄硬膜外麻醉手术发生寒战,值得临床推广应用.     

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.