不同镇痛方法用于下肢术后镇痛的比较

目的：观察比较静脉曲马多自控镇痛（PCIA）和硬膜外罗哌卡因吗啡自控镇痛（PCEA）用于下肢术后镇痛的临床效果及安全性。方法：选择ASA Ⅰ-Ⅱ病人64例，均行下肢手术，随机分为静脉曲马多组（PCIA组）和硬膜外罗哌卡因吗啡组（PCEA组），每组32例。PCIA组：术毕外周静脉单次给予曲马多负荷量1 mg／kg，继之接镇痛泵，PCIA药物配方为：曲马多800 mg＋氟哌利多5 mg＋0．9％生理盐水至100 ml。PCEA组：术毕经硬膜外导管单次注入0．125％罗哌卡因5 ml，继之接镇痛泵。PCEA药物配方：1％罗哌卡因20 ml＋吗啡10 mg＋氟哌利多5 mg＋0．9％生理盐水至100 ml。两组持续给药速度均为2 ml／h，单次PCA剂量0．5 ml，锁定时间15 min，术后定时进行镇痛镇静评分，观察有无恶心、呕吐、皮肤瘙痒、头晕嗜睡、尿潴留等不良反应。结果：两组病人的一般资料无显著性差异（P〉0．05）。术后视觉模拟评分（VAS评分），PCIA组明显高于PCEA组，有显著性差异（P〈0．01）。术后镇静评分（Ramsay评分）PCIA组明显高于PCEA组，有显著性差异（P〈0．01）。恶心呕吐、尿潴留、皮肤瘙痒发生率PCIA组明显低于PCEA组。头晕嗜睡发生率PCIA组明显高于PCEA组。结论：下肢术后镇痛，采用吗啡PCEA镇痛优于曲马多PCIA。     

曲马多和吗啡用于术后PCIA的观察与比较

目的通过对开胸术后剧痛病人行曲马多病人自控镇痛(patient controlled intravenous analgesia,PCIA)并与吗啡PCIA比较,评定曲马多对病人镇痛程度和恶心、呕吐等不良反应的发生率以及在呼吸系统和心血管系统方面的安全性.方法择期开胸手术病人60例随机分为曲马多组和吗啡组,每组30例,两组病人全麻诱导术中麻醉维持用药相同,术毕清醒拔管后与外周输液静脉连接PCA泵.镇痛治疗时间48h.PCIA选择负荷剂量 维持剂量 PCIA给药模式.术后4,8,12,24和48h随访并记录BP,P,R及药物用量、疼痛评分、恶心呕吐、皮肤骚痒等情况.结果两组镇痛效果无显著性差异;曲马多组不良反应低于吗啡组.结论曲马多用于术后PCIA与传统的吗啡相比:镇痛效果较好,曲马多用于术后PCIA是一种有效、安全的方法.     

胆道手术后格拉司琼和氟哌啶用于PCIA效果比较

目的比较胆道系统手术后格拉司琼和氟哌啶用于病人静脉自控镇痛(PCIA)中术后疼痛和恶心呕吐(PONV)发生率。方法120例胆道系统手术病人随机分为2组,A组为曲马多12 mg/kg复合格拉司琼3 mg,B组为曲马多12 mg/kg复合氟哌啶5 mg,均用生理盐水稀释至75 ml,负荷量为曲马多2 mg/kg,持续输注2.0 ml/h,单次PCIA 1. 0 ml,锁定时间15分钟。结果两组镇痛效果满意(有效率100%),A组PONV发生率(5%),明显低于B组(15%)(P <0.05),两组尿潴留发生率分别为46.7%和50%(P>0.05)。结论曲马多、格拉司琼复合液较曲马多、氟哌啶复合液能明显降低胆道系统手术后病人镇痛期间恶心呕吐发生率。     

硬膜外吗啡负荷量对静脉曲马多镇痛的平衡作用

目的探讨硬膜外吗啡负荷量对静脉曲马多镇痛的影响。方法40例健康产妇随机分成2组：手术结束后吗啡＋曲马多组（MT组）硬膜外腔注射吗啡2mg,曲马多组（T组）静脉注射曲马多50mg,然后2组皆静脉联接plato自控镇痛泵。镇痛泵内药液配伍为曲马多5mg／mL＋氟哌啶5mg＋生理盐水至200mL。PCA设置：静脉持续输注量10mg／h,PCA量10mg,锁定时间6min。记录病人各时段PCIA按压次数和用药总量以及恶心、呕吐、皮肤瘙痒、呼吸抑制发生率。用视觉模拟镇痛评分法（VAS）评估病人的镇痛效果。结果T组的按压次数明显多于MT组（P〈0．01）,用药总量明显高于MT组（P〈0．01）：MT组的无痛率明显高于T组（P〈0．015）。2组恶心、呕吐发生率及对呼吸的频率与深度无明显影响。结论吗啡硬膜外负荷量可以大大减少静脉曲马多的剂量,同时镇痛效果优于单纯曲马多,而不良反应没有明显增加,二者联合应用有平衡镇痛作用,具有临床应用价值。     

曲马多与吗啡用于微创冠脉搭桥术后病人自控镇痛的比较

目的　比较微创冠脉搭桥手术病人术后 ,静脉注射吗啡与曲马多病人自控镇痛的临床效果和安全性。方法　 80例微创冠脉搭桥手术后的患者随机分为静脉注射吗啡自控镇痛组与静脉注射曲马多自控镇痛组 ,两组病人均在清醒、拔除气管导管后给药。吗啡组持续剂量 0 .0 1mg (kg·h) ,曲马多持续剂量 0 .3mg (kg·h) ,锁定时间均为 15min。术后 4、8、12、2 4、36、4 8h随访并记录两组用药量、疼痛评分、镇静程度和副作用情况。结果　两组在镇痛效果及患者对术后镇痛总体满意度上无明显差别 ,但曲马多与吗啡相比副作用更少。结论　吗啡与曲马多都能较好的用于微创冠脉搭桥手术后病人自控静脉镇痛 ,但曲马多副作用更少。     

硬膜外与静脉PCA用于术后镇痛的效果评估

目的　比较硬膜外与静脉自控镇痛 (PCEA、PCIA)在术后镇痛中的临床效果。方法　 6 0例在硬膜外麻醉下行妇科手术患者 ,随机分为硬膜外注射吗啡病人自控镇痛 (PCEA)组和静脉注射吗啡病人自控镇痛(PCIA)组。PCEA组在手术结束时 ,经硬膜外导管注入负荷量 (吗啡 1mg + 0 9%生理盐水至 5ml) ,然后连接镇痛泵在术后患者感到疼痛时自行给药镇痛 ,给药剂量每次吗啡 0 2mg ,锁定时间为 2 0min ;PCIA组在手术结束时静脉注入负荷量 (吗啡 0 5～ 1mg)然后连接镇痛泵在术后患者感到疼痛时自行给药镇痛 ,给药剂量每次吗啡 1mg ,锁定时间为 5min。术后 4、8、12、2 4h进行观察 ,并记录吗啡用药量、疼痛评分 (VAPS)、平均动脉压、呼吸频率、镇静程度和恶心、呕吐等情况。结果　术后 2 4h用药总量PCIA组明显高于PCEA组 ;术后疼痛评分PCIA组在术后 4、8、12h高于PCEA组 ;PCIA组术后镇静程度明显高于PCEA组 ;PCIA组恶心、呕吐发生率及程度明显高于PCEA组 ;患者对术后镇痛总体满意度评估PCEA组略高于PCIA组 ,但无统计学差异 ;2组患者术后各时相呼吸频率及平均动脉压都在正常范围 ,且无统计学差异。结论　PCEA、PCIA均达到较好的镇痛效果 ,减轻术后应激反应。PCIA组恶心、呕吐发生率高 ,且易发生明显镇静。对于硬膜外麻醉?     

静脉持续输注曲马多用于老年人术后镇痛的剂量探讨

目的探讨老年人静脉持续输注曲马多术后镇痛的合适剂量。方法60例ASAⅠ～Ⅱ级、年龄60～75岁老人经静脉行术后镇痛 ,随机分为Ⅰ、Ⅱ、Ⅲ3个组 ,负荷量1mg·kg-1 后分别给予曲马多0.20、0.25、0.30mg·kg-1·h-1,监测生命体征 ,观察记录镇痛效果、镇静效果及副反应。结果Ⅲ组VAS镇痛评分0.4±0.1,与Ⅱ组比较差异有显著性 ;Ramsay镇静评分5.5±0.4 ,恶心呕吐12例 ,多汗8例 ,Ⅱ、Ⅲ组比较差异有显著性。Ⅰ、Ⅱ组镇痛满意 ,镇静、副反应发生率差异无显著性。结论老年人术后静脉镇痛曲马多用量0.20～0.25mg·kg-1·h -1恒速静注为合适剂量。     

静脉曲马多不同给药方法术后镇痛效果的临床观察

目的　探讨合理的静脉内曲马多不同给药方法的镇痛效果 ,为临床提供理想的镇痛方法。方法　选择ASAⅠ～Ⅱ级、年龄 (46 .5± 11.5 )岁的择期手术患者 15 0例随机分为 3组。Ⅰ组 :术前 5min内静脉注射曲马多 3mg kg、氟哌啶 0 .1mg kg ,微量泵持续静脉给予曲马多 10 0 0mg +氟哌啶 5mg(用生理盐水稀释至 10 0ml)维持剂量2ml h。Ⅱ组 :术后微量泵持续静脉给予曲马多 10 0 0mg +氟哌啶 5mg(用生理盐水稀释至 10 0ml)维持剂量 2ml h。Ⅲ组 :术后 5min内静脉注射曲马多 1.5mg kg、氟哌啶 0 .1mg kg ,微量泵持续静脉给予曲马多 10 0 0mg +氟哌啶 5mg(用生理盐水稀释至 10 0ml)维持剂量 2ml h。观察给药后 10min ,术后 1h、4h、12h、2 4h、4 8h脉搏氧饱和度 (SpO2 )、镇痛效果 (VAS评分 )、不良反应。结果　Ⅰ组患者术后 1、4h的疼痛评分明显低于Ⅱ、Ⅲ组 (P <0 .0 1) ,镇痛效果最好 ;Ⅰ组用药后 10minSpO2 与同组其他时刻及Ⅱ、Ⅲ组相比无显著差异 (P >0 .0 5 ) ;Ⅰ组嗜睡率与Ⅱ、Ⅲ组相比有显著差异 (P <0 .0 1)。结论　静脉内预先给予较大剂量曲马多用于术后镇痛 ,效果好 ,并发症少     

小儿术后硬膜外持续输注吗啡的镇痛效果观察

目的 :探索小儿硬膜外持续输注吗啡术后镇痛的有效剂量及并发症。方法 :选择ASAI～Ⅱ级择期腹部、尿道及下肢手术行硬膜外复合全麻患儿32例 ,随机分为3组。术毕前60min于硬膜外腔注入30μg/kg吗啡 ,术后镇痛维持量分别为 :组1为1μg·kg-1·h-1 ,组2为1.5μg·kg-1·h-1,组3为2μg·kg-1·h-1。观察镇痛效果及不良反应。结果 :镇痛评分组2、3明显低于组1 ,组3恶心、呕吐、搔痒、呼吸抑制发生率明显高于组1、2。结论 :负荷量30μg/kg,维持量1.5μg·kg-1·h -1为小儿硬膜外持续输注吗啡的安全有效剂量     

静脉与硬膜外自控镇痛在剖宫产术后的应用对比观察

目的：对剖宫产术后患者采用患者自控静脉镇痛（PCIA）与患者自控硬膜外镇痛（PCEA）的效果和不良反应进行比较分析。方法：80例剖宫产术后要求行镇痛患者随机均分为两组：PCIA组和PCEA组。PCIA组配方为：芬太尼0．8mg、曲马多500mg及氟哌利多5mg加生理盐水至100mL,静脉泵入;PCEA组：芬太尼0．5mg、0．75％盐酸罗哌卡因20mL及氟哌利多5mg加生理盐水至总量100mL,硬膜外泵入。两组负荷量各5mL,持续速度2mL／h,PCA单次剂量0．5mL,锁定时间15min,镇痛时间48h。结果：两组患者疼痛评分、镇静评分、头晕、恶心呕吐、皮肤瘙痒及心动过缓发生率和肛门排气时间比较差异均无统计学意义,PCIA组下肢运动阻滞程度评分及尿潴留发生率明显低于PCEA组（P〈0．05）。结论：PCIA和PCEA用于剖宫术后镇痛均可获得满意的镇痛效果,PCIA不良反应较PCEA明显低。     

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.