布比卡因复合碳酸利多卡因用于臂丛神经阻滞的临床观察

目的　观察布比卡因复合碳酸利多卡因和布比卡因复合盐酸利多卡因用于臂丛神经阻滞 (肌间沟法 )的麻醉效果和不良反应。方法　随机选取 16 0例肱骨骨折在臂丛神经阻滞下进行手术的患者 ,其中 80例以布比卡因复合碳酸利多卡因进行麻醉 ,另 80例以布比卡因复合盐酸利多卡因进行麻醉 ,分析两组麻醉效果和不良反应。结果　碳酸利多卡因组麻醉起效时间及完善时间显著短于盐酸利多卡因组 (P <0 .0 5 ) ,但两组麻醉持续时间、麻醉效果I级率、麻醉前后血压及心率变化、副反应发生率均无显著性差异 (P >0 .0 5 )。结论　布比卡因复合碳酸利多卡因用于臂丛神经阻滞起效快 ,阻滞完全 ,值得在临床推广使用。     

布比卡因复合碳酸利多卡因用于臂丛神经阻滞的临床观察

目的观察布比卡因复合碳酸利多卡因和布比卡因复合盐酸利多卡因用于臂丛神经阻滞(肌间沟法)的麻醉效果和不良反应.方法随机选取160例肱骨骨折在臂丛神经阻滞下进行手术的患者其中80例以布比卡因复合碳酸利多卡因进行麻醉另80例以布比卡因复合盐酸利多卡因进行麻醉分析两组麻醉效果和不良反应.结果碳酸利多卡因组麻醉起效时间及完善时间显著短于盐酸利多卡因组(P<0.05)但两组麻醉持续时间、麻醉效果I级率、麻醉前后血压及心率变化、副反应发生率均无显著性差异(P>0.05).结论布比卡因复合碳酸利多卡因用于臂丛神经阻滞起效快阻滞完全值得在临床推广使用.     

利多卡因用于坐骨神经-"三合一"阻滞的药效及药代动力学研究

目的探讨利多卡因用于联合坐骨神经-"三合一"阻滞的临床药效学和药代动力学特性.方法20例择期行下肢手术的患者,随机分为盐酸利多卡因组和碳酸利多卡因组,每组10例.均采用联合坐骨神经-"三合一"阻滞,分别使用600mg含肾上腺素的盐酸利多卡因和碳酸利多卡因.首先行坐骨神经阻滞,随后行"三合一"阻滞.在第2次注药后的5、10、20、30、40、50、60及90min采静脉血测定血药浓度,并对感觉和运动阻滞进行评价.结果两组血浆利多卡因浓度均在安全范围内,无一例患者出现临床毒性反应.碳酸组麻醉完善时间明显快于盐酸组,且血浆药物浓度达峰值时间(Tmax)提前,而两组麻醉维持时间、血药峰值浓度(Cmax)、血药-时曲线下面积(AUC)比较均无显著性差异.结论含肾上腺素的碱化利多卡因可明显缩短麻醉完善时间,而血浆药物浓度未明显增加.     

布比卡因复合碳酸利多卡因用于臂丛神经阻滞的临床观察

目的：观察布比卡因复合碳酸利多卡因和布比卡因复合盐酸利多卡因用于臂丛神经阻滞（肌间沟法）的麻醉效果和不良反应。方法：随机选取160例肱骨骨折在臂神经阻滞下进行手术的患者，其中，80例以布比卡因复合碳酸利多卡因进行麻醉，另80例以布比卡因复合盐酸利多卡因进行麻醉，分析两组麻醉效果和不良反应，结果：碳酸利多卡因组麻醉起效时间及完善时间显著短于盐酸利多卡因组（P＜0．05），但两组麻醉持续时间，麻醉效果I级率，麻醉前后血压及心率变化，副反应发生率均无显著性差异（P＞0．05），结论：布比卡因复合碳酸利多卡因用于臂丛神经阻滞起效快，阻滞完全，值得在临床推广使用。     

3%盐酸氯普鲁卡因与1.73%碳酸利多卡因用于腋路臂丛神经阻滞麻醉效应的比较

目的探讨3%盐酸氯普鲁卡因与1.73%碳酸利多卡因用于腋路臂丛神经阻滞麻醉的效应。方法选择120例手外伤手术病人,随机双盲分为Ⅰ组和Ⅱ组,每组60例。Ⅰ组用2%盐酸氯普鲁卡因,Ⅱ组用1.73%碳酸利多卡因,采用腋路臂丛神经阻滞。由一位麻醉医生操作,在腋动脉搏动最强处穿刺,有突破感后观察针头随动脉搏动,一次性于1min內注药30ml(含肾上腺素1:300000U)。观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间以及呼吸循环的变化和副反应等。结果①麻醉起效时间、痛觉消失起始时间、运动阻滞起始时间。Ⅰ组均长于Ⅱ组(P<0.05)。运动恢复时间、痛觉恢复时间Ⅰ组短于Ⅱ组(p<0.05)。②需要加氟芬合剂加强镇痛者,Ⅰ组为11例,Ⅱ组为4例。③两组呼吸循环变化无明显差异。④Ⅰ组未见明显不良反应,Ⅱ组有2例出现轻微中毒反应,均未见有后遗症状。结论3%盐酸氯普鲁卡因与1.73%碳酸利多卡因均能安全有效地用于臂丛神经麻醉,碳酸利多卡因麻醉效果更好。     

碳酸利多卡因与盐酸丁卡因混合液肌间沟臂丛阻滞的临床效果观察

选择ASAI—II级上肢手术患者 40例 ,随机分为两组 ,对照组和实验组各 2 0例。分别用两种混合液行肌间沟臂丛神经阻滞。结果与对照组相比碳酸利多卡因与盐酸丁卡因混合液组起效时间、阻滞完善时间明显缩短 ,作用时间延长 ,阻滞范围增加 (P <0 .0 1)。利用血气分析仪测得的碳酸利多卡因与盐酸丁卡因混合液的 pH为 7.15 9± 0 .0 12 ,CO2 含量为 430± 0 .2 8kPa。提示 ,在无碳酸丁卡因注射液的情况下 ,将盐酸丁卡因与碳酸利多卡因注射液混合应用 ,同样能达到良好的临床效果 ,能满足长时间手术及术后镇痛的要求     

碳酸利多卡因与盐酸利多卡因用于硬膜外麻醉的效果比较

目的：比较碳酸利多卡因和盐酸利多卡因用于硬膜外麻醉的临床效果。方法：82例ASAⅠ-Ⅱ级择期手术病人,随机分为碳酸利多卡因组（A组）42例,盐酸利多卡因组（B组）40例。分别观察起效时间、阻滞完全时间、阻滞范围,首剂量维持时间,结果：碳酸利多卡因组的起效时间、阻滞完全时间较盐酸利多卡因组明显缩短;阻滞范围,首剂量维持时间无明显差异,结论：碳酸利多卡因与盐酸利多卡因相比,起效快,阻滞作用强,麻醉诱导时间明显缩短。     

碳酸利多卡因在硬膜外麻醉中的临床应用

目的:比较碳酸利多卡因和盐酸利多卡因在硬膜外阻滞中的临床效果.方法:74例腹部或下肢择期手术的患者,ASAⅡ～Ⅲ级.随机分为观察组(碳酸利多卡因组,37例)和对照组(盐酸利多卡因组,37例).比较两种局麻药的起效时间、阻滞完全时间、麻醉持续时间、阻滞节段、局麻药首剂总量及首剂量维持时间.结果:碳酸利多卡因起效时间、阻滞完全时间均短,与对照组比较,P<0.05;局麻药首剂总量、首剂量维持时间、麻醉持续时间、阻滞节段与对照组比较,P>0.05.结论:碳酸利多卡因应用于硬膜外麻醉,具有阻滞作用强、诱导时间短等优点.     

盐酸氯普鲁卡因与碳酸利多卡因硬膜外麻醉的临床观察

目的评估盐酸氯普鲁卡因与碳酸利多卡因用于硬膜外麻醉的效应及安全性。方法80例急诊手术患者,随机分为盐酸氯普鲁卡因组(3%盐酸氯普卡因,n=40)和碳酸利多卡因组(碳酸利多卡因,n=40)。均硬膜外试验量4mL 5min后,一次性注入12mL(含肾上腺素1∶20万)。观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间以及不良反应。结果两组麻醉起效、痛觉消失、运动阻滞、痛觉恢复时间基本相同,运动恢复时间盐酸氯普鲁卡因组优于碳酸利多卡因组(P<0.05);盐酸氯普鲁卡因的寒战、耳鸣显著少于碳酸利多卡因(P<0.01);盐酸氯普鲁卡因安全范围大。结论3%盐酸氯普鲁卡因与碳酸利多卡因用于硬膜外麻醉在麻醉起效、疼痛消失、运动阻滞、疼痛恢复无显著差别,运动恢复时间比碳酸利多卡因早,盐酸氯普鲁卡因安全范围大,不良反应小,较碳酸利多卡因安全。     

盐酸氯普鲁卡因与利多卡因硬膜外麻醉用于剖宫产的比较

目的 评估盐酸氯普鲁卡因与利多卡因硬膜外麻醉用于剖宫产的效应比较.方法 100例剖宫产手术病人,随机分为试验组(3%盐酸氯普鲁卡因,n=50)和对照组(2%利多卡因,n=50).均硬膜外(L1-2)试验量5ml后5min,一次性注入11ml.观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间以及不良反应.结果 试验组麻醉起效时间、痛觉消失时间、运动阻滞时间均快于对照组(P＜0.05),痛觉恢复时间两组一致,运动恢复时间试验组快于对照组(P＜0.05);两组均未见明显不良反应.结论 3%盐酸氯普鲁卡因用于硬膜外麻醉起效快,感觉和运动阻滞效果好,无明显不良反应,较利多卡因优.     

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.