瑞芬太尼静脉麻醉对窦性心动过缓者心率的影响

目的评估瑞芬太尼全麻应用于窦性心动过缓患者的可行性.方法ASA 1～2级,无心脏病的患者;窦性心动过缓者（阿托品试验阴性）为A组,心律正常者为B组.观察两组病例在基础时、诱导时、插管时、切皮等各时点心率（HR）、血压（BP）,手术结束时的SvO2值,围麻醉期应用阿托品、麻黄素药物的情况.结果两组病人瑞芬太尼麻醉后HR、BP均有显著变化,A组变化使HR处于正常低值,但血压仍在正常范围.结论瑞芬太尼全麻用于窦性心动过缓者,也是可行的,但应严密观察动态心电图,备好心肌正性药物应对等措施.     

消化性溃疡合并窦性心动过缓的临床分析

目的 探讨消化性溃疡合并窦性心动过缓的临床特点及原因。方法 对248例消化性溃疡患者进行回顾性分析，明确是否合并窦性心动过缓并对其影响因素进行研究。结果 248例消化性溃疡患者中81例(32．7％)合并窦性心动过缓，男性、服用H2拮抗剂者易合并窦性心动过缓。结论消化性溃疡患者易合并窦性心动过缓，其机制可能与迷走神经兴奋以及H2拮抗剂的作用等有关。     

舒芬太尼三种麻醉诱导方式在较大切口手术中的比较

舒芬太尼为强效的麻醉性镇痛药,与芬太尼相比,镇痛效果更强,作用持续时间更长,对呼吸抑制的恢复时间短,但仍然可引起血压下降和心动过缓.本研究,我们在腹部或下肢较大切口手术的靜吸复合全麻诱导中采用三种方式使用舒芬太尼,旨在找出合理的方式,能够较好的抑制气管插管反应和切皮的疼痛反应,使整个诱导过程平稳.     

心得快抗大鼠心动过缓的作用

目的　研究心得快抗心动过缓作用。方法　分别用普萘洛尔和乙酰胆碱制造大鼠心率减慢模型 ,用硫代巴比妥酸测定脂质过氧化物含量 ,用Green法测一氧化氮的含量。结果　ig心得快在 40～ 16 0mg·kg-1范围内抑制普萘洛尔心率减慢和缩短乙酰胆碱致心率下降的持续时间 ,并可降低大鼠心肌组织一氧化氮的含量。 16 0mg·kg-1心得快还降低大鼠心肌组织脂质过氧化产物的含量。结论　心得快有一定的抗心动过缓作用 ,其作用机制可能与抑制一氧化氮生成及抗氧化作用有关。     

甘附冲剂对维拉帕米致大鼠心动过缓的影响

目的：观察甘附冲剂对维拉帕米致大鼠心动过缓的影响,并初步探讨其抗心动过缓可能的作用机制。方法：采用静脉注射（iv）维拉帕米（Ver）制备心动过缓模型,比较ivVer前后大鼠心率的变化,制备心肌匀浆,用Green法测定一氧化氮（NO）的含量,用硫代巴比妥法测定脂质过氧化产物丙二醛（MDA）的含量。结果：甘附冲剂在ivVer后2min对大鼠心率减慢有明显的抑制作用（P〈0.05）;90、270mg·kg^-1甘附冲剂可明显地抑制大鼠心肌组织中NO含量的升高（P〈0.05）;30、90mg·kg^-1甘附冲剂可明显地抑制大鼠心肌组织中MDA含量的降低（P〈0.01）。结论：甘附冲剂有明显的抗Ver致心动过缓作用,其抗心动过缓的作用可能与调节心肌组织中NO的含量在适度水平有关。     

瑞芬太尼和丙泊酚泵注全凭静脉麻醉用于腹腔镜手术

目的:为观察一种新型的u型阿片受体激动剂-瑞芬太尼的作用,以及评价瑞芬太尼和丙泊酚分别微量静脉泵注用于腹腔镜手术中麻醉的可行性和临床效果。方法:选择择期进行腹腔镜手术患者40例,随机分为R和F两组,F组为对照组,每组20例。麻醉快速诱导后,R组以瑞芬太尼和丙泊酚分别微量静脉泵入维持麻醉,F组以静吸复合维持麻醉,记录并比较两组病人的收缩压(SBP)、舒张压(DBP)、心率(HR),术毕苏醒拔管时间。同时记录并比较术中体动反应及心动过缓的发生情况,并观测不良反应如恶心、呕吐及肌僵现象的发生结果:瑞芬太尼和丙泊酚分别微量静脉泵注用于腹腔镜手术全麻,苏醒快,但可抑制心血管系统,出现心动过缓、血压降低,但可通过控制速率及剂量来控制。仍可发生不良反应,与对照组比较无差异性。结论:瑞芬太尼和丙泊酚分别微量静脉泵注用于腹腔镜手术是可行的,且安全有效。     

胞质空泡化的研究进展

胞质空泡化是哺乳动物细胞经过细菌、病毒、各种自然或者人工化学物质处理后发生的现象。尽管这些空泡化现象看起来一样,机制却因为诱因不同而异。胞质空泡化会导致细胞功能状态的改变,甚至会导致细胞死亡。目前关于空泡化机制的研究很多,这些研究成果为新的空泡化现象的研究提供了很多便利。因此,本文旨在通过文献复习,对空泡化现象的起因、机制进行总结,探讨空泡化现象在细胞功能改变和死亡中的作用。     

瑞芬太尼复合丙泊酚在无痛胃镜检查中的应用

目的探讨瑞芬太尼复合丙泊酚在无痛胃镜检查中的应用效果。方法将200例ASAⅠ~Ⅱ级拟行无痛胃镜检查的患者随机分为两组,分别给予瑞芬太尼 丙泊酚和丙泊酚,观察两组患者的生命体征、镇静镇痛效果、苏醒时间及不良反应发生情况。结果瑞芬太尼 丙泊酚组镇静镇痛效果明显优于丙泊酚组,而低血压、心动过缓的发生明显低于丙泊酚组。结论瑞芬太尼复合丙泊酚可为无痛胃镜检查提供安全可靠的麻醉。     

瑞芬太尼复合丙泊酚在无痛人工流产术中麻醉效果的探讨

目的:研究瑞芬太尼复合丙泊酚在无痛人工流产术中的麻醉效果。方法:选择无痛人工流产术的女性120例,随机分为研究组与对照组,每组60例,研究组应用瑞芬太尼复合丙泊酚静脉麻醉,对照组单纯应用丙泊酚静脉麻醉,比较两组的麻醉效果和不良反应。结果:研究组术后的苏醒时间以及清醒后的疼痛评分均小于对照组,呼吸抑制发生率高于对照组,两组比较差异有统计学意义(P<0.05);研究组低血压和体动不良反应少于对照组,差异有统计学意义(P<0.05),心动过缓和低氧血症的发生率两组比较差异无统计学意义(P>0.05)。结论:瑞芬太尼复合丙泊酚静脉麻醉应用于无痛人工流产术,麻醉效果好、不良反应少、安全可靠,值得在临床上应用。     

尼美舒利对人宫颈癌Hela细胞株的抑制作斥及其机制研究

目的探讨尼美舒利体外抗宫颈癌的活性及相关机制。方法采用体外培养的Hela细胞株为研究对象,MTT法检测尼美舒利对Hela细胞的抑制率．倒置显微镜和透射电镜观察细胞形态学改变,Westernblot检测细胞凋亡关键蛋-环氧化酶-2（COX-2）、Caspase-3的表达变化。结果尼美舒利可显著抑制Hela细胞增殖,形态学观察发现尼美舒利可诱导肿瘤细胞凋亡;尼美舒利还可抑制Hela肿瘤细胞COX-2表达,引发Caspase-3促凋亡蛋白Caspase-3高表达。结论尼美舒利具有明确的抑制宫颈癌细胞的作用,其机制之一可能是通过抑制COX-2引发肿瘤细胞的凋亡。     

流行性出血热并发心动过缓机理的初步探讨

本文应用临床电生理检查及药物激发试验,探讨了流行性出血热(EHF)并发心动过缓的机理,27例EHF中并发心动过缓18例,占66.7%.其中5例窦房结功能经电生理及药物试验揭示明显异常,符合窦房结功能不全诊断标准.余13例电生理参数较非心动过缓组及对照组明显增高,但尚在正常范围.提示EHF并发心动过缓病例中部分系窦房结功能不全所致,推测可能与窦房结区充血、水肿、炎症、出血有关;部分病例则可能是植物神经功能失调,迷走神经张力增高所致.     

药物治疗烧烫伤机理研究进展

烧烫伤是临床上常见的外伤伤害之一,用于治疗烧烫伤的药物较多,但疗效差异较大.随着现代医学技术的发展,发现药物治疗烧烫伤过程中对免疫系统、细胞因子、酶等均有影响,现对药物治疗烧烫伤的机理研究及其进展进行综述.     

老年人埋藏永久起搏器的经验

报告29例(53次)缓慢心律失常的老年人(≥60岁)经静脉埋藏永久起搏器的结果,就埋藏永久起搏器患者缓慢心律失常类型,病因,适应证,随访等方面进行分析,并着重了解老年患者某些特点     

氨刺激兔鼻粘膜引起心血管反应的神经机制分析

为了进一步研究氨刺激兔鼻粘膜引起心血管反应(CVRA)的神经机制,特别是心交感神经的作用,在38只兔身上观察了心率和动脉血压的变化,吸入氨可引起心率减慢和动脉血压升高。切断双侧颈迷走神经后吸氨时心率减慢反应仍存在,静注心得安后吸氨时心率减慢反应消失.静注酚妥拉明后吸氨时血压上升程度明显减小。去除缓冲神经后仍引起 CVRA,电刺激一侧减压神经中枢端引起心率减慢和血压下降。离断嗅叶后 CVRA 不变,离断中脑后 CVRA 减弱。结果表明:在 CVRA 中,冲动经三叉神经传至脑桥和延髓引起心迷走中枢和交感缩血管中枢兴奋,心交感中枢抑制。高位中枢对 CVRA 可能有易化作用。减压反射与 CVRA 的中枢机制不同。因此可以认为在完整机体中,各种环境刺激引起的心血管反应都各表现为特殊但又有规律的整合型式。     

缺血预处理脑保护机制研究

脑缺血预处理即给予短暂亚致死量缺血可对随后的长时间致死性缺血损伤产生耐受。各国学者就其机制进行了广泛研究并发现这与受体激活和一系列信号转导有关,涉及阿片受体、一氧化氮、腺苷、丝裂原活化蛋白激酶等信号途径、N-甲基-D-天冬氨酸受体、生长因子、线粒体和核生存蛋白、Toll样受体等。但具体机制尚未完全阐明且还处于动物实验阶段,如何把实验结果应用于临床是今后将要解决的问题。     

恶性心律失常62例临床分析

报道了恶性心律失常62例,其中快速型24例;缓慢型24例;快慢混合型14例。主要病因为冠心病,心肌炎,心肌病,风湿性心脏病和肺源性心脏病。治疗快速型以药物为主;缓慢型以人工心脏起搏为主;快慢混合型以药物治疗和人工心脏起搏。预激综合征并房颤者,慎用洋地黄。     

Current Tracking on Effectiveness and Mechanisms of Acupuncture Therapy: A Literature Review of High-Quality Studies

The scientific evidence of acupuncture studies has been improved in recent years, and one of the important manifestations is that more and more acupuncture clinical trials and mechanism researches have been published in the source periodicals of Science Citation Index (SCI). This study summarized the dominant diseases of acupuncture focusing on of acupuncture efficacy and mechanisms, and discussed the existing problems, highlighting the direction of future developments. Most clinical studies were published in journals with journal impact factor (JIF) score of 10 or above, and majority of the basic researches had JIF scores of 5 to 10. The above literature were further divided according to the International Classification of Diseases (ICD). The most concerned diseases in these articles were neurological diseases, musculoskeletal system and connective tissue diseases, tumor and digestive system diseases. The therapeutic effect and mechanism of acupuncture on each kind of disease were summarized. The results showed that the therapeutic effect of acupuncture on nerve injury focused on the anti-oxidation pathway, neuroprotective and anti-inflammatory processes. The anti inflammatory effect also played an important role in the treatment of musculoskeletal diseases. The analgesic effect was underlined in most of these studies. Clinical trials were well carried out on acupuncture curative effect of tumor complications and side effects of chemo-radiotherapy, but the potential mechanisms have not been clarified. Somato-visceral reflex was suggested to be strongly associated with the effects of acupuncture changing the motor activity of the gastrointestinal tract. Functional magnetic resonance imaging studies indicated that non-specific effects play important roles in acupuncture analgesia. Lines of evidence have pointed out that the regulation of neuro-endocrine-immune networks may be a common switch of acupuncture on different nerve system diseases.     

Efficacy of empirical cardiac pacing in syncope of unknown cause.

Cardiac pacing is often considered in patients with recurrent syncope after repeated attempts to document the cause have failed. To assess the results of this tactic we reviewed the records of 104 patients who had received pacemakers for known or suspected bradycardia between September 1973 and March 1985. The patients were classified retrospectively into three groups: group 1 (31 patients with a mean age of 73 years) had unequivocal documentation of bradycardia during syncope, group 2 (42 patients with a mean age of 71 years) had electrocardiographic or electrophysiologic evidence of potential bradycardia but no documentation during spontaneous syncope, and group 3 (31 patients with a mean age of 69 years) had a history "suggestive of" bradycardia-related syncope but no other evidence to support the diagnosis. The rates of recurrence of syncope during follow-up were 6.3%, 7.3% and 32.2% in groups 1, 2 and 3 respectively (p less than 0.01). In group 3 recurrence was more probable in patients with loss of consciousness for more than 2 minutes than in those who were unconscious for 2 minutes or less (p less than 0.05). The results suggest that pacemaker implantation is justified for recurrent syncope after extensive attempts to document a spell have failed if abnormal diagnostic test results suggest bradycardia as a possible cause. Empirical pacing is less satisfactory in patients with normal results of evaluation but may arguably be justified when patients have recurrent syncope with injury.     

Fetal arrhythmias; intrauterine diagnosis and treatment.

Fetal echocardiographic examination was performed on 945 pregnant women (normal pregnancy: 291, high risk pregnancy: 654) since 1980. Of these, 39 fetuses (4.1%) were diagnosed as having cardiac arrhythmia. Fifteen fetuses had bradycardia, 7 tachycardia and 17 had an ectopic beat. These had been followed from 1 day to 8 years (mean 1 year and 6 months) soon after birth. Of the 15 cases with bradycardia (complete AV block; 8, 2:1 AV block; 3 and sinus bradycardia; 4), four resulted in an intrauterine fetal death, one was terminated and 5 died soon after birth. The remaining 5 cases are alive and 3 of these 5 have received an implanted pacemaker. Of these 15 cases with bradycardia 7 were associated with congenital heart disease, 6 of which died. Seven cases had tachycardia (supraventricular tachycardia: 3 and atrial flutter with 2:1 AV block: 3). Transplacental antiarrhythmic drug (digoxin and/or verapamil) administration was instituted in 5 cases and a conversion of the arrhythmia was achieved in 4. Paroxysmal tachycardia still remained after delivery in the other 3 cases. Two cases with supraventricular tachycardia (one of them with WPW syndrome type B) were resolved. One case has had persistent chaotic atrial rhythm for 7 years after birth. Of the 17 with an ectopic beat, 11 cases were diagnosed to have a supraventricular ectopic beat and 6 cases with a ventricular ectopic beat. A remaining arrhythmia was observed in 10 cases after delivery but all of these were resolved within 3 months after birth. Fetal tachycardia had relatively favorable prognosis because usually the intrauterine treatment was effective. However, fetal bradycardia had poor prognosis and further investigations to establish more effective treatments are essential.     

肺腺癌相关因子的表达及其研究进展

肺腺癌（lung adenocarcinoma）属于非小细胞肺癌.肺腺癌较容易发生于女性,其机制尚不明确.发病早期通常无任何症状,胸部CT检查表现为圆形或椭圆形肿块,常发生于肺脏周边部.诊断明确时多已为晚期,所以早期诊断和治疗这类疾病面临诸多挑战.肺腺癌的形成过程极其复杂,近期研究发现,在肺腺癌形成过程中众多因子参与表达.