神经刺激器定位阻滞麻醉在老年患者单侧下肢手术中的应用

目的:观察外周神经刺激器定位下腰丛-坐骨神经阻滞麻醉应用于老年患者单侧下肢手术中的效果。方法:52例老年患者拟行单侧下肢手术,施行单侧腰丛-坐骨神经阻滞。局部麻醉药为0.5%罗哌卡因,腰丛阻滞剂量为15²5 ml,坐骨神经阻滞剂量为1025 ml,坐骨神经阻滞剂量为10¹5 ml。观察并记录麻醉血流动力学、麻醉效果及不良反应。结果:麻醉效果好,生命体征平稳,血流动力学稳定,不良反应小。结论:神经刺激器定位腰丛-坐骨神经阻滞麻醉应用于老年患者单侧下肢手术,麻醉效果好,对各系统干扰小,并发症少,对有严重并发症的患者更为适应。     

神经刺激器定位在老年人下肢手术中的应用

目的观察神经刺激器定位行腰丛-坐骨神经联合阻滞在老年人单侧下肢手术中的临床效果。方法选择80例择期单侧下肢手术病人,ASA1～3级,年龄60～86岁。患者入手术室后开放静脉,预先输入平衡盐溶液补充血容量。病人采取侧卧位,根据体表解剖标志定位腰丛及坐骨神经穿刺点、皮丘浸润后,用1％利多卡因＋0.45％罗哌卡因混合液25～30ml分别实施腰丛和坐骨神经阻滞麻醉。监测血压、脉搏、呼吸、血氧饱和度、心电图、尿量等指标变化。结果腰丛神经联合坐骨神经阻滞能满足几乎所有单侧下肢手术,未出现低血压、恶心、呕吐等不良反应。结论通过腰丛-坐骨神经联合阻滞绝大部分病人麻醉效果满意、损伤小、并发症少、恢复快,简便易行,值得临床推广。     

神经刺激器定位腰丛-坐骨神经阻滞在高龄病人单侧下肢手术中的应用

目的 观察神经刺激器定位腰丛-坐骨神经阻滞应用于高龄病人单侧下肢骨科手术的效果.方法 68例年龄≥75岁、拟行单侧下肢骨科手术的老年患者,根据麻醉方法 随机分为组Ⅰ、组Ⅱ,各34例.组Ⅰ行常规腰硬联合麻醉,组Ⅱ以神经刺激器定位,实施腰丛-坐骨神经阻滞.观察两种方法 的麻醉效应,以及对病人循环、呼吸功能的影响.结果 两组患者麻醉效果满意,组Ⅰ病人麻醉后10min,切皮时出现血压下降,呼吸频率增加,组Ⅱ循环、呼吸平稳;术后尿潴留发生率组Ⅱ明显低于组Ⅰ.结论 外周神经刺激器定位腰丛-坐骨神经阻滞用于高龄病人下肢手术阻滞成功率较高,对循环功能影响较少,术后并发症少.     

神经刺激仪定位下的腰丛联合坐骨神经阻滞在下肢手术中的应用

目的 探讨神经刺激器定位下的腰丛-坐骨神经阻滞在单侧下肢手术的麻醉效果.方法 观察31例行单侧下肢手术的病人,采用神经刺激器定位行单侧坐骨神经-腰丛阻滞效果.所用局麻药均为1%利多卡因及0.5%罗哌卡因注射液,记录阻滞前基础值,阻滞后5、10及15min,切皮后5、10min,手术结束时的MAP、HR及阻滞效果、相关并发症.结果 93.5%的患者麻醉效果满意,6.5%患者出现阻滞欠佳,给予少量咪达唑仑及芬太尼完成手术;无麻醉失败病例.神经阻滞后与基础值比较,患者HR、MAP无明显变化(P＞0.05).所有病人均未出现并发症.结论 单侧下肢手术采用单侧腰丛和坐骨神经阻滞是一种简易安全和效果良好的麻醉方法.     

坐骨神经阻滞的入路及定位方法

根据区域麻醉的观点,单侧下肢手术麻醉可选用腰骶丛联合阻滞或下肢神经联合阻滞。腰骶丛联合阻滞也称腰大肌间沟阻滞,定位方法较为统一,但存在着潜伏期长、成功率低、局麻药通过后腹膜侵入对侧腰大肌间隙或扩散入硬膜外腔,产生不同程度的双侧阻滞,发生率达5.3％～30％,并可发生高位脊神     

腰丛联合坐骨神经阻滞在老年人下肢手术中的临床应用

目的探讨神经刺激仪辅助定位腰丛联合坐骨神经阻滞在老年病人下肢手术中应用的麻醉效果和安全性及对血流动力学影响。方法选择40例拟行单侧下肢手术的老年病人,入手术室后常规监测,吸氧2L/min,酌情予咪达唑仑镇静及适量芬太尼,经刺激仪定位下行腰丛和坐骨神经阻滞,于腰丛注入1%利多卡因20mL和0.375%罗哌卡因15mL,坐骨神经处注入1%利多卡因15mL和0.375%罗哌卡因5mL,观察患者阻滞后感觉神经阻滞效果、阻滞维持时间、手术时间,以及术中、术后不良反应。记录本组麻醉前、麻醉后15、30、60min的收缩压（SBP）、舒张压（DBP）和心率（HR）。结果所有患者术中都获得满意的麻醉效果,无严重麻醉意外及死亡病例。与麻醉前比较,本组病人麻醉后血压虽有明显下降,但平均降幅低于术前20%。结论神经刺激器定位下行腰丛联合坐骨神经阻滞,麻醉效果佳,循环维持稳定。     

腰丛-坐骨神经联合阻滞用于下肢手术麻醉的体会

目的分析神经刺激器引导腰丛-坐骨神经阻滞用于下肢手术麻醉的镇痛效果.方法选取40例19~75岁的下肢手术患者,行腰丛一坐骨神经联合阻滞(NER),然后对其麻醉开始时间、麻醉的效果以及手术过后镇痛的持续时间进行记录.结果36例阻滞效果为优,2例患者阻滞效果为良,2例阻滞效果为差.麻醉前后及术后的收缩压、舒张压及心率差异无统计学意义(P>0.05).结论神经刺激器引导腰丛-坐骨神经阻滞技术用于下肢手术的麻醉效果很好,不良反应较少.     

神经刺激器定位腰丛加坐骨神经阻滞用于老年病人下肢手术的麻醉

外周神经刺激器的问世，对神经阻滞的麻醉是一突破性的进展。改变了传统异感法盲探式操作，精确定位所要阻滞的神经，大大提高了麻醉的成功率，最大程度减少了神经损伤。外周神经刺激器定位下的腰丛加坐骨神经阻滞可取得下肢单侧肢体的完全麻醉，同时避免了全身麻醉、椎管麻醉对循环呼吸系统的影响，适用于单侧下肢的手术、尤其适用于合并严重系统疾病的高危病人。我科从2004年至2007年应用（Stimuplex HNS11，B／BRAUN公司，德国）神经刺激器对一些有严重合并症的病人进行了麻醉和手术，取得了满意的效果。现报道如下。     

高龄患者下肢手术选择腰丛-坐骨神经阻滞麻醉的效果研究

目的 探讨腰丛-坐骨神经阻滞麻醉应用于高龄患者下肢手术的安全性和有效性.方法 在80例高龄患者手术中采用外周神经刺激器定位下的腰丛-坐骨神经阻滞.结果 全部病例麻醉满意安全完成手术.结论 腰丛-坐骨神经阻滞麻醉应用于高龄患者下肢手术是安全和有效的麻醉方法.     

腰丛-坐骨神经联合阻滞复合硬膜外麻醉用于老年患者单侧下肢手术中的研究

目的 探讨腰丛-坐骨神经联合阻滞复合硬膜外麻醉在老年患者单侧下肢手术中应用的可行性.方法 将90例70岁以上拟行单侧下肢手术的患者随机均分为A、B两组,每组各45例.A组采用神经刺激器定位技术,正确定位腰丛和坐骨神经后分别给予0.375%罗哌卡因20～25ml和0.5%罗哌卡因15～20ml,然后进行硬膜外穿刺备用,以防腰丛和坐骨神经阻滞不全,同时进行术后镇痛.B组选择硬膜外麻醉,L3～4间隙为穿刺点,给予0.75%罗哌卡因10～15ml.观察两组血流动力学变化、阻滞效果及其术后并发症.结果 A组42例单纯应用腰丛-坐骨神经联合阻滞,仅3例复合了硬膜外麻醉,而且硬膜外给予的麻醉药量明显减少.B组麻醉后30min(T1)、1h(T2)时点与麻醉前(基础值)及A组比较MAP降低、HR升高;B组患者术后24h内恶心、呕吐、尿潴留等不良反应的发生率明显高于A组.结论 腰丛-坐骨神经联合阻滞复合硬膜外麻醉适用于老年患者单侧下肢手术,对血流动力学影响小,并发症少,麻醉效果确切.     

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.