无创正压通气复合腰-硬联合麻醉在妇科腹腔镜手术中的应用

目的 探讨无创正压通气复合腰-硬联合麻醉行妇科腹腔镜手术的安全性和可行性.方法 30例在腰-硬联合麻醉下行妇科腹腔镜手术的患者随机分为两组,每组15例,A组:鼻饲给氧,B组:无创正压通气(NPPV).记录麻醉前、麻醉后、气腹后10,30,60 min,术毕15 min各时点的HR,SPO2,MAP,RR,并采集动脉血,行血气分析.结果 A组SpO2,RR,pH麻醉后与麻醉前及B组同时点比较下降明显(P＜0.05).A,B两组MAP,HR及B组SpO2,RR麻醉后各时点与术前比较无明显变化(P＞0.05).两组PaO2术中均较麻醉前明显增高(P＜0.05),麻醉后B组与A组各时点比较增加更为明显(P＜0.05).A组PaCO2麻醉后与麻醉前及B组同时点比较明显增高(P＜0.05).但各参数术毕15 min均恢复至麻醉前水平.结论 无创正压通气复合腰-硬联合麻醉行妇科腹腔镜手术安全有效,可避免术中因二氧化碳蓄积而发生高碳酸血症和酸中毒危险.     

腹腔镜手术麻醉方法的安全性分析

目的 探讨不同麻醉方法在腹腔镜手术中的安全性与麻醉效果.方法 将给予妇科腹腔镜手术患者192例随机分为甲、乙两组,甲组给予腰-硬联合麻醉,乙组给予气管内插管全麻,比较两组麻醉方法的安全性与麻醉效果.结果 甲组在气腹后5min各项指标与乙组和治疗前相比均有显著性差异(P＜0.05＝.尤其是PETCO2在气腹后15min与乙组和治疗前相比差异显著(P＜0.05).pH:甲组气腹后5min、气腹后15min及放气后10min与麻醉前相比,P＜0.05.PaCO2:甲组气腹后5min、气腹后15min与麻醉前相比,P＜0.05.乙组的pH和PaCO2则无明显变化.结论 在妇科腹腔镜手术中给予气管内插管全麻较腰-硬联合麻醉安全可行.     

不同麻醉方法对妇科腹腔镜手术患者氧代谢的影响

目的通过对两种麻醉方式下行妇科腹腔镜手术患者氧代谢变化情况的对比观察,探讨异丙酚复合腰硬联合麻醉方式用于妇科腹腔镜手术的安全性、可行性。方法将30例ASAⅠ-Ⅱ级的患者随机分为两组A组15例为气管插管全麻组,B组15例为异丙酚复合腰硬联合麻醉组。两组均在局麻下行左侧桡动脉穿剌和右颈内静脉穿剌置漂浮导管。A组以咪唑安定5mg、依托咪酯0.1-0.3mg/kg、维库溴胺0.1mg/kg、芬太尼2-4μg/kg诱导插管,泵注异丙酚,间断给予维库溴铵、芬太尼维持麻醉平稳。B组择L2-3椎间隙硬膜外穿剌,针内针推注重比重盐酸布比卡因注射液10mg,留置硬膜外管备用,调整麻醉平面至T6水平,泵注异丙酚至患者意识消失即开始手术。分别于麻醉前、麻醉后、气腹后10、30、60min、术毕放气腹后15min抽取桡动脉血和混合静脉血进行血气分析,同时记录两组各时点脉搏氧饱和度（SpO2）、心率（HR）、平均动脉压（MBP）、肺动脉压（PAP）、肺动脉楔压（PCWP）、心排量（CO）、外周血管阻力（SVR）、气腹时间、不良反应,计算两组各时点的氧供（DO2）、氧需（VO2）及氧摄取率（ERO2）。结果两组患者DO2、VO2及ERO2各时点比较差异无统计学意义（P〉0.05）,与麻醉前基础值比较,两组麻醉后及气腹过程中VO2、ERO2均显著降低（P〈0.05）;B组术毕停气腹15min后VO2、ERO2均恢复至麻醉前水平。A组患者动脉二氧化碳分压（PaCO2）气腹过程中较麻醉前均有所增加,且术后15min未能恢复至麻醉前水平,但差异无统计学意义（P〉0.05）;B组麻醉后及气腹过程中PaCO2较麻醉前明显增高（P〈0.05）,气腹后30min比A组高（P〈0.05）,术毕15min下降至麻醉前水平。结论两种麻醉方法应用于ASAⅠ-Ⅱ级患者的妇科腹腔镜手术的临床麻醉效果均满意。异丙酚复合腰硬联合麻醉操作更简便,术后恢复较快,但气腹过程中有高碳酸血症风险,术中应加强监测和麻醉管理。     

三种麻醉方法对妇科腹腔镜手术患者血气影响的比较

目的 评价腰硬联合麻醉复合异丙酚浅全麻或咪达唑仑应用于妇科腹腔镜手术时在血气方面的安全性及其在控制术中躁动方面的有效性.方法 90例妇科腹腔镜手术患者随机分为三组:腰硬联合麻醉复合咪达唑仑(Ⅰ)组,腰硬联合麻醉复合异丙酚浅全麻(Ⅱ)组和气管插管全身麻醉(Ⅲ)组,观察麻醉前(手术前)、麻醉后气腹前、气腹后10分钟、气腹后60分钟、停止气腹并腹腔放气后10分钟患者的动脉血pH、氧分压、CO2分压、剩余碱、CO2总量及Ⅰ、Ⅱ组术中发生躁动的患者例数.结果 手术前三组间各指标比较差异无显著性;Ⅰ、Ⅱ组各指标组间比较各时点差异无显著性;Ⅰ、Ⅱ组与Ⅲ组比较,气腹前至手术后除氧分压Ⅰ、Ⅱ组明显低于Ⅲ组外,其余指标比较差异无显著性;术中躁动Ⅱ组明显低于Ⅰ组.结论 腰硬联合麻醉复合异丙酚浅全麻时,患者血气虽可出现呼吸性酸中毒的变化,但这种变化是轻度的可逆的,因而可安全有效地应用于较短时间的妇科腹腔镜手术.     

异丙酚复合氯胺酮辅助腰-硬联合麻醉应用于妇科腹腔镜手术

目的评价异丙酚复合氯胺酮辅助腰-硬联合麻醉应用于妇科腹腔镜手术的麻醉效果。方法80例行妇科腹腔镜手术患者(ASAⅠ～Ⅱ级),随机分为两组:Ⅰ组为异丙酚复合氯胺酮辅助腰-硬联合麻醉组;Ⅱ组为异丙酚辅助腰-硬联合麻醉组。术中保证患者睡眠、无体动。记录各时段各项监测指标。观察术中有无呼吸抑制、舌后坠及恶心呕吐。记录气腹时间、苏醒时间、异丙酚及氯胺酮总量。结果两组各时间段患者的BP、HR、SpO2变化均在正常范围内。两组气腹后PETCO2与气腹前比较均显著升高(P<0.01)。Ⅰ组异丙酚总用量显著少于Ⅱ组(P<0.01)。Ⅰ组舌后坠发生率显著低于Ⅱ组(P<0.01)。两组术中均无恶心呕吐。两组苏醒时间无显著差异(P>0.05)。结论腰-硬联合麻醉行妇科腹腔镜手术中,辅用异丙酚复合氯胺酮静脉麻醉,具有呼吸抑制、舌后坠发生率较低,无恶心呕吐,苏醒快等优点。术中严密监测,加强呼吸管理可确保麻醉安全。     

腰-硬联合麻醉在妇科腹腔镜术中的应用

目的：比较腰-硬联合麻醉和气管插管全身麻醉在妇科腹腔镜手术中的应用效果。方法：100例ASA Ⅰ-Ⅱ级行腹腔镜妇科手术患者,随机分为腰-硬联合麻醉复合静脉麻醉组（Ⅰ组,n=50）和气管插管全身麻醉组（Ⅱ组,n=50）。Ⅰ组患者采用腰-硬联合麻醉,术中静注丙泊酚维持麻醉。Ⅱ组患者麻醉诱导后气管插管,术中吸入异氟烷、静注异丙酚维持麻醉。两组患者均进行心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）等生命体征监测。记录麻醉前、气腹前、气腹中、停气腹后HR、MAP、SpO2以及术中、术后并发症。结果：Ⅰ组患者术中HR、MAP、SpO2平稳,术毕即可回病房。而Ⅱ组患者麻醉诱导气管插管后、气腹后、拔管后MAP明显升高,且高于Ⅰ组（P〈0.05）,患者术后20-60 min才能回病房。结论：腰-硬联合麻醉较好控制机体的应激反应,适用于妇科腹腔镜手术的麻醉。     

无创正压通气在妇科腹腔镜手术中的应用

目的探讨无创正压通气复合腰-硬联合麻醉行妇科腹腔镜手术的安全性和可行性。方法30例在腰-硬联合麻醉下行妇科腹腔镜手术的患者(ASAⅠ-Ⅱ级),随机分为两组,每组15例,A组:鼻饲给氧,B组:无创正压通气(NPPV)。观麻记录麻醉前、后,气腹后10min、30min、1h,术毕15min各时点的HR、SpO2、MAP、RR,并采集动脉血,行血气分析。结果A组SpO2、RR、PH麻醉后与麻醉前及B组同时点比较下降明显(P<0.05)。A、B两组MAP、HR及B组SpO2、RR麻醉后各时点与术前比较无明显变化(P>0.05)。两组PaO2术中均较麻醉前明显增高(P<0.05),麻醉后B组与A组各时点比增加更为明显(P<0.05)。A组PaCO2麻醉后与麻醉前及B组同时点比较明显增高(P<0.05)。但各参数术毕15min均恢复至麻醉前水平。结论无创正压通气复合腰-硬联合麻醉行妇科腹腔镜手术,可避免术中因二氧化碳蓄积而发生高碳酸血症和酸中毒危险。     

两种不同麻醉方法在妇科腹腔镜手术中的对比研究

目的 探讨腰-硬联合阻滞复合浅全麻与插管全麻在妇科腹腔镜手术中的麻醉效果及可行性.方法 选择80例患者,分为腰-硬联合阻滞(A组)和插管全麻(B组)各40例,分别记录气腹前、气腹后10min、20min、30min排气后10min的BP、HR、RR、SPO2、PETCO2,同时观察患者的反应及术后苏醒情况.结果 A组CO2气腹后,RR加快、PETCO2升高差异有统计学意义(P＜0.01),仍可维持正常范围,而SPO2变化差异不显著(P＞0.05);B组气腹时应激反应活跃,DBP、SBP、HR与气腹前比较差异有统计学意义(P＜0.01),两组患者在气腹30min后,各项指标均有所改善,排气后10min各项指标与气腹前比较差异不显著(P＞0.05),A组比B组术后苏醒快差异有统计学意义(P＜0.01),所有患者均顺利完成手术,无发生麻醉并发症.结论 在妇科腹腔镜手术中,应用腰-硬联合阻滞复合浅全麻比插管全麻能更好地控制机体的应激反应,术后苏醒快,是一种效果佳、可行、实用的麻醉方法.     

腰麻-硬膜外联合麻醉在妇科腹腔镜手术中的应用

目的:观察腰麻-硬膜外联合麻醉(CSEA,下称腰硬联合麻醉)下行妇科腹腔镜手术时气腹对呼吸、循环系统的影响。方法:选择18例心肺功能良好的妇科腹腔镜手术患者行腰硬联合麻醉,麻醉成功后20min行人工气腹及头低位并进行腹腔镜手术。观察麻醉前、气腹前、体位改变后、恢复正常体位及气腹消除后血压、心率、呼吸频率、血氧饱和度(SpO2)及心电S-T段的变化。结果:建立气腹后与麻醉前相比血压、心率下降(P﹤0.05或P﹤0.01),但均不低于正常值。气腹后与气腹前相比呼吸频率明显增快(P﹤0.05或P﹤0.01),但术中(SpO2)无明显改变。心电图观察各导联的S-T段无明显改变。结论:该麻醉方法下行妇科腹腔镜手术时气腹对呼吸、循环系统有一定的影响,但其可以满足心肺功能良好患者的短时间妇科腹腔镜手术的需要。     

硬膜外复合全麻与腰硬联合麻醉对妇科腹腔镜手术患者血流动力学的影响

目的对比硬膜外复合全麻与腰硬联合麻醉对妇科腹腔镜手术患者血流动力学及血气的影响。方法选取妇科腹腔镜手术患者60例,依据麻醉方式不同分为观察组与对照组,各30例,观察组采用硬膜外复合全麻,对照组采用腰硬联合麻醉,观察2组不同时段血流动力学改变及血气变化。结果观察组气腹时血压(BP)、心率(HR)、心电图(ECG)与气腹前无统计学意义(P0.05);对照组麻醉后SBP、DBP显著降低,10 min后HR、SBP、DBP与观察组比较有统计学意义(P0.05);对照组气腹20 min时PaCO2、HCO-3较麻醉前显著升高(P0.05),且显著高于观察组(P0.05)。结论硬膜外复合全麻应用于妇科腹腔镜手术,能较好控制患者呼吸循环功能、维持血气状态,减轻机体应激反应,较腰硬联合麻醉更具优越性。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.