氯胺酮复合瑞芬太尼在小儿短小手术中的应用

目的:探讨氯胺酮复合瑞芬太尼在小儿不插管全身麻醉中的应用。方法:择期小儿全身麻醉80例,性别不限,年龄2~8岁,ASA分级Ⅰ~Ⅱ级。随机分为氯胺酮复合瑞芬太尼组(P组)和氯胺酮组(C组),每组40例,两组静脉诱导氯胺酮2 mg/kg,P组3分钟后持续泵注瑞芬太尼0.15μg/(kg·min),C组诱导后10分钟或患儿肢体有反应时追加首次诱导剂量的1/2,直至手术结束。术中监测患儿血压、心率、Sp O2,记录苏醒时间。结果:两组患儿Sp O2较平稳,P组患儿诱导前、诱导后、手术开始5分钟、15分钟、30分钟的心率与诱导前无明显变化,而C组心率明显增加;P组术后苏醒时间明显短于C组。结论:氯胺酮复合瑞芬太尼临床用于小儿短小不插管全身麻醉既能满足手术需要又能降低并发症发生,苏醒时间明显缩短,麻醉过程平稳。     

七氟醚与丙泊酚复合瑞芬太尼麻醉用于眼科手术喉罩气道患儿的比较

目的 比较眼科手术患儿七氟醚与丙泊酚复合瑞芬太尼麻醉术中血流动力学及麻醉恢复情况.方法 择期行眼科手术(斜视矫正术、白内障摘除术、眶内肿物摘除术)患儿40例,ASA Ⅰ级或Ⅱ级,随机分为七氟醚组(S 组)与丙泊酚复合瑞芬太尼组(PR组),每组20例.麻醉诱导相同,咪达唑仑0.05 mg/kg,芬太尼3 μg/ks,丙泊酚2 mg/kg,插入喉罩.麻醉维持:S组吸入七氟醚,氧流量2.0 L/min,呼气末浓度1.0 MAC,手术结束时,停止吸入七氟醚,纯氧吸入,氧流量调整为5.0 L/min.PR组瑞芬太尼0.10μg/(kg·min)恒速输注,丙泊酚在静注2 mg/kg后6 min以9 mg/(kg·min)恒速输注,40 min后7 mg/(kg·min)恒速输注,两组术中均未使用肌松药.记录两组患儿术中收缩压(SBP)、舒张压(DBP)、心率(HR)、听觉诱发电位指数(AEPI).记录手术时间、术毕自主呼吸恢复时间,拔除喉罩时间,Alrete评分达到9分时间及麻醉恢复室(PACU)停留时间.结果 与PR组比较,S组自主呼吸恢复时间缩短(P<0.05),但拔除喉罩时间两组差异无统计学意义,Aldrete评分达到9分时间及PACU停留时间延长(P<0.05).与诱导前比较,两组在插入喉罩即刻、手术开始后5 min、10 min、15 min、30 min SBP、DBP均降低(P<0.05),但两组间比较差异无统计学意义;PR 组 HR 降低(P<0.05),两组间比较差异有统计学意义(P<0.05). 结论眼科手术喉罩气道患儿七氟醚麻醉或丙泊酚复合瑞芬太尼麻醉循环稳定;七氟醚麻醉患儿呼吸恢复较快,丙泊酚复合瑞芬太尼麻醉患儿早期意识状态恢复较好.     

瑞芬太尼持续静脉输注对外耳再造手术小儿全身麻醉拔管的影响

目的观察瑞芬太尼持续输注对外耳再造手术小儿全身麻醉拔管的循环反应以及拔管相关不良反应的影响。方法选取美国麻醉医师协会分级Ⅰ~Ⅱ级择期全身麻醉拟行自体肋软骨移植外耳再造手术患儿60例,按随机数字法分为对照组和瑞芬太尼组,每组30例。两组患儿的麻醉诱导均采用舒芬太尼+丙泊酚+罗库溴铵方案,麻醉维持采用瑞芬太尼+丙泊酚+60%N_2O方案。两组均术毕前5 min停用吸入和静脉麻醉药物,瑞芬太尼组将瑞芬太尼浓度减至0.05μg/(kg·min)持续输注直至拔出气管导管,对照组停瑞芬太尼输注。观察两组小儿麻醉诱导前(T0)、手术结束时(T1)、拔管前即刻(T2)、拔管后1 min(T3)、拔管后3 min(T4)、拔管后5 min(T5)的平均动脉压(MAP)、心率和脉搏血氧饱和度(SpO_2);记录自主呼吸恢复时间、苏醒时间、拔管时间;记录拔管时患儿呛咳反应状况,拔管后5 min内是否发生呼吸抑制及恶心呕吐。结果两组患儿T1_时间点MAP、心率出现明显降低,T_2、T_3时间点的MAP、心率出现明显升高;T_4、T_5时间点MAP、心率出现降低,与T_0时间点接近。对照组T_2、T_3的MAP明显高于T_0(P<0.05);瑞芬太尼组除T_5外其余各时点MAP均明显低于T_0(P<0.05)。对照组和瑞芬太尼组T_2、T_3的心率均较T_0明显加快,瑞芬太尼组T_2、T_3的MAP、心率较对照组明显下降(P<0.05)。对照组和瑞芬太尼组各时点的SpO_2均无明显变化(P>0.05)。瑞芬太尼组的拔管呛咳反应评分显著低于对照组[(1.33±0.60)分比(2.03±0.90)分,P<0.05]。两组患儿的自主呼吸恢复时间、苏醒时间、拔管时间、清醒镇静评分、呼吸抑制及恶心呕吐发生率差异无统计学意义(P>0.05)。结论小儿全身麻醉拔管期持续静脉输注瑞芬太尼0.05μg/(kg·min),可以明显减轻拔管期间的心血管反应和拔管时的呛咳反应,且不延长麻醉恢复时间。     

瑞芬太尼预处理对老年体外循环冠脉搭桥患者心肌的保护作用

目的 探讨瑞芬太尼预处理对体外循环下冠脉搭桥患者心肌缺血再灌注损伤的影响。方法 选择年龄65 ～75岁、体外循环下行冠脉搭桥患者80例，分为瑞芬太尼组（R组）和对照组（C组），每组40例。麻醉诱导成功后胸骨劈开前R组单次给予瑞芬太尼1.0 μg/kg，随后0.4μg/(mg·min)泵注25 min；C组按相同速度输...     

瑞芬太尼复合丙泊酚静脉麻醉在小儿腭裂修复术中的应用

目的 观察瑞芬太尼、内泊酚用于小儿腭裂修复手术麻醉中的可行性、安全性及其临床效果.方法 选择50例小儿腭裂修复手术患者.其中男29例,女21例,ASA Ⅰ～Ⅱ级.随机分为两组:Ⅰ组为对照组,Ⅱ组实验组.Ⅰ组静脉推注氯胺酮1～2mg/kg,芬太尼4 μg/kg,阿曲库胺0.5mg/kg,快速气管插管.术中间断静脉推注氯胺酮0.5～1mg/kg或吸0.5%～1%的氨氟醚维持麻醉.Ⅱ组静脉推注氯胺酮1～2mg/kg、阿曲库胺0.5mg/kg,快速气管插管,控制呼吸,术中用微量泵持续泵注瑞芬太尼、丙泊酚维持麻醉,输注速度瑞芬太尼0.2μ/g(kg·min)、丙泊酚80～100μg/(kg·min)、阿曲库胺5μg/(kg·min).记录两组诱导前、诱导后、术中(游离皮瓣)、术后HR、MAP、SpO2及术毕患儿清醒时间(麻醉时间).所得数据进行统计学分析.结果 两组病人年龄、性别、体萝及诱导前、诱导后、术后MAP、HR及SpO2无统计学意义(P>0.05).术中Ⅰ组MAP及HR明显高于Ⅱ组(P<0.05),两组手术时间无统计学意义(P>0.05).Ⅱ组麻醉时间明显少于Ⅰ组(P<0.05).结论 瑞芬太尼、丙泊酚用于小儿腭裂修复手术是一种安全、有效、可行的静脉麻醉方法.     

不同剂量瑞芬太尼对小儿全麻插管应激反应影响的研究

目的通过观察插管前后血流动力学和血浆应激激素水平的变化,探讨不同剂量瑞芬太尼诱导插管对小儿血流动力学和气管插管反应的影响。方法选择ASAⅠ~Ⅱ级60例择期全麻手术小儿,随机分为三组,每组20例:瑞芬太尼用量分别为1μg/kg(Ⅰ组)、1.5μg/kg(Ⅱ组)和2μg/kg(Ⅲ组)。麻醉诱导后记录诱导前(T0)、气管插管前即刻(T1)、插管后即刻(T2)、插管后3min(T3)SBP、DBP、HR变化并于T0、T1、插管后5min(T4)、手术结束时(T5)四个时点抽取病人静脉血测量皮质醇和血糖。结果各组病人诱导后与基础值(诱导前,T0)相比SBP、DBP、HR均明显下降,Ⅲ组下降更加明显;插管后Ⅰ、Ⅱ组SBP、DBP上升,HR增快,Ⅲ组无明显变化;诱导后(T1)Ⅲ组患儿低血压的发生率明显高于Ⅰ、Ⅱ组。各组诱导后血浆皮质醇和血糖明显下降,插管后Ⅰ、Ⅱ组皮质醇升高,Ⅲ组没明显变化。三组病人诱导后血糖均明显下降,插管后5minⅠ、Ⅱ组病人血糖升高,Ⅲ组无明显变化。结论 2μg/kg瑞芬太尼能明显抑制小儿麻醉诱导期间的应激反应。     

瑞芬太尼在腹腔镜手术麻醉中的应用

目的研究瑞芬太尼在腹腔镜手术麻醉中应用的安全性和有效性。方法60例择期行腹腔镜胆囊切除术病人,随机分为R组(瑞芬太尼组)和F组(芬太尼组),每组30例。麻醉诱导采用静脉注射异丙酚、维库溴铵、咪唑安定,以及瑞芬太尼或芬太尼。麻醉维持采用吸入异氟醚以及持续静脉泵注瑞芬太尼或芬太尼。观察诱导前、诱导后1min、气管插管后5min内及术后5min的血流动力学变化,同时观察麻醉深度、麻醉苏醒及不良反应等情况。结果两组诱导后MAP和HR值均较诱导前下降(P<0.05)。气管插管5min内R组血流动力学变化幅度明显小于F组(P<0.05),R组的呼之睁眼和拔管时间小于F组(P<0.05),术后苏醒恢复状况也优于F组。结论使用瑞芬太尼麻醉的腹腔镜手术病人,其血流动力学更稳定,术后苏醒快,麻醉效果好和安全性佳。     

瑞芬太尼复合氯胺酮麻醉在小儿不插管手术中的应用

目的:探讨瑞芬太尼复合氯胺酮麻醉在小儿不插管手术中的应用效果。方法:将40例患儿随机分为两组,Ⅰ组术中使用瑞芬太尼、氯胺酮维持麻醉;Ⅱ组术中使用氯胺酮维持麻醉,分别记录患儿麻醉诱导前、手术开始切皮时,手术开始5 min的血流动力学变化,连续观察MAP、HR和SpO2。结果:切皮时、手术开始后5 min、HR、MAPⅡ组高于Ⅰ组,差异有统计学意义(P<0.05),Ⅰ组患儿复苏时间、躁动方面少于Ⅱ组(P<0.01)。结论:静脉靶控瑞芬太尼复合氯胺酮麻醉在小儿四肢、下腹部及会阴部短小手术中应用具有心血管反应轻,术中麻醉镇痛强反应小,术后苏醒迅速完全,有较佳的临床实用性。     

咪达唑仑复合瑞芬太尼丙泊酚在小儿斜视矫正术中麻醉效果观察

目的:比较咪达唑仑复合瑞芬太尼丙泊酚麻醉与单纯瑞芬太尼丙泊酚麻醉在小儿斜视矫正术中的麻醉效果.方法:将70例择期行斜视矫正术患儿随机分为两组:Ⅰ组为咪达唑仑复合瑞芬太尼丙泊酚麻醉组,Ⅱ组为瑞芬太尼丙泊酚麻醉组,每组各35例.比较两组麻醉各时段血流动力学变化、瑞芬太尼丙泊酚使用剂量及苏醒情况,记录术中和术后不良反应的发生情况,记录麻醉诱导前、气管插管后、术中30min、术中60min及拔管后的收缩压、舒张压、心率、脉搏血氧饱和度及脑电双频指数.结果:两组在术中维持血压及心率较基础值均显著降低(均P<0.05);Ⅱ组在插管时血压与心率升高明显,与Ⅰ组相比差异显著(P<0.05).Ⅱ组使用丙泊酚量较Ⅰ组显著增加(P<0.05),瑞芬太尼用量也有增加.Ⅰ组拔管期躁动的患儿比例与Ⅱ组相比显著降低(P<0.05).两组拔管时间无显著性差异(P>0.05).结论:瑞芬太尼丙泊酚麻醉用于小儿斜视矫正术中安全、有效,复合咪达唑仑后更为安全经济.     

瑞芬太尼和芬太尼用于咽喉部短小手术麻醉效果的对比观察

目的:研究瑞芬太尼在咽喉短小手术麻醉中的应用。方法:选择ASAⅠ～Ⅱ级,择期行咽喉短小手术80例,随机分为两组,瑞芬太尼组(Ⅰ组)和芬太尼组(Ⅱ组)。Ⅰ组采用瑞芬太尼诱导和维持麻醉,Ⅱ组采用芬太尼诱导,两组均持续输注丙泊酚维持麻醉,观察两组麻醉诱导及维持期血流动力学变化和苏醒期苏醒质量及相关时间。结果:Ⅰ组插管时、手术开始时和手术结束时BP和HR明显低于Ⅱ组(P<0.05)。手术结束后Ⅰ组的清醒时间和拔管时间明显短于Ⅱ组(P<0.01)。结论:瑞芬太尼可安全有效地用于咽喉部短小手术的麻醉,血流动力学平稳,苏醒质量较高。     

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.