SLIPATM喉罩在老年患者阴式子宫切除术中的应用效果分析

目的 研究SLIPATM喉罩在老年患者阴式子宫切除术中的效果及安全性.方法 择期行阴式子宫切除术的40例老年患者,ASA分级Ⅰ～Ⅲ级,无严重心肺疾患,无张口困难,无咽喉痛.随机分为SLIPATM喉罩组(喉罩组)和气管插管组,每组20例,分别记录两组入室时(T0)、麻醉诱导后插入喉罩或气管导管前(T1)、插入后即刻(T2)、拔管(喉罩)前(T3)、拔管(喉罩)后即刻(T4)各时点的平均动脉压(MAP)、心率(HR)以及人工气道建立成功时、成功后30 min及手术结束时的气道平均压(Pmean)、气道峰压(Ppeak)、呼气末二氧化碳(PetCO2)水平;记录两组患者首次置入成功率、置管(喉罩)时间、拔管期的不良反应和术后咽喉部的相关并发症等.结果 气管插管组T2、T3、T4时MAP、HR均显著高于喉罩组(P＜0.01);两组在人工气道建立成功时、成功后30 min及手术结束时Pmean、Ppeak、PetCO2水平比较,差异均无统计学意义(P＞0.05);两组首次置入成功率无明显差异,置管时间喉罩组明显少于气管插管组,拔管期气管插管组体动、呛咳、术后咽喉痛、声嘶等发生率明显高于喉罩组(P＜0.01).结论 SLIPA喉罩全麻通气用于老年阴式子宫切除术患者优于气管插管,易维持血流动力学稳定,应激反应轻微,术后不良反应少.     

SLIPA喉罩在院前急救快速开放气道中的临床研究

SLIPA喉罩是一种新型的声门上通气装置,可以用于择期手术全麻患者、插管困难的患者、急诊科、ICU及各科室急救复苏,可在无任何辅助装置下盲置[1].为探讨SLIPA喉罩在院前急救快速开放气道中应用的可行性.笔者近年来对25例不明原因昏迷急需快速开放气道的患者使用了SLIPA喉罩,并与同期喉镜气管插管病例进行了对比,发现SLIPA喉罩临床效果比喉镜气管插管更好,现分析报告如下.     

SLIPA喉罩与气管插管对腹腔镜胆囊手术患者心血管应激反应的比较

目的探讨SLIPA喉罩与气管插管两种通气方式在全麻腹腔镜下胆囊手术患者心血管应激反应的差异。方法选择我院择期全麻下腹腔镜胆囊手术患者65例,按照入院随机数字表随机分为喉罩组和气管插管组,喉罩组为置入SLIPA喉罩,气管插管组为插入气管导管,比较两组置罩管（罩）前后以及拔管（罩）前后HR和MAP变化以及波动幅度。结果两组置罩（管）前HR、MAP差异无统计学意义（P〉0.05）;喉罩组置/拔罩前后HR、MAP差异无统计学意义（P〉0.05）;气管插管组置/拔管前后HR、MAP差异有统计学意义（P〈0.05）;喉罩组置/拔罩前后HR、MAP波幅变化显著低于气管插管组,差异有统计学意义（P〈0.05）。结论 SLIPA喉罩在麻醉过程中血流动力学平稳,机体应激反应轻,心率、血压波动幅度小,可望成为具有心血管基础疾病患者麻醉气道管理的一个新的选择。     

SLIPA喉罩在急诊心肺复苏困难插管中的应用

目的 探讨SLIPA喉罩在急诊心肺复苏困难插管中的临床应用价值.方法 肺复苏困难插管患者108例,按随机数字表法分为L组、S组和Q组各36例.S组采用SLIPA喉罩置入,L组采用标准型喉罩(standard laryngeal maskairway,LMA)置入,Q组采用气管内插管.比较3组一次置入成功率、置入时间、胃内容物误吸率和心肺复苏成功率.结果 ①一次置入成功,S组、L组一次置入成功率均明显高于Q组(P＜0.01,P＜0.05＝;S组和L组比较差异无统计学意义(P＞0.05).②置入时间,S组、L组置入时间均明显短于Q组(P＜0.01,P＜0.05＝,S组明显短于L组(P＜0.05＝.③心肺复苏成功率,S组、L组心肺复苏成功率均明显高于Q组,S组和L组比较差异无统计学意义(P＞0.05).④胃内容物误吸率,S组胃内容物误吸率明显少于L组和Q组(P＜0.05＝,L组和Q组比较差异无统计学意义(P＞0.05).结论 与气管插管和LMA比较,SLIPA喉罩操作更加简便,能够明显降低胃内容物反流误吸的危险,且价格低廉,值得在临床推广应用,     

SLIPA喉罩与气管插管在全麻腹腔镜手术中的应用比较

目的:比较应用SLIPA喉罩与气管插管在腹腔镜手术中血流动力学的影响.方法:腹腔镜宫外孕手术57例、卵巢囊肿45例,年龄19～57岁.随机均分喉罩组(S组)和气管插管组(G组).记录入室后(T0)、麻醉诱导时(T1)、置入喉罩或气管插管即刻(T2)、置入喉罩或气管插管后3分钟(T3)、气腹后20分钟(T4)、拔除喉罩或气管插管前(T5)、拔除喉罩或气管插管即刻(T6)的SBP、DBP、HR、SpO2、Paw,观察拔除喉罩或气管插管后并发症的发生情况.结果:与T0时比较,两组T1时SBP、DBP均下降,HR减慢(P＜0.05);与T1时比较,G组T2时SBP、DBP明显升高,HR增快(P＜0.05);与T5时比较,G组T6时SBP、DBP明显升高,HR增快(P＜0.05).G组发生呛咳、躁动、喉痛及声嘶的患者明显多于S组.结论:全麻腹腔镜手术中使用SLIPA喉罩控制血流动力学平稳、安全性好、并发症少.     

SLIPA喉罩在全麻颈椎外伤手术中的临床应用

目的比较SLIPA喉罩和气管插管用于颈椎外伤手术对患者血流动力学的影响。方法 ASA I-Ⅱ级择期行颈椎外伤手术的30例病人,年龄20-60岁,体重45-70kg,随机分为喉罩组(H组)和气管插管组(Q组),每组15例。麻醉诱导后分别采用喉罩及气管导管进行气道通气。观察麻醉诱导前(T0),气管导管或喉罩置入后1 min(T1),拔管前即刻(T2)及术毕拔管后1 min(T4)的平均动脉压(MAP),心率(HR)变化,记录术后咽痛、呛咳等并发症发生例数。结果气管插管组(Q组)T1和T2,MAP、HR均高于T0(P0.05),且高于SLIPA喉罩组(H组)的T1、T2时点(P0.05),Q组并发症的发生率高于H组(P0.05)。结论颈椎外伤手术中使用SLIPA喉罩具有安全性好,血流动力学平稳,并发症少的优点。     

喉罩应用于困难气管内插管的临床观察

目的观察喉罩应用于困难气管内插管的临床效果。方法选择ASAⅠ～Ⅱ级、Cormack-LehaneⅢ～Ⅳ类、年龄25～65岁,拟行择期腹部手术的患者40例,随机分为喉罩组（L组,n=20）和气管导管组（E组,n=20）。常规静脉麻醉诱导后分别置入喉罩或插入气管导管。观察记录两组患者喉罩置入/气管内插管的次数及时间,喉罩置入或气管内插管时MAP、HR及SpO2的变化,以及操作时及术后的相关不良反应。结果 L组1次成功置入喉罩的例数明显多于E组1次成功完成气管内插管的例数（P〈0.05）;L组建立有效气道的时间明显较E组短（P〈0.05）;E组气管内插管时和气管内插管后5min的MAP及HR较诱导后显著升高（P〈0.05）;E组气管内插管时SpO2较诱导后显著降低（P〈0.05）;L组操作时发生口腔粘膜出血及术后发生咽喉疼痛的患者明显少于E组（P〈0.05）。结论喉罩通气是解决困难气管内插管有效的方法之一,具有安全、方便及快捷的特点。     

欧普乐喉罩在侧卧位腹腔镜肾切除术中的临床应用

目的 研究欧普乐喉罩在全身麻醉侧卧位后腹腔镜肾切除术中的应用.方法 选取ASA分级Ⅰ~Ⅱ级择期行侧卧位腹腔镜肾切除术患者60例,随机分为欧普乐喉罩组(O组)和气管内插管组(T组),每组30例.静脉快速诱导后分别置入欧普乐喉罩和气管内插管.观察插管时间、一次插管成功率、心率、血压、密封压、气道压力的变化及不良反应.结果 O组置管时间(12.1±3.0)s,显著短于T组(31.8±5.8)s(P＜0.05).T组置管后收缩压显著高于置管前(P＜0.05).O组侧卧位气道密封压显著低于平卧位(P＜0.05);T组侧卧位气道峰压和平均气道压显著高于平卧位(P＜0.05);O组气腹后气道峰压和平均气道压显著高于侧卧位(P＜0.05);T组气腹后气道峰压和平均气道压显著高于侧卧位(P＜0.05);T组侧卧位和气腹后平均气道压显著高于O组(P＜0.05).2组的染血发生率和咽痛发生率差异无统计学意义(P＞0.05).结论 欧普乐喉罩具有操作简便快速,通气功能良好,患者耐受性好,术后并发症少的特点,可用于侧卧位腹腔镜肾切除手术.     

SLIPA喉罩与普通喉罩在气道管理的对比应用

目的:比较分析SLIPA喉罩与普通喉罩(LMA)在气道管理的对比应用。方法:60例拟行全身麻醉患者随机分成SLIPA组与LMA组各30例,全身麻醉诱导后分别置入SLIPA喉罩和LMA,观察并比较血流动力学、并发症情况。结果:两组置入一次成功率、呼吸道密封压、气道峰压比较差异无统计学意义(P>0.05),两组患者插管前后及拔管后平均动脉压、心率无显著性变化(P>0.05)。两组均未发现喉罩移位及返流误吸情况。SLIPA组患者置管部位舒适度显著高于LMA组(P<0.05)。结论:SLIPA喉罩在全身麻醉气道管理中应用简便,对呼吸参数、血流动力学影响小,并发症少,患者舒适度高,较普通喉罩优势明显。     

喉罩与气管内导管在乳腺癌手术麻醉中的比较

目的观察SLIPA喉罩在乳腺癌手术全麻时对患者心血管系统的影响,气道维持的有效性和安全性。方法全麻下行乳腺癌改良根治术的女性患者60例,ASAⅠ级或Ⅱ级,随机分为SLIPA喉罩组(S组),气管插管组(T组),每组30例。均采用丙泊酚、芬太尼、维库溴铵快速诱导后分别置入喉罩或气管内插管。记录两组麻醉诱导前(T0)、诱导后置(插)入前(T1)、置(插)入即刻(T2)及3 min(T3)、5 min(T4)、手术结束时(T5)、拔除前(T6)、拔除后1min(T7)各时点的HR、SBP、DBP数值。并测定S组气道密封压、两组的气道峰压(Ppeak),观察两组通气时PETCO2、SpO2及术后清醒拔管时间、不良反应。结果 (1)SLIPA喉罩置入用时比气管内插管用时短(P<0.05);(2)两组对应点测得的SpO2、PETCO2、Ppeak均在正常范围内,组间比较差异无统计学意义(P>0.05);(3)两组对应点测得HR、SBP、DBP结果显示T组波动变化较明显(P<0.05);(4)S组较T组术后清醒拔管快、喉罩耐受好,术后不良反应少。结论 SLIPA喉罩用于乳腺癌全麻通气,对患者心血管系统应激反应小,效果安全满意。     

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.