喉罩通气用于静脉麻醉下腹腔镜胆囊切除手术

目的:分析探讨喉罩通气替代气管内插管应用于静脉麻醉下腹腔镜胆囊切除手术的可行性和安全性。方法:68例ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除手术患者,采用全凭静脉麻醉。观察记录入室后、诱导后即刻、喉罩置入后即刻BP、HR、血氧饱合度(SpO2);喉罩置入是否成功,手控呼吸和机械通气下检查有无漏气;记录气腹前后呼气末二氧化碳分压(PetCO2)、气道压力(Paw)、潮气量(Vt)的变化;麻醉后的恢复情况以及术后调查患者有无术中知晓。结果:有4例因喉罩周围漏气严重而致喉罩通气失败,其余64例患者喉罩置入顺利,手控呼吸和机械通气下无漏气现象,顺利完成手术;Paw气腹后较气腹前明显增加,Vt变化不明显,PetCO2仅轻度增加,调整呼吸参数后恢复;患者血流动力学变化不显著;麻醉后苏醒迅速恢复平稳,对手术过程无记忆,无术后不良反应。结论:应用喉罩通气全凭静脉麻醉在加强监测下可安全用于腹腔镜胆囊切除手术患者。     

喉罩通气用于静吸复合麻醉下妇科腹腔镜短小手术的应用体会

目的：分析探讨喉罩通气替代气管内插管用于静吸复合麻醉下妇科腹腔镜短小手术的可行性和安全性。方法：选择2007年1～12月56例ASAⅠ～Ⅱ级在我院行妇科腹腔镜手术的患者,观察记录入室后、诱导后即刻、喉罩置入后即刻DBP、HR、SpO2,喉罩置入是否成功,手控和机控通气下检查有无漏气,气腹前后呼末二氧化碳分压（Pet-CO2）,气道压力（Paw）,潮气量（Vt）的变化,麻醉后恢复情况。结果：有4例因漏气严重改气管插管,其余52例置入喉罩顺利,手控和机控通气下无漏气现象,顺利完成手术,Paw气腹后较气腹前明显增加;PetCO2轻度增加,调整呼吸参数后恢复;Vt变化不明显,血流动力学变化不明显,麻醉后苏醒恢复迅速平稳,无术后不良反应。结论：应用喉罩通气在静吸复合麻醉下加强监测管理可安全用于妇科腹腔镜短小手术。     

喉罩联合硬膜外麻醉用于腹腔镜手术初探

腹腔镜胆囊切除术和妇科腹腔镜手术因其手术创伤小、术后疼痛轻、恢复快、住院时间短等优点已被临床广泛应用.喉罩用于腹腔镜手术的麻醉已有较多的报道,而本研究则是观察同样使用喉罩的前提下,对比单纯喉罩置入通气全凭静脉麻醉(使用肌松药)和喉罩置入通气复合硬膜外麻醉(不使用肌松药)两种方法对循环功能、呼吸方面的影响和麻醉质量进行对比分析,得出初出结果和体会.     

喉罩联合高频喷射通气在乳腺癌根治术麻醉中的应用

目的 评价喉罩配合高频喷射通气在乳腺癌根治术麻醉应用中的安全性和有效性。方法 47例患者拟在全麻下行乳腺癌根治术，静脉较深麻醉后，置入合适喉罩，进行高频喷射通气，同时采用全凭静脉麻醉维持麻醉平稳，监测动脉血气值、SPO2、PetCO2、气道压、平均动脉压、心率等参教。结果 乳腺癌根治术采用全凭静脉麻醉，置入喉罩进行高频喷射通气能保证患者有效的气体交换，PetCO2和PaCO2较高频通气前明显降低，而PaO2明显升高。结论 全凭静脉麻醉。采用喉罩配合高频喷射通气能安全有效地应用于乳腺癌根治术。     

SLIPA喉罩在腹腔镜胆囊切除手术麻醉中的应用

目的:评估SLIPA喉罩在腹腔镜胆囊切除手术麻醉中的应用效果,并探讨其安全性和有效性。方法:随机将行腹腔镜胆囊切除手术的患者分为两组:SLIPA喉罩组(S组)和经典喉罩组(C组)。分别记录喉罩成功置入率、一次放置成功所需时间以及术中需调整喉罩位置病例数;人工气道建立成功时、气腹后5min及气腹后30min时的气道峰压(Ppeak)、呼气末二氧化碳分压(PetCO2)和患者入室时(T1)、置入喉罩即刻(T2)、置入后3min(T3)、拔除喉罩即刻(T4)、拔除后3min(T5)的平均动脉压(MAP)、心率(HR);并观察术中有无胃胀气、返流误吸情况及术后咽喉部并发症,如声嘶或咽痛等。结果:两组患者在人工气道建立成功时、气腹后5min及气腹后30min时的Ppeak和PetCO2比较,差异均无统计学意义(P>0.05);同时两组患者在所选取的各时点的MAP和HR比较,差异无统计学意义(P>0.05);S组在一次放置成功率、一次放置成功所需时间以及术中需调整喉罩位置病例数方面优于C组,差异均有统计学意义(P<0.05)。两组术后各发生7例轻微咽痛,C组有4例患者术中发生胃胀气,两组均未见声音嘶哑及返流误吸。结论:SLIPA喉罩适用于腹腔镜胆囊切除手术,并发症少、操作便捷、安全性和有效性较高。     

腹腔镜胆囊手术患者Supreme喉罩与ProSeal喉罩气道管理效果的比较

目的比较Supreme喉罩与ProSeal喉罩用于腹腔镜胆囊手术患者气道管理的效果。方法 ASAⅠ~Ⅱ级择期腹腔镜胆囊切除手术的患者60例,随机分为Supreme喉罩组（S组）和经ProSeal喉罩组（P组）。常规麻醉诱导后,分别插入SLMA或PLMA,并将通气罩充气至60 cmH2O。分别记录喉罩置入成功率、一次放置成功所需时间;记录两组纤支镜下喉罩对位分级情况及两组喉罩密封压。人工气道建立成功时、气腹后5 min及气腹后30 min时的气道峰压（Ppeak）、呼气末二氧化碳分压（PetCO2）、氧合指数（OI=PaO2/FiO2）、SpO2和患者入室时（T1）、置入喉罩即刻（T2）、置入后3 min（T3）、拔除喉罩即刻（T4）、拔除后3min（T5）的平均动脉压（MAP）、心率（HR）;并观察术毕喉罩拔除时带血丝及术后咽喉部并发症,如声嘶或咽痛等情况。结果两组患者年龄、性别、身高、体质量、ASA分级、手术时间差异均无统计学意义（P（0.05）。S组的置入时间（13±4）s及一次置入成功率（97%）优于P组,气道密闭压（25±6 cmH2O）低于P组,差异均有统计学意义（P〈0.05）,总的置入成功率及纤支镜分级情况,两组比较差异无统计学意义（P〉0.05）。两组患者在所选取的各时点的MAP和HR比较,差异无统计学意义（P〉0.05）。同时两组患者在人工气道建立成功时、气腹后5 min及气腹后30 min时的Ppeak、PetCO2、OI和SpO2比较,差异均无统计学意义（P〉0.05）。两组患者胃管成功置入率均为100%。S组3例拔除喉罩后表面带有血丝,P组5例;两组术后各发生6例轻微咽痛均未见声音嘶哑,差异均无统计学意义（P〉0.05）。结论 Supreme喉罩和ProSeal喉罩通气效果好,气道密封效果可靠,可安全有效地用于腹腔镜手术,患者的全麻气道管理。两者比较Supreme喉罩置入更加便捷。     

SLIPA喉罩在留置胃管的腹腔镜胆囊切除术全麻患者中的应用研究

目的研究SLIPA喉罩对留置胃管的腹腔镜胆囊切除术全麻患者PaCO2、PetCO2、气道压及漏气率、胃胀气等的影响,评估SLIPA喉罩用于该类患者的安全性、有效性及相关注意事项。方法 90例全麻腹腔镜胆囊切除术患者,随机均分为气管内插管组(Ⅰ组)、SLIPA喉罩组(Ⅱ组)和留置胃管使用SLIPA喉罩组(Ⅲ组)。记录气腹前即刻(T0)、气腹后10 min(T1)、气腹后20 min(T2)、气腹结束前即刻(T3)、气腹结束后5 min(T4)、气腹结束后15 min(T5)时患者的气道峰压(Ppeak)、平均压气道(Pmean)、呼气末二氧化碳分压(PetCO2)、动脉血二氧化碳分压(PaCO2)。并测定喉罩植入后即刻气道密封压,观察术中漏气率,评估胃胀气程度。结果气道密封压Ⅱ、Ⅲ组均能满足通气要求,组间无差异;Ppeak、Pmean各时点Ⅱ组和Ⅲ组较Ⅰ组低(P<0.05),Ⅱ、Ⅲ组间无差异;三组PetCO2、PaCO2各时点无差异;漏气率Ⅱ、Ⅲ组较Ⅰ组高,Ⅱ、Ⅲ组间差异无统计学意义;三组间胃胀气评分差异无统计学意义。Ⅰ组有18例患者术后随访有咽痛,Ⅱ、Ⅲ组各3例患者术后随访有轻度咽痛(P<0.01)。结论 SLIPA喉罩可安全应用于留置胃管的腹腔镜胆囊切除术全麻患者。     

腹腔镜麻醉时小儿喉罩通气容量控制模式与压力控制模式的比较

目的：比较腹腔镜麻醉时儿喉罩通气VCV与PCV对气道压力和喉罩漏气的影响。方法：选择我院腹腔镜下手术喉罩通气ASA I-Ⅱ级小儿患者46例随机分VCV组和PCV组,每组23例。静脉麻醉诱导后置入喉罩。VCV组接受VCV通气方式,PCV组接受PCV通气方式,通气期间保持相同PETCO2。比较两组患者气道峰压、气道平台压、漏气率、呼气潮气量以及循环参数包括HR、BP、SPO2、PETCO2。结果：PCV时气道峰压和漏气率明显低于VCV（P〈0.05）。结论：腹腔镜手术小儿全麻喉罩通气期间,PCV能在较低的气道压力下提供有效的肺通气效果。     

双管喉罩浅全麻复合硬膜外阻滞在腹腔镜胆囊切除术中的应用

目的：探讨双管喉罩浅全麻复合硬膜外阻滞与全凭静脉麻醉在腹腔镜胆囊切除术（LC）中的麻醉效果。方法：择期行LC患者32例,随机分为双管喉罩浅全麻复合硬膜外阻滞（A组,n=16）及全凭静脉麻醉（B组,n=16）。监测记录患者入室时（T0）、切皮时（T1）、二氧化碳气腹时（T2）、拔管/罩时（T3）心率（HR）、平均动脉（MAP）的变化。记录术毕自主呼吸恢复时间,完全清醒时间,拔管时间及术后躁动情况。结果：A组在T1、T2、T3时HR、MAP变化均小于B组。A组术后自主呼吸恢复时间,完全清醒时间,拔管时间均早于B组。结论：双管喉罩浅全麻复合硬膜外阻滞完全能满足LC手术的要求;术毕自主呼吸恢复、清醒快,术后躁动情况少,减少了术后并发症。     

喉罩在腹腔镜胆囊切除术中的应用及护理

目的:探讨喉罩用于全麻下腹腔镜胆囊切除手术的效果和护理经验.方法:总结我院自2011年1月～6月120例腹腔镜胆囊切除手术患者,采用喉罩进行通气的临床护理体会.结果:116例患者置入成功率没有明显差异,生命体征平稳,能保证有效通气.4例患者出现漏气或气道压力较高,通气不良.结论:提出喉罩通气前应做好患者的心理护理,物品、药品的准备,与麻醉医生熟练配合.严格控制术前禁食时间,做好喉罩插入时的护理配合,把握拔管时机,可以保证喉罩置入过程平稳,成功率高,通气效果好,术后并发症少,提高手术安全性.     

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.