液体输入对术中寒战发生率的影响

目的：探讨术中输入液体对术中寒战发生率的影响。方法：选择硬腰联合麻醉、腹部手术患者600例,随机分为观察组（输入32℃-36℃加温液体）和对照组（输入常温下液体）,每组各300例。观察两组患者输液后30 min、输液后60 min和输液后120 min寒战发生情况,并记录结果进行统计学处理。结果：对照组术中寒战发生率受输入液体量与速度的影响非常明显,相同时间输入液体量越多,寒战率越高,相同液体量输入时间越短寒战率越高;手术时间越长,输入液体量越大寒战发生率越高;观察组在相同条件下寒战率明显降低,两组差异有统计学意义（P均〈0.01）。结论：术中寒战与输入常温液体的时-量关系非常明显,输入加温液体可显著降低术中寒战的发生率,是一种安全有效的预防寒战的方法。     

冬季加温输液对剖宫产术中患者体温及寒战发生率的影响

目的评价加温输液对冬季剖宫产术中患者体温及寒战发生率的影响。方法选择ASAI~II级,在腰硬联合麻醉下择期行剖宫产的健康初产妇80例,按手术日期排序随机分成试验组和对照组。试验组进入手术室后输注经电子加温仪加热到37℃的液体,对照组输注的液体未做加温处理。引起剖宫产术中寒战的因素如麻醉方式,麻醉用药,术中输液量,术中失血失液量,皮肤消毒,术中处置,环境温度等无显著区别情况下,分别于麻醉前及麻醉后15、30、60min及术终记录肛温和寒战反应,并进行统计学比较。结果腰硬联合麻醉后15min两组患者肛温升高0.5℃后逐渐降低,试验组患者较对照组肛温降低幅度小,寒战发生率低,有显著差异。结论冬季剖宫产术中加温输液不仅可以有效防止患者术中体温降低,还可以减少术中寒战的发生率。     

加温输液复合术中镇静对腰硬联合麻醉下剖宫产术中寒战反应的临床研究

目的探讨加温输液复合术中镇静对腰硬联合麻醉下行剖宫产产妇术中寒战反应的影响。方法将腰硬联合麻醉下择期行剖宫产手术的健康初产妇90例随机分为3组,各30例。Ⅰ组术中输注未经特殊处理的液体,Ⅱ、Ⅲ组术中输注预先加温至37℃的液体;胎儿娩出断脐后即刻Ⅰ、Ⅱ组静脉注射生理盐水5 mL,Ⅲ组静脉注射咪达唑仑0.04 mg/kg(生理盐水稀释至5 mL)。观察三组产妇寒战的发生情况。结果Ⅱ、Ⅲ组寒战总发生率和2级寒战发生率低于Ⅰ组,差异有统计学意义(P<0.05)。结论加温输液和加温输液复合术中镇静均能减轻腰硬联合麻醉下行剖宫产术中产妇寒战的发生率,但加温输液复合术中镇静更为有效。     

术中加温输液对患者体温的影响

目的：探讨术中加温输液对患者体温的影响。方法：将患者分为两组,温液组进入手术室后通过液体加温器,输入37～38℃液体。室温组不使用加温器进行输液。对两组患者进行体温与一般状态的观察。结果：温液组的患者与室温组的患者在手术时间、年龄以及输入液体量上,无显著性差异（P〉0.05）,在肛温变化,寒战发生率方面比较,有统计学意义（P〈0.05）。结论：加温输液在一定程度上可减少低体温的发生。     

术中保温对全麻患者术后苏醒延迟及寒战的影响

目的：探讨全身麻醉下行开腹手术患者术中保温对术后苏醒延迟及寒战的影响。方法：选择择期ASAI～Ⅱ级50～60岁开腹子宫全切术女性患者120例,随机分为两组：A组（60例）术中未进行任何保温措施,B组（60例）术中使用热风毯与加温输液仪。回顾性分析这两组患者全麻后苏醒延迟及寒战的发生率及原因。结果：A组患者发生术后苏醒时间为（8．7±1．9）min,寒战发生率为31．7％;B组术后苏醒苏醒时间为（5．3±1．1）min,寒战发生率为6．7％。结论：术中保温是一种预防术后寒战、促进全麻苏醒的简捷有效的方法。充分的术中保温是保证手术成功的重要环节。并直接影响疾病的预后。     

术中保温联合能量合剂对剖宫产患者术中寒战防治研究

目的:评价术中保温联合能量合剂对剖宫产术中患者硬腰联合麻醉后寒战发生率的影响。方法:选择ASAI-II级,在硬腰联合麻醉下择期行剖宫产手术160例,将其随机分成试验组和对照组。试验组患者进入手术间前,提高手术室内的温度,使室温保持在24~26℃,且于手术前60min恒定室温;准备经电子加温仪加热到36.5~37℃的液体,其中包括静脉输注的液体及术中冲洗液;术前30min肌肉注射能量合剂。对照组患者进入常温手术间,使室温保持在22~24℃,使用室温保存下的液体,包括静脉输注的液体及术中冲洗液;术前30min肌肉注射2ml生理盐水。记录两组麻醉前及麻醉后15min、30min、60min及术终肛温和寒战反应。结果:硬腰联合麻醉后15min,两组患者肛温升高0.5℃后逐渐降低,试验组患者较对照组患者肛温降低幅度小,差异有统计学意义。试验组与对照组相比较寒战发生率低,差异有统计学意义。结论:术中保温联合能量合剂对剖宫产术中患者硬腰联合麻醉有效防止患者术中体温降低,同时减少术中寒战的发生率。     

静脉输注加温液体与体外暖风加温对预防术中低体温效果的比较

目的 探讨静脉榆注加温液体与体外暖风加温对预防术中低体温效果的比较.方法 选择100例行全麻腹腔镜直肠癌根治术的患者作为研究对象,将100例患者随机分成观察组和对照组,每组50例.观察组行术中静脉输注加温液体来预防低体温;对照组行体外暖风加温来预防术中低体温,两组加温方式均在术中.比较两组患者的体温状况、术后并发症发生情况、寒战发生率以及寒战程度.结果 两组患者经过不同方式加温以后,观察组的体温高于对照组,两组患者的中心体温测量结果差异有统计学意义(P＜0.05).观察组出现3例恶心、呕吐,1例呼吸抑制;对照组出现10例恶心、呕吐,3例呼吸抑制,两组术后并发症发生率有统计学差异(P＜0.05).观察组的寒战发生率为8％(4例)、对照组的寒战发生率为46％(23例),按照时间节点的不同,在麻醉苏醒后的10 min时,观察组寒战发生率更低(x2=6.573,P＜0.05),当麻醉苏醒后30 min时,两组的寒战率比较无统计学差异(x2 =3.481,P＞0.05);根据寒战程度比较,观察组寒战程度为1、2、3、4级的病例数分别为2、1、1、0例;对照组寒战程度为1、2、3、4级的病例数分别为9、7、5、2例,两组统计学差异明显(x2=16.072,P＜0.05).结论 静脉输注加温液体预防术中低体温效果显著,可以减少并发症发生率、降低寒战发生率并改善寒战程度,值得临床推广应用.     

围术期保温对小儿全身麻醉腹部手术后的影响

目的:探讨围术期保温对全身麻醉小儿腹部手术后的影响。方法:将40例择期全身麻醉下行腹部手术的小儿随机分为对照组和加温组,每组各20例。对照组患者术中不采用任何升温装置,加温组患者术中采用输液加温器及加温毯加温。观察两组患者术中、术后中心体温,苏醒时间、拔管时间及术后寒战发生率。结果:加温组术后温度为(36.56±0.18)℃,对照组为(35.07±0.17)℃(t=17.463 5,P<0.01)。加温组苏醒时间为(16.5±6.3)min,短于对照组(20±6.8)min(t=4.824 2,P<0.01);加温组拔管时间为(20±5)min,短于对照组的(28±6)min(t=8.0164,P<0.01)。对照组有8例患者术后发生寒战(40%),加温组无术后寒战发生(0%,)(χ2=7.656 3,P<0.01)。结论:围术期采用输液加温器及加温毯加温,可有效地维持患者正常体温,并能缩短麻醉后苏醒和拔管时间、减少术后寒战发生。     

围术期体温保护对肝癌患者行肝叶切除术中出血量的影响

目的探讨肝叶切除术中固术期保温对肝癌患者出血量的影响。方法择期肝癌手术患者60例,随机分为观察组和对照组各30例。对照组术中不采用任何升温装置,观察纽患者术中采用输液加温器及充气保温毯加温。所有患者用鼻咽温度探头监测其术前、术中、术后体温变化、凝血功能指标及术中出血量,并进行比较。结果观察组体温高于对照组体温（P〈0．05）,使用保温毯加温后30min体温明显高于入室后体温（P〈0．05）,使用保温毯加温30min以后不同时间点体温比较差异无统计学意义（P〉0．05）。观察组出血量与对照组比较明显减少,差异具有统计学意义（P〈0．01）。结论对肝癌患者行肝叶切除手术过程中使用输液加温器和保温毯,可有效维持患者正常体温,减少术中出血量。     

输注加温液体对围手术期病人体温的影响

目的研究静脉输注37-38℃液体对围手术期病人体温及术后寒战的影响方法将120例病人随即分成两组,对照组60例（输注室温液体）,实验组60例（输注加温温液体）;分别记录两组病人麻醉前、麻醉后30分钟、麻醉后60分钟及手术结束时病人的体温,术后寒战发生率,同时记录输注液体总量、全麻病人拔管时间和苏醒时间,并进行统计学处理。结果实验组病人在实验组手术中病人体温维持恒定,手术前及术毕病人体温无显著差异。而对照组各时间段肛温变化及手术后寒战发生率均有统计学显著意义。结论输注加温液体能有效预防围手术期低体温,降低术后寒战发生率。     

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.