异氟醚在婴幼儿支气管镜检及异物取出术中的应用

选择１３０例年龄３天－３岁施支气管镜检及异物取出术的小儿应用异氟醚吸入麻醉。术前给阿托品０．０１～０．０２ｍｇ／ｋｇ，面罩给氧并吸入１％～４％的异氟醚，麻醉深度达Ⅲ级Ⅱ级后以２％利多卡因咽喉喷雾表面麻醉，插入支气管镜接紧闭循环装置或Ｍａｐｌｅｓｏｎ改良Ｄ回路装置给氧或维持麻醉，异氟醚诱导平稳，迅速，苏醒快，无致吐作用，在支气管镜检及异物的浸出术中应用能取得良好的麻醉效果。     

地氟醚循环紧闭麻醉的研究

目的：研究气管插管后预氧对地氟醚循环紧闭麻醉过程中低氧的预防作用,以及维持1．0 MAC麻醉状态其挥发器刻度（Cv）的调整方法。方法：80例择期颅脑手术病人,随机分为预氧组和无预氧组。麻醉诱导前不行紧闭面罩吸氧去氮,仅在呼吸减弱、停止时给予面罩辅助、控制呼吸,气管插管后接Ohmeda麻醉呼吸机。预氧组用5L／min氧流量进行正压通气3min（预氧）,然后降低氧低流量紧闭吸入地氟醚;无预氧组直接紧闭吸入地氟醚。两组均以1．0MAC维持麻醉。分别记录两组吸入氧浓度（FiO2）下降至30％的时间和再充氧后的变化情况,同时记录Cv分别维持于不同刻度的时间。结果：预氧组FiO2首次降至30％的时间[（404．8±19．5）min]明显长于无预氧组[（246．5±95．7）min],预氧组在术中各个时刻FiO2均显著高于无预氧组。维持1．0MAC麻醉时Cv置于18％、14％、12％、10％、8％、6％的时间分别为（42．6±16．5）min、（37．9±25．1）min、（47．4±32．4）min、（49．9±47．2）min、（55．2±40．2）min、（86±50．2）min。结论：地氟醚循环紧闭麻醉有发生低氧的可能,预氧可有效预防其发生;紧闭维持1．0MAC麻醉时,推荐Cv置于18％、14％、12％、10％、8％的时间分别40、40、50、50、50min。然后以6％维持。     

地氟醚超小流量麻醉20例报告

继安（异）氟醚超小流量麻醉成功应于临床之后［１］,我院从１９９８年１月～６月,试用地氟醚超小流量麻醉２０例取得成功,报道如下。１　临床资料１．１　一般资料　选择术前ＡＳＡⅠ～Ⅱ级上腹部手术２０例,男性１２例,女性８例;年龄５３．９±１０．９７岁（３５～７７岁）;体重４６～６９ｋｇ,平均５７．５３±６．８７ｋｇ。１．２　麻醉方法　麻醉诱导常规应用芬太尼４μｇ／ｋｇ,东茛菪碱０．３ｍｇ,异丙酚２ｍｇ／ｋｇ,以及琥珀胆碱２ｍｇ／ｋｇ,静脉注射,并纯Ｏ２去氮。气管插管后固定的氧气（Ｏ２）０．３Ｌ,氧化亚…     

异氟醚麻醉胃切除术病人的应激反应及硬膜外注入小剂量芬太尼的作用

为了观察异氟醚麻醉下病人的应激反应及硬膜外注入小剂量芬太尼的作用，选择２０ 例胃切除术病人随机分为两组，Ａ 组为异氟醚吸入麻醉复合Ｔ９～１０硬膜外注入小剂量芬太尼１０ 例，Ｂ组为异氟醚吸入麻醉１０ 例。分别于麻醉前、麻醉气管插管后１ｍ ｉｎ、术中９０ｍ ｉｎ、拔除气管导管后即刻采静脉血，用放免法测定血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度，同时记录血压和心率的变化。结果：Ａ组四项内分泌指标全程无显著变化（Ｐ＞ ０．０５）；Ｂ组肾素活性、皮质醇水平术中及拔管后较术前显著增高（Ｐ＜ ０．０５），同时也显著高于Ａ 组（Ｐ＜ ０．０５）；手术中及拔管时Ａ 组血压低于Ｂ组（Ｐ＜ ０．０５）。本组结果说明：异氟醚吸入麻醉复合Ｔ９～１０硬膜外注入小量芬太尼是抑制上腹部手术中机体应激反应较好的麻醉方法。     

异丙酚、安氟醚及其复合组对麻醉后期恢复的影响

目的 采用双盲法观察不同麻醉维持方法麻醉后期的恢复情况。方法 ３０例择期手术的病人,ＡＳＡⅠ～Ⅱ级,随机分为三组;安氟醚组、异丙酚组及复合组,每组１０例,安氟醚组以１％醉,复合组吸入１％安氟醚并静脉输注异丙酚６～９ｍｇ．ｋｇ＾－１／ｈ维持麻醉,复合组吸入１％安氟醚并静脉输注异丙酚６～９ｍｇ．ｋｇ＾－１／ｈ。结果 安氟醚组的术后呼吸、吞咽反射、呼之睁眼恢复时间明显短于其它二组（Ｐ〈０．０５或Ｐ〈０．     

口服可乐定对小儿全麻安氟醚吸入浓度的影响

目的：探讨口服可乐定对小儿全麻安氟醚吸入浓度的影响。方法：随机将２０ 例５～１３ 岁 Ａ Ｓ Ａ Ⅰ级择期全麻手术患儿分为两组（每组 １０ 例）进行比较,可乐定组（Ⅰ组）于术前９０～１００ ｍ ｉｎ 口服可乐定 ５ μｇ·ｋｇ－ １,并于术前 ３０ ｍ ｉｎ 给予 Ａｔｒｏｐｉｎｅ ０．０１５ ｍ ｇ·ｋｇ－ １ 和 Ｌｕｍ ｉｎａｌ２ ｍ ｇ·ｋｇ－ １肌注;对照组（Ⅱ组）只给 Ａｔｒｏｐｉｎｅ 和 Ｌｕｍ ｉｎａｌ,不服用可乐定。两组患儿全麻插管后,将血流动力学稳定作为主要控制条件,记录三个时点的氨氟醚吸入浓度。结果：Ⅰ组患儿氨氟醚吸入浓度显著减小,较Ⅱ约下降 ３０％ （ Ｐ＜ ０．０１）。结论：小儿口服可乐定作为术前用药可以明显地降低术中氨氟醚吸入浓度。     

癫痫手术的麻醉处理

本文报道静吸复合麻醉行脑皮层癫痫灶切除术２０例。用ｒ－ＯＨ５０－６０ｍｇ／ｋｇ、２．５％ＳＰ６－８ｍｇ／ｋｇ、芬太尼０．２－０．３ｍｇ、司可林１－２ｍｇ／ｋｇ静脉注射诱导，气管插管后２％普鲁卡因１００ｍｌ内加芬太尼０．２ｍｇ静脉点滴，普鲁卡因滴速０．４－０．６ｍｇ／ｋｇ／ｍｉｎ；同时间断吸入小剂量氨氟醚或异氟醚，吸入浓度〈１ＭＡＣ；１７例加肌松剂用机械呼吸维持。普鲁卡因、芬太尼为主，间断吸入小剂量     

异丙酚笑气氨氟醚用于腹腔镜胆囊切除术麻醉的临床探讨

对异丙酚、笑气、氨氟醚静吸复合麻醉用于腹腔镜胆囊切除术１４５例进行临床分析。静注芬太尼２～４μｇ／ｋｇ，异丙酚２ｍｇ／ｋｇ，卡肌宁０．５ｍｇ／ｋｇ诱导插管后，吸入４５％～６０％笑气，１％～２％氨氟醚，并间断静注异丙酚和卡肌宁加深麻醉和维持肌松。诱导后血压下降１．８５±０．５１ｋＰａ，插管后恢复到诱导前水平或略高，ＣＯ２人工气腹后５～１０ｍｉｎ血压升高１．４５±０．３９ｋＰａ，ＰＥＴＣＯ２上升０．５４３±０．０５９ｋＰａ，Ｐｐｅａｋ上升０．３９５±０．０５７ｋＰａ，ＴＶ下降１５０±４１．５ｍｌ，牵拉胆囊时无明显低血压及窦缓等胆心综合征，术毕迅速清醒，无严重意外及并发症发生。     

最低流量循环紧闭式异氟醚麻醉中气体浓度及用量的研究

最低流量循环紧闭式异氟醚麻醉８９例开胸手术报道，载体新鲜气流量为０．５Ｌ／ｍｉｎ。的纯氧，使用异氟醚挥发罐刻度浓度为１．５～２％，均达到满意的效果。平均使用液体异氟醚为１１．４ｍｌ／人次。此为一种经济，无污染手术室符合我国具体国情的良好的气体麻醉方法。     

异丙酚,硫喷妥钠,依托咪酯用于腹腔镜胆囊切除术的临床麻醉

目的评估和比较异丙酚，硫喷妥钠和依托咪酯用于腹腔镜胆囊切除术麻醉中诱导情况，麻醉稳定性，苏醒情况和麻醉并发症。方法选择６０例行腹腔镜胆囊切除术的病人，随机分为３组，Ａ组硫喷妥钠用于麻醉诱导，３０％氧化亚氮－七氟醚用于麻醉维持；Ｂ组异丙酚用于麻醉诱导和维持；Ｃ组依托咪酯用于麻醉诱导和维持。结果各组诱导意识消失时间依次为３７．７±１．０ｓ，４９．９±１．８ｓ，５７．３±２．０ｓ，麻醉后睁眼时间依次为１３．９±０．８ｍｉｎ，９．４±０．４ｍｉｎ，１２．３±０．７ｍｉｎ。各组间比较差异均有显著性（Ｐ均＜０．０１）。异丙酚组苏醒后无１例复睡。结论异丙酚诱导迅速，可以提供一个稳定的腹腔镜麻醉，而不需要大量的其它静脉麻醉药，苏醒最快，且苏醒质量好，术后并发症少。     

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.