180例小儿骶管阻滞的临床观察

目的观察罗哌卡因阻滞效果。方法观察了1～6岁患儿180例，分另q行下腹部、会阴部及下肢手术，采用氯胺酮基础麻醉加骶管阻滞，A组：90例，罗哌卡因2．53mg／ml；B组：90例，罗哌卡因3．75mg／ml。结果低浓度大容量可取得较大阻滞范围，麻醉维持时间缩短，较高浓度和小容量则作用时间明显延长。结论不同种类的手术应用不同浓度和容量的罗哌卡因，能更好地满足手术需要，取得完善的麻醉效果；0．25％和0．375％的罗哌卡因用于小儿骶管阻滞是安全和有效的。     

低容量/高浓度与高容量/低浓度罗哌卡因骶管阻滞作用的比较

小儿骶管阻滞是小儿外科手术常用的麻醉方法,适用于小儿下腹部、会阴、下肢的手术.罗哌卡因属酰胺类局麻药,具有时效长、毒性低等特点,近年来越来越多地被用于骶管阻滞.罗哌卡因用于骶管阻滞的剂量为2.0～2.5mg/kg[1].本文旨在比较低容量/高浓度与高容量/低浓度罗哌卡因骶管阻滞作用效果,选择最佳的药物配比方案.     

不同浓度罗哌卡因用于小儿骶管麻醉的临床观察

目的观察不同浓度罗哌卡因在小儿骶管麻醉中的作用。方法将90例行腹股沟斜疝修补术，睾丸下降固定术患儿分为1％利多卡因组（A组）、0．5％利多卡因加0．2％罗哌卡因组（B组）和0．375％罗哌卡因组（C组），测定麻醉后感觉神经阻滞起效时间、总感觉阻滞时间和运动阻滞时间。结果诱导药量与阻滞平面三组无差异；感觉神经阻滞起效时间A组短于B、C组（P〈0．01），B组短于C组（P〈0．01）；总感觉阻滞时间与运动阻滞时间A、B、c三组依次递增（P均〈O．01）。结论B组药物起效快，诱导时问短，可用于多台接台手术麻醉；C组药物更适宜于诱导时间长、需要更好肌松的手术麻醉。罗哌卡因有良好的术后镇痛作用。     

小剂量罗哌卡因骶麻在PPH手术中的应用探讨

目的：探讨小剂量罗哌卡因骶管麻醉在PPH手术中的可行性与优越性。方法：采用0．75％罗哌卡因10ml做骶管麻醉，观察麻醉效果、麻醉起效时间、麻醉维持时间、术中与术后并发症问题。结果：用小剂量罗哌卡因作骶管麻醉，麻醉效果较好，起效时间较快，并发症较少，但是未能消除手术中存在的直肠牵拉反应。结论：小剂量罗哌卡因骶麻用于PPH手术安全、有效。     

氯普鲁卡因及芬太尼缩短硬膜外罗哌卡因起效时间的临床观察

目的：探讨妇科手术患者复合氯普鲁卡因及芬太尼对罗哌卡因硬膜外麻醉起效时间的影响。方法：择期妇科手术患者60例，随机分为Rc，Rf，R三组，硬膜外分别给予0．75％罗哌卡因18ml＋氯普鲁卡因200mg＋生理盐水2ml；0．75％罗哌卡因18ml＋芬太尼0．1mg／2ml；0．75％罗哌卡因18ml＋生理盐水2ml。记录感觉阻滞最高平面、感觉阻滞起效时间、血流动力学改变及不良反应。结果：感觉阻滞平面迭T10的时问Rc、Rf组均明显短于R组，Rc组短于Rf组；最高阻滞平面Rc、Rf组均明显短于R组。结：论氯普鲁卡因200mg与芬太尼0．1mg均可缩短罗哌卡因硬膜外阻滞起效时间，且复合氯普鲁卡因200mg较芬太尼0．1mg起效时间更短。     

不同浓度罗哌卡因用于颈丛阻滞临床观察

目的：比较不同浓度罗哌卡因行颈丛阻滞时麻醉起效时间、完善时间和恢复时间的不同。方法：20名颈部手术患者随机分为两组，分别用0.375％和0．25％罗哌卡因行颈丛阻滞，观察麻醉起效、完善和恢复时间。结果：两种浓度罗哌卡因用于颈丛阻滞时，麻醉起效和完善时间无显著差异，但0．375％组麻醉持续时间明显长于0．25％组。结论：增加罗哌卡因浓度可以延长麻醉作用时间。     

布托啡诺延长罗哌卡因硬膜外阻滞作用时间的临床观察

目的观察布托啡诺对罗哌卡因硬膜外麻醉起效时间、阻滞平面和作用时间的影响。方法ASAⅠ～Ⅱ级选择40例择期行下肢手术的患者，随机分为A、B两组，每组20例。A组为0．75％罗哌卡因15mL＋布托啡诺0．25mg／mL，B组为0．75％罗哌卡因15mL＋NS1mL。记录硬膜外麻醉起效时间，同时记录30min内能到达的最高感觉阻滞平面和感觉阻滞的持续时间。另外分别在手术开始前和手术结束后根据改良Bromage评分系统判断患者运动阻滞的起效时间和持续时间。结果A组患者感觉阻滞平面到达T10的时间比B组快（P〈0．05），最高感觉阻滞平面也比B组高（P〈0．05），特别是感觉阻滞持续时间更是明显比B组长（P〈0．01）。与此相反，两组患者运动阻滞起效时间及手术后运动阻滞恢复程度基本一致。结论在腰部硬膜外阻滞麻醉中布托啡诺0．25mg混合0．75％罗哌卡因15mL的麻醉效能要优于单纯应用罗哌卡因。     

罗哌卡因用于小儿骶管麻醉及术后镇痛

罗哌卡因是一新型单旋长效酰胺类局麻药物，毒性小及感觉运动阻滞分离是其显著特点，已广泛应用于区域阻滞麻醉。罗哌卡因用于小儿麻醉报道不多．我院2003年1月～2004年1月采用罗哌卡因实施小儿骶管麻醉，现报道如下。     

不同的长效局麻药物用于下腹部手术硬膜外麻醉的比较

目的 比较0．894％甲磺酸罗哌卡因和0．75％盐酸罗哌卡因、0．75％盐酸布比卡因用于下腹部手术硬膜外麻醉的安全性和有效性。方法 采用随机双盲法，将90例下腹部手术患者随机分为三组（n=30）：Ⅰ组应用0．894％甲磺酸罗哌卡因；Ⅱ组应用0．75％盐酸罗哌卡因；Ⅲ组应用0．75％盐酸布比卡因。记录平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）以及感觉阻滞和运动阻滞的起效时间和维持时间。结果 三组患者感觉阻滞和运动阻滞的起效时间、维持时间均相似。三组脉搏氧饱和度（SpO2）麻醉前后无明显变化；平均动脉压（MAP）麻醉后下降，Ⅲ组与Ⅰ、Ⅱ组相比有显著性差异；麻醉后心率（HR）Ⅰ、Ⅱ组无明显变化，Ⅲ组明显下降，与Ⅰ、Ⅱ组相比有显著性差异。结论 0．894％甲磺酸罗哌卡因、0．75％盐酸罗哌卡因、0．75％盐酸布比卡因应用于下腹部手术硬膜外麻醉具有相似的有效性，而0．894％甲磺酸罗哌卡因和0．75％盐酸罗哌卡因较0．75％盐酸布比卡因具有更高的安全性。     

不同浓度利多卡因用于臂丛神经阻滞麻醉的临床观察

目的 寻找适用臂丛神经分离阻滞麻醉的最佳利多卡因浓度。方法 选择80例前臂与手部手术患者，随机分为8组(每组各10例)，1组用0．25％罗哌卡因24ml，其他各组分别予以2％利多卡因1、2、3、4、5、6、12ml与0．25％罗哌卡因混合，混合液均为24ml，1～8组均经锁骨上入路行臂丛神经阻滞麻醉。分别记录其麻醉起效时间，5、10、15、20min时患肢肌力及感觉阻滞维持时间。结果 0．17％利多卡因能明显加快0．25％罗哌卡因的起效时间，但并不加深对运动神经的阻滞。不同浓度利多卡因与0．25％罗哌卡因的混合液与单纯0．25％罗哌卡因相比其感觉阻滞维持时间无显著差异。随利多卡因浓度增加，其运动神经阻滞作用逐渐增强。结论 0．25％的罗哌卡因与0．17％利多卡因的混合液用于锁骨上臂丛神经分离阻滞麻醉是较优的组合。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.