罗哌卡因在子宫切除术后行硬膜外镇痛的效果研究

目的观察低浓度罗哌卡因硬膜外术后镇痛的临床效果。方法择期子宫切除手术患者60例,随机分为3组(n=20)。A、B组分别用0.125%罗哌卡因和0.125%布比卡因 2mg吗啡 氟哌利多5mg/100ml进行硬膜外镇痛(PCEA),C组术后疼痛时按需肌注哌替定。对比术后镇痛效果,并分别于麻醉前、切皮后90分钟、术后1、2、3天抽取外周静脉血测定血糖、胰岛素、皮质醇、肾上腺素浓度。结果A组术后运动评分明显优于B组(P<0.05)。3组于切皮后90分钟血皮质醇、血糖浓度均升高,但A组低于B、C两组(P<0.05)。结论0.125%罗哌卡因复合小剂量吗啡用于术后镇痛,效果确切,运动神经阻滞轻微,优于同等浓度布比卡因。     

曲马多复合0.125%罗哌卡因用于产妇术后镇痛的效果评价

目的评价曲马多联合对于分娩后镇痛临床效果。方法选择分娩后患者300例,随机分成A、B、C组,分别给予曲马多复合0.125%罗哌卡因、芬太尼复合0.125%罗哌卡因和单用0.125%罗哌卡因。比较3组之间的镇痛效果和不良反应情况。结果A组在产后镇痛程度方面显著好于B、C组,组间的差异有统计学意义（P〈0.05）。结论曲马多复合0.125%罗哌卡因用于产妇术后镇痛效果好、安全性佳,可用于产妇术后镇痛。     

左旋布比卡因、盐酸罗哌卡因、氯普鲁卡因术后持续硬膜外自控镇痛效应研究

目的:观察0.125%左旋布比卡因(LBUP)、0.125%盐酸罗哌卡因(ROP)、1.8%氯普鲁卡因(CH)用于持续硬膜外自控镇痛(PCEA)的效果。方法:75例下腹部手术ASAⅠ～Ⅱ级患者随机分为LBUP组(L组)、ROP组(R组)、CH组3组,每组25例,L组0.125%左旋布比卡因、R组0.125%罗哌卡因、CH组1.8%氯普鲁卡因,各组均加入40μg舒芬太尼,采用PCEA,设置为负荷剂量(5mL)+持续剂量(2mL/h)+PCA剂量(2mL/次),时间10min,镇痛时间48h。观察并比较3组PCEA期间4、8、12、24、48h的视觉模拟评分(VAS)、布氏(BCS)舒适评分、Ramsay镇静评分、Prince-Henry评分、Bromage评分情况。结果:3组患者术中硬膜外用药剂量、术中辅助用药剂量及手术时间差异均无统计学意义(P>0.05);3组的镇痛效果均满意,VAS、BCS、Ramsay、Prince-Henry评分差异均无统计学意义(P>0.05),L组术后4、8hBromage评分达到0级者分别为32%、44%,明显低于R(60%、60%)、CH组(52%、52%)(P<0.05～0.01),术后12h后各组差异无统计学意义(P>0.05)。结论:3组镇痛效果相似,但盐酸罗哌卡因、氯普鲁卡因运动阻滞恢复时间较快,更利于术后患者运动功能的恢复。     

不同浓度甲磺酸罗哌卡因复合芬太尼用于产科术后硬膜外自控镇痛的临床观察

目的 比较不同浓度甲磺酸罗哌卡因复合4 μg/ml芬太尼用于腰一硬联合麻醉剖宫产术后硬膜外自控镇痛(PCEA)的镇痛效果.方法 选择200例腰-硬联合麻醉下剖宫产术后要求硬膜外镇痛的初产妇,随机分为A、B、C、D四组,每组50例(n=50):A组选择0.119%甲磺酸罗哌卡因复合4pg/ml芬太尼;B组选择0.150%...     

不同剂量布托啡诺联合芬太尼和罗哌卡因用于剖宫产术后硬膜外镇痛的效果

目的观察不同剂量布托啡诺联合芬太尼患者自控硬膜外镇痛(PCEA)对剖宫产患者的术后镇痛效果与不良反应。方法80例患者按布托啡诺用量不同随机平均分为4组,分别为:1mg组(A组),2mg组(B组),3mg组(C组),4mg组(D组),均伍用0.2mg芬太尼和0.125%罗哌卡因。负荷剂量以布托啡诺1mg 0.5%罗哌卡因共5mL于关腹后注入硬膜外腔;背景输注量均为2mL/h,自控剂量0.4mL/Bolus,锁定时间为15min。术后4、8、12、24、36、48h分别观察BP、HR、RR、镇痛评分、镇静评分、患者满意度、恶心呕吐等不良反应。结果B、C、D 3组患者镇痛效果和满意度均较好,组间差异无统计学意义,A组比B、C、D组较差(P<0.01);D组镇静作用大于A、B、C组(P<0.05);C、D组恶心呕吐发生率低于A、B组(P<0.05)。结论布托啡诺3mg联合芬太尼0.2mg与0.125%罗哌卡因对剖宫产患者行PCEA可提供满意的镇痛效果,且无明显不良反应。     

不同浓度的罗哌卡因用于分娩镇痛的临床观察

目的比较0.1%及0.15%、0.2%罗哌卡因在病人PCEA分娩镇痛中应用的临床效果。方法选择要求无痛分娩的无禁忌证的足月初产妇(ASAⅠ～Ⅱ级)60例进行PCEA分娩镇痛,随机分为三组:A组20例,采用0.1%罗哌卡因 芬太尼2ug/mL;B组20例,采用0.15%罗哌卡因 芬太尼2ug/mL;C组20例,0.2%罗哌卡因 芬太尼2ug/mL。在第一产程活跃期行硬膜外穿刺,以不同浓度罗哌卡因实施PCEA,监测并记录各组产妇的BP、HR、RR及SpO2,并按照(VAS)评定产妇的疼痛强度,按照Bromage法评定产妇的下肢的运动神经阻滞情况。结果C组产程时间较A、B组稍有增长,剖宫产及器械助产率无增加。VAS评分A组显著高于B、C两组,但B、C间无显著性差异。运动阻滞情况Bromage评分,C组Bromage评分显著高于A、B组,A、B两组间无显著性差异。结论罗哌卡因是一种纯左旋体新型长效酰胺类局麻药,与布比卡因比较,对心脏及中枢神经系统毒性小、安全、作用时间长,低浓度时产生明显感觉和运动阻滞分离,0.15%罗哌卡因与2ug/mL芬太尼合用,在PCEA分娩镇痛中,对分娩的影响更小,效果更好,利用镇痛泵施行PCEA是近年来行分娩镇痛的常用方法。     

罗哌卡因分别复合芬太尼咪唑安定或曲马多用于术后硬膜外自控镇痛的比较

目的:比较罗哌卡因分别复合芬太尼、咪唑安定、曲马多行术后硬膜外自控镇痛(PCEA)的临床效果。方法:80例在腰麻加硬膜外麻醉下行择期妇科手术的病人分为四组。A组:0.15%罗哌卡因;B组:0.15%罗哌卡因+芬太尼(2.5μg/ml);C组:0.15%罗哌卡因+咪唑安定(0.5mg/ml);D组:0.15%罗哌卡因+曲马多(3mg/ml)。PCEA参数设置:负荷剂量6ml,单次剂量3ml,锁定时间30分钟,持续剂量2ml/h。术后分别记录24h用药总量、PCEA泵使用次数及术后4、8、12和24h的视觉模拟评分(VAS)评分、恶心呕吐的发生率、呼吸频率(RR)及平均动脉压(MAP)。结果:A组的24h用药总量及PCEA的使用次数明显高于其他三组(P<0.01),而D组的上述指标最低(P<0.01)。B组的恶心呕吐的发生率最高,各组的RR和MAP无显著差异(P>0.05)。结论:B、C、D三组罗哌卡因复合用药行PCEA比单纯应用罗哌卡因的镇痛作用更确切。     

低比重布比卡因腰麻在剖宫产手术中的应用效果分析

目的探讨低比重布比卡因腰麻在剖宫产手术中麻醉效果及合并症的处理。方法选择150例剖宫产手术,抽签形式分三组:A组(0.125%布比卡因6mL)、B组(0.25%布比卡因3mL)、C组(0.5%布比卡因2mL),每组50例进行麻醉效果观察。观察麻醉起效时间、麻醉平面、麻醉效果、恶心、呕吐、低血压、心动过缓、呼吸抑制合并症及新生儿Apgar评分等。结果三组起效时间差异无统计学意义(P>0.05)。新生儿Apgar评分后所占百分比差异无统计学意义(P>0.05),麻醉效果:A组肌松满意度98%,B组肌松满意度100%,C组肌松满意度100%,差异无统计学意义(P>0.05)。三组镇痛效果均满意(P>0.05)。C组(7.0±1.0)麻醉平面高于A组(8.3±2.0)、B组(8.0±1.5)(P<0.05)。术后下肢运动神经恢复0-1级所需要时间C组[(210±30)min]大于A组(120±6)、B组[(140±10)min](P<0.05)。C组恶心、呕吐、低血压、心动过缓,呼吸抑制合并症发生率高于A组、B组(P<0.05),结论 0.125%布比卡因、0.25%布比卡因更适合用于剖宫产手术。     

舒芬太尼复合罗哌卡因剖宫产术后患者硬膜外自控镇痛的效果

目的比较剖宫产术后不同浓度舒芬太尼复合罗哌卡因患者自控硬膜外镇痛的效果。方法比较ASA I～Ⅱ级,年龄21～32岁,腰麻硬膜外麻醉下行剖宫产的足月初产妇,术后随机分为3组（n=20）,行患者自控硬膜外镇痛（PCEA）,A、B、C组术后分别用0.3、0.40、.5μg/ml舒芬太尼复合0.125%罗哌卡因PCEA,分别于术后4、8、20、24、48h记录VAS评分,镇痛药用量,PCA的按压次数并计算PCA按压计数比,镇静及恶心、呕吐等不良反应。结果随着舒芬太尼浓度的增加,VAS评分,镇痛药用量PCA按压次数降低,PCA按压次数比逐渐上升,术后48h之内,C组VAS评分低于A、B组（P〈0.05）,B组实际PCA按压次数比高于A组（P〈0.05）,C组镇痛药用量,实际PCA按压次数低于A、B组（P〈0.05）,PCA按压次数比高于A组（P〈0.05）,术后镇静、恶心呕吐等发生率低（P〉0.05）。结论剖宫产术后0.5μg/ml舒芬太尼复合0.125%罗哌卡因PCEA镇痛效果好,且不增加不良反应。     

吗啡、芬太尼、曲马多术后硬膜外自控镇痛对产妇血浆催乳素浓度影响的比较

[目的]比较吗啡、芬太尼、曲马多硬膜外病人自控镇痛(PCEA)对产妇血浆催乳素(PRL)浓度的影响.[方法]选择行剖宫产术的健康足月孕妇60例,随机分成4组,每组15例.所有病人均在硬膜外利多卡因麻醉下完成手术,术毕保留硬膜外导管联接Microject PCEA泵.镇痛方法对照组(A组),术后病人未用PCEA.吗啡组(B组),布比卡因1.5mg/mL 吗啡50μg/mL 氟哌利多50 μg/mL.芬太尼组(C组),布比卡因1.5 mg/mL 芬太尼5μg/mL 氟哌利多50 μg/mL.曲马多组(D组),布比卡因1.5 mg/mL 曲马多5 mg/mL 氟哌利多50 μg/mL.所有PCEA病人手术结束前均给予负荷剂量10 mL,背景输入2 mL/h,单次给药剂量(PCA)1 mL,锁定时间 20 min,持续镇痛时间48～50 h.疼痛程度用视觉模拟评分量表(VAS)方法评估.镇静程度用Ramsay镇静评分法评分.术前、术后24 h、48 h,抽取病人静脉血用放免法检测血浆催乳素(PRL)浓度.[结果]A组术后VAS评分明显高于B、C、D组(P＜0.01),安静时B、C、D组VAS值无显著差异,活动时C、D组VAS值高于B组(P＜0.01).A组病人术后多处于焦虑状态,而镇痛组多处于平静合作,B组镇静程度深于C、D组.4组病人术前PRL水平无显著差异,术后24 h、48 h PRL明显高于术前(P＜0.01),术后48 h高于术后24 h,镇痛组术后24 h、48 h明显高于同时期对照组(P＜0.01).[结论]镇痛组病人安静时都能产生完善的镇痛效果.吗啡的PCEA镇静、镇痛效果优于曲马多、芬太尼,但副作用较多.吗啡、曲马多、芬太尼硬膜外术后镇痛能明显提高产妇的血浆PRL水平.     

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.