腹腔镜下泌尿外科手术128例麻醉分析

目的:探讨后腹膜腔镜手术对全身麻醉患者血流动力学、呼吸及动脉血气的影响.方法:选择了128例(ASAⅠ～Ⅱ)后腹膜腔镜下泌尿外科手术的患者,监测气腹前及气腹后 30 min血压(Bp)、心率 (HR)、心电图 (ECG)、脉搏、氧饱和度(SpO2)及动脉血气、气道压力的变化.结果: 气腹前、后患者的血流动力学及气道压力变化不明显(P>0.05),动脉血气发生显著改变,出现高碳酸血症(P<0.05).结论:后腹膜腔镜手术CO2气腹对全身麻醉患者血流动力学、呼吸及血气产生一定的影响,术中应加强麻醉的管理及监测.     

腹腔镜与后腹腔镜CO2气腹对患者血流动力学及CO2排除量的影响

目的:探讨经腹腔和经腹膜后腔入路手术CO2气腹对患者血流动力学及CO2排除量的影响。方法:选择经腹膜后腔(A组)和经腹腔(B组)入路手术患者各35例,监测气腹前、气腹后30min、60min和气腹结束后30min血流动力学和动脉血气以及不同时段机体对CO2的排除量。结果:两组患者组内气腹后30min、60min患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)均较气腹前差异显著,有统计学意义(P<0.05),组间比较无统计学意义(P>0.05)。两组患者组内气腹后30 min、60min患者动脉血二氧化碳分压(PaCO2)和CO2排除量较气腹前明显增加,pH明显下降(P<0.05)。且A组在60min明显高于B组(P<0.05)。结论:经腹膜后腔入路手术CO2气腹对患者血流动力学和动脉血气的影响更大,后腹腔镜手术更容易引起高碳酸血症,术中需加强呼吸管理和内环境监测。     

后腹腔镜CO2气腹对患者血流动力学及血气的影响

目的探讨后腹腔镜手术CO2气腹对患者血流动力学及血气的影响。方法选择后腹腔镜手术患者60例,监测气腹前、气腹后30min、60min和放气后30min血流动力学和动脉血气的变化。结果气腹后30min、60min患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)均较气腹前有显著性差异(P<0.05)。气腹前与放气后心率、平均动脉压(MAP)、中心静脉压(CVP)比较无显著性差异(P>0.05)。气腹后30min、60min患者动脉血二氧化碳分压(PaCO2)较气腹前明显增加,pH明显下降(P<0.05)。动脉血氧分压(PaO2)气腹前后比较无显著性差异(P>0.05)。结论后腹腔镜CO2气腹对患者血流动力学和动脉血气有一定影响,术中需加强监测。     

低压性后腹腔镜CO2气腹对患者机能的影响

目的 探讨低压性CO2气腹(12mmHg)在后腹腔镜手术中的应用价值.方法 选择后腹腔镜手术患者60例,随机分为两组,术中气腹压力分别设定为12mmHg(低压力组)和15mmHg(标准压力组),监测气腹前、气腹后30min、60min和放气后30min血流动力学和动脉血气的变化;观察手术时间、术中出血量、并发症发生率等指标.结果 两组患者组内气腹后30min、60min患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、动脉血二氧化碳分压(PaCO2)、pH较气腹前有显著性差异(P<0.05),组间比较无差异(P>0.05);手术时间、术中出血量、并发症发生率比较无差异(P>0.05).结论 低压力CO2气腹在后腹腔镜手术中有一定的应用价值,尤其适合有熟练操作技巧的医生.     

老年后腹腔镜手术CO2气腹对循环及呼吸的影响

目的:探讨老年病人行后腹腔镜手术时CO2气腹对血流动力学、气体交换、动脉血气的影响.方法:30例择期后腹腔镜手术病人,年龄大于65岁,ASAⅡ-Ⅲ级,在静脉、吸入复合全身麻醉下完成手术.分别于麻醉前、CO2气腹前、CO2气腹后5、10、30、60、120min时记录血压、心率、血氧饱合度、呼气末二氧化碳分压(PetCO2)等参数,同时行血气分析.结果:CO2气腹后10min,BP、HB显著增高(P＜0.05).CO2气腹后30minPetCO2、PaCO2显著增高(P＜0.05),随时间延长有加重趋势,60min达高峰,以后变化不大.CO2气腹后30min pH显著下降(P＜0.05).结论:老年后腹腔镜手术时CO2气腹对机体有一定影响,应在密切监护下可完成手术.     

比较人工腔隙与自然腔隙CO2气腹对血流动力学及动脉血气的影响

目的探讨人工腔隙腔镜下手术CO2气腹与自然腔隙腔镜下手术CO2气腹对血流动力学及动脉血气的影响。方法58例人工腔隙腔镜下手术的择期病人,45例自然腔隙腔镜下手术的择期病人：于CO2充气前、充气后15、30、45、60和90min分别观测并记录血压（BP）,心率（HR）,血氧饱和度（SpO2）,呼吸末二氧化碳分压（PETCO2）等参数,并行动脉血气分析,观察其变化。结果充气后两组组内比较与充气前的BP、HR、PETCO2、PaCO2有显著性差异（P〈0．05）。充气后30min各指标组间比较无统计学差异（P〉0．05）。充气后45min及其后时间点,BP、HR组间比较无统计学差异（P〉0．05）,PETCO2、PaCO2两组组间比较有统计学差异（P〈0．05）。结论两组充气后机体内PETCO2、PaCO2的变化大,30min后处于相对稳定,但人工腔隙组影响更大。     

腹膜后腹腔镜手术CO2气腹对患者动脉血气的影响及对策

目的探讨腹膜后腹腔镜手术CO2气腹对患者动脉血气的影响及对策。方法选择40倒择期行泌尿外科手术患者,年龄22～60岁,ASAI～11级,随机分为经腹腔腹腔镜组（L组）,经腹膜后腹腔镜组（R组）,各20例。选择全身麻醉,分别在气腹前（T0）、气腹后30min（T1）、气腹后60min（T2）、解除气腹后30min（T3）抽取动脉血检测动脉血二氧化碳分压（PaCO2）、pH值,同时间点记录呼气末CO：分压（PETCO2）。T0至T1时点,两组患者均设定潮气量8ml／kg,呼吸频率12次／min;T1时点至机械通气结束,则依据T1、T2、L时点的PaCO2、pH及即时PETCO2,调节潮气量6～10ml／kg,呼吸频率12～18次／min。结果T1时点：R组PETCO2、PaCO2高于L组,pH值小于L组（P〈0．05）;T2时点：两组间PETCO2、PaCO2差异无统计学意义（P〉0．05）,R组pH值小于L组（P〈0．05）;T3时点：两组间PETCO2、PaCO2、pH值差异均无统计学意义（P〉0．05）,并恢复至T0水平。结论腹膜后腹腔镜手术CO：气腹对全身麻醉患者动脉血气的影响大,但通过加强术中监测,及时调整呼吸参数,进行适度过量通气,可以减轻该影响。     

妇科腔镜手术麻醉时二氧化碳气腹对肾素-血管紧张素-醛固酮系统的影响

目的动态监测妇科腔镜麻醉手术CO2气腹时肾素（REN）、血管紧张素Ⅱ（AT-Ⅱ）及醛固酮（ACD）的变化。方法选择妇科腔镜手术麻醉患者30例,分别抽取CO2气腹前10min（T1）,气腹中30min（T2）,气腹中60min（T3）及气腹后60min（T4）各时点静脉血,运用放射免疫法测定血清REN、AT-Ⅱ、及ACD含量。结果与T0比较,T1、T2点REN、AT-Ⅱ、ACD均升高（P〈0.05）,T3点REN、AT-Ⅱ、ACD变化差别无统计学意义（P〉0.05）。结论妇科腔镜麻醉手术CO2气腹时REN、AT-Ⅱ、及ACD均会升高。     

人工腔隙与自然腔隙CO_2气腹对血流动力学及动脉血气的影响分析

目的探究腹腔镜肾囊肿切除术人工腔隙与自然腔隙CO_2气腹在血流动力学、动脉血气方面的作用效果。方法对采取人工腔隙患者为A组,采取自然腔隙患者为B组,对比分析不同腔隙CO_2气腹对血流动力学、动脉血气的作用效果。结果建立气腹前、后相比较,2组PETCO_2、Pa CO_2、HR、MAP指标明显升高(P0.05),建立气腹后30 min,与A组比较,B组PETCO_2、Pa CO_2指标明显下降,有差异(P0.05),HR、MAP指标下降不明显,无差异(P0.05)。结论气腹建立方式对PETCO_2、Pa CO_2影响较大,与自然腔隙比较,人工腔隙对血流动力学及动脉血气影响更大。     

异丙酚静脉全麻复合硬膜外腔阻滞麻醉期间CO2气腹对血流动力学和氧耗的影响

目的观察异丙酚静脉全麻复合硬膜外腔阻滞麻醉期间CO2气腹对机体血流动力学和氧耗及CO2排出量的影响.方法择期行腹腔镜胆囊切除术(LC)患者24例,快速诱导气管插管后行机械通气,持续静脉输注异丙酚及吸入氧化亚氮维持麻醉,并间断硬膜外腔给药.分别在诱导前、气腹前1 min和气腹后5、10、20、30、40、50、60 min及放气后5min记录血流动力学和呼吸功能各项参数.结果在气腹前1 min,平均动脉压(MAP)、心率(HR)、呼气末CO2分压(PErO2)、氧耗量(VO2)、二氧化碳排出量(VCO2)较诱导前显著降低(P<0.01).气腹期间及放气后5 min,MAP及HR较稳定,波动幅度不大.PETCO2在气腹后10min时较气腹前显著增加(P<0.01),以后继续升高.VO2和VCO2在气腹开始后逐渐升高,VO2在气腹后10 min时显著高于气腹前水平(F＜0.01),VCO2在气腹后20min时较气腹前显著增加(P＜0.05),以后VO2继续升高,而VCO2升幅较小.结论在LC手术期间,应用异丙酚静脉全麻复合硬膜外麻醉及气腹前适当过度通气可以减轻CO2气腹对呼吸和循环系统的影响.     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.