诺维本滴注浓度对兔外周血管组织损伤的实验研究

目的探讨不同浓度诺维本对兔耳缘血管壁及其周围组织损伤的影响,为临床采用适合的诺维本滴注浓度提供依据。方法将36只兔随机分成A、B、C三组,均于其双耳耳缘静脉同时滴注诺维本溶液。A组左耳注射浓度0．2mg／ml、右耳0．4mg／ml;B组左耳注射浓度0．2mg／ml、右耳0．6mg／ml;C组左耳注射浓度0．4mg／ml、右耳0．6mg／ml。均用输液泵控制滴速40gtt／min,输液时间3min。分别于滴注8h、24h、48h观察双耳外观后,切取兔耳缘静脉及其周围组织．常规制作组织切片,观察兔耳缘静脉及其周围组织的损伤程度。结果滴注不同浓度的诺维本8h时兔耳缘静脉及周围组织损伤评分比较．差异无统计学意义（均P〉0．05）;24h时评分比较,差异有统计学意义（均P〈0．01）;在48h时,0．2mg／ml、0．4mg／ml浓度的损伤评分比较,差异无统计学意义（P〉0．05）,而0．6mg／ml浓度评分显著高于0．2mg／ml及0．4mg／ml（均P〈0．01）;相同浓度不同时间段的损伤评分比较,差异有统计学意义（均P〈0．01）。结论诺维本滴注浓度与血管壁组织损伤呈正比,浓度越高,血管壁及周围组织损伤越严重;诺维本滴注适宜浓度为≤O．4mg／ml,且每天应更换输液部位进行治疗。     

瑞替普酶治疗急性下肢深静脉血栓临床研究

目的：评价瑞替普酶（rPA）给药方法在治疗急性下肢深静脉血栓中的临床有效性及安全性。方法将187例急性下肢深静脉血栓形成（ADVT）患者随机分为2组,其中静脉快速滴注 rPA 溶栓组85例,24 h 静脉泵入维持 rPA 溶栓组102例。通过对其治疗效果进行分析,比较两组患者治疗前后健患肢大、小腿消肿效果,溶栓效果,溶栓效率及溶栓期间并发症。结果两组患者治疗前后健患肢大、小腿消肿及溶栓效果比较差异均无统计学意义（P 均＞0．05）;24 h 静脉泵入组患者溶栓时间[（4．76±1．56）d]少于静脉快速滴注组溶栓时间[（6．56±0．83）d],即24 h静脉泵入组溶栓效率高于静脉快速滴注组患者（P ＜0．05）;24 h 静脉泵入组患者溶栓期间并发症发生率（3．9％）明显少于静脉快速滴注组（17．6％）（P ＜0．05）。结论rPA 为治疗 ADVT 疗效好、起效迅速的溶栓药物,经静脉溶栓效果好,但24 h 静脉泵入较静脉快速滴注起效更为迅速,且更为安全。     

特利加压素治疗肝叶切除术后肝肾综合征的疗效分析

目的分析特利加压素治疗肝叶切除术后肝肾综合征（HRS）的临床疗效。方法42例患者分为A组和B组,在综合治疗的基础上,A组给予利尿合剂和白蛋白治疗,B组给予特利加压素和白蛋白治疗,疗程均为7d。治疗期间观察患者一般临床症状、尿量、血清尿素氮和肌酐以及并发症等指标。结果疗程结束后,A组尿量治疗前为（663±249）ml／d,治疗后为（987±354）ml／d,差异有统计学意义（P〈0．05）,尿素氮和肌酐较治疗前有所下降,但差异无统计学意义（P〉0．05）;B组尿量治疗前为（598±324）ml／d,治疗后为（1956±875）ml／d,尿素氮由（19．4±5．8）mmol／L下降至（10．5±4．3）mmol／L,肌酐由（231．2±69．8）μmol／L下降至（128．9±35．2）μmol／L,治疗前、后差异均有统计学意义（P〈0．05）;治疗前两组的尿量、尿素氮和肌酐差异无统计学意义（P〉0．05）,治疗后与A组比较,B组变化更明显,差异有统计学意义（P〈0．05）;两组的并发症差异无统计学意义。结论特利加压素治疗肝叶切除术后HRS优于常用的利尿合剂,具有良好的疗效。     

来氟米特对5／6肾切除大鼠肾皮质TGF-β1表达的影响

目的：探讨来氟米特对5／6肾切除大鼠转化生长因子-β1（TGF-β1）表达的影响。方法：将36只SD大鼠随机分为假手术组（A组）12只和手术组24只,术后3d再将手术组大鼠随机分为模型组（B组）12只和来氟米特组（C组）12只。第4,9周末各组随机选取6只大鼠处死并收集标本,记录血肌酐、尿素氮、胆固醇、三酰甘油、白蛋白及24h尿蛋白排泄量;取肾组织做病理检查,用RT-PCR方法测定肾皮质TGF-β1 mRNA的表达,免疫组化（SP法）检测TGF-β1在肾脏的表达。结果：（1）与A组相比,B组和C组大鼠造模成功后4周末尿素氮、肌酐、血脂等无明显变化（P〉0．05）;B组24h尿蛋白排泄量明显增加（P〈0．01）,血白蛋白下降（P〈0．01）,肾皮质TGF-β1 mRNA表达明显增加（P均〈0．05）。9周末B组肾皮质TGF-β1 mRNA表达量、尿素氮、肌酐、胆固醇明显增加（P〈0．05）,24h尿蛋白排泄量增加更为明显（P〈0．05）。（2）与B组相比,C组24h尿蛋白排泄量明显下降（P均〈0．01）;于9周末尿素氮、肌酐、胆固醇明显降低（P〈0．05）;血白蛋白升高（P〈0．05）,肾小球硬化指数下降（P〈0．01）,肾皮质TGF-β1 mRNA表达量明显下降（P〈0．01）。免疫组织化学染色：B组可见系膜区TGF-β1大量沉积,C组也可见TGF-β1沉积,但较B组明显减轻。结论：来氟米特能减少5／6肾切除大鼠尿蛋白排泄量,纠正其脂代谢紊乱,减轻肾脏的硬化程度,其机制可能与下调系膜细胞上TGF-β1 mRNA的表达量及功能活性有关,最终延缓慢性肾脏病的进展。     

3%高渗盐水治疗重型颅脑损伤脑水肿的临床研究

目的研究3%高渗盐水治疗重型颅脑损伤的临床疗效。方法在颅内压监护下对13例患者使用3%的高渗盐水脱水治疗,与同期15例使用甘露醇脱水患者进行对比研究,观察两组患者用药后6小时内,连续监测患者颅内压(ICP)、平均动脉压(MAP)、中心静脉压(CVP)、血脑灌注量(CPP)。记录起效时间以及治疗后至ICP恢复用药前水平所间隔的时间。结果 3%高渗盐水的脱水效果与甘露醇比较差异无统计学意义,远期疗效及死亡率相当。结论 3%的高渗盐水脱水效果确切,对重型颅脑损伤患者可作为临床一线脱水药物。     

3%高渗氯化钠对神经外科手术患者炎症反应的影响

目的观察3%高渗氯化钠对神经外科手术患者血浆炎症反应程度的影响。方法选择拟于全身麻醉下行幕上深部肿瘤切除术的患者50例,男30例,女20例,年龄18~65岁,ASAⅠ或Ⅱ级。运用电脑随机数字表将患者分为两组,每组25例。切皮前MT_组予以20%甘露醇1g/kg,HS组予以3%高渗氯化钠溶液2ml/kg,15min内滴注完毕。记录诱导前10min(T_0)、滴注3%高渗氯化钠溶液(MT_组为20%甘露醇)时(T_1)、滴注完成即时(T_2)、滴注完成后30 min(T_3)、60 min(T_4)的MAP、HR、尿量、颅内压(ICP)和脑灌注压(CPP),检测T_0~T_4时患者内环境及电解质水平,并记录苏醒时间和术中出血量;检测T_0~T_4时血浆T_NF-α、IL~(-1)β和IL-6水平。结果 T_2~T_4时HS组ICP明显低于MT_组,T_3、T_4时HS组尿量明显少于MT_组,HS组T_NF-α、IL-6和IL~(-1)β明显低于MT_组(P0.05)。结论与20%甘露醇比较,3%高渗氯化钠能更有力地抑制神经外科手术患者血浆炎症反应。     

高渗盐水与甘露醇对颅脑手术患者脑氧代谢的影响

目的 比较3％高渗盐水（HTS）与20％甘露醇对颅脑手术患者脑氧代谢的影响。方法 择期大脑半球胶质瘤切除术患者40例，ASAⅠ级或Ⅱ级，随机分为2组（n=20）：3％HTS组（HTS组）和20％甘露醇组（M组）。采用静吸复合麻醉，呼气末异氟醚浓度为1 MAC、血液动力学稳定15．min后，分别于15 min内静脉输注3％HTS 5．35 ml／kg或20％，甘露醇1 g／kg。L3，4珠网膜下腔置管测脑脊液压力（CSFP），行右颈静脉球穿刺置管、采血，测定颈静脉球氧饱和度。分别于输注前（T0）、输注完即刻（T1）、输注完15min（T2）、30min（T3）、60min（T4）、120min（T5）监测CSFP;于T0、T3-T5时监测平均动脉压，采集颈静脉球部和桡动脉血，进行血气分析，计算动脉-静脉氧含量差（Da-jvO2）、脑氧摄取率（CERO2）。结果 与T0比较，2组CSFP在T2-T5时降低，Da-jvO2和CERO2在T4，5时降低（P〈0．05）;与M组比较，HTS组CSFP在T2时降低（P〈0．05）。结论 3％HTS与20%甘露醇均可有效地降低颅内压，改善颅脑手术患者的脑氧代谢。     

甘露醇对颅脑手术患者脑氧供需平衡的影响

目的：探讨颅脑手术麻醉期间静脉输注甘露醇对脑氧供需平衡的影响。方法：选择静脉全麻醉上开颅行幕上肿瘤切除术患者14例，分别检测静脉输液25％甘露醇1g/kg输液前和输注后，30，60分钟时的颅内压（ICP），颈内静脉和桡动脉的血气，计算脑灌注压（CPP），动－颈静氧含量差（C(a-j)O2)和脑氧摄取率（CEO2）。结果：甘露醇输注后30分钟，ICP和心率（HR）较输注前显著降低（P＜0．05），但CPP，C(a-j)O2和CEO2虽呈下降趋势，但与输液前比较均无统计学差异。结论：颅脑手术麻醉期间输注甘露醇，不仅可降低ICP，对MAP和CPP无明显影响，而且能改善脑血流代谢耦联，对开颅手术的病人有利。     

配合尿道灌注治疗男性支原体性尿道炎

目的 观察配合尿道灌注治疗男性支原体性尿道炎的疗效。方法 将530例患者随机分为4组。A组：尿道灌注组；B组：静脉给药组；C组：上述两种方法并用；D组：C组的基础上，加用紫苓胶囊。结果 A组与B组间总有效率差异无显著性（P〉0．05）；C组与D组总有效率高于A组与B组（P〈0．05）；C组与D组间总有效率差异无显著性（P〉0．05），在复查支原体阴性患者中，D组治愈率高于C组（P〈0．05）。结论 阿奇霉素尿道灌注与静点疗效相同，联合用药可提高疗效，紫苓胶囊可以改善不适症状。     

甘露醇注射速度对留置针穿刺部位血管损伤的实验研究

目的了解在25℃环境中以不同速度静脉注射20％甘露醇对兔耳静脉损伤情况。方法选择健康成年的新西兰兔36只，随机取4只作为对照组，另32只随机分为A、B、C、D四组各8只。均于兔两耳留置静脉留置针。对照组给予生理盐水5ml／kg 30min注入；另四组给予20％甘露醇5ml／kg分别于5min（A组）、10min（B组）、20min（C组）、30min（D组）注射完毕。均8h给药1次，连续3d。最后1次给药后处死兔，在穿刺点及以上2cm处取血管组织行病理检查。结果对照组血管壁增厚、血管周围炎症、纤维组织增生及血栓形成情况与其余四组之间比较，差异有显著性意义（均P〈0．05）；实验组四组比较，差异无显著性意义（均P〉0．05），D组血管壁增厚、血管周围炎症相对较多，A组血栓形成相对较多。结论注射甘露醇对穿刺部位血管均有损伤；根据注射甘露醇时的速度、持续时间不同，穿刺部位血管的损伤特点不一。     

Volume replacement with lactated Ringer's or 3% hypertonic saline solution during combined experimental hemorrhagic shock and traumatic brain injury

BACKGROUND: The devastating effects of hypotension on head-trauma-related mortality are well known. This study evaluates the systemic and cerebral hemodynamic responses to volume replacement with 3% hypertonic saline (HSS) or lactated Ringer's solution (LR), during the acute phase of hemorrhagic shock (HS) associated with traumatic brain injury (TBI). METHODS: Fifteen dogs were assigned to one of three groups (n = 5, each) according to the volume replacement protocol, infused after TBI (brain fluid percussion, 4 atm) and epidural balloon to an intracranial pressure (ICP) higher than 20 mm Hg and HS, induced by blood removal to a mean arterial pressure (MAP) of 40 mm Hg in 5 minutes: Group HS+TBI+HSS (8 mL/kg of 3% HSS), HS+TBI+LR (16 mL/kg LR), and Group HS+TBI (controls, no fluids). We simulated treatment during prehospital and early hospital admission. Groups HS+ TBI and HS+TBI+LR received shed blood infusion to a target hematocrit of 30%. Measurements included shed blood volume, fluid volume infused to restore MAP, MAP, cardiac output, cerebral perfusion pressure, cerebral and systemic lactate, and oxygen extraction ratios. RESULTS: Fluid replacement with HSS 3% or LR promoted major hemodynamic benefits over control animals without luids. Cerebral perfusion pressure was higher than controls and similar between treated groups; however, HSS 3% infusion was associated with lower ICP during the "early hospital phase" and a higher serum sodium and osmolarity. CONCLUSION: In the event of severe head trauma and hemorrhagic shock, the use of HSS 3% and larger volumes of LR promote similar systemic and cerebral hemodynamic benefits. However, a lower ICP was observed after HSS 3% than after LR.     

Is hypertonic saline resuscitation safe in 'uncontrolled' hemorrhagic shock?

Hypertonic saline treatment of hemorrhagic shock (HS) results in increased systemic blood pressure, cardiac output, and splanchnic blood flow. To determine whether this elevation in blood pressure and flow would augment blood loss from injured intra-abdominal vessels and thus enhance mortality rate, "controlled" HS was induced by bleeding of 20 ml/kg from an arterial cannula that was immediately occluded after hemorrhage, and "uncontrolled" HS was induced by incision of three major radicals of the ileocolic artery leading to continuous intra-abdominal blood loss. Seventy rats were divided into eight groups: Group I (n = 5) underwent carotid artery and jugular vein cannulation and was observed for 3 hr; in Group II (n = 10) "controlled" HS was induced by arterial hemorrhage of 20 ml/kg; in Group III (n = 7) "controlled" HS was treated by 5 ml/kg NaCl 0.9%; in Group IV (n = 8) "controlled" HS was treated by 5 ml/kg NaCl 7.5%; in Group V (n = 4) midline laparotomy and identification of the ileocolic artery was performed; in Group VI (n = 9) "uncontrolled" HS was induced by incision of three major branches of the ileocolic artery; in Group VII (n = 9) "uncontrolled" HS was treated by 5 ml/kg NaCl 0.9%, and in Group VIII (n = 18) "uncontrolled" HS was treated by 5 ml/kg NaCl 7.5%. In untreated "controlled" HS (Group II), mean arterial pressure (MAP) fell to 35 torr followed by a spontaneous rise to 62 torr (p less than 0.001) after 3 hr with a survival of 80% of the animals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery

Objective

This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery.

Methods

Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn''t receive diltiazem infusion.

Results

Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters.

Conclusion

We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.     

The therapeutic effect of hypertonic solutions on the changes in the effective circulating plasma volume in acute necrotizing pancreatitis in rats

125 I]bovine serum albumin. Samples of blood and of ascitic fluid were obtained 3, 6, and 12 h after the onset of pancreatitis. Lactated Ringer's solution (LR) and HS were administered consecutively for 3 h beginning 3 h after the induction of pancreatitis. ECPV was measured 6 h after the onset of pancreatitis. The survival rates were investigated for up to 10 days. The mean ECPV decreased significantly from 24.9 ± 1.1 ml/kg before disease onset to 11.5 ± 1.3 ml/kg 6 h postoperatively. LR failed to achieve a normal value for ECPV even following a 150 ml/kg infusion. HS200 and HS300 restored the ECPV to the normal level, and with smaller volumes infused. All rats in the untreated group died within 3 days. LR and HS improved the survival rates, with the infusion of HS200, 100 ml/kg, thus attaining a 45% survival at 10 days. (Received for publication on May 20, 1997; accepted on Mar. 10, 1998)     

Effect of Equiosmolar Solutions of Mannitol versus Hypertonic Saline on Intraoperative Brain Relaxation and Electrolyte Balance

Background: The purpose of the study was to compare the effect of equiosmolar solutions of mannitol and hypertonic saline (HS) on brain relaxation and electrolyte balance.

Methods: After institutional review board approval and informed consent, patients with American Society of Anesthesiologists physical status II-IV, scheduled to undergo craniotomy for various brain pathologies, were enrolled into this prospective, randomized, double-blind study. Patients received 5 ml/kg 20% mannitol (n = 20) or 3% HS (n = 20). Partial pressure of carbon dioxide in arterial blood was maintained at 35-40 mmHg, and central venous pressure was maintained at 5 mmHg or greater. Hemodynamic variables, fluid balance, blood gases, electrolytes, lactate, and osmolality (blood, cerebrospinal fluid, urine) were measured at 0, 15, 30, and 60 min and 6 h after infusion; arteriovenous difference of oxygen, glucose, and lactate were calculated. The surgeon assessed brain relaxation on a four-point scale (1 = relaxed, 2 = satisfactory, 3 = firm, 4 = bulging). Appropriate statistical tests were used for comparison; P < 0.05 was considered significant.

Results: There was no difference in brain relaxation (mannitol = 2, HS = 2 points; P = 0.8) or cerebral arteriovenous oxygen and lactate difference between HS and mannitol groups. Urine output with mannitol was higher than with HS (P < 0.03) and was associated with higher blood lactate over time (P < 0.001, compared with HS). Cerebrospinal fluid osmolality increased at 6 h in both groups (P < 0.05, compared with baseline). HS caused an increase in sodium in cerebrospinal fluid over time (P < 0.001, compared with mannitol).     

Postoperative pain relief and bupivacaine plasma levels during continuous interscalene brachial plexus block

Interscalene brachial plexus block was performed on 40 patients for prophylactic pain relief after shoulder surgery. A dose of 1.25 mg/kg of 0.5% bupivacaine was injected for the block (Group 1) and continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h (Group 2). If the postoperative analgesia was insufficient, the patients received i.m. oxycodone 0.15 mg/kg. In Group 1, one patient managed without oxycodone supplementation during the 24-h observation period compared with eight patients in Group 2 (P less than 0.01). The rest of the patients received 3.8 +/- 1.6 doses (Group 1) and 2.5 +/- 1.2 doses (Group 2) of oxycodone (P less than 0.05). At 30 min, the mean bupivacaine plasma concentration was 1.0 microgram/ml in Group 1 and 0.9 microgram/ml in Group 2. The mean plasma level of bupivacaine increased from 0.7 microgram/ml after 180 min to 1.1 micrograms/ml (P less than 0.01) after 24 h of infusion, providing some evidence of accumulation during infusion. The dizziness and confusion experienced by three patients could be associated with the local anaesthetic, as they obtained relief after the infusion was stopped.     

Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance

BACKGROUND: The purpose of the study was to compare the effect of equiosmolar solutions of mannitol and hypertonic saline (HS) on brain relaxation and electrolyte balance. METHODS: After institutional review board approval and informed consent, patients with American Society of Anesthesiologists physical status II-IV, scheduled to undergo craniotomy for various brain pathologies, were enrolled into this prospective, randomized, double-blind study. Patients received 5 ml/kg 20% mannitol (n = 20) or 3% HS (n = 20). Partial pressure of carbon dioxide in arterial blood was maintained at 35-40 mmHg, and central venous pressure was maintained at 5 mmHg or greater. Hemodynamic variables, fluid balance, blood gases, electrolytes, lactate, and osmolality (blood, cerebrospinal fluid, urine) were measured at 0, 15, 30, and 60 min and 6 h after infusion; arteriovenous difference of oxygen, glucose, and lactate were calculated. The surgeon assessed brain relaxation on a four-point scale (1 = relaxed, 2 = satisfactory, 3 = firm, 4 = bulging). Appropriate statistical tests were used for comparison; P < 0.05 was considered significant. RESULTS: There was no difference in brain relaxation (mannitol = 2, HS = 2 points; P = 0.8) or cerebral arteriovenous oxygen and lactate difference between HS and mannitol groups. Urine output with mannitol was higher than with HS (P < 0.03) and was associated with higher blood lactate over time (P < 0.001, compared with HS). Cerebrospinal fluid osmolality increased at 6 h in both groups (P < 0.05, compared with baseline). HS caused an increase in sodium in cerebrospinal fluid over time (P < 0.001, compared with mannitol). CONCLUSION: Mannitol and HS cause an increase in cerebrospinal fluid osmolality, and are associated with similar brain relaxation scores and arteriovenous oxygen and lactate difference during craniotomy.     

不同液体腹腔复苏对失血性休克大鼠肠道炎性反应的影响

目的 探讨不同液体腹腔复苏对失血性休克大鼠肠道炎性反应的影响.方法 清洁级健康雄性SD大鼠50只,体重200～250 g,随机分为5组(n=10):假手术组(S组)仅行手术操作,不制备失血性休克模型;采用股动脉置管放血法制备大鼠失血性休克模型,常规静脉复苏组(CVR组)失血性休克1 h后,经左侧股静脉匀速回输自体血及相当于2倍失血量的生理盐水行常规静脉复苏;不同液体腹腔复苏组(DPR1～3组)行常规静脉复苏,同时分别腹腔输注生理盐水、6%羟乙基淀粉130/0.4、2.5%腹膜透析液20 ml行腹腔复苏.输注时间均为30 min.右颈总动脉连接多功能监测仪持续监测平均动脉压;于复苏后2 h时股动脉采血,测定乳酸浓度,取小肠组织检测髓过氧化物酶(MPO)活性,采用免疫组化法检测小肠组织肿瘤坏死因子α(TNF-α)表达水平,光镜下观察小肠黏膜组织形态,计算小肠黏膜上皮损伤指数.结果 与S组比较,其余各组大鼠复苏后平均动脉压差异无统计学意义(P>0.05),动脉血乳酸浓度、小肠组织MPO活性、TNF-α表达水平及小肠黏膜上皮损伤指数升高(P<0.05或0.01);与CVR组比较,DPR3组动脉血乳酸浓度、小肠组织MPO活性、TNF-α表达水平及小肠黏膜上皮损伤指数降低(P<0.05).结论 采用2.5%腹膜透析液20 ml行腹腔复苏可有效抑制肠道炎性反应,从而对失血性休克大鼠产生保护作用.     

Intra-arterial ACNU chemotherapy employing 20% mannitol osmotic blood-brain barrier disruption for malignant brain tumors.

The clinical effects and problems of intra-arterial water-soluble antitumor nitrosourea (ACNU) therapy following osmotic blood-brain barrier modification are discussed. Twenty-one patients with malignant brain tumors were divided into two groups. Group 1 consisted of 16 patients treated by operation, irradiation, and two or more courses of intracarotid infusion of ACNU 100 mg/body (1.7-2.2 mg/kg) following 20% mannitol 200 ml (1.3-1.6 ml/sec) (7 grade 4 astrocytomas, 5 grade 3 astrocytomas, and 4 others). Group 2 consisted of five patients treated by operation, irradiation, and repeated intracarotid infusion of ACNU 100 mg/body alone (grade 4 astrocytoma). The 2-year survival rate in Group 1 was 79% (11 of 14 cases followed up for longer than 2 years) and the 3-year survival rate was 67%. Five of seven grade 4 astrocytoma patients (71%) in Group 1 survived for more than 1 year 6 months, whereas four of five grade 4 astrocytoma in Group 2 died within 1 year 6 months. The measurement of the ACNU concentration in tumor tissues and blood in 11 brain tumors, after intracarotid infusion of ACNU with blood-brain barrier disruption, showed peak values in the tumor tissues of 3.02-32.53 micrograms/gm (mean, 9.67 micrograms/gm), about three to five times as high as that in blood in most cases. This method used in Group 1 appears to be relatively safe without permanent neurological deficits and offers a potential therapeutic effect when used in combination with appropriate premedication in suitable patients.     

高渗氯化钠溶液对前列环素和内皮素的影响

比较３０例硬膜外阻滞择期手大患者，输入７．５％ＨＳ和５％ＧＳ后血浆ＰＧＩ２、ＥＴ及血流动力学的变化。输入ＨＳ后ＰＧＩ２明显升高，ＥＴ显著降低，伴主动脉顺应性快速增加。输入ＧＳ后１０分钟ＰＧＩ２和ＥＴ均无明显变化，６０分钟时ＰＧＩ２轻度增加，ＥＴ亦有上升，但较离散；ＴＰＲ持续增加，ＣＯ和ＳＶ短暂降低，血压明显下降。本研究提示ＰＧＩ２和ＥＴ在ＨＳ降低外周血管阻力、改善血流动力学过程中可能起着重要的介导作用。