氯普鲁卡因与利多卡因用于硬膜外阻滞的比较

目的比较氯普鲁卡因与利多卡因用于硬膜外阻滞的效果. 方法将40例拟在硬膜外麻醉下施行下腹部、盆腔部择期手术的妇产科患者,随机分入氯普鲁卡因组和利多卡因组各20例.行硬膜外穿刺置管,分别注入2%氯普鲁卡因5ml或2%利多卡因5ml.5min后,如无全脊麻现象,再予2%氯普鲁卡因或2%利多卡因10ml,观察心率、血压、呼吸次数和氧饱和度及阻滞起效时间、痛觉消失与持续时间、硬膜外阻滞范围. 结果利多卡因组麻醉起效时间为4.13±1.51min,痛觉消失时间为10.27±2.31min.氯普鲁卡因组分别为2.00±0.65min和7.76±1.95min(P均< 0.01),麻醉持续时间:利多卡因组为47.27±11.82min,氯普鲁卡因组为52.00±8.40min(P<0.05).两组阻滞范围相同.用药后10、30、60min,利多卡因组收缩压均显著低于用药前(P<0.01),氯普鲁卡因组仅在用药后10min低于用药前水平(P<0.05). 结论氯普鲁卡因用于妇产科硬膜外阻滞麻醉较利多卡因起效快,痛觉完全消失快.在阻滞范围和持续时间上二者无显著差异.     

盐酸氯普鲁卡因与利多卡因硬膜外麻醉用于剖宫产的比较

目的 评估盐酸氯普鲁卡因与利多卡因硬膜外麻醉用于剖宫产的效应比较.方法 100例剖宫产手术病人,随机分为试验组(3%盐酸氯普鲁卡因,n=50)和对照组(2%利多卡因,n=50).均硬膜外(L1-2)试验量5ml后5min,一次性注入11ml.观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间以及不良反应.结果 试验组麻醉起效时间、痛觉消失时间、运动阻滞时间均快于对照组(P＜0.05),痛觉恢复时间两组一致,运动恢复时间试验组快于对照组(P＜0.05);两组均未见明显不良反应.结论 3%盐酸氯普鲁卡因用于硬膜外麻醉起效快,感觉和运动阻滞效果好,无明显不良反应,较利多卡因优.     

盐酸氯普鲁卡因与利多卡因硬膜外麻醉的临床观察

目的 :评估盐酸氯普鲁卡因与利多卡因用于硬膜外麻醉的效应。方法 :6 0例剖宫产手术病人 ,随机分为试验组 (3%盐酸氯普鲁卡因 ,n=30 )和对照组 (2 %利多卡因 ,n=30 )。均硬膜外 (L2～ 3)试验量 4 ml后 5 min,一次性注入 12 ml(含肾上腺素 1∶ 2 0万 )。观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间以及不良反应。结果 :试验组麻醉起效时间、痛觉消失时间、运动阻滞时间均快于对照组 (P<0 .0 5 ) ,痛觉恢复时间两组一致 ,运动恢复时间试验组快于对照组 (P<0 .0 5 ) ;两组均未见明显不良反应。结论 :3%盐酸氯普鲁卡因用于硬膜外麻醉起效快 ,感觉和运动阻滞效果好 ,无明显不良反应 ,较 2 %利多卡因优。     

盐酸氯普鲁卡因用于低位硬膜外麻醉的临床观察

目的 :评估国产盐酸氯普鲁卡因用于低位硬膜外麻醉的效能 ;方法 :选择ASAⅠ～Ⅱ级病人 60例 ,随机双盲分为试验组和对照组 ,每组 3 0例 ,试验组为 3 %盐酸氯普鲁卡因 ,对照组为 2 %利多卡因 ;均硬膜外麻醉 ,试验量 5ml后 5分钟 ,一次性注入 1 0ml～1 2ml,观察麻醉起效时间、痛觉消失起始时间、运动阻滞起始时间、痛觉恢复起始时间、运动恢复起始时间、以及呼吸循环的变化和中枢神经系统反应与过敏反应等 ;结果 :①试验组麻醉起效时间快于对照组 ,但差别无显著性 (P >0 .0 5,)痛觉消失起始时间、运动阻滞起始时间均快于对照组 (P <0 .0 5) ,痛觉恢复起始时间两组一致 ,运动恢复起始时间快于对照组(P <0 .0 5) ;②两组呼吸循环变化一致 ;③两组均未见明显不良反应 ;结论 :国产盐酸氯普鲁卡因用于硬膜外麻醉起效快 ,感觉和运动阻滞效果好 ,无明显不良反应     

盐酸氯普鲁卡因硬膜外麻醉20例临床观察

目的 :观察 3%盐酸氯普鲁卡因在硬膜外麻醉中应用的可行性。方法 :选择ASAI- 级手术患者 40例 ,随机分为 P组 ( 3%盐酸氯普鲁卡因 )和 L组 ( 2 %利多卡因 )两组。 L2～ 3穿刺成功后给予试验量 5 ml,观察 5 min无全脊麻征象再一次性注入 1 5 ml局麻药(含肾上腺素 1 /2 0万 )。两组分别记录麻醉起效时间、痛觉消失起始时间、运动阻滞起始时间、运动阻滞程度、痛觉恢复起始时间、运动恢复起始时间以及呼吸循环系统、中枢神经系统反应与过敏反应。结果 :P组麻醉起效时间、痛觉消失起始时间、运动阻滞起始时间、运动恢复起始时间均快于 L组 ;运动阻滞程度和痛觉恢复起始时间两组相似 ;痛觉恢复 5 min时疼痛程度重于 L组 ;两组呼吸循环系统变化相似 ;未见中枢神经系统不良反应与过敏反应。结论 :3%盐酸氯普鲁卡因用于硬膜外麻醉起效快 ,阻滞效果好 ,安全有效 ,未见不良反应。     

盐酸氯普鲁卡因与利多卡因硬膜外麻醉的临床观察

目的:评估盐酸氯普鲁卡因与利多卡因用于硬膜外麻醉的效应.方法:60例剖宫产手术病人,随机分为试验组(3 %盐酸氯普鲁卡因,n=30)和对照组(2 %利多卡因,n=30).均硬膜外(L2～3)试验量4 ml后5 min,一次性注入12 ml(含肾上腺素1∶20万).观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间以及不良反应.结果:试验组麻醉起效时间、痛觉消失时间、运动阻滞时间均快于对照组(P<0.05),痛觉恢复时间两组一致,运动恢复时间试验组快于对照组(P<0.05);两组均未见明显不良反应.结论:3 %盐酸氯普鲁卡因用于硬膜外麻醉起效快,感觉和运动阻滞效果好,无明显不良反应,较2 %利多卡因优.     

2％盐酸氯普鲁卡因与利多卡因在腹部手术麻醉中的效果比较

目的评估2％盐酸氯普鲁卡因与利多卡因硬膜外麻醉用于腹部手术的效果比较。方法腹部手术病人80例，随机分为试验组（2％盐酸氯普鲁卡因，n=40）和对照组（2％利多卡因，n=40）。均硬膜外（L1-2）试验量5ml后5min，一次性注入10ml。观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间以及不良反应。结果试验组麻醉起效时间、痛觉消失时间、运动阻滞时间略快于对照组，但无统计学意义，痛觉恢复时间、运动恢复时间试验组快于对照组（P〈0.05）；两组均未见明显不良反应。结论2％盐酸氯普鲁卡因用于硬膜外麻醉，痛觉恢复时间和运动恢复时间快，安全性高，可减少毒性反应的发生率。     

氯普鲁卡因与利多卡因在上腹部手术麻醉中的效果比较

目的:观察国产3%氯普鲁卡因(可谱诺)与2%利多卡因硬膜外麻醉用于上腹部手术的效果比较.方法:选择上腹部择期手术60例,随机分为实验组(3%氯普鲁卡因n=30)和对照组(2%利多卡因n=30),均为硬膜外T9～10椎间隙正中入路.实验量3ml后5分钟1次性注入15ml.观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间以及不良反应.结果:实验组麻醉起效时间、痛觉消失时间、运动阻滞时间略快于对照组,但无统计学差异.痛觉恢复时间、运动恢复时间实验组略快于对照组(P＜0.05);两组均未见明显不良反应.结论:3%氯普鲁卡因用于硬膜外麻醉上腹部手术,麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间快,安全性高.     

盐酸氯普鲁卡因注射液临床应用观察

目的观察盐酸氟普鲁卡因注射液臂丛神经阻滞和硬膜外麻醉的临床效果及不良反应。方法选择ASAⅠ—Ⅱ级病人160例，其中臂丛神经阻滞麻醉、硬膜外麻醉各80例，每种麻醉患者随机分为二组：即2％盐酸氯普鲁卡因注射液臂丛神经阻滞组（试验组，n=40），1．5％盐酸利多卡因注射液臂丛神经阻滞组（对照组，n=40）；3％盐酸氯普鲁卡因注射液硬膜外麻醉组（试验组，n=40），2％盐酸利多卡因注射液硬膜外麻醉组（对照组，n=40）。观察麻醉起效时间、痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间等指标及给药后不同时相心率、血压、呼吸、脉搏、血氧饱和度的变化以及中枢和全身等不良反应。结果臂丛神经阻滞麻醉时，盐酸氯普鲁卡因注射液起效较快（P〉0．05），痛觉消失与运动阻滞较快（P〈0．05）痛觉恢复较早（P〈0．05），一旦痛觉恢复很快感觉明显，并随即出现运动恢复；硬膜外麻醉时，3％盐酸氯普鲁卡因注射液与2％盐酸利多卡因注射液阻滞效能相当，但3％盐酸氯普鲁卡因注射液起效更快（P〉0．05），痛觉消失与运动阻滞出现较早（P〈0．05），痛觉恢复相近，一旦痛觉恢复5分钟后痛觉即比对照组明显（P〈0．05），运动也几乎同时恢复。两组病人均未出现不良反应。结论盐酸氯普鲁卡因注射液麻醉起效快、效果确切、无明显毒副作用，可安全地应用于临床臂丛神经阻滞和硬膜外麻醉，值得推广应用。     

国产盐酸氯普鲁卡因硬膜外麻醉的临床观察

目的对氯普鲁卡因与利多卡因用于硬膜外麻醉的效果进行比较。方法选择200例拟在硬膜外麻醉下行下肢或下腹部手术的择期手术病人，随机分为氯普鲁卡因组（观察组）和利多卡因组（对照组）各100例。两组均硬膜外L^1-2或L^2-3头向置管，试验量后5min一次性注入局麻药（不含肾上腺素或麻黄素），观察麻醉起效时间、痛觉消失、痛觉恢复时间、运动阻滞时间及呼吸、循环的变化等。结果观察组起效快，痛觉消失与运动阻滞更快（P〈0．05），痛觉恢复时间相近，运动阻滞与运动恢复均快于对照组。60min液体总量相近。麻醉维持时间：观察组38．54±16．46，对照组33．38±16．62。结论氯普鲁卡因硬膜外麻醉起效快，镇痛效果好，痛觉消失快，肌松好，麻醉维持时间长。     

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.     

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.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.