七氟醚,异氟醚与笑气吸入麻醉对脑电双频指数和边缘频率的变化

目的：观察七氟醚、异氟醚与笑气吸入麻醉时脑电双频指数（ＢＩ）与９５％边缘频率（ＳＥＦ）的变化。方法：选择非心脑疾患的择期手术病人，ＡＳＡⅠ￣Ⅱ组，２８例，随机分为４组。分别在麻醉维持时吸入七氟醚（第１组，ｎ＝７），七氟酡复合笑气（第２组，ｎ＝９），异氟醚（第３组，ｎ＝６），异氟醚复合笑气（第４组，ｎ＝６）。观察ＨＩ、ＳＥＦ与ＭＡＣ之间的相关情况及切皮时的反应。结果：麻醉的不同联合会ＢＩ与ＭＡＣ有良     

胰岛素样生长因子及其结合蛋白水平在儿童肾病综合征中的变化

目的：了解胰岛素样生长因子（ＩＧＦⅠ）及其结合蛋白（ＩＧＦＢＰｓ）水平在儿童肾病综合征（ＮＳ）中的变化。方法：用免疫放射法和放射免疫法对２０名ＮＳ患儿,即ＮＳ活动期组（ＮＳＡ组,ｎ＝１１）和ＮＳ缓解期组（ＲＥ组,ｎ＝９）进行了血清ＩＧＦⅠ和ＩＧＦＢＰｓ水平测定;并以同年龄组正常儿童（ＮＣ组,ｎ＝１０）作对照。结果：与ＮＣ组比较,ＮＳＡ组血清ＩＧＦⅠ、ＩＧＦＢＰ３明显下降（Ｐ＜００１）,ＩＧＦＢＰ１和ＩＧＦＢＰ２均明显升高（Ｐ＜００１）;ＲＥ组的血清ＩＧＦⅠ及ＩＧＦＢＰ１、ＩＧＦＢＰ２和ＩＧＦＢＰ３均可恢复正常;ＮＳＡ组血清ＩＧＦＢＰ３与白蛋白存在明显相关关系（ｒ＝０７６,Ｐ＜００１）。结论：ＮＳ活动期存在着ＩＧＦⅠ和ＩＧＦＢＰｓ的异常改变,但缓解期可完全恢复正常;ＩＧＦⅠ和ＩＧＦＢＰｓ的异常改变可能与ＮＳ患儿生长障碍有关     

不同浓度笑气麻醉深度的观察

目的：了解笑气与其它麻醉药合用时所产生的麻醉强度。方法：５６例择期手术病人，随机分成８组，各组病人分别应用不同浓度的笑气（Ｎ＿２Ｏ）和异氟醚（ＩＳＯ），保证每组病人的呼气末麻醉药浓度达到１．０ＭＡＣ，脑电功率谱及９５％边缘频率（ＳｐｅｃｔｒａｌＥｄｇｅＦｒｅｑｕｅｎｃｙ，ＳＥＦ）。结果：应用７０％Ｎ＿２Ｏ组病人的ＳＥＦ值最大，单纯ＩＳＯ组的ＳＥＦ值最小（Ｐ＜０．０５）。结论：７０％、６０％、５０％、４０％的麻醉效能达不到０．７、０．６、０．５、０．４ＭＡＣＩＳＯ的麻醉强度，临床麻醉中应适当增加其它麻醉药的用量。     

重症急性胆管炎手术的麻醉与监测

目的：观察不同麻醉方法在重症急性胆管炎手术的麻醉效果，以及围麻期生命体征监测的重要性。方法：连硬组１１例占１４．４％，采用利多卡因有效浓度，小剂量、分次给药。全麻组３４例占７５．６％，选择气管内插管静脉／静吸复合全麻，麻醉维持用１％￣２％普鲁卡因（含０．０８％￣０．１％琥珀胆碱），安氟醚／异氟醚０．５￣１．５ｖｏｌ％间断吸入，辅助芬太尼。围麻期连续监测ＢＰ、ＳｐＯ２、ＥＣＧ、ＣＶＰ等。结论：连硬组     

静吸复合麻醉中不同小剂量芬太尼对脑电边缘频率和双波谱指数的影响

目的　研究静吸复合麻醉中不同小剂量芬太尼对脑电边缘频率 (ＳＥＦ)和双波谱指数 (ＢＩＳ)的影响。方法　随机将ＡＳＡⅠ～Ⅱ级病人 30例分为Ⅰ、Ⅱ、Ⅲ组 ,于全麻诱导吸入安氟醚达 0 8ＭＡＣ后 ,3组分别静注芬太尼 3μｇ·ｋｇ-1、5 μｇ·ｋｇ-1、7μｇ·ｋｇ-1,于给药后 6ｍｉｎ记录每组病人的ＭＡＰ、ＨＲ、ＳＥＦ及ＢＩＳ。结果　 3组组内、组间ＭＡＰ、ＨＲ相比均无显著性差异 (Ｐ >0 .0 5 )。与给药前相比 ,Ⅰ组给药后ＳＥＦ显著性降低 (Ｐ <0 .0 5 ) ,ＢＩＳ无显著性差异 (Ｐ >0 .0 5 ) ,Ⅱ组给药后ＳＥＦ、ＢＩＳ均显著性降低 (…     

N^G—硝基—L—精氨酸甲酯的抗伤害作用及其对异氟醚麻醉作用的影响

目的 探讨Ｎ＾Ｇ－硝基－Ｌ－精氨酸甲酯（Ｌ－ＮＡＭＥ）的抗伤害作用及其对异氟醚麻醉作用、大鼠大脑不同脑区突触体一氧化氮合酶（ＮＯＳ）活性和一氧化氮（ＮＯ）的影响。方法 ３０只雄性ＳＤ大鼠,随机分为生理盐水对照组、Ｌ－ＮＡＭＥ异氟醚组和Ｌ－ＮＡＭＥ抗伤害组;分别测定给予Ｌ－ＮＡＭＥ后大鼠的甩尾潜伏期（ＴＦＬ）、最大镇痛效应百分率（％ＭＰＥ）、异氟醚最低肺泡有效浓度（ＭＡＣ）和大鼠不同脑区粗制突触体ＮＯＳ活性以及ＮＯ的生成。结果 Ｌ－ＮＡＭＥ可延长大鼠的ＴＥＬ,增加％ＭＰＥ,降低异氟醚的ＭＡＣ,抑制大脑不同脑区突触体ＮＯＳ活性和ＮＯ的生成（Ｐ〈０．０１）。结论 Ｌ－ＮＡＭＥ能通过对中枢神经系统突触体ＮＯＳ活性和ＮＯ生成的抑制,发挥其抗伤害和减轻异氟醚麻醉作用。     

食物对胰岛素样生长因子—Ⅰ及其结合蛋白的影响

目的：研究营养对胰岛素样生长因子（ＩＧＦⅠ）和胰岛素样生长因子结合蛋白（ＩＧＦＢＰｓ）的影响。方法：检测限制食物５０％的幼年大白鼠，并以随意进食的同龄大白鼠作对照。血清ＩＧＦⅠ和胰岛素采用放射免疫分析法测定，血清ＩＧＦＢＰ３、ＩＧＦＢＰ４与ＩＧＦＢＰ２、ＩＧＦＢＰ１分别采用Ｗｅｓｔｅｒｎｌｉｇａｎｄｂｌｏｔ与Ｉｍｍｕｎｏｂｌｏｔ方法测定；肝脏的ＩＧＦＢＰｓｍＲＮＡ采用Ｎｏｒｔｈｅｒｎｂｌｏｔ方法测定。结果：食物限制组的体重、身长的增长以及食物效益明显低于对照组。血清ＩＧＦⅠ（Ｐ＜００１）和血清ＩＧＦＢＰ４（×６１％，Ｐ＜００５）也同时降低。而血清ＩＧＦＢＰ１（×３４４％，Ｐ＜００１）和肝脏ＩＧＦＢＰ１、ＩＧＦＢＰ２ｍＲＮＡ（×４２０％、×３７０％，Ｐ均＜００１）明显升高。结论：①食物限制可导致血清ＩＧＦⅠ和ＩＧＦＢＰ４降低，可能与儿童生长障碍有关；②增加的ＩＧＦＢＰ１可能是ＩＧＦⅠ活性抑制因子；③ＩＧＦＢＰ２可能有异常代谢存在。     

年龄对吸入麻醉药物动力学的影响

将ＡＳＡ－Ⅰ，Ⅱ级病人２０例分成２组，成年组和老年组各１０例，临床观察研究在静脉普鲁卡因复合全麻基础上，吸入１％安氟醚（ＥＮＦ）或异氟醚（ＩＳＯ）时肺摄取及排出吸入麻醉药物的动态变化。结果全部病人静吸复合麻醉效果满意；与成年组相比，老年组ＦＡ／ＦⅠ高，ｔ１／２ＦＡ／ＦⅠ短，ＦＡ／ＦＡｏ低，ｔ１／２ＦＡ／ＦＡＯ短，差异显著（Ｐ＜０．０５）。结果表明老年人吸入麻醉药物时肺摄取和排出均较成年人迅速。     

地氟醚、七氟醚、异氟醚和安氟醚药代动力学特征的比较研究

目的比较地氟醚、七氟醚、异氟醚、安氟醚在平衡麻醉中的药代动力学特征。方法选择妇科手术患者４０例,随机分为地氟醚（Ｄ）组,七氟醚（Ｓ）组,异氟醚（Ｉ）组及安氟醚（Ｅ）组,每组１０例。麻醉诱导、气管插管后,各组均先给予等效的设定浓度,即Ｄ组６％、Ｓ组２％、Ⅰ组１２％、Ｅ组１７％。同时吸入１∶２的Ｏ２和Ｎ２Ｏ,经静脉持续输入芬太尼和间断追加肌肉松弛药泮库溴铵维持麻醉。术中连续监测吸入麻醉药的肺泡浓度及吸入浓度,并维持肺泡浓度衡定在１ｍｏｌ／ＬＡＣ,即Ｄ组３％,Ｓ组０７％,Ⅰ组０５％,Ｅ组０６％。结果吸入麻醉后,肺泡浓度∶吸入浓度＝１／２及肺泡浓度达到１ｍｏｌ／ＬＡＣ值时间在Ｄ组及Ｓ组均明显快于Ⅰ组及Ｅ组。肺泡浓度∶吸入浓度及肺泡浓度∶设定浓度比值的升高速度在Ｄ组和Ｓ组均明显快于Ⅰ组和Ｅ组。终止麻醉后,Ｄ组肺泡浓度达到肺泡原始浓度５０％的时间明显快于其它吸入麻醉药。结论地氟醚吸入及呼出均较快,易于调控麻醉深度     

地氟醚对交感兴奋作用的临床研究

目的探讨地氟醚的交感兴奋作用及其机理。方法择期手术病人３０例,ＡＳＡⅠ～Ⅱ级,随机分为地氟醚（１５例）、异氟醚（１５例）两组。不用术前药。气管插管后观察不同地氟醚和异氟醚水平（０．５ＭＡＣ、ＯＭＡＣ和１．５ＭＡＣ）对平均动脉压（ＭＡＰ）和心率（ＨＲ）、心率变异性（ＨＲＶ）和用改良荧光法测定血浆中肾上腺素（Ｅ）、去甲肾上腺素（ＮＥ）浓度的影响。结果二组ＭＡＰ、ＨＲ、Ｅ和ＮＥ在麻醉前、０．５ＭＡＣ和１．０ＭＡＣ时无差异（Ｐ＞０．０５）,达１．５ＭＡＣ后地氟醚组则出现２～４ｍｉｎ的ＭＡＰ增高和ＨＲ增快,且血浆Ｅ和ＮＥ浓度升高,明显高于异氟醚组（Ｐ＜０．０５）,而异氟醚组无变化。ＨＲＶ的总功率（ＴＰ）、低频（ＬＦ）和高频（ＨＦ）二组都随着ＭＡＣ的增加逐渐降低,但在１．５ＭＡＣ时与异氟醚组相比,地氟醚组ＨＦ明显降低,ＬＦ／ＨＦ明显升高（Ｐ＜０．０５）。结论快速增加地氟醚浓度至１．５ＭＡＣ可出现交感兴奋作用,其作用机制可能是迷走神经受抑制超过交感神经的抑制程度。     

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.     

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.