腹腔镜下肾上腺切除手术麻醉时对患者的影响

目的 探讨腹腔镜下切除肾上腺对患者的影响.方法 选取择期腹腔镜下肾上腺切除手术患者13例, 分别在气腹前,气腹后15,30,60,90 min和气腹毕各个时间点抽取桡动脉血液做血气分析,同时监测心率(HR)、收缩压(SBP)、舒张压(DBP)等生命体征的变化.结果与气腹前比,气腹后15 min至气腹毕,动脉血二氧化碳分压(PaCO2)明显升高(P<0.05),pH、剩余碱(BE)也逐渐下降,而动脉血氧分压(PaO2)和血氧饱和度(SaO2)无明显变化(P>0.05). 结论 二氧化碳(CO2)气腹可明显提高PaCO2造成高碳酸血症,从而加剧血液生理紊乱. 提示气腹手术中应增加潮气量,增大吸呼比,以使PaCO2、pH控制在正常范围.     

妇科腹腔镜手术不同麻醉方法对SPO2及PaCO2的影响

目的比较妇科腹腔镜手术不同麻醉方法对脉搏血氧饱和度(SPO2)及动脉血二氧化碳分压(PaCO2)的影响.方法选用腰麻、硬膜外及全麻3种麻醉方法,对36例腹腔镜下妇科手术患者在气腹前15 min、气腹后20min、放气后20min分别监测其SPO2及PaCO2变化.结果腰麻及硬膜外组在气腹后20min其SPO2较气腹前明显降低,PaCO2较气腹前明显升高,有显著性差异(P＜0.05),而全麻组变化不明显.结论腹腔镜下妇科手术采用全麻方法较安全.     

腹腔镜手术麻醉方法的安全性分析

目的 探讨不同麻醉方法在腹腔镜手术中的安全性与麻醉效果.方法 将给予妇科腹腔镜手术患者192例随机分为甲、乙两组,甲组给予腰-硬联合麻醉,乙组给予气管内插管全麻,比较两组麻醉方法的安全性与麻醉效果.结果 甲组在气腹后5min各项指标与乙组和治疗前相比均有显著性差异(P＜0.05＝.尤其是PETCO2在气腹后15min与乙组和治疗前相比差异显著(P＜0.05).pH:甲组气腹后5min、气腹后15min及放气后10min与麻醉前相比,P＜0.05.PaCO2:甲组气腹后5min、气腹后15min与麻醉前相比,P＜0.05.乙组的pH和PaCO2则无明显变化.结论 在妇科腹腔镜手术中给予气管内插管全麻较腰-硬联合麻醉安全可行.     

腹腔镜手术麻醉方法的安全性评价

目的探讨不同麻醉方法在腹腔镜手术中的安全性与麻醉效果。方法将我院给予妇科腹腔镜手术患者96例随机分为甲、乙两组,甲组给予腰-硬联合麻醉,乙组给予气管内插管全麻,比较两组麻醉方法的安全性与麻醉效果。结果甲组在气腹后5min各项指标与乙组和治疗前相比均有显著性差异（P〈0．05）。尤其是PETCO2在气腹后15min与乙组和治疗前相比差异显著（P〈0．05）。pH：甲组气腹后5min、气腹后15min及放气后10min与麻醉前相比,P〈0．05。PaCO2：甲组气腹后5min、气腹后15min与麻醉前相比,P〈0．05。乙组的pH和PaCO2则无明显变化。结论在妇科腹腔镜手术中给予气管内插管全麻较腰一硬联合麻醉安全可行。     

腹腔镜手术中头高位或头低位时β—微球蛋白和肾素血管紧张素系统的变化

目的 :探讨全麻下腹腔镜手术中肾功能和肾素血管紧张素醛固酮系统 (RAAS)的变化及其与体位的关系。方法 :测定ASAⅠ～Ⅱ级的腹腔镜胆囊切除术女性患者 15例 (头高位组 )和妇科腹腔镜手术患者 11例 (头低位组 )气腹前 10min(平卧位 )、气腹后 3 0min(头高位或头低位 )及解除气腹后 10min(头高位或头低位 )各时点的血浆 β2 微球蛋白 ( β2 MG )、肾素 (PRA)、血管紧张素Ⅱ (AⅡ )、醛固酮 (ALD)浓度。结果 :与气腹前比较 ,两组患者气腹期间血浆PRA(P <0 .0 5 )、AⅡ (P <0 .0 5 )、β2 MG(P <0 .0 5 )浓度均明显升高 ,但两组间比较差异均无显著性。以上各指标在解除气腹后均明显下降 ,接近气腹前基础值。结论 :腹腔镜手术中10～ 12mmHg的气腹压可引起肾小球滤过率明显降低和RAAS活性显著升高 ,头高位与头低位时其变化程度并无明显差别     

腹腔镜胆囊摘除术中七氟醚复合麻醉对血流动力学影响的观察

目的　观察新吸入麻醉药七氟醚对腹腔镜胆囊摘除术全麻下患者血流动力学的影响。方法　对 2 0例胆囊结石或胆囊息肉患者施行静脉全麻 ,用七氟醚作吸入麻醉药维持麻醉 ,分别记录每例患者诱导麻醉时、诱导麻醉后、吸七氟醚 5min后、手术开始前、气腹后、胆囊切除后以及术毕时的心率 (HR ,次 /min)、平均动脉压 (MAP ,KPa)、中心静脉压(CVP ,KPa)、肺动脉压 (PAP ,KPa)、每搏量 (SV ,ml/beat)、每搏指数 (SI ,ml/m2 )、心输出量 (CO ,L/min)、心指数 (CI,Lmin 1 /m2 )及每搏量比率 (SVR ,dyn·s 1 /cm5)。结果　 2 0例病人诱导麻醉前、后各血流动力学指标变化不明显。吸入七氟醚5min ,SV及SI明显高于诱导麻醉前 (P <0 .0 5 ,P <0 .0 1) ;气腹后SV和SI则下降并接近诱导麻醉前水平。吸入七氟醚5min后、气腹后及胆囊切除后 ,MAP均明显低于诱导麻醉前 (P <0 .0 5 ) ,到术毕时接近诱导麻醉前水平。结论　七氟醚用于腹腔镜手术麻醉安全可靠 ,能有效减轻CO2 气腹对患者血流动力学的影响。     

全麻腹腔镜胆囊切除术患者呼吸力学的观察

为观察全麻腹腔镜胆囊切除术呼吸力学的改变。选择24例ASA分级Ⅰ-Ⅱ级在全麻下行腹腔镜胆囊切除术病人，分别在气腹前5min，气腹后5min，15min，放气后0．5min及10min分别记录肺的顺应心性(Crs)，呼吸末二氧化碳分压(PET-CO2)，动脉血的氧分压及二氧化碳分压。结果，Crs气腹后5min及15min较气腹前5min明显减低(P＜0．05)，放气后0．5min改善但与放气后10min相比没有显著性差异。动脉血氧分压在术中维持稳定。气腹后PET-CO2和PaCO2逐渐上升到放气后0．5min达到最高值，放气后10min下降。提示膈肌上抬和暂时肺不张引起肺顺应性下降，气腹后PET-CO2和PaCO2上升是有CO2吸收引起。并注意气腹后一段时间可能出现PaCO2上升。     

腹腔镜胃癌根治术二氧化碳气腹对PaCO2及PETCO2的影响

目的 探讨腹腔镜胃癌根治术二氧化碳(CO2)气腹对动脉血二氧化碳分压(PaCO2)及呼气末二氧化碳分压(PETCO2)的影响。方法 择期全身麻醉下行腹腔镜胃癌根治术患者60例,分别在气腹开始前5min(T0)、建立气腹后15min(T1)、30min(T2)、45min(T3)及停气腹后5min(T4)时采集动脉血测定PaCO2及PETCO2,计算PaCO2与PETCO2的差值(Pa-ETCO2)和Pa-ETCO2与PaCO2的比值(Pa-ETCO2/PaCO2)。结果 60例患者手术时间为175~285(227.8±42.6)min,气腹时间为121~158(136.3±11.8)min。T0时PaCO2、PETCO2、Pa-ETCO2和Pa-ETCO2/PaCO2变化与T1比较差异均无统计学意义(均P>0.05)。T2、T3时患者PaCO2、PETCO2、Pa-ETCO2和Pa-ETCO2/PaCO2明显高于T0和T1(均P<0.05)。T4时患者的PaCO2和PETCO2较T2、T3明显降低,Pa-ETCO2和Pa-ETCO2/PaCO2较T2、T3明显升高(均P<0.05)。结论 腹腔镜胃癌根治术中PETCO2不能准确反映PaCO2,且两者差异随CO2气腹时间的延长而扩大。     

腹腔镜术中改善血流动力学方法的分析

目的观察腹腔镜手术麻醉中行过度通气时血流动力学及血气变化。方法30例胆石症及妇科病人随机分为过度通气组（Ⅰ组）辛口常规通气组（Ⅱ组）。分别于人工气腹前、气腹后10min、30min、1h和术毕测定动脉血二氧化碳分压（PaCO2）、心率（HR）、收缩压（SBP）、动脉血氧分压（PaO2）。结果Ⅰ组气腹后PaCO2逐渐升高，但仍在正常生理范围内，HR、SBP无明显变化（P〉0．05）；Ⅱ组气腹后PaCO2升高超出正常范围，HR、SBP升高明显（P〈0．05）。结论腹腔镜手术麻醉时，气腹前行过度通气，有利于病人血流动力学稳定。     

腹腔镜手术中PaCO_2和气道压变化的观察

目的观察CO2气腹下实施腹腔镜手术麻醉时PaCO2及气道压的变化。方法术前（气腹前）、术中（气腹时）、术后（气腹毕）抽取桡动脉血,进行血气分析,同时观察机械通气时气道压的变化。结果术中CO2气腹时PaCO2升高,与气腹前、气腹毕比较差异有意义;气道压明显升高,与气腹前、气腹毕比较差异有意义。结论CO2气腹下行腹腔镜手术时PaCO2及气道压明显升高。     

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.