25G脊麻针单穿腰麻用于急诊剖宫产术

目的探讨25G脊麻针单穿腰麻在急诊剖宫产术中的应用。方法选择急诊剖宫产术患者216例,随机分为单穿腰麻组（SA组,n=108）和腰-硬联合麻醉组（CSEA组,n=108）,SA组单用25G脊麻针直接穿刺行腰麻,CSEA组采用针内针技术行联合麻醉。观察2组产妇术中平均动脉压（MAP）、心率（HR）的变化,记录麻醉操作时间、穿刺成功率及麻醉效果,对术后并发症进行比较。结果 2组产妇麻醉过程中HR、MAP的变化差异无统计学意义（P〉0.05）;穿刺成功率和麻醉效果2组比较差异无统计学意义（P〉0.05）;麻醉操作时间SA组明显短于CSEA组（P〈0.01）;术后感觉运动障碍和硬脊膜穿破后头痛发生率CSEA组稍高于SA组,但差异无统计学意义（P〉0.05）。结论 25G脊麻针单穿腰麻比腰-硬联合麻醉操作更快、更简单,是急诊剖宫产术更为可取的麻醉选择。     

腰-硬联合麻醉在瘢痕子宫剖宫产术中应用效果观察

目的:探讨腰-硬联合麻醉在瘢痕子宫剖宫产术中的应用效果.方法:选取桂林医学院第二附属医院2015年3月至2016年2月90例瘢痕子宫剖宫产术产妇,按照不同麻醉方式分成三组,腰麻麻醉为SA组,硬膜外麻醉为EA组,腰硬联合麻醉为CSEA组,观察三组麻醉效果.结果:CSEA组麻醉总有效率明显高于SA组、EA组(P<0.05);CSEA组麻醉后5、10 min时的MAP均低于SA组、EA组(P<0.05);CSEA组麻醉后5、10 min时的HR均明显高于SA组、EA组,30 min时HR低于SA组、EA组,对比差异均有明显统计学意义(P<0.05);CSEA组起效时间、麻醉消失时间与SA组、EA组相比较均明显减少(P<0.05);三组新生儿Apgar评分比较均无显著统计学差异(P>0.05).结论:腰-硬联合麻醉在瘢痕子宫剖宫产术中的应用效果显著,值得推广使用.     

腰硬联合麻醉腰麻与单用腰麻针穿刺腰麻在剖宫产术中的应用效果比较

目的 对比腰硬联合麻醉腰麻(CSEA)与单用腰麻针穿刺腰麻(SA)在剖宫产术中的应用效果。方法 选取医院120例行剖宫产手术产妇(2019年9月～2020年9月)为研究对象,按随机数字表法将研究对象分成CSEA组(n=60)、SA组(n=60)。其中SA组接受SA麻醉,CSEA组接受CSEA麻醉。对比2组麻醉质量、麻醉情况(麻醉起效时间、穿刺时间、一次穿刺成功率)、胎儿娩出后5min阿氏评分(Apgar)、不良反应发生率(术后腰痛、低血压、头痛、寒战、恶心呕吐等)。结果 2组麻醉质量、胎儿娩出后5min Apgar评分对比,无明显差异(P＞0.05);SA组麻醉起效时间及穿刺时间较CSEA组短,一次穿刺成功率较CSEA组高(P＜0.05);SA组术后腰痛发生率较CSEA组低(P＜0.05)。结论 CSEA与SA应用于剖宫产手术中麻醉质量相当,且对新生儿影响较小,但应用SA麻醉起效更迅速,穿刺顺利时时间更短,一次穿刺成功率更高稍低,且能减少术后腰痛发生,但有一定的失败率,需再次穿刺或更改麻醉方式,值得临床推广。     

腰麻行急诊剖宫产的临床观察

目的：探讨急诊剖宫产术选择小剂量重比重布比卡因腰麻（SA）的麻醉效果及优点。方法：90例临产孕妇随机分为硬膜外（EA）组、腰硬联合（CSEA）组、腰麻（SA）组,比较3种麻醉方法应用于急诊剖宫产术的麻醉效果及优缺点。结果：SA组的麻醉操作用时较EA组和CSEA组明显缩短,感觉阻滞起效果时,SA组和CSEA组较EA组明显缩短。结论：急诊剖宫产术应用SA同样可以达到CSEA的麻醉效果,且从开始麻醉操作至手术切皮时间更短,尤其对于急诊剖宫产术,相比前二者,SA更具有操作简便易行、效果确切、经济实用的特点。     

在行剖宫产手术中为患者采取硬膜外麻醉和腰硬联合麻醉的效果观察

目的：对比分析在剖宫产手术中应用硬膜外麻醉（CEA）和腰-硬联合麻醉（CSEA）的麻醉效果及临床应用价值。方法：随机选取笔者所在医院收治的84例行剖宫产手术的产妇,将其随机分为CEA组和CSEA组,在为其行剖宫产手术的过程中分别为其采取硬膜外麻醉和腰硬联合麻醉。对比分析两组产妇的麻醉时间、麻醉效果及其新生儿的健康情况。结果：与CEA组产妇相比,CSEA组产妇的麻醉起效时间较短,在术中发生低血压、恶心、呕吐及牵拉反应的几率均较低,差异显著,有统计学意义（P＜0.05）。两组产妇在分娩时间及新生儿Apgar评分方面相比较,差异不显著,无统计学意义（P＞0.05）。结论：在为产妇行剖宫产手术的过程中采取腰硬联合麻醉（CSEA）的效果理想,对产妇及其新生儿的影响较小,可作为施行剖宫产手术的首选麻醉方法。     

腰-硬联合麻醉在剖宫产中的应用

目的观察腰-硬联合麻醉（CSEA）用于剖宫产的麻醉效果。方法把120例剖宫产术产妇随机分为CSEA组和硬膜外组（EA组）,每组60例。结果 CSEA组麻醉起效时间、麻醉效果优于硬膜外麻醉（P〈0.05）,对新生儿Apgar评分无影响（P〉0.05）。结论腰-硬联合麻醉在产科手术中具有起效快、麻醉效果好等特点,对胎儿的安全性高。     

腰麻针单刺麻醉在剖宫产手术中的应用

目的探讨腰麻针单刺麻醉在剖宫产手术中的应用。方法选取2010年3月—2013年3月在该院接受剖宫产手术的1000例产妇随机分为A、B两组，A组采用腰麻针单刺麻醉，B组采用腰硬联合麻醉，对两组产妇的麻醉平面、镇痛效果及不良反应发生率进行比较。结果A组产妇的麻醉后不良反应中腰痛的发生率明显低于B组产妇，两组间比较差异有统计学意义（P〈0．05）；两组麻醉平面、镇痛效果及新生儿评分情况之间差异无统计学意义（P〉0．05）。结论腰麻针单刺麻醉对于剖宫产产妇临床效果较好，起效快，镇痛效果较好，无腰痛发生，临床应用价值较好。     

腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产病人血流动力学影响的对比研究

目的：研究及完善剖宫产的麻醉管理,为临床提供借鉴,确保母婴安全。方法：将80例需剖宫产产妇随机分为腰麻硬膜外联合麻醉（combined spinal epidural anesthesia,CSEA）组和硬膜外麻醉（epiduralanaesthesia,EA）组,监测２组剖宫产患者血流动力学变化,并比较麻醉效果、新生儿Apgar评分、并发症及不良反应。结果：CSEA组产妇心率（heart rate,HR）在T4（胎儿娩出10 min）、T5（手术结束）高于EA组（P=0.023、0.022）;CSEA组产妇收缩压（systolic blood pressure,SBP）和舒张压（diastolic blood pressure,DBP）在T3（胎儿娩出）高于EA组（P=0.000、0.000）;CSEA组产妇平均动脉压（mean arterial pressure,MAP）在T2（麻醉平面满意-消毒前）、T5（手术结束）高于EA组（P=0.000、0.003）;2组产妇不同时刻心输出量（cardiac output,CO）、每博输出量（stroke volume,SV）、体循环阻力（systemic circulation resistance,SVR）及胸部液体含量（thoracic fluid content,TFC）比较,差异无统计学意义（P >0.05）;2组产妇不同时刻HR、SBP、DBP、MAP、CO、SV及SVR组内比较差异均具有统计意义（均有P<0.05）;CSEA组麻醉效果优于EA组,差异有统计学意义（P=0.000）;2组之间麻醉并发症、不良反应及新生儿出生后Apgar评分差异无统计学意义（P >0.05）。结论：硬膜外麻醉和腰麻硬膜外联合麻醉均为适合剖宫产手术的麻醉方式,但腰麻硬膜外联合麻醉：起效更快、麻醉效果更完善、对产妇血流动力学影响小,更为推荐。     

两种麻醉方法对妊高征剖宫产患者血液动力学和血糖的影响

目的探讨腰硬联合麻醉（CSEA）和连续硬膜外麻醉（CEA）对妊高征剖宫产产妇血液动力学和血糖（GLU）的影响。方法78例妊高征剖宫产产妇随机分为CSEA组和CEA组，分别观察两组患者麻醉前（T0）、麻醉后5min（T1）、胎儿娩出后（T2）和术后（T3）的平均动脉压（MAP）、心率（HR）及GLU的变化。结果两组患者T1、T2和T3时间点的MAP较T0均明显下降；CSEA组患者T1、T2和T3时间点的MAP均高于CEA组。CEA组患者T1和T2时间点的HR较T0升高；CSEA组T2时间点的HR较CEA组低。两组T1、T2和L时GLU与T0时比较，水平均明显升高。CSEA组T1、T2和T3时GLU水平均低于CEA组。结论CSEA在妊高征剖宫产术麻醉过程中血液动力学较稳定，机体应激反应较轻，值得临床推广应用。     

全麻与硬腰联合麻醉应用于子痫前期剖宫产的效果对比研究

目的对比全麻和硬腰联合麻醉应用于子痫前期剖宫产手术的效果。方法82例子痫前期产妇分为GA组和CSEA组,观察两种麻醉方法效果、起效时间及对新生儿的影响。结果两组的麻醉效果优良率均高,组间比较无统计学差异（P〉0．05）;GA组麻醉起效时间、麻醉到新生儿娩出时间短于CSEA组（P〈0．05）;新生儿Apgar评分组间无统计学差异（P〉0．05）;GA组血压在术后拔管时统计学意义升高（P〈0．05）。结论两种麻醉均适用子痫前期剖宫产,而硬腰联合麻醉对产妇血压的影响更小。     

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.