咪达唑仑清醒镇静在支气管镜检查中的作用及其对肺功能的影响

目的 探讨在支气管镜检查中应用静脉注射咪达唑仑清醒镇静的作用及其对肺功能的影响.方法 40例患者分为A、B两组,各20例,分别采用丁卡因、利多卡因局部麻醉和局部麻醉加咪达唑仑静脉注射镇静;对比患者术中麻醉效果,观察其各时点的生命体征和肺功能指标.结果B组在麻醉效果四个方面均优于A组;两组肺功能指标FVC、FEV1.0及PEF在术后10 min均比术前下降,其中B组FVC下降程度较A组更显著(P<0.05);两组术后4h的肺功能可回到基线水平;A组生命体征指标在术中及术后均较麻醉前有明显波动;B组内仅术中HR、MAP较麻醉前有差异,且A组进声门时HR的升高程度大于B组.结论 静脉应用咪达唑仑清醒镇静安全、有效、便捷,对患者术后4 h肺功能没有影响.     

小剂量芬太尼-咪达唑仑在支气管镜检查中的应用

目的探讨小剂量芬太尼-咪达唑仑静脉麻醉,联合进镜时局部喷利多卡因麻醉,在支气管镜检查中的应用。方法将62例患者随机分成两组(A、B两组),每组31人,治疗组(A组)在行支气管镜检查前5 min给予静推小剂量咪达唑仑及芬太尼,待患者进入浅睡眠状态且可唤醒时开始操作,进支气管镜时局部喷利多卡因,对照组(B组)在行支气管镜检查时仅给予局部喷利多卡因。观察其麻醉前、麻醉后及术前、术后的生命体征指标(心率、呼吸频率、血氧饱和度、平均动脉压)及不良反应。结果 A组患者能在无知觉和无痛苦中接受检查,且出现呛咳、憋气及胸闷等不良反应很少;生命特征监测均在正常范围内,较前无明显变化;B组上述不良反应多,程度重,与A组比较有显著差异。结论小剂量芬太尼-咪达唑仑静脉推注合并局部喷利多卡因,用于支气管镜检查,镇静镇痛作用效果好,而且对循环和呼吸影响较小,并发症极少。     

达克罗宁联合利多卡因、咪达唑仑和芬太尼复合麻醉在支气管镜检查中的应用

目的观察达克罗宁胶浆联合利多卡因、咪达唑仑、芬太尼静脉复合麻醉在支气管镜检查中的麻醉效果及安全性。方法将拟行支气管镜检查患者160例分为观察组80例和对照组80例。对照组给予利多卡因表面麻醉联合咪达唑仑、芬太尼静脉复合麻醉;观察组在对照组基础上,于术前加用达克罗宁胶浆含服。观察两组患者血压、心率、呼吸及氧饱和度在术前、进声门及术中的变化,比较两组患者术中麻醉效果及术后麻醉满意度。结果观察组和对照组分别有1例、4例因麻醉效果差而改用全麻完成检查,最终观察组79例、对照组76例获得完整数据。两组患者在进声门时及术中血压、心率、呼吸均有所增高,氧饱和度在进声门时短暂下降,术中恢复至术前水平,观察组血压、心率、呼吸、氧饱和度的波动幅度低于对照组(P0.05)。观察组术中麻醉效果优良率及术后麻醉满意度高于对照组(P0.05)。结论在支气管镜检查中应用达克罗宁胶浆联合利多卡因、咪达唑仑、芬太尼静脉复合麻醉减轻了病人的痛苦,提高了麻醉效果。     

长期饮酒对咪达唑仑在无痛气管镜检查中镇静作用的影响

目的 探讨长期饮酒对咪达唑仑在无痛气管镜检查中镇静作用的影响.方法 176例无痛气管镜检查患者根据是否有饮酒史分为非饮酒组(A组)、饮酒组(B组);B组患者依据咪达唑仑用量随机分为B1组和B2组.A组和B1组在复合麻醉中咪达唑仑的剂量为0.08 mg/kg;B2组的咪达唑仑剂量为0.1 mg/kg.对患者进行Ramsay镇静分级,观察患者声门开放情况、呛咳、心率变化、血氧饱和度变化、血压变化、术后不良记忆等.结果 各组间在Ramsay镇静分级中差异无统计学意义;B1较A组在检查过程中声门开放更差、心率改变更大、血压变化更大、不良记忆更多;B1组较B2组在检查过程中声门开放更差、心率改变更大、血压变化更大;A组和B2组在所有的观测指标上差异均无统计学意义.结论 长期饮酒可使咪达唑仑在无痛气管镜检查中的镇静作用降低;对长期饮酒患者咪达唑仑用量应增加至0.1 mg/kg.Ramsay镇静分级不适用于无痛气管镜检查中镇静状态的评估.     

不同剂量芬太尼联合咪哒唑仑在纤维支气管镜检查中的镇静效果和安全性研究

目的探讨纤维支气管镜检查中采用不同剂量芬太尼联合咪达唑仑镇静麻醉的有效性及安全性。方法将60例择期行纤维支气管镜检查的患者随机分为两组,每组30例。在利多卡因局麻的基础上,A组给予芬太尼0.2μg/kg联合咪达唑仑0.05 mg/kg静脉注射镇静,B组给予芬太尼0.5μg/kg联合咪达唑仑0.1 mg/kg静脉注射镇静。比较两组用药前及用药后1、3、5、10 min不同时间点心率(HR)、舒张压(SBP)、收缩压(DBP)及血氧饱和度(Sp O2)变化情况,以及苏醒时间、不良反应等。结果两组用药后各时间点HR、SBP、DBP比较差异无统计学意义(P0.05);用药后3 min两组Sp O2均较麻醉前降低,但B组较A组下降更为明显(P0.05)。A组苏醒时间、不良反应发生率、操作知晓情况均低于B组(P0.05)。结论芬太尼0.2μg/kg联合咪哒唑仑0.05 mg/kg用于纤维支气管镜的检查中具有良好的镇静效果,对Sp O2影响小,患者无不良记忆,不良反应少,安全性高,苏醒快,具有较高临床应用价值。     

右美托咪啶与咪达唑仑在电子支气管镜检查中随机双盲研究

目的 评估右美托咪啶联合芬太尼与咪达唑仑联合芬太尼在电子支气管镜镇静中的临床应用价值比较.方法 选择年龄在18～70岁、美国麻醉医师协会(ASA)分级1～3级的电子支气管镜检查患者52例进行前瞻性双盲研究,随机分为右美托咪啶组(右美托咪啶十芬太尼,D组)26例和咪达唑仑组(咪达唑仑十芬太尼,M组)26例.记录患者一般资料,麻醉前(T0)、进鼻腔时(T1)、过声门时(T2)、过声门后1 min (T3)、3 min (T4)、5 min (T5)的平均动脉压(MAP)、心率(HR)和Sp()2,镜检中情况、镜检时间及复苏时间,术后调查患者满意度.结果 D组HR在T1、T2、T3、T4、T5低于M组,差异有统计学意义(P＜0.05),T0两组差异无统计学意义(P＞0.05);D组Sp()2在T1、T2、T3、T4、T5高于M组,差异有统计学意义(P＜0.05),T0两组差异无统计学意义(P＞0.05).镜检过程中D组追加芬太尼人次、出现低氧血症人次均少于M组,差异有统计学意义(P＜0.05);使用阿托品或异丙肾上腺素人次两组差异无统计学意义(P＞0.05).D组患者镜检过程满意度较M组高,差异有统计学意义(P＜0.05);镜检时间、复苏时间两组差异无统计学意义(P＞0.05).结论 右美托咪啶合并芬太尼在电子支气管镜检查中相比咪达唑仑合并芬太尼具有呼吸抑制不明显,患者舒适度高的优点,而对镜检和复苏时间影响不明显.     

不同剂量咪达唑仑对硬膜外麻醉的老年患者术中镇静遗忘作用的观察

目的观察不同剂量咪达唑仑对硬膜外麻醉的老年患者术中镇静遗忘的作用。方法参照美国麻醉医师协会(ASA)病情分级标准,选择ASAⅠ~Ⅱ级硬膜外麻醉下行胆囊切除术的老年患者150例,随机分为A、B、C 3组,硬膜外注射维持量前A、B、C组分别静脉注射咪达唑仑0.02、0.03、0.04 mg/kg。观察用药后患者意识状态,术后24 h遗忘情况,并进行组间比较。结果 A、B、C组麻醉前后心率、平均动脉压以及血氧饱和度(SpO2)无统计学差异。C组手术开始时SpO2显著低于A、B组。B、C组的镇静效果及遗忘作用优于A组,但C组28%出现严重的呼吸抑制。结论硬膜外麻醉的老年患者静脉注射0.03 mg/kg咪达唑仑有较好的术中遗忘作用及镇静效果,且不会出现严重的呼吸抑制。     

咪达唑仑-丙泊酚序贯镇静在术后机械通气中的应用研究

目的为临床医生选择合理的镇静镇痛方案提供参考。方法采用前瞻性对照研究,选术后出现呼吸衰竭需机械通气的122例患者,均给予芬太尼持续静脉泵入镇痛,根据镇静方法不同随机分为A组(丙泊酚组)、B组(咪达唑仑组)、C组(咪达唑仑+丙泊酚组)、D组(咪达唑仑-丙泊酚序贯组),比较4组患者的起效时间、停药至拔除气管插管的时间、平均动脉压及心率的变化。结果 A组镇静起效时间最短(P0.05);B、D组起效时间较长(P0.05)。A组停药至拔管时间显著短于D、B、C组(P0.05)。用药30 min后,A、C组平均动脉压、心率显著低于用药前(P0.05),D组著高于A组(P0.05)。D组低血压发生率显著低于A、B、C组(P0.05)。结论咪达唑仑-丙泊酚序贯镇静效果最好。     

咪达唑仑用于无痛纤支镜的临床研究

目的探讨在无痛纤支镜术前麻醉诱导过程中使用咪达唑仑的利弊。方法将288例行无痛纤支镜检查的患者随机分为2组,采用不同的麻醉诱导方法,第1组（A组）静注异丙酚、芬太尼联合咪达唑仑,第2组（B组）静注异丙酚和芬太尼,从安全性、舒适性和便捷性三方面选择指标进行比较。结果 B组对呼吸、循环的影响小于A组,整个麻醉过程中患者经皮血氧饱和度和心率的变量比较差异有统计学意义;术后感受A组优于B组,A组对操作过程有记忆的患者少于B组（P=0.004）,A组术后呕吐的发生率与B组无显著性差异（P=0.211）;A组的麻醉诱导时间（T1）比B组短,但麻醉苏醒时间（T2）比B组长,总的药物相关时间（T=T1＋T2）A组长于B组（P=0.000）。结论静注异丙酚、芬太尼的麻醉诱导方式安全性更好,效率更高,静注异丙酚、芬太尼联合咪达唑仑术后记忆较少,相比而言,前者更值得临床推广。     

局部麻醉伴或不伴芬太尼行支气管镜检查的对照研究

目的 比较局部麻醉伴或不伴芬太尼下进行常规支气管镜检查时的耐受度、满意度及安全性.方法 将行常规支气管镜检查的60例患者随机分为局部麻醉不伴芬太尼镇静镇痛(A组)和局部麻醉伴芬太尼镇静镇痛(B组),每组30例.通过术中记录生命体征及不良事件观察操作的安全性,术后用视觉模拟评分(VAS)观察患者对操作的耐受度和满意度.结果 两组患者术中及术后心率差异有统计学意义(P＜0.05),而两组收缩压及SaO2差异无明显统计学意义(P＞o.05).对于操作过程中整体不适,A组患者术中比B组患者明显感觉到不适(P＜o.05),明显感觉到呼吸困难(P＜0.05),表达更多疼痛(P＜0.05),但两组患者术中咳嗽、恶心及再次检查意愿差异无统计学意义(P＞0.05).A组1例患者和B组2例患者出现低氧血症,是短暂性的,没有生命危险.结论 行常规支气管镜检查的患者采用局部麻醉联合芬太尼静脉麻醉可减少术中不适、呼吸困难及疼痛,安全性较高.     

妊娠时间与肺结核复发的相关性研究及诊治对策

目的 分析肺结核史患者妊娠时间和肺结核复发间相关性.方法 选取我院收治的有肺结核史的妊娠妇女576例作为研究对象,对其妊娠前肺结核治疗、治愈后妊娠时间、妊娠后复发肺结核等进行分析,总结有肺结核史育龄女性的妊娠时间和肺结核复发之间的关系.结果 肺结核治愈后不同时间段妊娠者的结核复发率比较,差异具有显著性（P＜0.05）,停药后间隔时间越久妊娠,肺结核复发的几率越小.结论 加强孕期痰菌检查,及早发现复发肺结核,提高母婴安全.     

我国骨关节结核诊治的回顾与展望

骨关节结核是危害人们健康的严重感染性疾病,近95％由他处结核病继发而来.罹患骨关节结核疾病后几乎均将致残,严重影响人们的健康、工作和生活.建国以来在党和国家的关心和支持下,骨关节结核的诊治水平取得了长足进步.时至今日,由于多种原因,学科发展和被重视程度受到一定的制约,同整个医疗行业的发展不相适应.回顾过去,展望未来,我们需要重新审视骨关节结核的诊治方法,努力推进骨关节结核诊疗技术的科学发展.     

Effect of phosphorylation of MAPK and Stat3 and expression of c-fos and c-jun proteins on hepatocarcinogenesis and their clinical significance

AIM To study the effect of phosphorylation ofMAPK and Stat3 and the expression of c-fos andc-jun proteins on hepatocellular carcinogenesisand their clinical significance.METHODS SP immunohistochemistry was usedto detect the expression of p42/44~(MAPK), p-Stat3,c-fos and c-jun proteins in 55 hepatocellularcarcinomas (HCC) and their surrounding livertissues.RESULTS The positive rates and expressionlevels of p42/44~(MAPK), p-Stat3, c-fos and c-junproteins in HCCs were significantly higher thanthose in pericarcinomatous liver tissues (PCLT).A positive correlation was observed between theexpression of p42/44~(MAPK) and c-fos proteins, andbetween p-Stat3 and c-jun, but there was nosignificant correlation between P42/44~(MAPK) and p-Stat3 in HCCs and their surrounding livertissues.CONCLUSION The abnormalities of Ras/Raf/MAPK and JAKs/ Stat3 cascade reaction maycontribute to malignant transformation ofhepatocytes. Hepatocytes which are positive forp42/ 44~(MAPK), c-fos or c-jun proteins may bepotential malignant pre-cancerous cells.Activation of MAPK and Stat3 proteins may be anearly event in hepatocellular carcinogenesis.     

Overweight and Obesity and Progression of ADPKD

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Replication and Inhibitors of Enteroviruses and Parechoviruses

The Enterovirus (EV) and Parechovirus genera of the picornavirus family include many important human pathogens, including poliovirus, rhinovirus, EV-A71, EV-D68, and human parechoviruses (HPeV). They cause a wide variety of diseases, ranging from a simple common cold to life-threatening diseases such as encephalitis and myocarditis. At the moment, no antiviral therapy is available against these viruses and it is not feasible to develop vaccines against all EVs and HPeVs due to the great number of serotypes. Therefore, a lot of effort is being invested in the development of antiviral drugs. Both viral proteins and host proteins essential for virus replication can be used as targets for virus inhibitors. As such, a good understanding of the complex process of virus replication is pivotal in the design of antiviral strategies goes hand in hand with a good understanding of the complex process of virus replication. In this review, we will give an overview of the current state of knowledge of EV and HPeV replication and how this can be inhibited by small-molecule inhibitors.     

Effect of phosphorylation of MAPK and Stat3 and expression of c-fas and c-jun proteins on hepatocarcinogenesis and their clinical significance

AIM To study the effect of phosphorylation ofMAPK and Stat3 and the expression of c-fos andc-jun proteins on hepatocellular carcinogenesisand their clinical significance.METHODS SP immunohistochemistry was usedto detect the expression of p42/44MAPK, p-Stat3,c-fos and c-jun proteins in 55 hepatocellularcarcinomas (HCC) and their surrounding livertissues.RESULTS The positive rates and expressionlevels of p42/44MAPK, p-Stat3, c-fos and c-junproteins in HCCs were significantly higher thanthose in pericarcinomatous liver tissues (PCLT).A positive correlation was observed between theexpression of p42/44MAPK and c-fos proteins, andbetween p-Stat3 and c-jun, but there was nosignificant correlation between p42/44MAPK and p-Stat3 in HCCs and their surrounding livertissues.CONCLUSION The abnormalities of Ras/Rat/MAPK and JAKs/ Stat3 cascade reaction maycontribute to malignant transformation ofhepatocytes. Hepatocytes which are positive forp42/ 44MAPK, c-fos or c-jun proteins may bepotential malignant pre-cancerous cells.Activation of MAPK and Stat3 proteins may be anearly event in hepatocellular carcinogenesis.     

心电图、心电向量图与冠状动脉造影结果对比分析

目的:通过分析心电图(Electrocardiogram,ECG)和心电向量图(Vectorcardiogram,VCG)的改变与冠脉造影（CAG）结果进行对比,探讨ECG、VCG在冠状动脉病变中的诊断价值。方法: 选择2008年1月~2009年12月临床拟诊断为冠心病患者108例,行常规ECG、VCG检查,并于1周内进行CAG,对检查结果依据各自的诊断标准进行判定,以CAG为标准诊断法,利用四格表法,计算相关评价真实性的指标并进行比较。结果: ①VCG检测的灵敏度、特异度、准确度显著高于ECG(P<0.05,P<0．01)。②ECG、VCG阳性率与冠脉病变支数组间比较:在单支病变、双支病变中,VCG阳性率明显高于ECG(P<0.05),左主干或三支病变无统计学意义;组内比较:ECG组左主干或三支病变组较单支病变、双支病变阳性率高(P<0.05,P<0.01);VCG组左主干或三支病变组较单支病变阳性率高(P<0.05);与双支病变阳性率比较无统计学意义;③ECG、VCG阳性率与冠脉病变程度组间比较:冠脉病变狭窄50%～69%的VCG阳性率明显高于ECG (P<0.05),其他两组阳性率比较无统计学意义;组内比较:ECG组冠脉病变狭窄≥90%较50%～69%、70%～89%的阳性率高(P<0.05,P<0.01); VCG组狭窄≥90%较50%～69%阳性率高（P<0.01),其他无统计学意义。结论: VCG对冠心病检测价值显著高于ECG。     

Detection and characterization of the product of hydroethidine and intracellular superoxide by HPLC and limitations of fluorescence

Here we report the structural characterization of the product formed from the reaction between hydroethidine (HE) and superoxide (O(2)(.-)). By using mass spectral and NMR techniques, the chemical structure of this product was determined as 2-hydroxyethidium (2-OH-E(+)). By using an authentic standard, we developed an HPLC approach to detect and quantitate the reaction product of HE and O(2)(.-) formed in bovine aortic endothelial cells after treatment with menadione or antimycin A to induce intracellular reactive oxygen species. Concomitantly, we used a spin trap, 5-tert-butoxycarbonyl-5-methyl-1-pyrroline N-oxide (BMPO), to detect and identify the structure of reactive oxygen species formed. BMPO trapped the O(2)(.-) that formed extracellularly and was detected as the BMPO-OH adduct during use of the EPR technique. BMPO, being cell-permeable, inhibited the intracellular formation of 2-OH-E(+). However, the intracellular BMPO spin adduct was not detected. The definitive characterization of the reaction product of O(2)(.-) with HE described here forms the basis of an unambiguous assay for intracellular detection and quantitation of O(2)(.-). Analysis of the fluorescence characteristics of ethidium (E(+)) and 2-OH-E(+) strongly suggests that the currently available fluorescence methodology is not suitable for quantitating intracellular O(2)(.-). We conclude that the HPLC/fluorescence assay using HE as a probe is more suitable [corrected] for detecting intracellular O(2)(.-).     

Effects of sex and time of day on metabolism and excretion of corticosterone in urine and feces of mice

Non-invasive techniques to monitor stress hormones in small animals like mice offer several advantages and are highly demanded in laboratory as well as in field research. Since knowledge about the species-specific metabolism and excretion of glucocorticoids is essential to develop such a technique, we conducted radiometabolism studies in mice (Mus musculus f. domesticus, strain C57BL/6J). Each mouse was injected intraperitoneally with 740 kBq of 3H-labelled corticosterone and all voided urine and fecal samples were collected for five days. In a first experiment 16 animals (eight of each sex) received the injection at 9 a.m., while eight mice (four of each sex) were injected at 9 p.m. in a second experiment. In both experiments radioactive metabolites were recovered predominantly in the feces, although males excreted significantly higher proportions via the feces (about 73%) than females (about 53%). Peak radioactivity in the urine was detected within about 2h after injection, while in the feces peak concentrations were observed later (depending on the time of injection: about 10h postinjection in experiment 1 and about 4h postinjection in experiment 2, thus proving an effect of the time of day). The number and relative abundance of fecal [3H]corticosterone metabolites was determined by high performance liquid chromatography (HPLC). The HPLC separations revealed that corticosterone was extensively metabolized mainly to more polar substances. Regarding the types of metabolites formed, significant differences were found between males and females, but not between the experiments. Additionally, the immunoreactivity of these metabolites was assessed by screening the HPLC fractions with four enzyme immunoassays (EIA). However, only a newly established EIA for 5alpha-pregnane-3beta,11beta,21-triol-20-one (measuring corticosterone metabolites with a 5alpha-3beta,11beta-diol structure) detected several peaks of radioactive metabolites with high intensity in both sexes, while the other EIAs showed only minor immunoreactivity. Thus, our study for the first time provides substantial information about metabolism and excretion of corticosterone in urine and feces of mice and is the first demonstrating a significant impact of the animals' sex and the time of day. Based on these data it should be possible to monitor adrenocortical activity non-invasively in this species by measuring fecal corticosterone metabolites with the newly developed EIA. Since mice are extensively used in research world-wide, this could open new perspectives in various fields from ecology to behavioral endocrinology.     

大鼠骨髓间充质干细胞的分离培养和外源基因的导入

目的探讨绿色荧光蛋白基因转染骨髓间质干细胞的可行性。方法采用F icoll-PaqueTMP lus淋巴细胞分离液,根据细胞密度梯度原理,分离大鼠骨髓间充质干细胞(rM SC s)并进行体外原代培养和传代扩增,倒置相差显微镜观察细胞生长情况,免疫细胞化学法对其初步鉴定。流式细胞仪分析转染效率。结果原代和传代培养的细胞呈现梭形外观,具有较强的生长增殖能力;细胞均一表达CD44、CD54、CD106、CD29抗原。电穿孔法转染rM SC s转染率为32.8%±3%。结论采用比重为1.077 g/L的F icoll-PaqueTMP lus能分离获得大鼠骨髓间充质干细胞,经原代培养和传代培养能够迅速扩增。电穿孔法具有较高的介导外源基因表达于rM SC s的效率。