下颌骨折24例手术麻醉方法分析

目的 观察慢诱导经鼻盲探气管插管用于下颌骨折患者的效果.方法 先进行鼻腔、咽喉部及气管的表面麻醉,再经静脉用药进行慢诱导,经鼻盲探行气管插管术.结果 24例患者中16例1次成功,7例经改变头位和套囊充气后2～3次成功,1例反复3次没成功后在喉镜明示引导下插入.结论 慢诱导经鼻盲探气管插管用于下颌骨折患者的插管成功率高,且无明显的损伤及循环波动.     

经鼻盲探气管插管用于下颌骨骨折12例的气道管理体会

目的观察经鼻盲探气管插管用于下颌骨骨折病人气道开放的效果.方法先进行鼻腔、咽喉部及气管的表面麻醉,再经静脉用药进行慢诱导,当塑过形的普通气管导管抵达咽部时,调整病人的头位,将气管导管套囊充气,继续推进导管通过声门进入气管后将套囊放气,并继续推进导管至适宜的深度.结果 12例病人中10例1次试插成功,2例试插2次成功;12例病人插管时均未发现明显的损伤及循环波动.结论套囊充气法经鼻盲探气管插管用于下颌骨骨折病人的气道开放成功率高,且无明显的损伤及循环波动.     

快速诱导下气囊充气法经鼻盲探气管内插管的应用

经鼻盲探气管内插管常用于困难气道、颈髓损伤等插管.在清醒情况下插管部分患者心血管反应、咽反射强烈,影响插管的成功率并延长插管时间.笔者在麻醉快速诱导下进行经鼻盲探气管内插管,并用气囊充气法提高插管成功率,取得了良好效果,现报道如下.     

地震后颈椎损伤患者的麻醉处理

目的:总结地震所致颈椎损伤患者的麻醉处理经验.方法:回顾性分析我院麻醉科在汶川大地震中救治的6例颈椎损伤患者的围手术期麻醉管理资料,总结相关经验.结果:经过抗休克、稳定生命体征等处理后,6例伤员(3例野外条件下伤员采用慢诱导清醒盲探插管;3例后送至医院本部的伤员采用纤维支气管镜插管)在全麻下成功实施手术,术中呼吸、循环平稳,术后恢复良好.结论:野外条件下,清醒盲探插管是颈椎损伤患者的良好选择;在后方医院麻醉时气管插管宜选择颈椎活动小的纤维支气管镜插管.     

改良经鼻盲探气管插管术的临床研究

５０例手术患者，随机分为改良组与对照组，每组各２５例，由专人麻醉操作，均采用安定，羟丁酸钠，氟哌啶芬太尼合剂静脉全麻诱导，环甲膜穿刺气管内表麻，保留自主呼吸，经鼻盲探气管内插管。改良组在气管导管出鼻后孔抵达咽部时，将导管套囊充气１５ｍｌ，对照组导管囊不充气。     

Halo氏架外固定的颈椎手术麻醉处理

目的:探讨颈椎不稳手术的麻醉处理方法。方法:术前依据颈椎骨折、脱位导致颈椎不稳,给予Halo氏架外固定处理;手术时采用清醒表麻慢诱导经口或经鼻盲探气管插管以及逆行经鼻气管插管,全部为静吸复合全麻,经颈前路钢板螺钉内固定术。结果:12例患者术毕10 min内苏醒,恢复自主呼吸,均拔管后安全返回病房。结论:完善的术前准备,清醒表麻慢诱导的气管插管全麻,可以完成该类手术的麻醉。     

107例Halo-vest装置固定下急性颈椎损伤病人手术的麻醉体会

目的探讨Halo-vest装置固定下急性颈椎损伤病人手术的麻醉处理经验。方法 107例急性颈椎损伤病人手术先在局部麻醉下行Halo-vest装置固定后,采用慢诱导经鼻盲探气管插管,术中麻醉维持采用静吸复合麻醉。结果 107例中105例（98.1%）经鼻盲探气管插管成功,2例应用纤维支气管镜引导经鼻气管插管,插管操作过程及围术期生命体征平稳。9例病人高位截瘫呼吸无力术毕行气管切开,其余病人术毕均顺利拔管,无并发症发生。结论对急性颈椎损伤术前应进行充分的评估和严格的处理,麻醉时保持颈椎的稳定性,以保证病人麻醉手术的安全。     

张口受限小儿的麻醉处理20例分析

目的：探讨张口受限小儿麻醉诱导药物、麻醉方法的选择，以及掌握经鼻盲探气管插管要领、拔管指征及术后处理。方法：对合并阻塞性睡眠呼吸暂停综合征的患儿采取清醒状态下气管切开后麻醉。其余采用经丁酸钠、氯胺酮、地西泮或芬太尼慢诱导加完善的咽喉表面麻醉下经鼻盲探气管插管。结果：清醒状态下气管切开1例，经鼻盲探气管插管19例，成功17例，失败2例。术后呕吐2例，窒息死亡1例。结论：术前正确评估气道困难的程度，选择适当的麻醉诱导和气管插管方法，加强生命体征监测及术后处理，可保障患儿的生命安全。     

气管导管套囊充气导向经鼻盲探插管用于口腔颌面整形手术

口腔、颌面与整形手术由于病变和手术操作的影响，麻醉处理难度大，要求高，原则上均应在气管插管全麻下实施。但全麻诱导时，常因颌面肿瘤、畸形或缺损致面罩漏气，使人工通气困难；尤其是巨大百体肿物与口底癌，喉镜置入很困难，且易发生肿瘤接触性出血，甚至发生误吸与窒息。为此，探讨保留自主呼吸的诱导方法，提高经界盲探气管插管成功率，促使口腔颌面整形外科发展，仍是临床麻醉研究的重要课题。本院自1994年以来，在静脉慢诱导保留自主呼吸的基础上，采用套囊充气法引导经鼻盲探气管插管，用于口腔颌面整形手术36例，效果满意，报告…     

镇痛健忘盲探经鼻气管内插管在颈椎损伤病人全麻插管中的应用

目的：探讨镇痛健忘盲探经鼻气管内插管用于颈椎损伤病人全麻气管内插管的可行性及优越性。方法：60例颈椎手术病人,ASA分级Ⅰ~Ⅱ级。A组：颈椎外伤病人30例,采用镇痛健忘盲探经鼻气管内插管;B组：脊髓型颈椎病病人30例,采用快速诱导明视经口气管内插管。组间年龄、性别、体重相似。监测麻醉诱导期BP、HR的变化,两组进行组内、组间比较,并观察A组插管的成功率。结果：A组诱导后血压下降不明显,插管即刻血压升高不明显;B组诱导后血压下降明显,插管即刻血压升高明显;两组比较差异显著。A组插管成功率为96.7%,术后对插管过程无不良记忆,无严重并发症。结论：镇痛健忘盲探经鼻气管内插管适用于颈椎损伤手术的全麻气管内插管。     

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.