七氟烷全程吸入麻醉在非体外循环冠脉旁路移植术中的应用

目的 探讨七氟烷全程吸入麻醉对行非体外循环冠脉旁路移植术(OPCABG)患者血液动力学和心功能的影响.方法 选择拟行择期OPCABG的ASAⅡ-Ⅲ级患者40例,随机分为丙泊酚全凭静脉麻醉组(Pro组)和七氟烷全程吸入麻醉组(Sevo组),分别以丙泊酚和七氟烷维持镇静,舒芬太尼和维库溴铵维持镇痛和肌松,术中维持BIS值40～50.分别于诱导前(T1),插管后(T2),锯开胸骨(T3),第一支桥血管吻合(T4),最后一支桥血管吻合(T5),关胸骨(T6),手术结束(T7),入ICU即刻(T8)记录血液动力学参数.经食道超声心动图观察术中室壁运动情况,双平面碟片法测量CO、SV、EF、FS等.结果 两组患者术中血液动力学参数组间比较无显著性差异,但七氟烷组波动较小.两组患者心功能指标组间比较,Sevo组较Pro组术后增高有统计学差异(P＜0.05).Sevo组组内比较,术后较术前增高有显著性差异(P＜0.05).结论 七氟烷全程吸入麻醉用于OPCABG手术较全凭静脉麻醉具有一定优势,可减轻血液动力学不稳定和心功能的抑制.     

异氟烷与丙泊酚对非体外循环冠脉搭桥患者术后认知功能的影响

目的 比较异氟烷静吸复合麻醉与丙泊酚全凭静脉麻醉对非体外循环冠脉搭桥患者术后认知功能的影响.方法 择期行冠脉搭桥术的冠心病患者30例,美国麻醉医师学会(ASA)心脏功能评定标准Ⅱ-Ⅲ级,按患者就诊顺序编号随机分为A、B两组,每组15例.全麻维持分别用异氟烷静吸复合(A组)或丙泊酚全凭静脉(B组)麻醉.两组患者分别于手术前1 d、术后第4天测定患者简易智力状态量表(MMSE)评分.结果 A组术后出现认知功能障碍的患者为5例(33%),B组为3例(20%).两组患者术前MMSE评分[A组(29.13±0.83),B组(29.13±1.13)]差异无显著性(P＞0.05);A组术后第4天MMSE评分(28.73±1.03)较手术前显著降低(f=2.45,P＜0.05),B组术后第4天MMSE评分(28.93±1.16)较手术前降低,但差异无显著性(t=1.87,P＞0.05).结论 异氟烷静吸复合麻醉与丙泊酚全凭静脉麻醉均可影响非体外循环冠脉搭桥患者的术后认知功能,但丙泊酚全凭静脉麻醉对认知功能的影响小于异氟烷静吸复合麻醉,更适合于临床应用.     

三种全麻维持方法对老年患者血流动力学和苏醒质量影响的比较

目的比较丙泊酚、七氟烷和丙泊酚-七氟烷静吸复合三种麻醉维持方法对老年人血流动力学和苏醒质量的影响。方法 44例ASAⅠ～Ⅱ级胃癌根治术患者随机分入丙泊酚组（P组）、七氟烷组（S组）和静吸复合组（PS组）。术中P组靶控输注丙泊酚,S组七氟烷吸入维持,PS组丙泊酚靶控浓度1μg/mL,复合吸入七氟烷。各组均靶控输注3.5ng/mL瑞芬太尼。调节丙泊酚或七氟烷浓度使AEPI维持15～25,比较三组HR、MAP和术后苏醒质量的差异。结果 S组患者MAP波动幅度小,拔管时间、定向力恢复时间早于另外两组。结论七氟烷吸入麻醉使老年患者血流动力学更平稳,术后苏醒质量更好。     

丙泊酚静脉麻醉对肺癌患者神经元特异性烯醇化酶的影响

目的:观察丙泊酚静脉麻醉对肺癌患者神经元特异性烯醇化酶(NSE)的影响。方法:30例ASAⅠ～Ⅱ级择期行肺癌切除术患者随机分为2组,每组各15例。A组:七氟烷组,吸入七氟烷用于维持麻醉;B组:丙泊酚组,用微量泵静注丙泊酚维持麻醉;于手术前及手术开始2h、手术结束时、术后24h各时间点抽取静脉血检测定血清NSE含量。结果:手术2h、手术结束时和术后24h与术前比较,七氟烷组NSE均升高,丙泊酚组无明显变化,2组间比较B组低于A组(P<0.05)。结论:在肺癌手术中使用丙泊酚麻醉能够降低NSE含量,改善预后,具有保护作用。     

体外循环过程中吸入七氟烷对婴幼儿心脏术后恢复过程影响的随机对照临床研究

目的 观察体外循环过程中吸入七氟烷对婴幼儿心脏手术后恢复过程及术后血清肌钙蛋白Ⅰ (cTnI)含量的影响.方法90例拟在体外循环下行根治手术的先天性心脏病患儿纳入本随机对照研究,随机分为七氟烷组(45例)和对照组(45例),七氟烷组在体外循环开始后通过氧合器吸入2％七氟烷,体外循环结束前停止吸入.对照组只给予空氧混合气.体外循环前后记录患儿血压,术后5个时间点(返回ICU即刻、ICU 3 h、ICU 6 h、ICU 12 h和ICU 24 h)取血样检测cTnI含量.术后恢复过程中其它参数如动脉血乳酸含量、血糖含量、呼吸机辅助呼吸时间、ICU 24 h尿量、ICU时间、术后正性肌力药物使用情况、术后住院时间、死亡和并发症发生情况同时记录.结果 两组患儿术前、术中各项参数无显著差异.七氟烷组患儿体外循环后动脉舒张压显著高于对照组(P =0.028).七氟烷组术后死亡1例,对照组术后因呼吸功能不全二次插管2例.七氟烷组呼吸机辅助呼吸时间显著低于对照组(P =0.0064).术后ICU时间、术后住院时间、术后24h内5个时间点血清cTnI含量、血乳酸含量和血糖含量两组比较无显著差异.结论 体外循环中吸入2％七氟烷在一定程度上有利于改善婴幼儿心脏手术后的恢复,对术后cTnI的血清含量无显著影响.     

七氟烷复合丙泊酚预处理对不停跳冠状动脉搭桥手术患者心肌的保护作用

目的观察七氟烷复合丙泊酚预处理用于不停跳冠状动脉搭桥手术(OPCABG)患者麻醉中对心肌的保护作用。方法择期行不停跳冠状动脉搭桥术患者80例,随机分为四组:对照组(C组,n=20);丙泊酚组(P组,n=20);七氟烷组(S组,n=20);七氟烷复合丙泊酚组(SP组,n=20)。所有患者分别于麻醉前、术后6 h、12 h、24 h采中心静脉血测定CK-MB和cTnI水平。结果术后6 h、12 h、24 h SP组cTnI和CK-MB释放量低于C组、P组和S组(P0.05),P组和S组低于C组(P0.05)。结论在不停跳冠状动脉搭桥麻醉管理中,用七氟烷复合丙泊酚预处理可使肌钙蛋白(cTnI)和心肌酶(CK-MB)释放量显著较少。对于OPCABG患者,七氟烷复合丙泊酚预处理对心肌具有更好的保护作用。     

瑞芬太尼复合丙泊酚或七氟烷对小儿扁桃体切除术术后躁动的影响

目的评估瑞芬太尼复合丙泊酚全凭静脉麻醉或复合七氟烷与纯七氟烷全麻分别用于小儿扁桃体、腺样体手术对术后躁动(EA)的影响。方法选择2011年7月~2012年10月间120例ASAⅠ~Ⅱ级择期行扁桃体、腺样体手术的学龄前患儿分为三组:瑞芬太尼复合丙泊酚静脉全麻组(Ⅰ组)、瑞芬太尼复合七氟烷组(Ⅱ组)和纯七氟烷吸入全麻组(Ⅲ组),每组40例。术中根据患儿的血压心率变化调整七氟烷吸入浓度和丙泊酚泵注速度。观察患儿术后苏醒、拔管情况及术后躁动发生情况。结果Ⅰ组患儿自主呼吸恢复时间、苏醒时间、拔管时间均少于Ⅱ组和Ⅲ组[(4.03±1.38)vs(9.42±1.21)vs(10.22±1.71)min,(5.15±1.27)vs(9.68±1.58)vs(11.64±1.78)min,(5.89±1.60)vs(10.58±2.10)vs(12.18±2.30)min,P0.001];Ⅰ组、Ⅱ组儿童麻醉后躁动评分(PAED)≥10分的例数少于Ⅲ组(15 vs 27,P0.001;16 vs 27,P0.05),Ⅰ组、Ⅱ组四点法EA评分≥3分的例数少于Ⅲ组(11 vs 11 vs21,P0.05)。结论瑞芬太尼复合丙泊酚全凭静脉或复合静吸复合七氟烷麻醉用于小儿扁桃体、腺样体手术,较单纯七氟烷吸入麻醉术后躁动的发生率低,其中瑞芬太尼复合丙泊酚全凭静脉麻醉术后苏醒更快。     

七氟烷和异氟烷对鼻内镜手术鼻黏膜血流及术野影响的比较

目的 研究七氟烷及异氟烷对血流动力学、鼻腔黏膜微循环血流及术野清晰度的影响.方法 ASA Ⅰ～Ⅱ级择期ESS手术30例,随机分为:七氟烷组(S组,15例)以氧化亚氮-氧-七氟烷维持麻醉;异氟烷组(Ⅰ组,15例)氧化亚氮-氧-异氟烷维持麻醉.两组均将BIS控制在40～50.监测记录术中平均动脉压、心率、诱导前及麻醉平稳后...     

不同麻醉方法腹腔镜胆囊切除术对循环应激反应术后恢复的影响

目的:比较3种不同麻醉方法用于腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)对病人围麻醉期循环应激反应及术后恢复的影响.方法:66例年龄18-60岁,ASA Ⅰ～Ⅱ级择期行LC手术病人(n=66),随机分为3组(n=22),瑞芬太尼+七氟烷组(Ⅰ组),芬太尼+异氟烷+丙泊酚组(Ⅱ组),瑞芬太尼+丙泊酚TCI组(Ⅲ组).观察围麻醉期平均动脉压(Meanarterical pressure,MAP)、心率(Heart rate,HR)、血清白介素-6(IL-6)、皮质醇以及血糖浓度的变化与麻醉恢复期各组病人麻醉后恢复时间、Aldrete评分≥9分的时间、术后恶心呕吐发生率以及用视觉模拟评分(Visual analogue scales,VAS)评定术后疼痛.结果:Ⅰ、Ⅱ组插管前MAP下降显著(P＜0.01),Ⅲ组在气腹建立1min后MAP上升显著(P＜0.01).各组血糖,皮质醇水平在手术结束时均显著高于诱导前(P＜0.01).Ⅰ、Ⅲ组IL-6在手术结束时显著增加(P＜0.01).麻醉恢复期Ⅱ组拔管时间、清醒时间、Aldrete评分≥9分时间较Ⅰ、Ⅲ组显著延长(P＜0.05).术后VAS评分,各组比较差异无统计学意义(P＞0.05).术后恶心呕吐各组发生率差异无统计学意义(P＞0.05).结论:3种麻醉方法均适用于LC手术,但用瑞芬太尼+七氟烷或瑞芬太尼+丙泊酚TCI维持麻醉更具恢复时间短、质量高的优点;LC手术可导致机体明显应激反应,术后疼痛明显,恶心呕吐发生率高,应予积极处理.     

不同浓度七氟烷联合丙泊酚麻醉对小儿肌钙蛋白I、C反应蛋白以及补体变化的影响

目的:探讨不同浓度七氟烷联合丙泊酚对小儿麻醉后肌钙蛋白I、C反应蛋白以及补体变化的影响。方法:选取ASAⅠ~Ⅱ级择期行非心脏手术患者96例,随机分为三组,其中A组32例给予2%七氟烷联合丙泊酚麻醉;B组32例给予2.5%七氟烷联合丙泊酚麻醉;C组32例给予3%七氟烷联合丙泊酚麻醉。分别于全身麻醉诱导前(T1)、麻醉开始后30min(T2)、手术结束后3h(T3)3个时间点检测三组患者血清肌钙蛋白I(cTn I)、C反应蛋白(CRP)和补体(C3、C4)含量水平。结果:1三组在麻醉前cTn I、CRP、C3、C4均无明显差异(P>0.05);2与T1相比较,三组在T2、T3时cTn I、CRP、C3、C4均明显升高(P<0.05);3相同时间各组间对比,B、C两组在T2、T3时cTnI、CRP、C3、C4明显高于A组(P<0.05);C组在T2、T3时cTnI、CRP、C3、C4较B组明显升高(P<0.05)。结论:七氟烷在有效浓度范围内与患者心肌损害成正相关,低浓度的七氟烷联合丙泊酚适合于小儿手术时全身麻醉诱导。     

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.