异丙酚并芬太尼在胃镜检查中的应用

目的观察异丙酚并芬太尼在胃镜检查中的应用效果。方法病人分为观察组和对照组，观察组先给芬太尼0．5μg／kg静脉注射，再缓慢静脉注射异丙酚（得普利麻）1．5mg／kg，病人进入睡眠状态后进镜，有异常躁动者追加异丙酚0．5mg／kg。对照组为常规法胃镜检查组．分别监测并记录两组胃镜操作前、操作中和操作后血压、心率、血氧饱和度，记录操作及完成时间、检查中不良反应、检查后询问受检者的感受、复检意向。结果观察组病人没有出现严重并发症。平均血氧饱和度、血压、心率有一过性轻度下降，但与对照组比较无显著差异（P〉0．05）。观察组检查成功率比对照组高。检查反应比对照组低；病人满意度达100％。结论应用异丙酚、芬太尼静脉注射进行无痛性胃镜检查可免除病人痛苦，是一种安全有效的人性化检查技术。     

异丙酚复合芬太尼在无痛肠镜中的临床观察

目的 探讨异丙酚复合芬太尼实施监护下麻醉管理（monitored anesthesia Care，MAC）技术，应用于肠镜检查中的有效性和安全性。方法 200例行肠镜检查者随机分为MAC组（n=100）和对照组（n=100），对照组行常规肠镜检查。MAC组以芬太尼1μg／kg静脉注射，继以异丙酚1～2mg／s速度推注，Ramsay镇静分级5级后行肠镜检查，术中5～10mg／min速度维持MAC。结果 MAC组无痛率100％，其中安静入睡98例（98％），轻微肢体活动16例（16％），明显肢体活动影响操作4例（4％），清醒时间短，不良反应少，检查中生命体征平稳。对照组病例则有不同程度的腹胀、腹痛、大声喊叫、肢体活动及其他不适，不良反应多。结论 异丙酚复合芬太尼MAC技术应用于肠镜检查，镇痛镇静效果确切，安全。     

咪唑安定联合芬太尼在无痛胃镜检查中的应用

目的探讨咪唑安定联合芬太尼在胃镜检查中的应用效果及安全性。方法随机选择在惠州市中心人民医院胃镜室接受胃镜检查的400例患者，将其分为对照组（m=200）和麻醉组（m=200）。对照组患者咽部经喷雾利多卡因局麻后，常规进行胃镜检查；麻醉组患者咽部局麻后，静脉注射咪唑安定（0．05mg/kg）和芬太尼（0．5mg），使患者进入睡眠状态后立即行胃镜检查。两组患者在胃镜检查中均监测血压、心率、指脉搏血氧饱和度，观察检查中患者的反应以及操作时间和成功率，并在检查后询问患者的感受。结果在胃镜检查中，麻醉组患者心率和收缩压均较对照组低（P〈0．05），两组指脉搏血氧饱和度差异无显著性（P〉0．05），麻醉组不良反应发生率明显低于对照组，感觉难受和不适患者所占的比例较小（2％），感觉尚可和舒适的比例较大（98％），对照组则相反，而麻醉组检查成功率、操作时间与对照组比较差异无统计学意义。结论咪唑安定联合芬太尼进行胃镜检查安全、舒适、有效。     

无痛前列腺穿刺活检术的临床效应

目的观察小剂量丙泊酚复合芬太尼与咪唑安定应用于前列腺穿刺活检术的麻醉效应及其对呼吸、循环功能的影响,评价其实用性及安全性。方法选择接受前列腺穿刺活检术的80例患者（≥60岁）,随机分为静脉镇静组40例和对照组40例。静脉镇静组给予咪唑安定0．02-0．03mg／kg,芬太尼0．001～0．002mg／kg,丙泊酚1-2mg／kg诱导,检查过程中以丙泊酚0．5mg／kg维持。对照组予1％利多卡因5mL局部浸润麻醉。比较静脉镇静组和对照组患者术中的反应及术前、术中、术后BP、HR及SpO2的变化。结果从注射丙}自酚至意识消失时间（33．05±6．5）s,前列腺穿刺活检术操作时间15～30min,意识恢复时间（5．5±4．1）min。静脉镇静组主诉疼痛、躁动发生率分别为2．5％、5．0％,而对照组为97．5％、57．5％,两组差异有统计学意义（P〈0．05）。结论小剂量丙泊酚复合芬太尼与咪唑安定用于前列腺穿刺活检术安全有效,患者对手术耐受性好,有利于病灶的观察与活检。     

不同全麻诱导用药对心脏手术患者BIS、MAP和HR的影响

目的观察不同麻醉诱导用药对脑电双频指数（BIS）、MAP和HR的影响。方法将40例心脏直视手术患者。随机分为依托咪酯组（E组）和异丙酚组（P组），每组20例。E组采用眯唑安定0．2mg／kg、依托眯酯0．3mg／kg、芬太尼6μg／kg、琥珀胆碱1．5～2．0mg／kg静注，P组采用咪唑安定0．2mg／kg、丙泊酚1mg／kg、芬太尼6μg／kg、琥珀胆碱1．5～2．0mg／kg静注气管插管。分别记录各时点BIS、MAP、HR值。结果两组麻醉诱导后BIS值随麻醉加深进行性降低（P＜0．01），组间比较有显著性差异（P＜0．05）。与麻醉前基础MAP相比．诱导及插管期E组MAP无显著变化（P＞0.05），P组MAP在静注丙泊酚后明显降低．与基础MAP相比差异显著（P＜0．05）。两组HR无明显波动（P＞0．05）。结论 依托眯酯或异丙酚联合阿片类药进行全麻诱导，皆可获得满意麻醉深度和同等BIS水平．但依托咪酯扩血管作用较弱，较异丙酚安全。     

异丙酚复合芬太尼在电子胃镜（结肠镜）检查中的应用

目的探讨异丙酚复合芬太尼在无痛电子胃镜（结肠镜）检查中的应用效果。方法将80例门诊或住院行电子胃镜（结肠镜）检查的患者随机分为观察组及对照组各40例,观察组检查中静脉给予芬太尼0.8～1.0μg/kg＋异丙酚1.0～1.2 mg/kg,对照组静脉给予异丙酚1.5～2.0 mg/kg,观察两组检查前、中、后血压（SBP/DBP）、心率（HR）、血氧饱和度（SPO2）,记录操作时间、唤醒时间、清醒时间,观察不良反应（呕吐、躁动、注射痛）情况。结果观察组检查中SBP、DBP低于检查前,对照组检查中SBP、DBP、SPO2低于检查前;观察组唤醒时间、清醒时间及不良反应发生率低于对照组。结论异丙酚复合芬太尼应用于电子胃镜（结肠镜）检查,止痛及镇静效果好,且较为安全。     

丁卡因表面麻醉复合神经安定镇痛麻醉在无痛胃镜检查和治疗中的应用

目的探讨丁卡因表面麻醉复合清醒镇静麻醉在无痛胃镜检查和治疗中应用的安全性和依从性。方法105例行无痛胃镜检查患者静注芬太尼1．5μg／kg，氟哌利多2．5～4．0mg，1％盐酸丁卡因注射液口咽腔喷雾，6min后进行胃镜检查，并进行多功能监护。结果所有受检者中90例均可顺利完成检查，无明显因手术操作引起的呛咳，咽喉部无反射（如恶心、呕吐等），无肢体挣扎等表现，检查中血压、心率、氧饱和度均较平稳，其中有13例术中有呛咳给于加深麻醉后好转完成操作。结论丁卡因表面麻醉复合清醒镇静麻醉在胃镜检查应用简单、无痛，安全性高，增加了患者的依从性，值得临床推广。     

The anesthetic effect of different drugs in painless gastroscopy of elderly patients

目的 探讨老年患者无痛胃镜检查中最佳麻醉用药配方,以提高老年患者无痛胃镜检查的安全性.方法 将270例健康状态符合美国麻醉医师学会生理状态分类等级(ASA)Ⅰ～Ⅱ级拟行无痛胃镜检查的老年患者随机分为3组.Ⅰ组为单纯异丙酚组,Ⅱ组为异丙酚复合芬太尼组,Ⅲ组为异丙酚复合瑞芬太尼组.比较各组药物在老年患者无痛胃镜检查中的作用.结果 3组患者麻醉满意度均为100％.检查中3组患者的平均动脉压、心率、呼吸、潮气量均低于检查前,而呼吸末二氧化碳分压均高于检查前.Ⅰ组、Ⅲ组与Ⅱ组相比,其平均动脉压、心率、呼吸、潮气量下降幅度,而呼吸末二氧化碳分压上升的幅度大;Ⅱ组和Ⅲ组的异丙酚用量明显少于Ⅰ组;Ⅰ组和Ⅲ组的不良反应较Ⅱ组多.结论 单用异丙酚、芬太尼复合异丙酚以及瑞芬太尼复合异丙酚均能满足老年患者无痛胃镜检查的要求,但综合分析麻醉效果及其安全性,芬太尼复合异丙酚更具优越性.     

安定联合氟马西尼用于无痛胃镜检查术的疗效观察

目的 为探讨无痛胃镜麻醉用药选择的多样性，我院选择安定联合氟马西尼应用于无痛胃镜检查中，并观察其临床疗效。方法 接受无痛胃镜检查患者70例，随机分为I、Ⅱ两组。I组给予丙泊酚麻醉，2mg／kg，iv；Ⅱ组给予安定0．2～0．6mg／kg梯次静脉给药，检查完毕立即给予氟马西尼0．5～1．0mg静脉注射以催醒。结果 I、Ⅱ组在麻醉后心率、清醒时间上差异无统计学。麻醉深度体动率、起效时间、术中呛咳发生率I组优于Ⅱ组。I组呼吸暂停率高于Ⅱ组。结论 虽然安定有部分缺陷，但因其安全性高等优点，一样可在临床推广。     

咪唑安定或异丙酚或联合用于腹部外科老年病人麻醉诱导

目的 研究老年人外科手术的麻醉诱导方法。方法 60例腹部外科老年病人，ASAⅠ-Ⅲ级，随机分为三组，先静注芬太尼4μg／kg，维库溴铵0．1mg／kg，A组咪唑安定0．2mg／kg，B组异丙酚1．5mg／kg，C组咪唑安定0．1mg／kg和异丙酚1．0mg／kg麻醉诱导，注药在1min内完成，气管插管。观察麻醉诱导显效时间，循环的变化；麻醉前T0，麻醉诱导后（T1），插管即刻（T2），插管后5min（T3）的PRA、AngⅡ值变化。结果 麻醉诱导显效时间C组较A组短（P〈0．05），与B组相似（P〉0．05）；与T0相比，三组PRA、AngⅡ于T1、T2、T3各时点值呈下降趋势，T1时下降明显（P〈0．05），T2时A组PRA、AngⅡ值升高显著（P〈0．05），显著高于B、C组同期值（P〈0．05）。与T0比较，A组在T2平均动脉压MAP和心率HR明显上升（P〈0．05），B组在T1MAP和HR明显下降（P〈0．05），C组循环变化轻微（P〉0．05）。血氧饱和度SPO2保持在97％～100％。结论 咪唑寄帘和导丙酚佰用县参年^麻醉诱导的理稠古法。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.