早期颅骨修补对脑血流动力学参数的影响

目的 探讨早期颅骨修补手术前、后病人脑血流动力学参数的变化,为早期颅骨修补提供理论依据.方法 对16例早期行颅骨修补手术病人,应用多普勒超声技术,在颅骨修补前1～2 d和术后7～10 d检测大脑前、中、后动脉的血流变化,记录双侧动脉的峰值流速（Vp）、舒张末期流速（Vd）、平均流速（Vm）,并评价神经功能恢复情况.结果 术前颅骨缺损侧的血流速度明显降低（t=2.34～3.05,P〈0.05）,健侧接近正常;术后颅骨缺损侧血流速度提高并接近正常（t=2.57～3.29,P〈0.05）,神经功能也明显恢复.结论 早期颅骨修补能够改善脑血流动力学参数紊乱,促进神经功能恢复.     

EFFECT OF THE INJECTION OF BILE ON THE CIRCULATION

1. We have confirmed previous work which shows that the injection of bile increases the tone of the vagus nerve, and that this action can be abolished after the administration of atropine. 2. We have found that the amount of bile salts in a lethal dose of pig''s bile for dog''s will, if inejcted alone, produce neither a fall in blood pressure nor a slowing in rate. 3. We have found that the amount of pigment in a lethal dose of the bile will, if injected alone, cause death with slowing of the heart and lowering of blood pressure. 4. We have found that the bile pigment in combination with calcium or sodium is less toxic than uncombined pigment. 5. We have found that in experimentally produced jaundice the calcium content of the blood is increased, while that of the liver, muscle and brain are decreased. 6. We are of the opinion that increase in calcium in the blood is a protective mechanism against the circulating pigments of obstructive jaundice.     

THE EFFECT OF PEPTONE ON THE PERIPHERAL CIRCULATION

1. Injection of a solution of peptone directly into the artery of the leg of a dog is followed by an abrupt increase in leg volume. This is of short duration and is quickly followed, usually in less than ½ minute, by a decrease in the volume of the limb below that previous to the injection. 2. The phases of the leg volume curve bear a fairly definite relation to the changes in arterial pressure. 3. These results, therefore, indicate that the long continued low arterial pressure in peptone shock, and probably in anaphylactic shock, may be hastened but is not maintained by peripheral dilatation, and suggest that there is an impounding of the blood in some other part of the body.     

THE EFFECT OF HEMATIN ON THE CIRCULATION AND RESPIRATION

1. Doses of less than six milligrams of hematin and, under certain conditions, larger doses may cause a slight rise of blood pressure. 2. Large doses of hematin cause a profound and prolonged fall of blood pressure. The principal factor in this fall of blood pressure is the marked dilatation of the splanchnic vessels. The splanchnic dilatation either does not occur at all or but very slightly if the splanchnic nerves are cut. The splanchnic dilatation is partly compensated for by a marked constriction of cutaneous vessels and it seems probable that the cutaneous constriction is active and not simply passive to the splanchnic engorgement. 3. Hematin acts upon the cardio-inhibitory center causing a marked slowing of the rate of heart-beat, and in large doses produces a typical vagal pulse or even marked irregularities in the amplitude and rhythm of the pulse. Under hematin the heart at first shows great loss of tone but later the tone increases beyond the normal. The cardiac output for a time is greatly diminished. 4. In the large doses employed by us, hematin depresses the respiratory center and death under hematin is due to paralysis of this center.     

七氟醚与异丙酚麻醉BIS为50时血流动力学参数变化

目的以脑电双频指数（BIS）50±5作为麻醉深度的监测指标,观察3种不同麻醉方法对血流动力学参数变化的影响。方法选择60例择期行上腹部手术的病人,随机分为3组：七氟醚吸入麻醉组（S组）、异丙酚静脉麻醉组（P组）、七氟醚和异丙酚复合麻醉组（C组）。术中维持BIS为50±5,血压和心率波动均不超过基础值的±30%,记录麻醉诱导后到手术探查结束期间不同时点血流动力学参数和BIS值。结果麻醉诱导后3组BIS、收缩压（SBP）和平均动脉压（MAP）均显著下降（F=4.14~19.29,q=8.05~12.31,P〈0.01）,HR在诱导后变化不明显;插管即刻,HR和SBP均上升,且P组、S组上升高于C组,差异有显著性（q=3.09~5.01,P〈0.05）。插管6 min至探查前3组HR、SBP变化差异无显著性（P〉0.05）;探查时,P组、S组HR和SBP上升明显高于C组,差异有显著性（q=3.44~4.67,P〈0.05）。结论维持BIS=50±5时,采用七氟醚和异丙酚（1 mg/L）静吸复合麻醉可使血流动力学参数波动更平稳。     

多模式镇痛对妇科腹腔镜手术芬太尼用量及血流动力学的影响

目的:通过比较多模式镇痛全身麻醉与传统模式镇痛全身麻醉,明确多模式镇痛对妇科腹腔镜术中芬太尼用量及血流动力学的影响。方法:回顾分析北京协和医院2016年9月至12月因为妇科良性疾病接受腹腔镜手术治疗的病人100例,其中33例(多模式镇痛组,M组)全身麻醉采用了联合应用芬太尼、瑞芬太尼、非甾体抗炎药(non-steroidal antiinflammatory drugs,NSAIDs)及持续静脉输注利多卡因(continuous intravenous injection of lidocaine,IVIL)等药物的多模式镇痛(multimodal analgesia,MMA)方案,67例(对照组,C组)全身麻醉采用芬太尼单一镇痛药物的传统模式镇痛方案。比较两组的芬太尼用量以及病人入室时(T_0)、麻醉诱导后即刻(T_1)、手术开始即刻(T_2)、手术结束即刻(T_3)、拔管后即刻(T_4)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)值。结果:与C组比较,M组病人术中芬太尼用量明显减少(P<0.05),M组T_2~T_4的SBP和HR,T_2和T_4的MAP,T_4的DBP均显著降低(P<0.05);与T_0比较,M组T_1时SBP、DBP、MAP显著降低(P<0.05),随后无统计学差异;C组T_1时SBP、DBP、MAP显著降低(P<0.05),T_2和T_4的SBP和MBP、T_3的DBP及T_2~T_4的HR显著升高(P<0.05)。结论:对于妇科腹腔镜手术病人,术中采用联合应用芬太尼、瑞芬太尼、非甾体抗炎药及持续静脉输注利多卡因等药物的多模式镇痛可以减少术中芬太尼用量并有利于维持术中血流动力学的稳定。     

血浆代用品血定安和林格氏液对机体血流动力学影响的比较观察

目的：比较血定安和林格氏液对机体血流动力学的影响。方法：选择２０例硬膜外阻滞下行子宫切除术的患者,在平面固定于Ｔ_６－Ｓ后分为血定安组（组Ⅰ）和林格氏液组（组Ⅱ）,用无创性连续心排血量监测仪（ＢＯＭＥＤ－ＮＣＣＯＭ－３）测定血流动力学数值。结果：两组患者心排血量（ＣＯ）、心脏指数（ＣＩ）、每搏量（ＳＶ）和每搏指数（ＳＩ）等指标在硬膜外阻滞平面固定后均有明显下降。但在组Ⅰ快速输注血定安 ５００ｍｌ后这些指标均有显著意义的上升（ｐ＜０． ０５）,而组Ⅱ输注林格氏液１０００ｍｌ后则没有出现明显的上升。结论：在硬膜外阻滞后血定安扩容效果比林格氏液好。     

内镜下静脉结扎术治疗食道静脉曲张出血及其对门静脉系血流动力学影响

该文报告应用内镜下静脉结扎术治疗门静脉高压症所致食道静脉曲张出血４１例。其中２２例活动性出血者结扎后２１例出血停止，即刻止血率９５．４５％，３３例食道静脉曲张完全清除或减轻至Ⅱ度以下，有效率８０．４９％。２５例在结扎治疗前后用彩色多普勒监测门静脉系统血流变化。门静脉血流量、脾静脉血流量、肠系膜上静脉血流量的术前术后变化无显著性差异（Ｐ＞０．０５）。此方法能阻断胃左静脉－奇静脉－腔静脉这条出血性侧枝，从而控制或预防食道静脉曲张出血。对门静脉系统血流量无明显影响，对肝功能无损害。该法疗效肯定、安全，操作简单，适应证广泛，是对肝功能不良不能耐受手术者或开腹手术后复发出血者的最佳治疗方法之一。该方法不能减低门静脉阻力也不能改善门静脉高血流状态，故有与时间延长相伴增长的较高复发率，强调定期随诊和跟踪治疗     

THE EFFECT OF PROLONGED APPLICATION OF LARGE DOSES OF FOLLICULAR HORMONE ON THE UTERUS OF RABBITS

Follicular hormone under physiological conditions produced hyperplasia of the muscular wall and proliferation of the mucous membrane of the uterus of rabbits. The following pathological changes were brought about by prolonged application of large doses of the hormone: (a) hyperaemia of the myometrium and the endometrium, with occasional scanty extravasal haemorrhages; (b) glandular-cystic hyperplasia of the endometrium; (c) infarct-like necrosis of the myometrium; (d) aseptic suppuration in the uterine cavity. These four processes can sometimes be found simultaneously in the same uterus, but they occur more frequently in sequence. While follicular hormone, applied in physiological doses, has a stimulating effect, prolonged application of large doses destroys the uterus. The effects described above were only to be observed in the rabbit, not in the rat. This illustrates the fact that hormone reactions may vary in different species.     

ON THE ACTION OF SUBSTANCES OF THE DIGITALIS SERIES ON THE CIRCULATION IN MAMMALS

In summing up the contents of the preceding pages it may be stated that the action of digitalis has been divided into two stages according to the changes evinced by the ventricles under its influence; of these the first is characterized by marked inhibitory action together with modification of the cardiac muscle, while in the second the inhibitory action is less marked and the muscular action becomes the more prominent feature. The inhibitory action is due to direct stimulation by this series of the pneumogastric centrally in the medulla oblongata and peripherally in the heart. The extent to which the inhibitory mechanism is stimulated varies in different animals and with different members of the digitalis series. The muscular action of small quantities betrays itself in a tendency to increase the extent of the contraction, while in some cases the degree of relaxation reached in diastole is also lessened by it. In larger quantities the series increases the irritability of the cardiac muscle very considerably, and the spontaneous rhythm of the ventricles therefore becomes developed. Through the interaction of these two factors in the first stage the rhythm of the whole heart is slowed, the contraction of the ventricle is more complete, and the diastolic relaxation is generally increased, although it may be unchanged or lessened. The systolic pressure is increased and the fall from maximum to minimum pressure is slower than normal owing to the increased completeness and longer duration of systole (Rolleston). The auricles generally contract with less force and may relax more completely than normally. Sometimes, however, their contractions also are more complete than before the injection of the drug. This latter condition generally precedes the diminution of the force of the auricular contraction. This variation of the effects of digitalis in the auricle explains the changes in intra-auricular pressure noted by Kaufmann. The contraction volume of the ventricles is always much increased, and the output per unit of time is generally augmented, and this together with the contraction of the peripheral arterioles causes an increase in the tension in the systemic circulation, an acceleration of the circulation, and possibly a temporary increase in the pressure in the great veins and in the auricle and ventricle in diastole (Kaufmann). The pressure in the pulmonary artery is practically unaffected by some members of the series, while by others it is considerably increased. This difference in the reaction of the pulmonary circulation is due to the varying extent to which these drugs act on the peripheral arteries and not to any difference in their action on the two sides of the heart. If the inhibitory action be very strongly marked the slowing of the heart may be extreme, the ventricles assuming their own spontaneous rhythm and all connection with the auricles being lost. While the contraction volume of the ventricle is still greater than normal, their output per unit of time may become less than normal, the aortic tension therefore fall and the rapidity of the circulation be lessened. The ventricles maintain their association throughout, and probably the rhythm of the two auricles also remains equal. The ventricular rhythm, however, becomes irregular owing to the variation in the duration of the diastolic pause. The auricles may cease altogether in diastole, or may continue to beat with a slower or faster rhythm than the ventricles. During the second stage the rhythm of the heart becomes accelerated owing to the increased irritability of the heart muscle. The ventricle tends to assume a rapid spontaneous rhythm, while the auricular rhythm is also quicker than in the first stage. When these two rhythms interfere by the passage of impulses across the auriculo-ventricular boundary in either direction, irregularity of the heart is produced, generally bearing a distinctly periodic character. The ventricles continue to maintain their common rhythm, while the auricles and ventricles may contract at quite different rates. The two ventricles, however, do not necessarily contract with equal force, and the contractions of one may present periodic variations in strength, while those of the other may be almost perfectly uniform. The contractions of the auricles vary in the same way as regards each other and the ventricles. The inhibitory nerves are no longer able to slow the ventricular rhythm, but may affect the completeness of systole and diastole in the ordinary way. The auricular contractions can still be lessened in force and possibly be abolished by their stimulation, and the impulses passing between the auricle and ventricle may therefore be blocked and regularity of the heart produced by powerful inhibition. The irregularity of the contractions is therefore due indirectly to the increased irritability of the cardiac muscle and the acceleration must be attributed to the same cause. An extreme phase of this stage produced by the interference of the rhythms is a temporary standstill of one of the chambers, generally the auricle. The irregularity leads to a lessened efficiency of the work of the heart. The output varies extremely in successive observations and the contraction volume of every individual beat may differ. The various chambers often show a tendency to dilate during this stage. The blood pressure in the systemic arteries at first remains high, in fact may be higher than in the first stage owing to the increased rapidity of the heart rhythm, but afterwards falls continuously as the periodic variations become shorter in duration. The auricles generally cease contracting before the ventricles, but not invariably. There is no fixed order in the cessation of the ventricles or auricles. Each division comes to a standstill in a position somewhat nearer diastole than systole and then passes into delirium and dilates to the fullest extent.     

急诊体外循环在心血管手术中的应用

目的　总结应用急诊体外循环抢救和治疗重危心血管病患者的经验。方法　 2 9例重危患者均在全麻体外循环下行紧急心血管手术 ,其中 5例采用常温左心辅助转流 ,其余采用中低温中、高流量灌注 ;上下腔静脉 主动脉转流 16例 ,上下腔静脉 股动脉转流 7例 ,左心房 股动脉转流 4例 ,股动脉 股静脉转流 2例。术中采用温血顺、逆灌等多种心肌保护方法。结果　全组快速建立体外循环的时间为 10～ 15min ,总体外循环时间 78～ 186min ,主动脉开放后自动复跳率 86%。手术早期死亡 3例 ,死亡率 10 3 4 % ,余 2 6例痊愈出院。结论　对心衰难以控制 ,全身重要脏器面临不可逆损害的患者ECC的使用应采取积极态度 ,尽早通过体外循环纠正原发病变 ,快速建立体外循环以股动、静脉插管为首选 ,体外循环管理强调“快”的同时不能忽视对并发症的预防