恩丹西酮不同给药方式对硬膜外自控镇痛患者术后恶心呕吐的影响

目的观察病人硬膜外自控镇痛时,不同途径应用不同剂量的恩丹西酮预防术后恶心、呕吐的疗效。方法 120例妇科择期手术患者,ASAI-Ⅱ级,以随机双盲法分为六组,分别或联合经静脉、硬膜外自控镇痛泵中给予恩丹西酮4 mg、8 mg,观察术后24 h内恶心、呕吐的发生率,并对其恶心、呕吐程度进行评分。结果应用恩丹西酮后术后恶心、呕吐的发生率降低,剂量达8 mg时效果满意。经静脉、硬膜外自控镇痛泵中各给予恩丹西酮4 mg效果最佳。结论恩丹西酮能有效预防术后恶心、呕吐,经静脉、病人硬膜外自控镇痛泵中各给予恩丹西酮4 mg的方案效果最佳。     

妇科硬膜外手术后格拉司琼和恩丹西酮预防自控镇痛恶心呕吐临床研究

目的 :探讨格拉司琼和恩丹西酮预防妇科手术后硬膜外病人自控镇痛恶心呕吐的效果。方法 :15 0例择期行妇科手术的病人 ,采用硬膜外病人自控镇痛治疗术后疼痛 ,随机分为 3组 :A组 (n =5 0 ) :在手术结束前静脉注射 0 .9%生理盐水 10ml;B组 (格拉司琼组 ,n =5 0 ) :在手术结束前静脉给予格拉司琼 3mg ;C组 (恩丹西酮组 ,n =5 0 ) :在手术结束前静脉给予恩丹西酮 8mg。每一病人观察手术后 12h和 2 4h的恶心、呕吐发生率及2 4h视觉模拟评分。结果 :术后 12h和 2 4h内格拉司琼组和恩丹西酮组恶心呕吐发生率显著低于对照组 (P <0 .0 1)。结论 :格拉司琼和恩丹西酮能安全、有效的预防妇科手术后硬膜外病人自控镇痛恶心呕吐的发生。     

三种止吐药减缓曲马多术后镇痛中呕吐的临床观察

目的 :比较甲氧氯普胺、恩丹西酮、格拉司琼与氟哌利多分别配伍曲马多术后自控硬麻外镇痛时呕吐的发生。方法 :随机将 2 0 0例ASAⅠ～Ⅱ级病人分为 4组 ,在连续硬膜外麻醉下腹部及下肢手术完毕时行自控硬麻外镇痛。Ⅰ组 5 0例曲马多 +氟哌利多作为对照、Ⅱ组 5 0例曲马多 +甲氧氯普胺、Ⅲ组5 0例曲马多 +恩丹西酮、Ⅳ组 5 0例曲马多 +格拉司琼。结果 :Ⅱ、Ⅲ、Ⅳ组恶心、呕吐发生率明显降低 ,与Ⅰ组相比差异有显著性 (P <0 0 5 )。结论 :止吐药配伍曲马多于手术后行自控硬麻外镇痛可明显抑制恶心、呕吐的发生。     

恩丹西酮预防全麻上腹部手术后恶心呕吐的临床研究

目的探讨病人硬膜外自控镇痛时,不同途径应用不同剂量的恩丹西酮预防术后恶心、呕吐的疗效。方法120例普外科择期手术患者,ASAⅠ～Ⅱ级,以随机双盲法分为两组,分别经静脉给予恩丹西酮8mg,观察术后24h内恶心、呕吐的发生率,并对其恶心、呕吐程度进行评分。结果两组患者镇痛后血压、呼吸均平稳。均有恶心、呕吐患者,但恶心、呕吐发生率及程度不同,加用恩丹西酮后恶心、呕吐发生率明显降低（P〈0．05）。结论术毕静脉注射恩丹西酮8mg更能有效预防全麻上腹部术后恶心呕吐。     

恩丹西酮不同给药方式对术后硬膜外自控镇痛恶心呕吐的预防作用

目的探讨恩丹西酮不同给药方式对术后硬膜外自控镇痛恶心呕吐的预防作用。方法120例择期行妇科手术的病人,采用硬膜外病人自控镇痛治疗术后疼痛,随机分为静脉组、硬膜外组和对照组,每组40例。静脉组在手术结束前经静脉注射恩丹西酮8mg;硬膜外组将恩丹西酮8mg溶解于硬膜外镇痛液中;对照组在手术结束前静脉注射0.9%生理盐水10ml。观察手术后12小时和24小时的恶心、呕吐发生率及24小时视觉模拟评分。结果三组24小时内VAS评分、Ramsay静评分无显著性差异(P>0.05);术后24小时内,对照组、静脉组及硬膜外组发生恶心呕吐的病例数分别为27例、11例和12例;与对照组相比,静脉组及硬膜外组术后24小时内恶心呕吐发生率显著降低(χ2=16.48,P<0.01);静脉组及硬膜外组术后24小时内恶心呕吐发生率无显著差别(P>0.05)。结论经静脉和硬膜外途径给予恩丹西酮均能安全、有效地预防妇科手术后硬膜外病人自控镇痛恶心呕吐的发生。     

曲马多及芬太尼联合用于上腹部术后静脉镇痛的观察

目的:探讨曲马多及芬太尼联合用于上腹部术后静脉镇痛的效果.方法:选择60例(ASA Ⅰ～Ⅱ级)上腹部全麻手术患者,随机分成三组,F组采用芬太尼1 mg+恩丹西酮8 mg;T组采用曲马多1000 mg+恩丹两酮8 mg;F+T组采用芬太尼0.5 mg+曲马多500 mg+思丹西酮8 mg.比较三组术后4、8、12、24、36 h VAS评分及恶心、呕吐、嗜睡、尿潴留、瘙痒等的发生率,36 h用药总量,静脉自控镇痛(PCA)有效按压次数.结果:术后4、8、12、24、36 hVAS评分三组问无统计学差异;36 h用药总量,PCA有效按压次数均相似;嗜睡、尿潴留、皮肤瘙痒发生率三组间也无统计学差异,但恶心、呕吐发生率F组和T组明显高于F+T组.F+T组曲马多及芬太尼的用量明显少于F组和T组.结论:曲马多及芬太尼联合用于上腹部术后静脉镇痛是一种简单、安全、不良反应少而又有效的镇痛方法.     

硬膜外腔注入恩丹西酮预防术后吗啡镇痛中副反应的临床观察

目的 :观察硬膜外腔注入恩丹西酮预防术后吗啡镇痛中副反应的临床效果。方法 :80例妇科手术术后48h行硬膜外吗啡镇痛 (负荷量 2mg ,维持量 8mg)病人 ,随机分为两组 :硬膜外恩丹西酮组 (实验组 ,n =40 ) ,静脉恩丹西酮组 (对照组 ,n =40 ) ,术毕分别于硬膜外腔和静脉内注射恩丹西酮 8mg ,观察术后 12 ,2 4,48h各时段恶心呕吐和皮肤瘙痒发生率。结果 :12h时段副反应发生率两组间无显著性差异 (P >0 .0 5 ) ,2 4h时段副反应发生率实验组低于对照组 ,但无显著性差异 (P >0 .0 5 ) ,48h时段副反应发生率实验组明显低于对照组 ,组间比较有显著性差异 (P <0 .0 5 )。对照组恶心呕吐及皮肤瘙痒发生率 48h内有明显增加趋势 ,组内比较有显著性差异 (P <0 .0 5 ) ,而对照组无显著变化。结论 :硬膜外腔注入恩丹西酮预防吗啡镇痛中副反应的效果优于静脉内应用     

恩丹西酮不同给药方式对术后硬膜外自控镇痛恶心呕吐的预防作用

目的 探讨恩丹西酮不同给药方式对术后硬膜外自控镇痛恶心呕吐的预防作用。方法 120例择期行妇科手术的病人，采用硬膜外病人自控镇痛治疗术后疼痛，随机分为静脉组、硬膜外组和对照组，每组40例。静脉组在手术结束前经静脉注射恩丹西酮8mg；硬膜外组将恩丹西酮8mg溶解于硬膜外镇痛液中；对照组在手术结束前静脉注射0．9％生理盐水10ml。观察手术后12小时和24小时的恶心、呕吐发生率及24小时视觉模拟评分。结果 三组24小时内VAS评分、Ramsay静评分无显著性差异（P〉0．05）；术后24小时内，对照组、静脉组及硬膜外组发生恶心呕吐的病例数分别为27例、11例和12例；与对照组相比，静脉组及硬膜外组术后24小时内恶心呕吐发生率显著降低（χ^2=16、48，P〈0．01）；静脉组及硬膜外组术后24小时内恶心呕吐发生率无显著差别（P〉0．05）。结论 经静脉和硬膜外途径给予恩丹西酮均能安全、有效地预防妇科手术后硬膜外病人自控镇痛恶心呕吐的发生。     

恩丹西酮不同给药模式预防妇科术后PCIA恶心呕吐的效果

目的 比较恩丹西酮不同给药模式对预防妇科术后芬太尼PCIA恶心呕吐的效果. 方法 随机选择120例择期妇科手术病人(ASAI-Ⅲ级),选择术后芬太尼PCIA镇痛.随机分四组且每组各30例:A组,用芬太尼复合咪唑安定加生理盐水至100ml于泵中,A组为对照组;B组,在A组基础上将8 mg恩丹西酮加入泵中;C组,在开启PCLA(A组配方)前10min缓慢静脉注入8 mg恩丹西酮;D组,在开启PCIA(A组配方)前10 min缓慢静脉注入4 mg恩丹西酮,并将4 mg恩丹西酮加入泵中.观察并记录各组在启动PCIA镇痛4,8,12,24,42 h各时点恶心呕吐评蕉、疼痛视觉评分、镇静评分. 结果 四组病人恶心呕吐不同时间之间比较有统计学差异(P<0.05).在使用PCIA后相同时点,A组病人恶心呕吐率最高,D组病人恶心呕吐率最低.A、B、C、D各组疼痛视觉评分、镇静评分差异无统计学意义(P>0.05). 结论 恩丹西酮负荷量给药,同时在镇痛泵中加入恩丹西酮可以有效地减少术后PCIA恶心呕吐.     

恩丹西酮预防经皮肾穿刺取石患者寒战效果观察

目的观察椎管内麻醉时静脉给予恩丹西酮对经皮肾穿刺取石(PCNL)患者寒战的预防效果。方法在腰麻-硬膜外联合阻滞下行PCNL患者90例,ASAⅠ~Ⅱ级,随机分成恩丹西酮组、曲马多组和对照组,每组30例,麻醉前开放静脉通路,恩丹西酮组给予恩丹西酮8 mg,曲马多组给予曲马多50 mg,对照组给予盐水10 m l,观察记录患者术中寒战发生的情况,并持续监测呼吸、循环变化。结果恩丹西酮组(10%)和曲马多组(6.67%)寒战发生率明显低于对照组(46.67%,P<0.05),3组围手术期呼吸循环变化比较无显著性差异(P>0.05);恩丹西酮组(3.33%)术中恶心、呕吐的发生率明显低于对照组(23.33%)和曲马多组(26.67%,P<0.05),而曲马多组与对照组比较无显著性差异(P>0.05)。结论麻醉前预先静脉注射恩丹西酮可以预防PCNL患者寒战的发生,并可降低术中恶心、呕吐的发生率。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.