氯胺酮复合咪达唑仑全凭静脉麻醉在地震创伤清创术中的应用

目的 观察氯胺酮复合咪达唑仑全凭静脉麻醉在地震创伤清创术中的应用效果.方法 因地震创伤急需行清创术的伤员56例,随机分为两组,氯胺酮复合味达唑仑组(KM组)和氯胺酮组(K组).KM组依次静脉注射咪这唑仑0.02～0.05mg/kg、氯胺酮1～2mg/kg,K组静脉注射氯胺酮1～2mg/kg,术中据情况追加氯胺酮0.5～1mg/kg.观察记录两组伤员术中平均动脉压(MAP)、心率(HR)、呼吸频率(R)及脉搏血氧饱和度(SpO2)的变化,记录诱导及苏醒时间,以及术中和术后发生不良反应的情况.结果 K组伤员在麻醉后各观察点MAP及HR均较麻醉前显著升高(P＜0.05),而KM组与麻醉前比较差异无统计学意义;两组诱导时间和苏醒时间差异无统计学意义.KM组术中肢体运动、术后恶心、呕吐的发生率明显比K组低(P＜0.05).结论 氯胺酮复合咪达唑仑全凭静脉麻醉可为地震创伤清创术提供一种安全、快捷、易于管理的麻醉方法.     

喉罩-雷米芬太尼复合丙泊酚在小儿微创手术中的应用

目的 比较喉罩-雷米芬太尼联合丙泊酚与喉罩-氯胺酮联合咪达唑仑两种麻醉方法在小儿腹腔镜疝囊高位结扎术中应用的优缺点.方法 64例择期行腹腔镜疝囊高位结扎术患儿,随机均分为喉罩-雷米芬太尼联合丙泊酚组(雷米芬太尼组)与喉罩-氯胺酮联合咪达唑仑组(氯胺酮组).静脉快速诱导置入喉罩后,雷米芬太尼组静脉泵入雷米芬太尼0.15μg/kg·min及丙泊酚6～8 mg/kg·h维持麻醉,氯胺酮组患者静脉泵入氯胺酮0.08～0.1 mg/kg·min及咪达唑仑0.15～0.2 mg/kg·h维持麻醉.记录患者术中生命体征、苏醒时间、术中及术后并发症发生情况.结果 麻醉诱导后雷米芬太尼组平均动脉压(MAP)及心率(HR)明显低于麻醉前水平(P<0.05),而氯胺酮组不明显,腹腔充气后,两组MAP及HR比充气前上升明显(P<0.05)而氯胺酮组上升更明显.雷米芬太尼组苏醒时间明显短于氯胺酮组(P<0.05),且氯胺酮组术中肢动、呛咳屏气及术后躁动明显多于雷米芬太尼组(P<0.05).结论 喉罩-雷米芬太尼联合丙泊酚用于小儿腹腔镜微创手术具有诱导苏醒迅速、血流动力学相对平稳,且不良反应少等优点.     

氯胺酮复合瑞芬太尼和咪达唑仑用于小儿全凭静脉麻醉

目的：探讨氯胺酮复合瑞芬太尼和咪达唑仑在小儿全凭静脉麻醉中的应用。方法：选择56例ASAⅠ～Ⅱ级择期手术患儿．入手术室后分别静注负荷剂量氯胺酮0．3mg／kg、瑞芬太尼0．1μg/k、咪达唑仑0．05mg／kg全凭静脉麻醉。结果：患儿术中安静入睡,镇痛完善（镇静评分在5分以上）。术中呼吸循环功能稳定,术毕苏醒时间缩短。结论：氯胺酮复合瑞芬太尼和咪达唑仑用于小儿全凭静脉麻醉是较好的麻醉方法：     

微泵静注氯胺酮-丙泊酚在烧伤微粒植皮手术中的效果

目的：探讨氯胺酮复合丙泊酚微泵静脉麻醉用于烧伤微粒植皮手术的麻醉效果。方法：选择择期行微粒植皮手术的特重度烧伤患者42例,ASAⅡ～Ⅲ级,烧伤总面积52%～75%TBSA,手术切痂面积20%～35%TBSA。随机分为2组,一组采用氯胺酮与咪达唑仑分次静脉给药（KM组）,另一组采用氯胺酮复合丙泊酚微泵持续静脉给药（KP组）,术中观察并记录不同时间点血流动力学变化、手术时间、术毕苏醒时间、氯胺酮总用量及术中、术后不良反应。结果：组内比较,KP组术中T1～6时的MAP,HR,SPO2与T0时比较差异无统计学意义（P〉0.05）。KM组T1～6时的MAP,HR与T0时相比升高（P〈0.05）;术中T1～6时的SPO2与T0时比较差异无统计学意义（P〉0.05）。组间比较,KP组在T1,T4,T5,T6时MAP与KM组相比降低（P〈0.05）;KP组在T2,T3,T4,T5时HR与KM组相比减慢（P〈0.05）。术中氯胺酮用量、术毕至苏醒时间KP组比KM组用量少,时间短,差异有统计学意义（P〈0.05）。KM组术中不自主肢体运动、术后嗜睡、梦幻现象与KP组比较差异有统计学意义（P〈0.05）。结论：氯胺酮复合丙泊酚微泵静脉麻醉用于烧伤微粒植皮手术的效果优于氯胺酮与咪达唑仑分次静脉麻醉。     

不同麻醉方式在小儿腹股沟区小手术中的应用比较

目的比较丙泊酚咪达唑仑联合骶管阻滞和氯胺酮复合丙泊酚咪达唑仑在小儿腹股沟区短小手术中应用的有效性和安全性。方法选择小儿(1～6岁)腹股沟区短小手术60例,随机分为A、B两组各30例,A组行丙泊酚咪达唑仑联合骶管阻滞麻醉,B组行氯胺酮复合丙泊酚咪达唑仑麻醉,记录麻醉诱导前T0、诱导后1minT1、切皮时T2、手术开始10minT3、术毕时T4心率(HR)、收缩压(SBP)、舒张压(DBP)、动脉氧饱和度(SpO2),术毕后苏醒时间以及不良反应。结果两组患者呼吸均比较平稳,均能顺利完成手术,但A组循环较B组平稳(P<0.05),苏醒时间短于B组(P<0.05),不良反应发生也低于B组(P<0.05)。结论两种麻醉方式均能安全有效应用于小儿腹股沟区小手术,相对而言,丙泊酚咪达唑仑联合骶管阻滞比氯胺酮复合丙泊酚咪达唑仑术中循环更平稳,苏醒时间更短,不良反应更少见。     

丙泊酚与咪达唑仑复合氯胺酮用于小儿心导管术麻醉的比较

目的 比较丙泊酚与咪达唑仑复合氯胺酮用于小儿心导管术麻醉的优缺点与安全性。方法 2～12岁先天性心脏病行心导管术的患儿60例,随机分为两组,入室时静脉注射氯胺酮2 mg/kg行基础麻醉,P组采用丙泊酚6 mg/（kg.h）复合氯胺酮3 mg/（kg.h）维持,M组采用咪达唑仑0.15 mg（/kg.h）复合氯胺酮3 mg/（kg.h）维持。结果 两组患儿性别、年龄、体重、术式及手术时间差异无统计学意义,血流动力学不稳定、呼吸支持及体动发生率差异无统计学意义,清醒时间P组（15.9±5.4）min短于M组（21.2±5.9）min（P<0.05）。结论 丙泊酚与咪达唑仑复合氯胺酮均能安全有效地进行小儿心导管术的麻醉,而丙泊酚复合氯胺酮麻醉患儿苏醒更加迅速。     

小剂量咪达唑仑对丙泊酚静脉麻醉中循环功能及术后苏醒的影响

目的：探讨小剂量咪达唑仑对丙泊酚静脉麻醉中循环功能及术后苏醒的影响。方法：选择ASAⅠ—Ⅱ级行择期手术病人40例,随机分成丙泊酚麻醉组（A组）、咪达唑仑丙泊酚麻醉组（B组）2组,每组20例。术前30min肌注阿托品0．5mg,苯巴比妥钠0．1g。A组给予芬太尼100μg,丙泊酚2mg／kg,阿曲库铵0．6-0．8mg／kg诱导,B组咪芬合剂（咪达唑仑2mg,芬太尼100μg）,丙泊酚2．0mg／kg,阿曲库铵0．6-0．8mg／kg诱导,然后观察其麻醉过程循环功能及麻醉后苏醒情况。结果：麻醉诱导时A组意识消失时间长于B组（P〈0．05）,术中B组病人循环功能较A组稳定（P〈0．05）,麻醉后苏醒时间较A组长（P〈0．05）,两组病人术后不良反应均较轻。结论：小剂量咪达唑仑复合丙泊酚静脉麻醉优于单纯异丙酚静脉麻醉。     

右美托咪定复合氯胺酮在女性乳房肿块切除术中的应用

目的：观察右美托咪定（Dex ）复合氯胺酮在女性乳房肿块切除术中的麻醉效果。方法将30例择期乳房肿块切除术患者分为A组和B组,每组15例,A组静脉注射咪达唑仑2．0mg,芬太尼0．1mg和氯胺酮2．0mg/kg,术中持续泵注丙泊酚5．0 mg?kg －1?h－1;B组注射负荷剂量Dex 0．5μg/kg（注射时间10 min）,持续泵注维持量0．2μg?kg －1?h－1,静脉注射氯胺酮2．0 mg/kg。常规监测心率（HR）、平均动脉压（MAP）和血氧饱和度（SPO2）,记录患者苏醒时间、术后1 h视觉模拟评分法（VAS）评分及Ramsay评分;记录相关不良反应。结果与A组相比,B组患者围术期HR、MAP降低（P＜0．05）;两组SPO2比较,差异无统计学意义（P＞0．05）;B组患者术后苏醒时间短于A组（P＜0．05）;两组患者术后1 h VAS评分及Ramsay评分比较,差异无统计学意义（P＞0．05）;B组患者呼吸抑制及舌后坠发生率低（P＜0．05）。结论 Dex复合氯胺酮用于女性乳房肿块切除术,麻醉效果确切,不良反应少。     

丙泊酚复合氯胺酮和芬太尼用于小儿静脉麻醉临床观察

目的:对比丙泊酚、氯胺酮复合芬太尼和咪达唑仑、氯胺酮复合芬太尼用于小儿全身静脉麻醉时的血流动力学变化、苏醒时间、有效性和安全性。方法:将160例ASAⅠ~Ⅱ级择期手术患儿随机分为两组,丙泊酚组(A组,n=80)和对照组(B组,n=80)。A组采用丙泊酚、氯胺酮复合芬太尼麻醉,B组采用咪达唑仑、氯胺酮复合芬太尼麻醉。两组患儿入室前均给予氯胺酮1~2mg/kg静注,安静入睡后入室。A组术中维持用丙泊酚0.16mg/(kg·min)持续输注,芬太尼1~2μg/kg、手术开始前1min静注氯胺酮2mg/kg,B组依次静注咪达唑仑0.05~0.1mg/kg、芬太尼1~2μg/kg、氯胺酮1mg/kg全凭静脉麻醉。记录围麻醉期血流动力学、血氧饱和度、麻醉后恢复情况。结果:A组麻醉前与麻醉后血流动力学比较,差异无统计学意义。B组麻醉前与麻醉后血流动力学比较,差异有统计学意义。A组麻醉苏醒时间短,且术中体动发生几率小,两组比较,差异有统计学意义。结论:丙泊酚、氯胺酮复合芬太尼可在小儿全凭静脉麻醉中维持血流动力学稳定、苏醒快速、术后躁动少是安全有效的麻醉方法。     

高血压病人无痛胃镜检查50例麻醉体会

目的观察异丙酚复合咪达唑仑行无痛胃镜检查的高血压病人麻醉时心血管不良反应的效果。方法 50例ASAⅠ-Ⅱ级高血压病人要求无痛胃镜检查,随机分为两组异丙酚（A组）、异丙酚复合咪达唑仑组（B组）。观察各组麻醉前、麻醉后2min、胃镜检查后2min,苏醒时SBP、DBP、HR、SPO2以及麻醉药用量、检查中体动、呛咳及检查后不良反应。结果异丙酚复合咪达唑仑为高血压病人行胃镜检查时良好选择。     

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.