小儿巨大纵隔肿瘤切除术的麻醉及围术期处理

目的:总结小儿巨大纵隔肿瘤手术麻醉及围术期处理的临床经验.方法:6例巨大纵隔肿瘤手术,采用气管内插管静吸复合麻醉,分析术中情况、低氧血症及失血情况.结果:6例患儿中,1例麻醉手术经过顺利,2例术中发生血流动力学急剧变化;麻醉手术期间发生脉搏氧饱和度(SpO2)、呼气末二氧化碳分压(PET CO2)降低4例,经积极处理后均恢复正常;6例患儿术后恢复良好,痊愈出院.结论:充分的术前评估和严密的术中监护和管理,术后进一步呼吸和循环功能支持,是保证纵隔肿瘤患儿安全度过麻醉及围手术期的关键.     

小儿喉蹼患者麻醉诱导期的管理

目的 探讨小儿喉蹼患者的最佳麻醉管理.方法 回顾性分析我院2009年12月至2013年3月经纤维喉镜、颈部X线或薄层CT确诊喉蹼的24例小儿患者的麻醉管理.结果 所有患儿在术前均有不同程度的呼吸困难,手术的目的是解决通气问题.气管切开13例,其中6例术前先局麻下行气管切开后全麻,7例全麻插管后行气管切开;未行气管切开11例,直接在全麻下行气管内插管.诱导方式:快诱导经气管切口插管6例,快诱导经口插管7例,保留自主呼吸浅全麻诱导10例,1例先采用保留自主呼吸浅全麻诱导,第1次经口喉镜明视下插管失败后,面罩通气良好的情况下,改用快诱导,换管第3次插管成功.插管成功率:5例一次插管成功,10例两次插管成功,3例三次插管成功,平均插管时间12 min.所有患儿均未出现诱导期缺氧,但有13例呼气末二氧化碳分压(PetCO2)明显偏高.所有患儿均安全完成麻醉诱导.结论 术前充分的气道评估、完善的麻醉前准备及良好的团队协作是先天性喉蹼患儿围术期麻醉管理的关键.小儿喉蹼作为已预料的困难气道推荐选用保留自主呼吸浅全麻比较安全.     

小儿麻醉方法与气管插管

由于小儿呼吸道解剖、生理的特点,多年来临床麻醉医生在患儿全麻中选择气管插管与否看法各异.气管插管不是麻醉的目的,是呼吸管理的一种手段,与麻醉方法一样.实际操作时两者如何选择需从医患双方因素考虑.医方:医院的麻醉药品、设备、气管插管等相应器材的状况;麻醉医生所具备相关技术的熟练程度及处理相关问题的能力、经验、安全系数;外科手术对麻醉的要求(肌松、特殊体位等);外科操作部位是否干扰患儿呼吸道,若发生呼吸意外,麻醉医生处理呼吸道时是否会对手术区的无菌环境构成污染.患方:患儿所接受的手术大小、时间长短,出血量及液体出入量多少以及对机体内环境的影响;患儿术前全身状况、估计术中术后是否必须呼吸支持;患儿罹患呼吸道疾病时,气管插管带来的负面影响大,还是全麻手术时不插管气道管理的风险更大.……     

先天性食管裂孔疝修补术的麻醉处理

目的：总结先天性食管裂孔疝修补术的麻醉选择与处理经验。方法：收集先天性食管裂孔疝修补术27例，其中胸入路12例选择气管插管静吸复合全麻，经腹入路15例气管插管静吸复合全麻 连硬外麻，术中常规监测ECG、Bp、Sp02、Vt、VE、EtC02、尿量，部分患儿监测Abp、CVP及血气。结果：除1例因合并先天性肺发育不良，术后4h死亡，2例肺不张经治疗恢复正常外，其余均恢复良好，麻醉满意。结论：术前须积极治疗并发症，改善患儿全身状况，提高患儿对麻醉和手术的耐受性；麻醉方法选择气管插管静吸复合全麻，经腹入路复合连硬外麻；术中加强监测和管理，确保呼吸和循环平稳，避免体温过低。     

1 225例次小儿复发性喉乳头状瘤激光手术麻醉的临床分析

目的总结分析该院20余年来儿童喉乳头状瘤病例围术期气道管理,以指导临床实践,提高患儿围术期的安全性。方法回顾性总结在本院接受手术治疗的患儿289例,共接受1 225次手术。根据肿瘤的位置和气道阻塞的程度分级。结果根据气道梗阻程度和部位不同,选择不同的麻醉诱导方法。术中使用肌松剂,采用静吸复合或全静脉麻醉。对于声门下乳头状瘤,术中间断呼吸暂停辅以喷射通气。结论对于大多数患儿,经验丰富的麻醉医师可采用快速诱导气管内插管。术中处理声门下肿瘤时,间断辅以呼吸暂停和喷射通气。麻醉、手术医师和护士的合作非常重要。     

气管支气管成形术的围术期麻醉管理

目的 探讨气管支气管肿瘤患者行气管支气管成形术的围术期麻醉管理方法.方法 回顾性总结了12例气管支气管肿瘤患者行气管支气管成形术围术期麻醉管理情况.根据肿瘤位置、气道阻塞程度和手术方式选择适当的麻醉方法.芬太尼和咪唑安定进行镇痛镇静,并对咽喉进行表面麻醉后行气管插管.术中应用异丙酚、芬太尼全凭静脉维持麻醉,通过经口插入的气管导管与手术者插入支气管的气管导管进行术中呼吸管理,两肺单独通气以达到最佳的通气效率.其中1例严重气管阻塞患者在麻醉诱导前先进行部分体外循环.结果 在手术期间,有4例术中发生SpO2＜90%,通过对气道分泌物充分吸引和(或)手控呼吸可恢复正常.所有患者术后均送入ICU,有5例患者在术后即拔管,其余7例均在术后24h内拔出.所有患者均无麻醉相关并发症.结论 充分的术前评估、麻醉医生与手术医生的广泛合作以及精细的麻醉管理方法在气管支气管成形术中具有重要作用.辅助体外循环的麻醉是严重气管阻塞患者围术期麻醉管理的一种有效方法.     

婴幼儿气管插管全麻处理20例

0　引言　婴幼儿患者体质娇小 ,发育未成熟 ,麻醉及手术耐受性差 ,气管插管和手术体位及方式对患儿各生命指征的影响给麻醉操作和术中管理提出了更高的要求 .我们总结了我科近来完成的 2 0例婴幼儿气管插管全麻的处理经验 .1　临床资料　患儿 2 0 (男 1 4 ,女 6 )例 ;年龄 35d～ 3岁 ;体质量 3～ 1 4kg;ASAⅡ Ⅲ级 ,其中先天性幽门肥厚梗阻 6例 ,纵隔囊肿 6例 ,肠套叠 4例 ,颈部淋巴管瘤 3例 ,腭裂术后出血 1例 .术前 30min常规肌注东莨菪碱 0 .0 1mg·kg-1 、咪唑安定0 .1mg·kg-1 ,全部患儿入室前im氯胺酮 5～ 8mg·kg-1 ,入睡后抱入手…     

新生儿手术的麻醉分析与体会

通过21例新生儿实施手术麻醉的体会，不断总结麻醉经验，提高新生儿麻醉的安全性。方法：16例行静吸复合麻醉气管插管术、5例静脉全麻末行气管插管下完成手术。结果：除2例分别在术后第5天、第8天死亡之外，其余患儿均康复出院。结论：做好围术期工作，准确评估病情、选择恰当麻醉方法及用药，严格的呼吸管理和循环监测、保暖以及控制输液是新生儿手术成功的关键。     

新生儿腹部手术的麻醉处理

总结127例新生儿腹部手术的麻醉处理方法，其中基础复合骶管麻醉51例，气管插管加骶管麻醉32例，静吸复合全麻44例。认为手术部位、术前循环系统及呼吸系统状况是选择不同麻醉方法的主要根据；术前准备充分、术中加强呼吸管理并注意保暖是保证患儿麻醉平稳的关键。     

气管切开术后患者再次手术的麻醉体会

目的 分析气管切开术后患者再次全麻手术时麻醉插管术.方法 气管切开患者再次手术25例,麻醉方式均选择气管插管全麻.结果 24例麻醉顺利,保证了手术完成.结论 麻醉前医生要认真检查患者的气管切开情况,严格评估患者,做好充分准备,制定合理有效的麻醉麻方案,积极配合.     

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.