不同剂量丙泊酚复合瑞芬太尼在经鼻纤维支气管镜插管中的应用

目的观察经鼻纤支镜气管插管患者不同剂量丙泊酚复合瑞芬太尼的麻醉效果,探讨经鼻纤支镜气管插管术中丙泊酚麻醉的适宜剂量。方法将60例择期需经鼻纤支镜气管插管全麻下行口腔颌面外科手术的病人随机分为三组（n=20）,按丙泊酚静脉输注速率,分别为4 mg/（kg.h）组（P1组）、6 mg/（kg.h）组（P2组）和8 mg/（kg.h）组（P3组）。三组均先给静脉注射瑞芬太尼1μg/kg（给药时间不低于60 s）,然后按6μg/（kg.h）静脉泵注瑞芬太尼。静脉注射丙泊酚2 mg/kg后分别以4、6、8 mg/（kg.h）静脉输注丙泊酚。丙泊酚静脉输注5 min后经鼻纤支镜气管插管。记录三组病人麻醉诱导时SBP、DBP、MAP、HR最低值及气管插管时最高值、气管插管所用时间;观察三组病人麻醉诱导过程中呼吸暂停的发生情况及气管插管时患者的不良反应;计算气管插管一次性成功率。结果 P1、P2组一次性经鼻纤支镜气管插管成功率低,气管插管完成时间长;而P3组麻醉较深,血流动力学平稳,插管条件好,气管插管一次性成功率高,虽然患者呼吸暂停时间较长,但通过有效辅助通气均可缓解,对患者生命安全无威胁。结论在经鼻纤支镜气管插管术中以8 mg/（kg.h）静脉输注丙泊酚复合瑞芬太尼麻醉比较适宜。     

不同麻醉诱导对视可尼可视喉镜辅助气管内插管反应的影响

目的探讨不同剂量芬太尼、丙泊酚及经环甲膜穿刺气管内表面麻醉,对全身麻醉患者行视可尼可视喉镜辅助快速诱导气管内插管反应的影响。方法选择60例ASAⅠ～Ⅱ级患者,随机分为3组,每组20例。麻醉诱导时除静脉注射咪达唑仑1～2mg、氟哌利多1～2mg/kg及罗库溴铵0.5mg/kg以外,Ⅰ组患者静脉注射芬太尼2μg/kg、丙泊酚1.5mg/kg,Ⅱ组患者静脉注射芬太尼3μg/kg、丙泊酚1.5mg/kg,Ⅲ组患者静脉注射芬太尼2μg/kg、丙泊酚1mg/kg。Ⅲ组患者在给予罗库溴铵和丙泊酚之前,经环甲膜穿刺并注射2%丁卡因2ml进行气管表面麻醉。3组患者均进行BIS监测,在BIS达最低值时,行视可尼可视喉镜辅助气管内插管。记录患者进入手术室后平静时（T0）、麻醉诱导后（T1）、插管后即刻（T2）、插管后5min（T3）无创血压、心率及BIS值的变化,以及拔管时患者呛咳评分、术后24h随访患者对环甲膜穿刺及气管插管等操作的不良记忆情况。结果各组患者麻醉诱导后血压、心率及BIS值均显著下降,其中Ⅱ组BIS下降最显著,明显低于Ⅲ组（P〈0.05）。插管后即刻Ⅰ、Ⅱ组血压、心率均明显升高,明显高于Ⅲ组（P〈0.05）;Ⅰ、Ⅱ组血压变化相似（P〉0.05）,与入室后平静时相当,但Ⅰ组心率升高明显高于Ⅱ组（P〈0.05）。拔管时,Ⅰ、Ⅱ组呛咳反应评分明显高于Ⅲ组（0.85±0.75、0.75±0.79vs.0.14±0.45,P〈0.01）。术后3组患者对麻醉诱导期的环甲膜穿刺及气管插管等操作均无记忆。结论在咪达唑仑和氟哌利多辅助镇静的基础上,芬太尼2～3μg/kg、丙泊酚1.5mg/kg快速诱导麻醉即可较好抑制视可尼可视喉镜辅助气管内插管反应;若进行气管内表面麻醉则丙泊酚可降至1mg/kg,同时气管插管时心血管反应更轻微。     

小儿腭裂修复术268例麻醉处理

报告小儿腭裂手术268例麻醉处理。麻醉以静吸复合全麻为主。氯胺酮5mg/kg肌注或羟基丁酸钠80-100mg/kg静注加琥珀胆碱1-1.5mg/kg插管142例，较大儿童用硫喷妥钠4-6mg/kg或丙泊酚2-2.5mg/kg加琥珀胆碱插管126例，75例辅用芬太尼2-3μg/kg。麻醉效果满意，发生导管滑出2例，喉水肿3例，心律失常3例，术后死亡1例。对腭裂手术麻醉药物及方法选择、气管插管途径、可能出现麻醉意外及并发症的原因和处理等加以分析。     

全麻诱导期间丙泊酚不同给药方法对血流动力学的影响

目的：探讨全麻诱导期间丙泊酚不同给药方法对血流动力学的影响.方法：120例择期行经皮肾镜取石术的患者,ASAⅠ～Ⅱ,分成三组：A组（依次静注咪达唑仑0.1 mg/kg,芬太尼4 μg/kg,阿曲库铵0.6 mg/kg,丙泊酚2 mg/kg,3 min后行气管插管）,B组（依次静注咪达唑仑0.1 mg/kg,芬太尼4 μg/kg,阿曲库铵0.6 mg/kg,丙泊酚1 mg/kg,3 min后追加丙泊酚1 mg/kg行气管插管）,C组（依次静注咪达唑仑0.1 mg/kg,芬太尼4 μg/kg,阿曲库铵0.6 mg/kg,3 min后静注丙泊酚2 mg/kg行气管插管）分别在麻醉诱导前,诱导后1 min、插管前、插管后即刻、插管后1 min、插管后3 min、插管后10 min监测MAP、HR、SPO2.结果：在麻醉诱导期间,A组MAP和HR变化幅度最大、B组变化幅度次之,C组变化幅度最小,三组间比较差异有统计学意义（P〈0.05）,而SPO2比较差异无统计学意义,术后24 h内随访三组患者均无诱导或手术期间术中知晓.结论：C组丙泊酚诱导给药方法可以明显减少MAP和HR波动,对全麻诱导期间血流动力学影响较小,是一种较好的给药方法.     

纤维支气管镜下小儿气管异物取出术的麻醉处理

为探讨纤维支气管镜下小儿气管异物取出术的麻醉处理方法,选择34例气管异物小儿均在肌注氯胺酮2~3mg/kg基础麻醉后入室,静注地塞米松0.3~0.5mg/kg、1%利多卡因1mg/kg、丙泊酚1.5~2.5mg/kg、芬太尼1~2μg/kg诱导,麻醉维持以丙泊酚5~8mg/(kg.h)泵注。结果,麻醉前后患儿HR、MAP、SPO2变化无明显差异。有5例出现一过性呼吸抑制,2例呛咳,经静脉推注地塞米松、丙泊酚后缓解。所有患儿均在20min内清醒。利多卡因、芬太尼、丙泊酚配伍全静脉麻醉用于小儿气管异物取出术是一种比较安全且苏醒快的麻醉方法。     

小儿腹腔镜手术行气管插管全身麻醉140例体会

目的 探讨小儿腹腔镜手术行气管插管全身麻醉的方法及安全性.方法 小儿腹腔镜手术140例,诱导给咪达唑仑0.2 mg/kg,芬太尼2～4 μg/kg,丙泊酚2 mg/kg,维库溴铵0.05～0.1 mg/kg诱导麻醉,1%异氟烷、丙泊酚0.1 mg/kg维持麻醉,根据术中肌肉松弛情况给予维库溴铵70 μg/kg,气管插管.监测心电图、心率、脉搏氧饱和度、平均血压、呼气末二氧化碳浓度监测等指标.建立二氧化碳气腹,术中腹腔压力8～20 mm Hg,新生儿和幼儿气腹压力不超过12 mm Hg.结果 所有患儿术中ECG为窦性心律,气腹后脉搏、MBP都升高,维持PetCO2在35～50 mm Hg之间,放气后5 min心率、MBP恢复至气腹前水平.结论 小儿腹腔镜手术行气管插管全身麻醉有利于呼吸管理,减轻手术操作对呼吸循环功能的影响,保证良好的通气和氧合.     

瑞芬太尼-利多卡因-丙泊酚不同剂量组合用于无肌松药气管插管的比较研究

目的比较不同剂量组合瑞芬太尼-利多卡因-丙泊酚在无肌松药情况下行气管插管时对插管状态和心血管反应的影响。方法 80例拟行择期手术患者随机均分为四组：瑞芬太尼3μg/kg、丙泊酚2 mg/kg（组Ⅰ）,瑞芬太尼3μg/kg、利多卡因1.5 mg/kg、丙泊酚2 mg/kg（组Ⅱ）,瑞芬太尼4μg/kg、丙泊酚2 mg/kg（组Ⅲ）,瑞芬太尼3μg/kg、丙泊酚3 mg/kg（组Ⅳ）。分别记录气管导管气囊充气前后的插管状态。记录麻醉诱导前、诱导后、气管插管后即刻、3、5分钟的平均动脉压（MAP）和心率（HR）值。结果气管导管气囊充气前后,组Ⅱ、Ⅲ和Ⅳ比组I获得满意插管率更高（P〈0.05）,Ⅱ、Ⅲ和Ⅳ组间无统计学差异。所有患者MAP和HR在麻醉诱导后与麻醉诱导前相比均有显著下降（P〈0.05）。结论联合使用瑞芬太尼3μg/kg-利多卡因1.5 mg/kg-丙泊酚2 mg/kg可能是用于无肌松药气管插管的较优组合。     

丙泊酚靶控输注在眼科手术中的应用(附258例临床分析)

目的　探讨丙泊酚靶控输注在眼科手术中的应用价值。方法　选择 2 5 8例各类眼病患者ASAⅠ～Ⅲ级 ,术前 30min肌注阿托品 0 1mg/kg ,安定 0 2mg/kg ,诱导后应用丙泊酚 1～ 2 μg/kg ,万可松 0 1mg/kg静脉推注 ,气管插管机械通气 ,静脉连接注射泵 ,输注浓度为 2～ 2 5mg/mL ,维持麻醉 ,设对照组比较。结果　术中血压、脉搏平稳 ,无术中知晓。术后苏醒较早。结论　丙泊酚靶控输注对各类眼科手术麻醉效果理想、安全     

喉罩与气管插管在腹腔镜手术中的临床应用

目的:比较喉罩与气管插管对全身麻醉腹腔镜手术患者心率(HR)和血压(BP)变化。方法:腹腔镜手术患者80例,随机分为全身麻醉气管插管组、喉罩组,每组40例。全身麻醉诱导:经静脉推注咪达唑仑0.04mg/kg,芬太尼0.004mg/kg,丙泊酚2.0mg/kg,维库溴铵0.08mg/kg,行气管插管和喉罩置入,术中采用静吸复合麻醉,即采用七氟烷低流量吸入,瑞芬太尼和丙泊酚持续泵注,间断给予维库溴铵分别于麻醉前(基础,入室静卧10min后)插管后1min,拔管1min记录平均血压动脉压(MAP)、血氧分压(SpO2)、HR、呼气末二氧化碳分压(PETCO2)。结果:喉罩组置入和拔除时HR和MAP均较气管插管组降低。结论:喉罩组置入和拔除时对HR和MAP的影响不如气管导管剧烈。     

丙泊酚麻醉在神经外科"锁眼"手术中的应用

50例择期手术患者在丙泊酚1.5～2 mg/kg诱导下行气管插管,术中静脉泵注丙泊酚4～6 mg*kg-1*h-1维持麻醉,观察麻醉诱导前后及术中颅内压(ICP)、平均动脉压(MAP)、脉搏氧饱和度(SpO2)、心率(HR)和呼气末二氧化碳分压(PETCO2)的变化.结果麻醉诱导插管前及术中ICP、MAP均保持在较低水平,HR、SpO2、PETCO2均无明显异常.认为丙泊酚麻醉用于神经外科"锁眼"显微手术中控制ICP,效果确切,安全,易于调节.     

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.