诱发电位监测地氟醚麻醉后苏醒

目的 探讨诱发电位（EP）监测地氟醚麻醉后苏醒的可靠参数。方法 择期全麻腹部手术患30例，诱导后地氟醚维持麻醉，麻醉停药前3min记录体感诱发电位（SEP）和听觉诱发电位（AEP），并观察麻醉停药后命令反应时间、拔管时间及达到modify aldrete score＞9的时间。结果 AEP的Nb潜伏期及SEP的P25潜伏期与苏醒各指标呈线笥相关，命令反应与Nb潜伏期相关系数（r）＝0.84（P＜0.01）、命令反应与P25潜伏期r=0.60（P＜0.01），拔管时间与Nb潜伏期r=0.88（P＜0.01）、拔管时间与P25潜伏期r=0.59（P＜0.01），达到modified aldrete score≥9的时间与Nb潜伏期r=0.86（P＜0.01）、与P25潜伏期r=0.68（P＜0.01）。结论 Nb及P25 伏期是反映苏醒时间的可靠指标。     

不同浓度异氟醚-芬太尼配伍对不孕症手术患者麻醉恢复的影响

目的控讨不同呼气末异氟醚浓度与不同剂量芬太尼配伍组合对不孕症腹腔镜手术患者麻醉恢复的影响。方法选择ASAI级因不孕症需手术诊治患者60例,随机分为0．6％呼气末异氟醚浓度组（A组）、0．9％呼气末异氟醚浓度组（B组）、1．2％呼气末异氟醚浓度组（C组）,每组20例。采用异氟醚．芬太尼配伍的静吸复合麻醉方式,以AEP监测麻醉深度,PM9000麻醉气体监测仪监测呼气末异氟醚浓度,在不同组别维持相应的呼气末异氟醚浓度不变,术毕停止吸入麻醉药并进行洗肺,观察麻醉恢复期患者自主呼吸恢复时间、睁眼时间、气管导管拔除时间及气管导管拔除后SpO2值。结果A、B两组在自主呼吸恢复时间、睁眼时间、气管导管拔除时间与C组相比差异具有统计学意义（P〈0．05）;组间比较差异无统计学意义（P〉0．05）,SpO2值在3组间比较差异无统计学意义（P〉0.05）。结论低浓度异氟醚．较大剂量芬太尼配伍全身麻醉后患者苏醒快,安全,值得推广。     

听觉诱发电位指数监测老年人地氟醚麻醉深度

目的：观察老年人地氟醚麻醉中听觉诱发电位指数（AEP指数）和血流动力学的变化,评估AEP指数监测老年人地氟醚麻醉深度的应用价值。方法：选择ASAⅠ-Ⅲ级,择期全麻气管插管下手术患者40例,按年龄分为2组：老年组（年龄≥65岁,n=20）和中青年组（年龄18～55岁,n=20）。异丙酚、维库溴铵诱导气管插管后行控制呼吸,吸入地氟醚维持麻醉,调整吸入浓度,使地氟醚呼气末浓度依次维持在0．6MAC,1．0MAC和1.3MAC,每一浓度均稳定20min。监测麻醉前（T1）、注射异丙酚后2min（T2）、气管插管时（T3）、气管插管后2min（T4）、地氟醚呼气末浓度为0.6MAC（T5）,1.0MAC（T6）和1．3MAC（T7）时的平均动脉压、心率和AEp指数。结果：地氟醚麻醉期2组患者平均动脉压均比麻醉前明显下降（P〈0.05）,老年组心率与麻醉前相比亦显著减慢（P〈0．05）。地氟醚呼气末浓度由0.6MAC～1．3MAC递增时,2组患者平均动脉压和心率无明显变化（P〉0．05）。地氟醚麻醉期2组患者AEP指数与麻醉前相比显著降低（P〈0．05）,老年组地氟醚呼气末浓度在1.0MAC和1．3MAC时AEP指数较0．6MAC时显著降低（P〈0．05）,但中青年组地氟醚呼气末浓度各浓度间AEP指数差异无统计学意义（P〉0．05）;在地氟醚各呼气末浓度时,老年组AEP指数均低于同时间点中青年组（P〈0．05）。AEP指数与地氟醚呼气末浓度在老年组和中青年组的相关系数分别为-0．983和-0．980（P〈0．05）。结论：听觉诱发电位指数与地氟醚呼气末浓度呈一定的剂量相关性,可监测老年人地氟醚麻醉深度变化并在一定程度上反映相同地氟醚呼气末浓度下老年人与中青年人麻醉深度的差异。     

七氟醚在脊柱矫形术麻醉中的临床应用

目的评价七氟醚对脊柱矫形术中唤醒试验的影响,观察听觉诱发电位（AEP）监测在唤醒试验中的作用。方法择期行脊柱矫形术患者22例,ASAI～Ⅱ级,年龄12～18岁,随机分为：七氟醚瑞芬太尼丙泊酚组（SRP）和异氟醚瑞芬太尼丙泊酚组（IRP）,每组11例。SRP组、IRP组分别吸入低流量七氟醚或异氟醚,术中均微泵输注瑞芬太尼及丙泊酚维持麻醉。唤醒试验成功后,所有麻醉药恢复原来的速度。两组麻醉前行AEP监测,术中以MAP、HR、AAI值调整七氟醚或异氟醚浓度。记录麻醉前、术中唤醒前停醚时、唤醒时、唤醒后10min及术毕清醒拔管时各时间点呼气末七氟醚浓度（ETsev）、呼气末异氟醚浓度（ETiso）及MAP、HR,AAI值。术后1天随访。结果所有患者均成功实施唤醒试验,唤醒期间有1例呛咳,术后随访对其他事件无回忆。与IRP组相比,SRP组唤醒时间缩短。AEP能比较准确预测唤醒时间,对唤醒试验有指导意义。结论与异氟醚相比,七氟醚更适用于脊柱矫形术,AEP监测对唤醒试验有指导作用,可以缩短唤醒时间,防止脊髓长时间缺血有一定意义。     

脊柱侧凸矫正术患者听觉诱发电位指数与脑电双频谱指数的比较

目的 七氟醚麻醉下脊柱侧凸矫正术中唤醒和术后恢复时脑电双频谱指数(BIS)和听觉诱发电位指数(AAI)快速鉴别意识存在和消失的比较.方法 30例行脊柱侧凸矫正手术的成年病人,入室后行BIS和AEP等监测,全麻诱导后持续泵注雷米芬太尼0.3μg/(kg·min).吸入七氟醚.根据调节七氟醚吸入浓度方法的不同,将病人随机分为3组,其中对照组病人完全凭麻醉医生的临床经验调节七氟醚吸入浓度;AEP组根据AAI数值调节七氟醚吸人浓度;BIS组根据BIS数值调节七氟醚吸人浓度.唤醒试验开始时,停止吸入七氟醚,雷米芬太尼的输注速度降至0.05μg/(kg·min),唤醒试验完成后按上述方案继续维持麻醉.记录三组病人在清醒时(T0)、开放环路即刻(T1)、自主呼吸恢复时(T2)、唤醒时(T3)、拔除气管内导管时(T4)和定向力恢复时(T5)的AAI、BIS、呼气末七氟醚浓度,唤醒试验中自主呼吸恢复、唤醒以及拔除气管导管和定向力恢复时间等参数.结果 与对照组比较,AEP组和BIS组在T1的AAI和BIS增加(P<0.05);与AEP组比较,BIS组在T5时的AAI升高(P<0.05).BIS、AAI与呼气末七氟醚浓度呈负相关.与对照组比较.AEP组和BIS组的自主呼吸恢复、唤醒、拔管和定向力恢复时间缩短(P<0.05),呼气末七氟醚浓度在T1时降低(P<0.05).讨论使用AEP监测和BIS监测均可预测脊柱侧弯矫正术病人的术中唤醒,区分清醒和麻醉状态.在预测无意识水平到清醒的转变方面,AAI要优于BIS,但从七氟醚麻醉状态苏醒后的AAI可能不如BIS稳定.     

七氟醚和异氟醚对罗库溴铵量-效关系的影响

目的探讨七氟醚和异氟醚呼气末浓度对罗库溴铵量-效关系的影响。方法 56例择期全身麻醉行五官科手术的患者随机分成7组,七氟醚组（S1-S3,七氟醚呼气末浓度分别维持0.4 MAC、0.7 MAC、1.0 MAC）、异氟醚组（I1-I3,异氟醚呼气末浓度分别维持0.4 MAC、0.7 MAC、1.0 MAC）及P组（异丙酚麻醉组,输注速度4-10mg.kg-1.h-1）,每组8例。所有患者插管后均持续输注瑞芬太尼0.1-0.2μg.kg-1.min-1,S1-S3组和I1-I3组七氟醚和异氟醚呼气末浓度稳定40 min后注入罗库溴铵0.6 mg.kg-1,P组在输注异丙酚40 min后注入罗库溴铵0.6 mg.kg-1,用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测,记录罗库溴铵的起效时间（T0）;临床作用时间（T25）;恢复指数（TI）。结果与P比较,S2、S3、I2、I3起效时间明显缩短（P〈0.05）,临床作用时间和恢复指数明显延长（P〈0.05）。与S2比较S3起效时间明显缩短,临床作用时间和恢复指数明显延长（P〈0.05）;与I2比较I3起效时间明显缩短,临床作用时间和恢复指数明显延长（P〈0.05）。结论 0.4MAC呼气末浓度七氟醚或异氟醚不能强化罗库溴铵的临床药效,0.7MAC以上七氟醚或异氟醚能明显强化罗库溴铵的临床药效,并有明显剂量依赖趋势。     

脑电双频指数监测在老年患者麻醉苏醒中的作用

目的 研究脑电双频指数（BIS）指导七氟醚吸入对老年患者麻醉苏醒的影响.方法 择期行下腹部手术的老年患者44例,ASAⅠ~Ⅱ级,随机数字表法分为BIS组（B组）和对照组（D组）,每组22例.D组由麻醉医生根据临床经验调节术中七氟醚的吸入浓度 B组术中维持BIS值在45~55,术毕前10min维持在56~70.记录麻醉诱导前、手术期间和拔管时的BIS值、七氟醚设定浓度和呼气末浓度 苏醒时间、拔管时间、OAA /S评分达到5分的时间.结果 与D组相比,B组术中七氟醚用量减少20%,手术期间的BIS升高、呼气末七氟醚浓度降低,手术结束时呼气末七氟醚浓度降低,苏醒时间、拔管时间、OAA /S评分达到5分的时间缩短.结论 BIS指导吸入七氟醚能加快老年患者腹部手术的麻醉苏醒,提高苏醒质量,并可减少术中七氟醚的用量.     

听觉诱发电位指数指导异氟醚与安氟醚麻醉的可行性

目的　观察听觉诱发电位指数 (AEP index)是否可用于指导异氟醚与安氟醚麻醉。方法　 4 0例择期手术病人 ,随机分成 4组 (n =10 ) :组Ⅰ为异氟醚指导组 (Iso t) ,组Ⅱ为异氟醚对照组 (Iso c) ,组Ⅲ为安氟醚指导组 (Enf t) ,组IV为安氟醚对照组 (Enf c)。对照组仅凭临床经验来调节异氟醚与安氟醚吸入浓度。指导组则通过维持AEP index值在 30左右来调节异氟醚与安氟醚吸入浓度。记录麻醉期间血压、心率及AEP index变化 ,并记录各麻醉药用量。结果　指导组收缩压明显高于对照组 (P <0 .0 5 ) ,且波动幅度较对照组大。对照组AEP index明显低于指导组 (P <0 .0 5 ) ,但麻醉维持过程相对较平稳 ,镇痛药与肌松药用量明显少于指导组。结论　AEP index可为异氟醚与安氟醚吸入麻醉镇静与睡眠的深度提供量化指标 ,且能预测体动 ,但尚不能完全依赖AEP index来指导麻醉。     

右美托咪定对异氟醚麻醉患者围手术期不良反应的影响

目的观察右美托咪定(Dex)对异氟醚麻醉患者围手术期躁动、寒战、苏醒延迟等不良反应的影响。方法择期行上腹部手术患者40例,随机分为两组:生理盐水对照组(C组)和右美托咪定组(D组)。D组麻醉诱导前给予右美托咪定0.8μg/kg,麻醉诱导后给予右美托咪定0.5μg/(kg·h)持续输注,C组同时给予等容量生理盐水。记录患者气管插管前(T_0)、气管插管后即刻(T_1)、气管拔管前(T_6)、气管拔管后即刻(T_7)的血流动力学指标和手术开始5 min(T_2)、30 min(T_3)、1 h(T_4)、手术结束时(T_5)异氟醚呼气末有效浓度及停异氟醚后苏醒时间、拔管后躁动、寒战等不良反应发生情况。结果 D组T_3、T_4、T_5时异氟醚呼气末浓度明显低于C组(P0.05);停异氟醚后苏醒时间明显低于C组(P0.05);气管插管和拔管时血流动力学波动小于C组(P0.05);C组苏醒期有8例发生躁动,9例发生寒战,D组有2例躁动,3例寒战,D组有3例心率低于50次/min,给予阿托品处理后好转。结论右美托咪定可明显降低全麻患者异氟醚呼气末浓度,稳定围术期循环功能,加快苏醒,减少躁动、寒战等不良反应。     

数量化脑电指标与地氟醚、异丙酚、安定浓度的相关分析

目的 研究双频指数(BIS)、95％边缘频率(SEF)等数量化脑电指标与异丙酚、安定血药浓度以及呼气末地氟醚浓度的关系,以探讨它们在全身麻醉与镇静监测中的应用价值。方法21例ASAI一Ⅱ级腹部或下肢择期手术病人,分为异丙酚组、安定组和地氟醚组,测定地氟醚的呼气末浓度及血浆异丙酚、安定浓度。将药物浓度与各数量化脑电指标作直线相关分析,并统计异丙酚、地氟醚二组苏醒过程BIS的差异。结果地氟醚组除绝对e功率外其余脑电指标与呼气末浓度的相关系数均有显著性差异;异丙酚组大部分脑电指标与血药浓度相关;安定组数量化脑电指标中仅BIS与血药浓度相关。三种药物,不论麻醉或镇静均以BIS与药物浓度相关系数最高。异丙酚、地氟醚二组苏醒过程的BIS无显著差异。结论随着麻醉、镇静药物浓度的改变BIS、SEF等多项数量化脑电指标呈相应改变,其中以BIS最为敏感。但BIS评定麻醉和镇静深度与麻醉药的种类有密切关系。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.