羟乙基淀粉130/0.4联合麻黄碱应用于腰硬联合麻醉下剖宫产术的临床观察

目的探讨羟乙基淀粉130/0.4联合麻黄碱应用于腰硬联合麻醉下剖宫产术的临床效果。方法抽取2011年8月—2012年8月期间的足月妊娠产妇60例,随机分为对照组和治疗组,每组各30例患者。对对照组中的产妇进行羟乙基淀粉氯化钠注射液治疗,而对治疗组中的产妇进行羟乙基淀粉130/0.4联合麻黄碱治疗,对两组患者麻醉前后的各项相关指标值的情况,并且进行比较分析。结果在对产妇进行麻醉后,患者的血压以及心率等有一定的改善,但是相对于对照组,治疗组中产妇的改善情况较好,并且恶心呕吐等情况更为良好,P〈0.05。结论对于腰硬联合麻醉下剖宫产术采取羟乙基淀粉130/0.4联合麻黄碱,对于改善患者的心率以及血压情况有一定的积极影响,并且能够有效的减少患者出现恶心呕吐等不良反应,有一定的积极临床意义。     

高渗氯化钠羟乙基淀粉40注射液预防轻比重腰麻下剖宫产患者术中低血压40例临床观察

目的：评价高渗氯化钠羟乙基淀粉40注射液预防轻比重腰麻下剖宫产患者术中低血压的临床效果。方法：选择择期于轻比重腰麻下行剖宫产手术患者80例,随机分为两组,分别于麻醉前给予高渗氯化钠羟乙基淀粉40注射液（I组）,羟乙基淀粉130注射液（Ⅱ组）静脉补液。结果：蛛网膜下腔注药后10 min平均动脉压I组高于Ⅱ组,术中麻黄碱用量I组少于Ⅱ组（P〈0.05）。低血压发生率I组低于Ⅱ组（P〈0.01）。结论：高渗氯化钠羟乙基淀粉40注射液预防腰麻下剖宫产患者术中低血压效果优于羟乙基淀粉130注射液。     

羟乙基淀粉200/0.5氯化钠注射液预输注在腰麻联合硬膜外麻醉下子宫肌瘤切除术中的应用

目的 观察麻醉前输注羟乙基淀粉200/0.5氯化钠注射液在腰麻联合硬膜外麻醉中预防低血压的效果.方法 将60例择期行子宫肌瘤手术患者分为2组,各30例.麻醉前30min分别输注500mL羟乙基淀粉200/0.5氯化钠注射液（A组）和乳酸钠林格液（B组）.观察麻醉前、起效后1、5、10及15min时点收缩压（SBP）、舒张压（DBP）的变化,低血压发生率和恶心呕吐及应用麻黄碱情况.结果 两组麻醉后DBP、SBP比较差异无统计学意义（P〉0.05）.B组低血压发生率、恶心呕吐发生率及应用麻黄碱率均高于A组,差异均有统计学意义（P＜0.05）.结论 预输羟乙基淀粉200/0.5氯化钠注射液较乳酸钠林格液更能预防腰麻联合硬膜外麻醉低血压.     

高渗氯化钠-羟乙基淀粉对产妇仰卧位低血压的防治作用

目的观察预先输注高渗氯化钠-羟乙基淀粉注射液（Home）对产妇仰卧位低血压的防治作用。方法选择150例拟在腰麻硬膜外联合麻醉下行剖宫产术的孕妇,随机均分成三组：H组输注Home250ml;V组输注6%氯化钠羟乙基淀粉130/0.4注射液（万汶）500ml;L组输注乳酸钠林格氏液500ml。输液速度：H组10-15ml/kg/h,V组与L组20ml/kg/h。麻醉前摆好穿刺体位时开始输液,椎管内穿刺完成后15min内滴完。连续测量（1次/2min）孕妇血液动力学数据,统计术中仰卧位低血压的发生率,记录新生儿Apgar评分。并分别于输液前、输注后30min、术后1d抽取产妇静脉血及术中采集胎儿脐动脉血检测血气、电解质,记录孕妇术中及术后24h尿量。结果 H组（12.0%）和V组（12.0%）仰卧位低血压发生率显著低于L组（34.0%）,H组和V组手术开始后血压恢复更快、术中血压更加平稳。H组和V组术后24h尿量显著多于L组。三组胎儿Apgar评分及脐动脉血气、电解质均在正常范围。结论预先输注高渗羟乙基淀粉可有效防治产妇仰卧氏血压综合征的发生,使产妇术中血压更加稳定,对胎儿无不良影响。     

羟乙基淀粉对剖宫产腰硬联合麻醉后低血压的疗效观察

目的观察比较羟乙基淀粉注射液和复方氯化钠注射液预充扩容对腰硬联合麻醉下行剖宫产低血压的治疗效果。方法选择100例剖宫产患者,随机分为羟乙基淀粉组（A组,n=50）及复方氯化钠组（B组,n=50）。在麻醉前分别输注羟乙基淀粉和复方氯化钠注射液预充液500ml。分别于入室时、麻醉前、麻醉后2、5、15min,术毕时,记录患者收缩压、舒张压和心率。结果两组患者麻醉后2、5、15min时的收缩压明显低于入室时（P〈0.05）,B组腰硬联合麻醉注药后15min时舒张压低于入室时（P〈0.05）。A组术中循环较B组稳定,麻醉后5、20min时A组收缩压,舒张压明显高于B组（P〈0.05）。结论羟乙基淀粉注射液预充能显著改善腰硬联合麻醉后剖宫产患者血流动力学,维持母体内环境稳定,从而大大提高剖宫产母婴的安全性。     

不同方法预防剖宫产腰麻后低血压的疗效观察

目的 观察比较预输注负荷量羟乙基淀粉及复方氯化钠对预防剖宫产手术腰麻后低血压的有效性及安全性.方法 选择ASA Ⅰ～Ⅱ级的择期剖宫产患者60例,随机分为两组,每组30例,羟乙基淀粉组（A）复方氯化钠组（B）,在麻醉前30 min分别输注羟乙基淀粉和复方氯化钠预充液500 ml,观察并记录各组患者入室时,麻醉前5 min,麻醉后5min、10 min、15 min血压心率及恶心呕吐等麻醉后不良反应及麻黄素使用情况.结果 两组产妇基础SBp,DBp及HR相似,麻醉后SBp,DBp,下降值及下降率B组高于A组.恶心呕吐发生率及应用麻黄素例数B组高于A组,Apgar评分无显著差异.结论 预输注负荷量羟乙基淀粉能显著改善剖宫产腰麻后的血流动力学,可安全应用于剖宫产手术.     

综合措施防治剖宫产术中低血压的临床观察

为寻找一种有效、合理的防治剖宫产手术麻醉期间低血压的方法,选择急诊刮宫产手术的病例90例,ASA Ⅰ-Ⅱ级,随机分为三组,每组30例,所有病例均采用腰麻联合硬膜外阻滞麻醉.Ⅰ组麻醉前预先输注复方氯化钠注射液500mL,麻醉后预防性静脉注射麻黄碱5mg;Ⅱ组麻醉前预先输注复方氯化钠注射液500mL,麻醉后采取左侧倾斜15～20°体位;Ⅲ组麻醉前预先输注6%羟乙基淀粉注射液500mL,麻醉后预防性静脉注射麻黄碱注射液5mg并采取左侧倾斜15～20°体位.结果(1)Ⅰ、Ⅱ、Ⅲ组低血压的发生率为70.0%、63.3%、26.6%;Ⅲ组低血压的发生率明显低于Ⅰ、Ⅱ组(P<0.05),且无1例发生严重的低血压;Ⅰ、Ⅱ组中严重低血压的病例可达13.3%.(2)Ⅲ组的Apgar评分明显高于Ⅰ、Ⅱ组,统计学处理差异有统计学意义(P<0.05).麻醉前预先输注6%羟乙基淀粉注射液500mL、麻醉后预防性静脉注射麻黄碱注射液5mg并采取左侧倾斜15～20°体位做为一种综合措施,可有效地防治剖宫产手术麻醉期间的低血压.     

羟乙基淀粉130/0.4氯化钠注射液用于剖宫产术蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉前预填充的有效剂量

目的 探讨蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉前静脉滴注羟乙基淀粉130/0.4氯化钠注射液预防行剖宫产术的产妇术中低血压的有效剂量.方法 选择美国麻醉医师学会分级Ⅰ或Ⅱ级、孕38～40周、第1胎、择期行剖宫产术的产妇160例,随机分为4组,每组40例.平衡液组在麻醉前静脉滴注5 mL/kg乳酸钠林格注射液,羟乙基淀粉低、中、高剂量组分别静脉滴注5、10、15 mL/kg羟乙基淀粉130/0.4氯化钠注射液.静脉输液结束后,在L3与L4间隙穿刺行蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉.观察产妇入手术室(T1),静脉滴注液体完即刻(T2),鞘内注射药物5 min(T3)、10 min(T4)、20 min(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)及新生儿出生后1和5 min的Apgar评分.采集T1和T2时间点,产妇的动脉血及胎儿取出时的脐动脉血行血气分析.结果 平衡液组和羟乙基淀粉低剂量组T3、T4、T5时间点的MAP均显著低于同组T1时间点(P值分别＜0.05、0.01),羟乙基淀粉中、高剂量组组内各时间点间MAP的差异均无统计学意义(P值均＞0.05),羟乙基淀粉中剂量组T4、T5时间点及羟乙基淀粉高剂量组T3、T4、T5时间点的MAP均显著高于平衡液组同时间点(P值分别＜0.05、0.01).4组组内和组间SpO2的差异均无统计学意义(P值均＞0.05).4组间产妇动脉血和胎儿取出时脐动血的pH值、动脉血氧分压、动脉血二氧化碳分压的差异均无统计学意义(P值均＞0.05).平衡液组产妇的麻黄素使用率为30％,显著高于羟乙基淀粉低剂量组的10％ (P ＜0.05),羟乙基淀粉中、高剂量组产妇均无未使用麻黄素.4组间新生儿出生后1、5 min的Apgar评分的差异均无统计学意义(P值均＞0.05).结论 择期行剖宫产术的产妇在蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉前静脉滴注羟乙基淀粉130/0.4氯化钠注射液预防术中低血压的有效剂量为10 mL/kg.     

共同负荷联合血管收缩药预防剖宫产术腰麻后低血压的研究

目的 观察羟乙基淀粉(130/0.4)共同负荷与羟乙基淀粉(130/0.4)共同负荷联合小剂量麻黄素预防剖宫产术腰麻后低血压的效果.方法 选择60例ASAⅠ～Ⅱ级脊麻下行剖宫产术的患者,随机分成三组,每组20例,A组为万汶共同负荷联合小剂量麻黄素组,B组为万汶共同负荷组,C组为对照组.采用腰硬联合麻醉技术穿刺,经腰穿针进入蛛网膜下腔向头部注入0.5%等比重布比卡因10mg.A组:用10mg麻黄素注入羟乙基淀粉130/0.4氯化钠注射液(万汶)500ml溶液中配成混合溶液,在脊麻注药后以10ml/kg在30min内快速输注.B组:在脊麻注药后以万汶10ml/kg在30min内快速输注.C组:脊麻后以乳酸林格液6～8ml/kg.h持续输注.记录不同时点的SBP、DBP、HR的变化及不良反应发生率.结果 A组SBP、DBP、HR在T1升高(P＜0.05); B组、C组的SBP、DBP在脊麻后各时点均有不同程度下降,但B组T2、T3及C组T1、T2、T3时点下降较为明显(P＜0.01);三组组间T1、T2、T3各时点SBP、DBP比较差异有统计学意义(P＜0.01).低血压发生率C组＞B组＞A组 (P＜0.01).结论 羟乙基淀粉(130/0.4)共同负荷联合小剂量麻黄素能有效减少剖宫产术脊麻后低血压发生率和提供相对平稳的血流动力学.     

剖宫产麻醉前预输胶体液维持循环稳定的临床意义

目的 探讨麻醉前快速输注负荷量的胶体液对维持术中产妇循环稳定的临床意义.方法 选取2009年6月～2010年1月笔者所在医院产科足月单胎剖宫产术产妇102例,随机分为观察组(B组)与对照组(A组),各51例,对照组给予500 ml乳酸林格氏液,观察组给予羟乙基淀粉(130/0.4万汶,比较两组患者麻醉期间心率和平均动脉压的变化以及对两者患者的不良反应.结果A组患者在麻醉后5 min、15 min以及胎儿娩出时平均动脉压和心率均较术前明显下降(P<0.05),B组患者仅在胎儿娩出时出现平均动脉压降低,心率增快表现,且与术前比较差异有统计学意义(P<0.05),A组低血压、恶心呕吐发生率明显高于B组(P<0.05),胸闷和呼吸困难两组间差异无统计学意义(P>0.05).结论 预充万汶可使腰硬联合麻醉下剖宫产产妇术中循环相对稳定,有效减少因为血容量不足所致的低血压以及心率增快.     

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.