舒芬太尼TCI麻醉对妇科腹腔镜手术围手术期应激反应的影响

目的探讨靶控输注舒芬太尼麻醉在妇科腹腔镜手术围手术期对患者应激反应的影响。方法选择择期全麻腹腔镜手术患者60例,采用单盲、随机、对照实验设计,分为舒芬太尼组和芬太尼组,每组30例,均采用靶控输注舒芬太尼或芬太尼复合丙泊酚全凭静脉麻醉。记录患者入室后基础值（T0）、插管后3min（T1）、气腹后10min（T2）、气腹后40min（T3）、解除气腹后20min（T4）的MAP、HR、PETCO2等指标,于相应时点采集静脉血3m1测定血清皮质醇（Cor）浓度及血糖（Glu）含量。结果两组间MAP、HR、Glu总体差异无统计学意义（P〉0.05）,Cor含量总体差异有统计学意义（P〈0.05）,舒芬太尼组含量较低;各时间点比较,术中两组MAP、HR均升高,但与T0比较差异无统计学意义（P〉0.05）,Cor、Glu含量均先升后降,与T0比较差异有统计学意义（P〈0.01）;各时间点间与组间交互效应,HR、MAP各时间点与组间不存在交互效应（P〉0.05）,Cor各时间点间与组间存在交互效应（P〈0.05）,舒芬太尼组中T1、T2、T3、T4时间点测得血清Cor含量均较芬太尼组低,Glu在术中各时间点间与组间存在交互效应（P〈0.05）,舒芬太尼组T1、T2、含量比芬太尼组低。结论舒芬太尼与芬太尼均有效地抑制妇科腹腔镜手术刺激所造成的应激反应,但舒芬太尼较芬太尼能更好地抑制妇科腹腔镜手术引起的Cor分泌,维持机体生理功能稳定。     

脊柱侧弯矫形术术中唤醒的临床分析

目的探讨脊柱侧弯矫形术术中唤醒的临床效果。方法选取90例行脊柱侧弯矫形术患者随机分为观察组与参考组，各为45例。两组患者均采用异丙酚联合瑞芬太尼麻醉，观察组患者行术中唤醒，参考组患者术中不行唤醒，比较两组患者麻醉前、唤醒时、手术结束时的心率、血压，观察两组患者躁动、呛咳发生情况。结果两组患者麻醉前、唤醒时、手术结束时的心率、血压比较无显著差异（P〉0.05）；两组患者躁动、呛咳等不良反应发生率比较差异无统计学意义（P〉0.05）。结论脊柱侧弯矫形术术中唤醒不会对患者生命体征造成较大影响，可控唤醒时间，唤醒期不会导致呛咳、躁动等不良反应，手术效果良好。     

右美托咪定-丙泊酚-舒芬太尼麻醉用于脊柱侧弯矫形术的临床观察

目的 观察右美托咪定辅助靶控丙泊酚-舒芬太尼麻醉用于脊柱侧弯矫形术的安全性和有效性.方法 择期行脊柱侧弯矫形术患者40例,按随机数字表法分为右美托咪定组（D组）和生理盐水组（C组）,每组20例,分别在麻醉诱导前给予0.8 μg/kg右美托咪定和等量生理盐水,10 min输完.术中D组持续泵入右美托咪定0.2μg/（kg·h）,C组输注等容量生理盐水.观察麻醉诱导前10 min（T1）、麻醉诱导后3 min（T2）、气管插管后1 min（T3）、停药（T4）、唤醒即刻（T5）、加深麻醉后6 min（T6）的收缩压（SBP）、舒张压（DBP）、心率（HR）.记录两组血液动力学、唤醒时间、唤醒成功率、唤醒期间的躁动情况及唤醒期间的出血量,记录有无术中知晓.结果 两组唤醒成功率比较差异无统计学意义（P＞0.05）,D组较C组血液动力学稳定（P＜0.05）,D组躁动的发生率及唤醒期间的出血量显著少于C组（P＜0.05）.结论 右美托咪定辅助靶控丙泊酚-舒芬太尼麻醉能有效实施术中唤醒,有助于减少唤醒期间的出血量及躁动的发生,使术中血流动力学更平稳.     

脑电双频指数在老年患者胸腔镜手术麻醉中的应用

目的 探讨脑电双频指数（BIS）在老年患者胸腔镜手术麻醉中的应用效果.方法 将60例择期行胸腔镜手术的老年患者随机分为治疗组和对照组,各30例.治疗组麻醉诱导前连接BIS监测仪,术中根据BIS值和血流动力学调控麻醉深度指导用药;对照组术中根据血压、心率（HR）、手术情况及操作者临床经验调整麻醉药用量.记录患者T0～T6平均动脉压（MAP）、HR、酸碱度（pH）、剩余碱（BE）、乳酸（Lac）、血糖（Glu）及皮质醇（Cor）值,记录麻醉药物用量、苏醒时间、拔管时间、术后恶心呕吐和躁动情况.结果 两组T0～T6MAP、HR差异均有统计学意义（均P＜0.05）,pH、BE、Lac、Glu和Cor值差异均无统计学意义（均P＞0.05）,两组患者术后恶心呕吐、躁动发生率差异均无统计学意义（均P＞ 0.05）,异丙酚用量、瑞芬太尼用量、患者睁眼及拔管时间差异均有统计学意义（均P＜0.05）.结论 BIS指数合并血流动力学指标可指导麻醉用药、调控麻醉深度、可控性好,值得临床推广使用.     

浅全麻加单次硬膜外阻滞在儿童脊柱矫形术中的应用

目的：探讨浅全麻加单次硬膜外阻滞在小儿脊柱侧弯矫形术中的应用。方法：95例ASA（Ⅰ～Ⅱ）级脊柱侧弯行脊柱矫形术患儿随机分为浅全麻加单次硬膜外阻滞组（A组）与全麻对照组（B组）。比较两组麻醉用药情况及血流动力学变化。结果：唤醒时A组心率低于B组（P＜0．05）。术中A组芬太尼及潘库溴胺用量明显少于B组（P＜0．01）,唤醒时间缩短（P＜0,05）。结论：浅全麻加单次硬膜外阻滞在小儿脊柱侧弯矫形术中是一种具有血流动力学稳定、静脉用药量少、易于唤醒及便于术中管理和术后镇痛等优点的麻醉方式。     

右美托咪啶复合七氟醚对儿童脊柱侧弯矫形术唤醒试验的影响

目的：评估使用0.4 μg/(kg·h)剂量的右美托咪啶复合七氟醚麻醉对儿童脊柱侧弯矫形术唤醒试验的影响。方法： 采用前瞻性、双盲、随机对照研究,选择60例符合入选标准拟在全身麻醉下行脊柱侧弯后路矫形术且术中需作唤醒试验的儿童患者为观察对象,美国麻醉医师协会（American Society of Anesthesiologist, ASA) 分级Ⅰ～Ⅱ,年龄5～16岁。将患者随机分为试验组（右美托咪啶组,RD组,n=30）和对照组（R组,n=30）,两组均用咪达唑仑、丙泊酚、舒芬太尼和顺阿曲库铵麻醉诱导,采用吸入七氟醚和持续泵注瑞芬太尼维持麻醉。在气管导管置入后,试验组以0.4 μg/(kg·h)的速度持续静脉输注右美托咪啶,对照组以同样的速度输注等量生理盐水。在实施唤醒试验前的手术期间,维持脑电双频指数（bispectral index,BIS）在40~60,平均动脉压（mean arterial pressure, MAP)≥ 60 mmHg;维持中心静脉压（central venous pressure, CVP)在手术前水平,上下不超过2 mmH2O。记录两组在入室第10分时、唤醒试验开始（停药即刻）时至唤醒成功期间的每5 min有创收缩压（systolic blood pressure, SBP）、舒张压（diastolic blood pressure, DBP）、平均动脉压、心率(heart rate,HR)、BIS值以及唤醒试验的历时时间、唤醒质量、镇静评分及术中使用麻黄碱和阿托品的总量,记录术中知晓情况。结果： 试验组的入室HR和MAP与唤醒时HR和MAP比较,差异无统计学意义（t=0.974,P=0.340;t = -1.449,P=0.161）,而对照组的入室HR和MAP与唤醒时HR和MAP比较,差异有统计学意义（t=-2.106,P=0.044;t=-2.352,P=0.026）。唤醒试验期间每5 min两组心率比较,试验组在各时点明显低于对照组,差异有统计学意义（P＜ 0.05）;在唤醒试验中的镇静评分和停药至成功唤醒时间两组比较,差异无统计学意义（t=1.986,P=0.052;t=0.392,P=0.697）,唤醒质量评分试验组明显优于对照组（R组）,差异有统计学意义（t=-2.098,P=0.041）。术后随访,试验组无术中知晓病例,对照组有4例发生术中知晓。 结论： 使用0.4 μg/(kg·h)剂量的右美托咪啶复合七氟醚麻醉用于儿童脊柱侧弯矫形术,能减轻唤醒试验期间血流动力学应激反应,提高唤醒质量,减低术中知晓发生率,不延长唤醒时间,有效提高手术安全系数。     

瑞芬太尼可唤醒麻醉在小儿斜视矫正手术中的应用

目的 探索瑞芬太尼可唤醒麻醉在不同麻醉方法下儿童斜视矫正术中的优越性,旨在为该类手术选择适宜的麻醉方法.方法 将斜视患儿60例随机分为3组：瑞芬太尼-丙泊酚组（RP组）,芬太尼-丙泊酚组（FP组）,喉罩组（LMA组）.记录唤醒时间（从停用镇静药至唤醒成功时间）及手术时间,分别于麻醉诱导前（T1）,牵拉眼肌时（T2）,唤醒前（T3）,唤醒成功时（T4）,手术结束时（T5）时记录脑电双频谱指数（BIS）、平均动脉压（MAP）、心率（HR）和呼气末二氧化碳分压（PETCO2）;记录术中体动,呼吸抑制和唤醒时痛感的发生情况.结果 所有患儿各时点MAP、HR、血氧饱和度（SpO2）和BIS均在正常范围,T2时PETCO2较T1时明显升高,各组间比较差异无统计学意义（P＞0.05）.与FP组和LMA组比较,RP组唤醒时间缩短,差异有统计学意义（P＜0.05）;与RP组和LMA组比较,FP组手术刺激较强时体动发生率增加,呼吸抑制发生率升高,差异有统计学意义（P＜0.05）;与FP组和LMA组比较,RP组唤醒时痛感减少,差异有统计学意义（P＜0.05）.结论 瑞芬太尼复合丙泊酚麻醉,提供了稳定的血流动力学状态,唤醒时间短,不良反应少,适宜于儿童斜视矫正术,非常有利于提高小儿斜视矫正手术的手术成功率.     

右美托咪定复合盐酸纳美芬用于阑尾切除术患儿喉罩麻醉对复苏质量及应激指标的影响

目的 探讨右美托咪定（dexmedetomidine,DEX）复合盐酸纳美芬用于阑尾切除术患儿喉罩麻醉对复苏质量及应激指标的影响。 方法 选取我院行阑尾切除术的患儿98例,采用DEX复合盐酸纳美芬喉罩麻醉的42例患儿纳入复合组,采用喉罩麻醉的56例患儿纳入对照组,比较两组手术情况、术中应激反应、术后复苏质量、精神状态及并发症情况。 结果 复合组患儿清醒时间、喉罩拔出时间、自主呼吸时间、下床活动时间、肛门排气时间、住院时间短于对照组（P＜0.05）;术后两组去甲肾上腺素（norepinephrine,NE）、肾上腺素（epinephrine,E）、皮质醇（cortisol,Cor）、促肾上腺皮质激素（adrenocorti-cotrophic hormone,ACTH）水平均较T0明显升高,复合组T2、T3时点的NE、E水平低于对照组,T1时点两组差异无统计学意义（P＞0.05）,复合组T1、T2、T3时点发热Cor、ACTH水平低于对照组（P＜0.05）;喉罩拔出后5 min两组Ramsay、FLACC评分差异无统计学意义（P＞0.05）;喉罩拔出后30 min、喉罩拔出后60 min两组Ramsay评分、FLACC评分降低,且复合组Ramsay评分、FLACC评分低于对照组（P＜0.05）;复合组精神状态优于对照组（P＜0.05）;两组术后并发症发生率差异无统计学意义（P＞0.05）。 结论 DEX复合盐酸纳美芬用于阑尾切除术患儿喉罩麻醉有助于缩短麻醉复苏时间,降低患儿的应激反应,提高患儿术后复苏质量,缓解患儿术后疼痛,安全可靠。     

腰椎旁神经阻滞联合全凭静脉麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响

目的探讨腰椎旁神经阻滞联合全凭静脉麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响。 方法选取行髋关节置换术患者115例,根据手术麻醉方法分为观察组60例和对照组55例。观察组给予腰椎旁神经阻滞联合全凭静脉全身麻醉,对照组给予单纯全凭静脉全身麻醉。于麻醉前（T0）、麻醉后10 min（T1）、麻醉后30 min（T2）、术毕（T3）时比较2组平均动脉压、心率、去甲肾上腺素及肾上腺素水平;比较2组术后苏醒时间、清醒镇静效果、手术期间不良反应发生情况。 结果观察组平均动脉压、心率变化不明显,对照组平均动脉压、心率均呈先升高后降低趋势,组间、时点间、组间·时点间交互作用差异有统计学意义（P＜0.05）。2组去甲肾上腺素、肾上腺素水平均呈升高趋势,观察组去甲肾上腺素、肾上腺素水平变化幅度小于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义（P＜0.05）。观察组苏醒时间明显短于对照组,术后唤醒时警觉/镇静评分低于对照组,差异有统计学意义（P＜0.01）。2组手术期间总不良反应发生率差异无统计学意义（P＞0.05）。 结论相较于单纯全凭静脉全身麻醉,腰椎旁神经阻滞联合全凭静脉全身麻醉用于髋关节置换术可有效防止血流动力学指标波动,减轻手术应激反应程度,术后苏醒快、苏醒质量佳,且未增加手术期间不良反应发生率。     

两种不同麻醉方式对患者围手术期应激的影响

目的探讨两种不同麻醉方式对患者围手术期应激的影响。方法按配对设计原则选择腹部手术治疗的患者62例,分为单纯全身麻醉组（A组）和全身麻醉复合硬膜外阻滞组（B组）,每组31例,分别于麻醉诱导前（T1）、手术开始后30min（T2）、关腹后（T3）和术后24h（T4）,记录患者心率、平均动脉血压（MABP）,测血浆去甲肾上腺素（NE）、血清皮质醇（Cor）和血清C反应蛋白（CRP）浓度。术后记录患者手术时间及出血量。结果两组患者手术时间和出血量比较差异均无统计学意义（P〉0．05）;T1、T2和T3时间点,B组患者MABP均低于A组患者（P〈0．05）,T4时两组患者MABP比较差异无统计学意义（P〉0．05）;T1～T4各时间点两组患者心率比较差异无统计学意义（P〉0．05）;T1时间点,B组NE水平明显高于A组（P〈0．01）。但两组间Cor、CRP比较差异无统计学意义（P〉0．05）;T2、T3、T4时间点,B组NE、Cor和CRP水平均显著低于A组（P〈0．01或P〈0．05）。结论全身麻醉复合硬膜外阻滞较单纯全身麻醉更能降低患者围手术期应激反应。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.