七氟烷复合丙泊酚-芬太尼在小儿气管异物取出术麻醉中的应用

目的 观察七氟烷吸入联合丙泊酚.芬太尼复合静脉麻醉用于小儿气管异物取出术的麻醉效果.方法 40例患儿,随机分为两组,七氟烷复合丙泊酚.芬太尼麻醉组(S组,n=21);r-羟丁酸钠复合氯氨酮麻醉组(K组,n=19).术中持续监测SpO2、HR、NIBP及ECG,并观察手术时间、苏醒时间、术中喉痉挛和术后恶心、呕吐发生率.结果 S组术中SpO2、HR、NIBP变化小,苏醒时间短(P＜0.05),术中未发生喉痉挛,术后恶心、呕吐发生率低(P＜0.05).结论 七氟烷吸入联合丙泊酚-芬太尼复合静脉麻醉用于小儿气管异物取出术,是一种更为安全、有效的麻醉方法.     

七氟醚吸入麻醉与丙泊酚-芬太尼全凭静脉麻醉用于输尿管镜下气压弹道碎石术的比较

目的探讨七氟醚吸入麻醉及丙泊酚-芬太尼全凭静脉麻醉用于输尿管镜下气压弹道碎石术（URSL）的有效性和安全性。方法ASAⅠ-Ⅱ级输尿管结石病人106例,随机分为两组,分别予七氟醚吸入麻醉（A组）及丙泊酚-芬太尼静脉麻醉（B组）下行URSL。持续监测两组患者HR、MAP、RR,SpO2、PET CO2,记录诱导时间、苏醒时间,观察有无术中呼吸抑制,术后头晕、术后恶心呕吐等并发症。结果两组病人麻醉效果均满意,A组术中呼吸抑制较B组少（P〈0．01）,术后头晕也较B组少（P〈0．05）,但术后恶心呕吐发生率较B组高（P〈0．01）。两组病人麻醉后MAP均有所下降（P〈0．05）,B组术中MAP低于A组（P〈0．05）,B组于诱导后出现一过性心率下降（P〈0．05）,A组RR、SpO2与PET CO2麻醉前后无显著变化（P〉0．05）,B组麻醉后RR、SpO2较麻醉前下降（P〈0．05）,PETCO2较麻醉前升高（P〈0．05）。结论七氟醚吸入麻醉及丙泊酚-芬太尼全凭静脉麻醉用于URSL麻醉效果确切,但丙泊酚-芬太尼全凭静脉麻醉安全性不及七氟醚吸入麻醉。     

丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响

目的探讨丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响。方法普通胸外科择期手术的60例老年患者随机分为丙泊酚组(丙泊酚复合芬太尼全凭静脉麻醉)和七氟烷组(七氟烷复合芬太尼吸入麻醉),每组30例。记录两组患者的手术时间、单肺通气时间、术中失血量、术后睁眼时间和拔管时间等手术相关情况;采用简易智力状态检查表(MMSE)评估患者术前和术后1、3、6、24、72 h的认知功能;双抗体夹心ABC-ELISA法测定麻醉诱导前和术毕1 h血清S100β蛋白水平。结果两组患者的手术时间、单肺通气时间和术中失血量比较差异无统计学意义(P>0.05);七氟烷组术后睁眼时间和拔管时间显著长于丙泊酚组(P<0.05)。两组术前MMSE评分比较差异无统计学意义(P>0.05),术后1 h和3 h的MMSE评分均显著低于术前(P<0.05);七氟烷组术后1、3、6 h的MMSE评分显著低于丙泊酚组(P<0.05);丙泊酚组和七氟烷组的MMSE评分分别于术后6 h和24 h恢复至术前水平。两组术后血清S100β蛋白水平均显著高于麻醉诱导前(P<0.05),且七氟烷组显著高于丙泊酚组(P<0.05)。结论丙泊酚和七氟烷麻醉均可引...     

丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响

目的探讨丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响。方法普通胸外科择期手术的60例老年患者随机分为丙泊酚组(丙泊酚复合芬太尼全凭静脉麻醉)和七氟烷组(七氟烷复合芬太尼吸入麻醉),每组30例。记录两组患者的手术时间、单肺通气时间、术中失血量、术后睁眼时间和拔管时间等手术相关情况;采用简易智力状态检查表(MMSE)评估患者术前和术后1、3、6、24、72 h的认知功能;双抗体夹心ABC-ELISA法测定麻醉诱导前和术毕1 h血清S100β蛋白水平。结果两组患者的手术时间、单肺通气时间和术中失血量比较差异无统计学意义(P>0.05);七氟烷组术后睁眼时间和拔管时间显著长于丙泊酚组(P<0.05)。两组术前MMSE评分比较差异无统计学意义(P>0.05),术后1 h和3 h的MMSE评分均显著低于术前(P<0.05);七氟烷组术后1、3、6 h的MMSE评分显著低于丙泊酚组(P<0.05);丙泊酚组和七氟烷组的MMSE评分分别于术后6 h和24 h恢复至术前水平。两组术后血清S100β蛋白水平均显著高于麻醉诱导前(P<0.05),且七氟烷组显著高于丙泊酚组(P<0.05)。结论丙泊酚和七氟烷麻醉均可引...     

瑞芬太尼复合丙泊酚全凭静脉麻醉在老年人脊柱手术中的应用

目的 观察瑞芬太尼复合丙泊酚静脉麻醉在老年人脊柱手术中应用的临床效果,并与七氟烷吸人麻醉进行比较.方法 选择行胸腰椎手术的老年病人(年龄≥65岁)40例,ASAⅠ～Ⅱ级,随机分为瑞芬太尼复合丙泊酚组(R组,n=20)和七氟烷组(S组,n=20)两组,每组20例.两组均采用以下麻醉诱导方式:咪达唑仑0.06mg/kg,丙泊酚1.5mg/kg,芬太尼4μg/kg及罗库溴铵0.8mg/kg.麻醉维持:R组持续输注瑞芬太尼6.0～8.0μg·kg-1·h-1,丙泊酚2.5～3.0mg·kg·h-1.S组持续吸入七氟烷,维持呼出气七氟烷浓度1.5%～2.0%.两组均持续吸人50%氧化亚氮,间断静注罗库溴铵维持肌松,控制呼吸,维持PETCO230～35mmHg.观察两组患者围术期血流动力学变化、术后苏醒时间和拔管时间及不良反应.结果 R组术中血流动力学较S组平稳,R组术后自主呼吸恢复时间、呼之睁眼及拔管时间短于S组(P>0.05),苏醒期躁动发生率明显低于S组(P<0.05).结论 瑞芬太尼复合丙泊酚静脉麻醉与七氟烷吸入麻醉比较,具有血流动力学稳定、苏醒期躁动发生率低、安全可行等优点,同样适用于老年脊柱手术患者.     

七氟烷吸入联合丙泊酚-芬太尼复合静脉麻醉用于小儿气管异物取出术的麻醉效果观察

目的探讨七氟烷吸入联合丙泊酚-芬太尼复合静脉麻醉应用于小儿气管异物取出术的麻醉效果。方法选取行气管异物取出术患儿45例,随机分为两组。观察组24例采用七氟烷吸入联合丙泊酚-芬太尼复合静脉麻醉,对照组21例采用丙泊酚复合芬太尼麻醉。观察手术前后相关指标的变化。结果两组患儿插气管镜后和清醒后平均动脉压、心率、呼吸频率均有所下降（P〈0．05）。观察组患儿术中呛咳、屏气及术后恶心呕吐、躁动的发生率低于对照组（P〈0．05）。且观察组的出入镜次数、手术时间以及麻醉恢复时间均短于对照组（P〈0．05）。结论七氟烷吸入联合丙泊酚-芬太尼复合静脉麻醉应用于小儿气管异物取出术效果显著,且安全有效．无严重不良反应发生,值得临床进一步推广研究。     

4种用药方案在小儿室间隔缺损介入封堵术麻醉中的比较

目的探讨适用于小儿先天性心脏病室间隔缺损介入手术的麻醉方法。方法将120例先天性心脏病室间隔缺损经心导管介入封堵术的患儿随机分为4组(每组30例),氯胺酮静脉麻醉(K组)、丙泊酚静脉麻醉(P组)、丙泊酚复合氯胺酮静脉麻醉(PK组)、七氟烷麻醉(S组)。K、P、PK组保留自主呼吸,S组气管插管后机械通气。记录各组患儿麻醉前、切皮时、放置封堵器时及术毕的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼吸频率(RR)以及患儿的清醒时间、不良反应等。结果各组患儿都顺利完成麻醉、手术,P组和KP组清醒时间明显短于K组(P<0.01)。S组的患儿术毕清醒时间明显短于其他麻醉组(P<0.01)。术中呛咳、屏气及体动等不良反应的发生率,气管内插管机械通气吸入七氟烷的患儿明显低于静脉麻醉组(P<0.01)。结论气管内插管机械通气并吸入七氟烷可以安全地用于小儿室间隔缺损介入封堵手术的麻醉。     

七氟醚、丙泊酚用于乳腺短小手术中的比较

目的探讨七氟醚、丙泊酚以及两药复合麻醉应用于乳腺短小手术的有效性和安全性.方法 ASAⅠ-Ⅱ级行乳腺肿块切除术的患者120例,随机分为三组,分别给予七氟醚吸入麻醉(A组)、丙泊酚静脉麻醉(B组)及七氟醚-丙泊酚复合麻醉(C组).术中监测三组患者HR、MAP、RR、SpO2,记录诱导时间、苏醒时间,观察患者术中体动、呼吸抑制和术后恶心呕吐的发生情况.结果三组患者麻醉均满意,都能实现快速诱导、苏醒迅速,而七氟醚-丙泊酚复合麻醉组诱导起效更快、苏醒时间更短,术中体动和术后恶心呕吐更少.结论七氟醚-丙泊酚复合麻醉组较七氟醚吸入和丙泊酚静脉麻醉诱导更快、苏醒更迅速,术后并发症少,更适合短小手术的麻醉.     

七氟烷静吸复合麻醉与丙泊酚静脉麻醉在老年冠心病患者腹腔镜手术中的应用

目的 探讨接受腹腔镜手术治疗的老年冠心病患者麻醉维持中丙泊酚全凭静脉麻醉与七氟烷静吸复合麻醉的应用。方法 回顾性选取2019年1月至2020年1月本院接受腹腔镜手术治疗的老年冠心病患者100例,依据麻醉维持方法分为七氟烷静吸复合麻醉组与丙泊酚全凭静脉麻醉组,每组各50例,统计分析两组患者的血流动力学、血管活性药物应用情况、心电图ST-T异常情况、心律失常发生情况、麻醉时间、术后恢复时间、补液量、尿量、认知功能。结果 T2、T3、T4时七氟烷静吸复合麻醉组患者的心率、平均动脉压均低于丙泊酚全凭静脉麻醉组,差异有统计学意义(P0.05)。七氟烷静吸复合麻醉组患者的多巴胺、阿托品、去甲肾上腺素应用率均低于丙泊酚全凭静脉麻醉组,差异有统计学意义(P0.05)。七氟烷静吸复合麻醉组患者的心电图ST-T异常率为14.00%(7/50),低于丙泊酚全凭静脉麻醉组的34.00%(17/50),差异有统计学意义(P0.05)。七氟烷静吸复合麻醉组患者的心律失常发生率为4.00%(2/50),低于丙泊酚全凭静脉麻醉组的18.00%(9/50),差异有统计学意义(P0.05)。结论 接受腹腔镜手术治疗的老年冠心病患者麻醉维持中七氟烷静吸复合麻醉的应用效果较丙泊酚全凭静脉麻醉好。     

雷米芬太尼-丙泊酚复合静脉麻醉在腹腔镜胃穿孔修补术的应用

目的探讨雷米芬太尼-丙泊酚复合静脉麻醉用于腹腔镜胃穿孔修补术的安全性。方法选择ASAⅡ~Ⅲ级的30例胃穿孔病人,采用雷米芬太尼-丙泊酚复合静脉麻醉进行胃穿孔修补术,观察诱导前、诱导后、插管后1 min、气腹10 min、术中30 min及术毕的HR、SBP、DBP、SpO2和PETCO2变化情况及术后苏醒时间、拔除气管导管时间、术后疼痛和恶心呕吐发生情况。结果诱导后HR、SBP、DBP较诱导前明显下降(P<0.05),但随后又逐渐恢复正常;SpO2和PETCO2在整个麻醉期间无明显变化(P>0.05);病人于术后7~16 min内苏醒,22 min左右拔除气管导管,无一例应用拮抗药,术后疼痛5例,恶心呕吐6例。结论雷米芬太尼-丙泊酚复合静脉麻醉用于腹腔镜胃穿孔修补术麻醉效果满意,术后苏醒快,恢复好,是一种较为理想的麻醉方式。     

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.