首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 140 毫秒
1.
静脉注射利多卡因对气管插管患者心血管反应的影响   总被引:11,自引:0,他引:11  
目的 比较观察患者全麻气管插管前静脉给予利多卡因或异丙酚麻醉对心血管反应的不同影响。方法  6 0例患者随机分为 3组 ,每组 2 0例 ,A组为单次单纯异丙酚组 ,B组为双次单纯异丙酚组 ,C组为异丙酚 利多卡因组。A组 :异丙酚 2mg/kg。B组 :异丙酚 1 5mg/kg,插管前 1min再给 0 5mg/kg。C组 :异丙酚 1 5mg/kg ,插管前 2min静脉注射利多卡因 1 5mg/kg。结果  3组患者麻醉诱导后血压均下降 ,但心率无明显改变 ,A组严重低血压发生率较B ,C组高 ;在气管插管后血压重新升高 ,与基础值相比A组明显增高 ,B ,C组差异无显著性 ;插管后A组心率明显加快 ,高血压、窦性心动过速发生率亦较B ,C组高。结论 在插管前 2min静脉注射利多卡因 1 5mg/kg可以有效的抑制气管插管的心血管反应。其抑制心血管反应的作用可能和利多卡因增加了麻醉深度相关。  相似文献   

2.
目的:比较3种静脉麻醉药在喉颈联合手术经气管切开插管麻醉诱导中的效果。方法:随机将10 8例SASⅠ~Ⅱ级择期全喉切除伴单侧或双侧颈淋巴清扫患者分为3组,A组:羟丁酸钠诱导剂量为6 5 .0 0±19 .0 0mg/kg ,B组:依托咪酯诱导剂量为0 .2 8±0 .12mg/kg ,C组异丙酚诱导剂量为2 .1±0 .2 8mg/kg。3组患者均在局麻气管切开手术开始后,予以咪唑安定0 .1~0 .2mg/kg ,芬氟合剂2~3ml ,并以2 %利多卡因经气管注入行表面麻醉,按3种药物不同的起效时间注入静脉,观察3组患者麻醉诱导前后,气管插管后的HR ,MAP ,RR和SpO2 的变化。结果:A组呼吸变慢18例,SpO2 比诱导前降低明显,MAP升高,差异有显著性(P <0 .0 1)。B组RR、HR、MAP与诱导前差异无显著性。C组入睡时间起效迅速,用药后MAP下降明显,与诱导前差异有高度显著性(P <0 .0 1)。SpO2 有下降趋势,但均在正常范围。结论:依托米酯,异丙酚均可作为喉颈联合手术经气管切开插管麻醉诱导剂,但应掌握静注剂量与速度  相似文献   

3.
柳垂亮  招伟贤  李向宇  李国才  谢健 《广东医学》2002,23(10):1096-1097
目的:比较不同配伍的咪唑安定与异丙酚复合麻醉诱导的麻醉效果及其对循环功能的影响。方法:将125例无心血管疾病、年龄19-60岁、ASA I-II级的择期全麻手术患者随机分为3组,I组采用咪唑安定0.1mg/kg,异丙酚2.0mg/kg;II组采用咪唑安定0.2mg/kg,异丙酚1.0mg/kg;III组采用咪唑安定0.1mg/kg,异丙酚1.0mg/kg合并芬太尼3цg/kg,观察全麻诱导和气管插管的麻醉效果及其对循环功能的影响。结果:3组的麻醉诱导过程基本平稳,均产生较好的顺行性遗忘作用,但Ⅰ组与Ⅱ组对插管引发的循环反应抑制仍嫌不足,而Ⅲ组对此有较好的抑制效果。结论:咪唑安定0.mg/kg与异丙酚2.0mg/kg,或咪唑安定0.2mg/kg与异丙酚1.0mg/kg复合诱导,能产生较好的麻醉效果和遗忘作用,若并用芬太尼3цg/kg,能更有效抑制气管插管刺激产生的循环不良作用。  相似文献   

4.
目的:观察帕瑞昔布钠对全凭静脉麻醉患者脑电双频指数的影响。方法:20例ASAⅠ-Ⅱ级择期手术患者,采用异丙酚、瑞芬太尼、维库溴胺诱导后行气管插管。插管后,异丙酚和维库溴铵维持麻醉。诱导及维持过程中均采用脑电双频指数(BIS)监测仪监测镇静深度。当患者血流动力学指标及BIS值趋于平稳后,静脉注射帕瑞昔布钠40 mg,观察注射前、注射后5,10,15,20,30,40 min的BIS值、95%边缘频率(SEF),心率(HR)、收缩压(SBP)和舒张压(DBP)的变化。结果:静注帕瑞昔布钠后各时间点BIS、SEF、HR、SBP和DBP均未见明显变化(P>0.05)。注射前,注射后5,10,15,20,30,40 min的BIS值分别为:50.00±2.51,50.25±1.74,51.50±2.02,53.75±2.74,52.63±2.07,55.13±2.13和51.50±2.19;95%SEF值分别为:15.64±0.82,15.70±0.94,15.64±0.79,16.10±0.70,16.11±0.66,16.24±0.69和16.20±0.67。结论:静脉注射40 mg帕瑞昔布钠对全凭静脉麻醉患者BIS、95%SEF及血流动力学指标均无影响。  相似文献   

5.
芬太尼不同诱导剂量对气管插管时心血管反应的影响   总被引:5,自引:0,他引:5  
梁根强  靳三庆  黄宏辉 《广东医学》2003,24(10):1119-1120
目的 观察麻醉诱导时不同剂量的芬太尼对气管插管引起的心血管反应的影响。方法 选择 60例ASAⅠ~Ⅱ级成年患者 ,随机分成Ⅰ ,Ⅱ ,Ⅲ 3组 ,全麻诱导时的芬太尼用量分别为 4μg/kg ,6μg/kg ,7μg/kg ,同时 3组均合用咪唑安定 0 1mg/kg、维库溴铵 0 12mg/kg进行诱导插管。记录诱导前 ,插管后 1,3 ,5min患者收缩压 (SBP)、舒张压(DBP)、心率 (HR)的变化 ,并进行统计分析。结果 Ⅰ组患者插管后 1,3 ,5min的SBP ,DBP及HR值较麻醉诱导前明显升高 (P <0 0 5 )。Ⅱ组及Ⅲ组患者插管后 1,3 ,5min的SBP ,DBP ,HR值与麻醉诱导前比较差异无显著性 (P >0 0 5 )。Ⅱ ,Ⅲ组患者插管后 1,3 ,5min的SBP ,DBP及HR值较Ⅰ组患者的低 ,差异有显著性 (P <0 0 5 )。结论 以咪唑安定0 1mg/kg ,芬太尼 6μg/kg ,维库溴铵 0 12mg/kg进行全身麻醉诱导 ,可以有效抑制气管插管时的心血管反应 ,且血压、心率平稳 ;而 4μg/kg的芬太尼则不能有效抑制气管插管的心血管反应。  相似文献   

6.
[[摘要] 目的 观察靶控输注(TCI)异丙酚诱导中,维持脑电双频指数(BIS)为55±5时,复合不同剂量的布托啡诺对异丙酚靶浓度及血流动力学的影响。 方法 择期全麻手术患者80例,ASA I或II级,年龄18~65岁,随机分为4组(n=20):I、Ⅱ、Ⅲ、Ⅳ组为不同剂量布托啡诺。麻醉诱导:异丙酚起始靶浓度(Cp)为3.0 ug/mL,每30秒以0.3 ug/mL浓度递增,至患者意识消失,且BIS在55±5左右时给予布托啡诺30 ug/kg(I组),40 ug/kg(Ⅱ组),50 ug/kg(Ⅲ组),60 ug/kg(Ⅳ组),维持予先设定的BIS不变,根据BIS调整异丙酚靶浓度以0.3ug/ml浓度递增或递减。BIS稳定后再静脉注射维库溴铵0.12mg/kg,肌松满意后行气管插管。记录麻醉前3 min(T0),BIS为55±5左右时给阿片类药前即刻(T1),给阿片类药BIS稳定后 (T2),插管前即刻(T3),插管后即刻(T4),插管后3 mim(T5),6 mim(T6)各时间点CP、HR、MAP及BIS。结果 各组T0、T1时刻CP,HR,MAP,及BIS差异无统计学意义(P>0.05);与I组比较,Ⅱ、Ⅲ、IV组在T2至T6时刻CP明显减小(P<0.05)。I组在T4至T6时刻HR、MAP上升明显(P<0.05),而Ⅱ、Ⅲ、IV组无明显变化(P>0.05)。 结论 TCI异丙酚诱导时,以BIS降至55±5为指标,静脉注射布托啡诺可进一步降低异丙酚的血浆及效应室靶浓度;可减轻异丙酚诱导时所导致HR减慢和MAP下降,静脉注射 40~60 ug/kg布托啡诺具有较好的镇静作用,可较好地抑制气管插管反应。  相似文献   

7.
黄美清 《华夏医学》2003,16(4):494-495
目的 :观察异丙酚在婴幼儿麻醉维持的效果。方法 :婴幼儿手术 2 0例 ,全部肌注氨胺酮 6 mg/ kg入睡后送入手术室 ,气管插管组静注咪唑安定 0 .2 mg/ kg+维库溴胺 0 .1 m g/ kg诱导插管 ,术中控制呼吸 ;不插管组肌注咪唑安定 0 .3~ 0 .4 mg/ kg诱导麻醉 ,术中面罩供氧 ,手术开始微泵注入异丙酚 3~ 5 mg· kg- 1 · h- 1 维持麻醉。结果 :全部患儿术中安静 ,麻醉平稳 ,HR、RR、SPO2 稳定 ,无明显循环呼吸抑制 ,术毕 (1 0± 4 .5 ) m in清醒。结论 :异丙酚可安全用于婴幼儿麻醉维持期  相似文献   

8.
[摘要] 目的 观察七氟烷麻醉维持时0.2、0.5、1.0 mg/kg的氯胺酮对Narcotrend的影响。方法 ASA Ⅰ~Ⅱ 级准备接受腹部手术的患者40例,随机分为Ⅰ~Ⅳ组对应0.2、0.5、1.0 mg/kg的氯胺酮及生理盐水。七氟烷进行麻醉诱导及维持,气管插管后待麻醉深度稳定10 min,没有外科刺激时,静脉注射氯胺酮或生理盐水,连续观察15 min血流动力学及Narcotrend 指数(NI)的变化并记录。结果 给药前各组的NI 基本无差异, Ⅰ组39.4±3.0 , Ⅱ组37.5±2.6,Ⅲ组38.0±4.5 , Ⅳ组38.4±4.5。给药后Ⅰ组与Ⅳ组的NI在各个时间点均无差异;Ⅱ组和Ⅲ组与Ⅳ组相比,NI 明显升高,但Ⅱ 组的Narcotrend 分级并无变化,而Ⅲ组NI明显升高并使Narcotrend 分级显著提高。结论 在七氟烷麻醉维持时,0.2 mg/kg的氯胺酮对NI无影响,0.5 mg/kg时NI增加,但不影响Narcotrend 分级,而1.0 mg/kg的氯胺酮明显增加NI, 并改变Narcotrend分级,可能导致麻醉深度的误判,致使麻醉药物过量。  相似文献   

9.
咪唑安定与异丙酚联合用于全麻的疗效观察   总被引:2,自引:0,他引:2  
目的 观察咪唑安定与异丙酚联合用于麻醉诱导和维持的效果及不良反应。方法 选择 15 0例全麻手术病人 ,随机分为三组 ,每组 5 0例。A组 :麻醉诱导 :咪唑安定 0 .3mg Kg ,麻醉维持 :咪唑安定 0 .1-0 .2mg·Kg- 1 ·hr- 1 ;B组 :麻醉诱导 :异丙酚 1-3mg Kg麻醉维持 :2 -4mg·Kg- 1 ·hr- 1 ;C组 :麻醉诱导 :咪唑安定 0 .1mg Kg ,异丙酚0 .5 -1mg Kg ,麻醉维持 :0 .1mg·Kg- 1 ·hr- 1 ,异丙酚 1-2mg·Kg- 1 ·hr- 1 。所有病例均加用适量的芬太尼和万可松进行气管内插管 ,同时吸入 1%-2 %异氟醚 ,并用万可松维持肌松行机械通气。麻醉过程中持续监测SBP、DBP、HR和Petco2。结果 诱导后SBPA组降低 11.5 0mmHg ;B组降低 2 1.3 2mmHg;C组降低 16.0 1mmHg。DBP和HR三组变化无显著差异。气管插管后比麻醉诱导前A组SBP升高 2 6.2 1mmHg ,DBP升高 2 3 .12mmHg ,HR增加 17.2 3bpm ;B组SBP降低 13 .0 2mmHg,DBP升高 4.49mmHg ,HR增加 9bpm ;C组SBP ,DBP和HR与诱导前无显著变化。苏醒时间 :从术毕到病人睁眼 ,A组 :3 5 .0 3± 14 .45min ,B组 :7.3 5± 5 .96min ,C组 :15 .78± 9.67min ,苏醒期出现躁动A组为 3 4%( 17 5 0 ) ,B组为 6%( 3 5 0 )。C组为 10 %( 5 5 0 )。结论 咪唑安定和异丙酚联合用于全麻诱导  相似文献   

10.
目的探讨用异丙酚和维库溴铵全麻诱导插管期间脑电双频指数(Bispectral index,BIS)和听觉诱发电位指数(auditory evoked pontential index,AEPindex)的变化及其临床意义。方法ASAⅠ、Ⅱ级,择期在全麻下行腹部手术的患者(18~55岁)40例。2%利多卡因2mL环甲膜穿刺气管内表麻,异丙酚2mg/kg和维库溴铵0.1mg/kg静脉诱导,3~5min后气管插管,控制呼吸(IPPV,潮气量6~8mL/kg,PETCO235~40mmHg)。分别于麻醉前(T0),诱导后2min(T1),插管后2min(T2),插管后5min(T4),记录MAP、HR、SEF、BIS和AEP。结果诱导后各观察指标均较诱导前的基础值有所下降,插管后明显上升,血流动力学和BIS、AEPindex的变化趋势一致。结论BIS、AEP均能有效的反映插管的应激反应,可作为插管时麻醉深度监测的有效指标。AEPindex较其他几项指标更为可靠。  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
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.  相似文献   

16.
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.  相似文献   

17.
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.  相似文献   

18.
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.  相似文献   

19.
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.  相似文献   

20.
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.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号