曲马多复合异丙酚在全麻术后拔管期的应用

目的了解曲马多复合异丙酚在全麻术后拔管期血流动力学影响。方法 40例全麻术后患者,ASAⅠ～Ⅱ级,择期全麻下行腹部手术,随机分观察组和对照组。观察组术毕拔管前静注曲马多30mg和异丙酚10～20mg。连续监测观察组和对照组用药前、用药后5min、拨管前、拨管时、拔管后5min及拔管后10min各时点的HR、RR、MAP、SPO2。结果与用药前比HR、RR、MAP降低（P〈0.05）,与拔管前比HR、RR、MAP增高,SPO2降低（P〈0.05）。结论曲马多复合异丙酚在全麻术后拔管期能有效抑制应激反应。     

芬太尼、异丙酚伍用麻黄碱在门诊宫腔镜手术麻醉中的应用

目的观察芬太尼、异丙酚伍用麻黄碱在宫腔镜手术中的麻醉效果与生命体征变化。方法选择80例宫腔镜手术患者,随机分为实验组（M组）和对照组（D组）,每组40例,用芬太尼、异丙酚行静脉复合麻醉。实验组在诱导液中加入麻黄碱0.08mg/kg,监测MAP、HR、RR、SPO2,比较2组麻醉效果的差异和生命体征变化。结果实验组MAP、HR、RR、SPO2稳定,苏醒快;对照组MAP、HR、RR、SPO2下降明显。结论芬太尼、异丙酚伍用麻黄碱可以减轻镇静深度和伤害反应,减少异丙酚的副作用,使苏醒更加迅速。     

异丙酚与芬太尼复合静脉麻醉在宫腔镜手术中的应用(附120例报告)

目的探讨异丙酚与芬太尼复合静脉麻醉在宫腔镜手术中的麻醉效果和安全性。方法选择ASAⅠ~Ⅱ级、血压及心电图检查正常、需行宫腔镜手术的妇女120例,随机分成异丙酚组(P组,n=60)和异丙酚加芬太尼组(F组,n=60),记录两组患者诱导前和诱导后2min MAP、SpO2、HR和异丙酚的用量,同时记录P组和F组患者局部注射痛和呼吸抑制的发生例数。结果两组患者MAP、SpO2、HR在诱导前、诱导后2min差异具有显著性(P<0.05),异丙酚用量F组可少用约1/3(P<0.01),F组局部注射痛比P组明显减少(P<0.01),但呼吸抑制F组比P组发生率明显升高(P<0.01)。结论异丙酚与芬太尼复合静脉麻醉在宫腔镜手术中麻醉效果满意,适宜在基层医院推广应用,但需注意呼吸抑制的发生。     

口服曲马多辅助丙泊酚无痛人流术效果观察

目的观察口服曲马多缓释片辅助丙泊酚无痛人工流产术的麻醉效果。方法早孕妇女80例,随机分为两组（n=40）：口服曲马多辅助丙泊酚组（PT组）和丙泊酚（P组）。PT组予术前1h口服盐酸曲马多缓释片100mg（1片）。两组均按丙泊酚2.0mg/kg诱导,术中维持每次追加丙泊酚0.5～1.0mg/kg,记录丙泊酚用量、意识恢复、自由对答和自行离去时间、呼吸和循环监测指标、苏醒期有无宫缩痛及疼痛程度（VAS评分）。结果两组注射丙泊酚麻醉诱导后1min的MAP和SpO2明显降低（P〈0.05）,但均在正常范围,组间比较无明显差别（P〉0.05）;PT组丙泊酚用量明显少于P组（P〈0.05）;PT组丙泊酚注射痛和术后宫缩痛明显低于P组（P〈0.05）,PT组呼吸抑制发生率明显低于P组（P〈0.05）。结论无痛人工流产术病人,术前口服曲马多缓释片可减少丙泊酚麻醉用药量,减轻丙泊酚注射痛,降低呼吸抑制和术后宫缩痛发生率。     

异丙酚复合氯胺酮用于小儿气管异物取出术的麻醉

目的　观察异丙酚复合氯胺酮用于小儿气管异物取出术的麻醉效果。方法　 6 0例患儿 ,随机分为 3组 ,组Ⅰ ,单纯用氯胺酮 ;组Ⅱ ,γ 羟基丁酸钠复合氯胺酮 ;组Ⅲ ,异丙酚复合氯胺酮 ;每组 2 0例。Datex监护仪监测BP、HR、ECG、SPO2 ,Ⅰ组静注氯胺酮 2mg·kg-1;Ⅱ组静注γ 羟基丁酸钠 80mg·kg-1;Ⅲ组静注异丙酚 2mg·kg-1。观察术中BP、HR、SPO2 的变化 ,手术时间、苏醒时间、术中喉痉挛和术手恶心、呕吐发生率。结果　异丙酚复合氯胺酮组 ,术中BP、HR、SPO2 的变化小 ,苏醒时间短 (P <0 .0 5 ) ,术中未发生喉痉挛 ,术后恶心、呕吐发生率低 (P <0 .0 5 )。结论　异丙酚复合氯胺酮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     

异丙酚复合瑞芬太尼用于无痛人流的临床观察

目的观察异丙酚复合瑞芬太尼用于人工流产的临床麻醉效能,及其对呼吸、循环的影响和不良反应.方法100例早孕者,均无麻醉前用药,随机分为2组,Ⅰ组用药为单纯1%异丙酚,静注剂量3mg/kg,Ⅱ组用药为在输注异丙酚前1min先静注0.3μg/kg瑞芬太尼,注药时间30秒,异丙酚静注量2mg/kg,待患者睫毛反射消失后开始操作,两组术中因操作刺激,患者有肢体动作时,可追加0.5mg/kg异丙酚以维持满意的麻醉效果.观察术前、睫毛反射消失时、扩宫时、吸宫时和手术结束时的SBP、DBP、MAP、SPO2、HR值,诱导时间、手术时间、苏醒时间和定向力恢复时间、患者体动及术后宫缩痛情况及异丙酚的总用量.结果和术前比,Ⅰ组睫毛反射消失时、扩宫时的MAP、HR显著降低(P＜0.01),吸宫时MAP、HR均显著增高(P＜0.05),Ⅱ组睫毛反射消失时、扩宫时、吸宫时MAP、HR和术前比显著降低(P＜0.01),Ⅰ组诱导时间明显缩短,苏醒时间和定向力恢复时间明显延长(P＜0.01),异丙酚用量显著增加(P＜0.01),术后宫缩痛发生率明显增加(P＜0.01).结论异丙酚复合瑞芬太尼用于人工流产麻醉效果确切,呼吸循环抑制显著降低,术后宫缩痛明显缓解,是人工流产较有效的麻醉方法.     

宫腔镜手术中应用右美托咪定复合异丙酚的麻醉效果

】目的研究和观察右美托咪定复合异丙酚及异丙酚静脉麻醉在妇产科宫腔镜手术中的应用效果。方法择期宫腔镜手术患者80例,随机均分为异丙酚组（P组）和异丙酚加右美托咪定组（PY组）,各40例。观察并记录手术前（T0）、诱导后（T1）、扩宫时（T2）、清除肿物（或异物）时（B）、手术结束时（T4）的MAP、HR、SpO2,记录异丙酚的诱导时间、手术时间、清醒时间、有无肢体运动、有无呼吸暂停及苏醒后患者对镇静镇痛的评价及有无术后宫缩痛。结果PY组异丙酚诱导时间明显短于P组（P〈0．05）,P组在T1、T2点MAP低于PY组（P〈0．05）;不良反应观察结果显示：术中PY组患者肢体活动明显低于P组,分别为6例和16例（P〈0．05）;呼吸暂停P组12例,多于PY组4例（P〈0．05）;P组患者对镇静镇痛不满意例数8例,高于PY组1例（P〈0．05）,P组有术后宫缩痛12例,多于PY组4例（P〈0．05）。结论右美托咪定复合异丙酚静脉麻醉既能保证手术安全顺利地实施又能增加患者的满意度,减少术后宫缩痛．是宫腔镜手术较为理想的麻醉方式。     

无痛内镜下治疗大肠息肉应用效果观察

目的:探讨联合应用异丙酚、咪唑安定、东莨菪碱内镜下治疗大肠息肉的镇静镇痛效果和安全性.方法:拟行内镜下大肠息肉高频电凝电切术68例,随机分为三组,即:A组(无麻醉组)、B组(异丙酚、咪唑安定组)、C组(异丙酚、咪唑安定、东莨菪碱组)各23例.观察记录各组受检者术中的反应、内镜操作时间、麻醉药物作用时间,操作过程前、中、后MAP、HR、SPO2和RR,术后问卷调查以及麻醉效果评定.结果:B、C组术中不适反应少、内镜操作时间短、受检者认为治疗过程舒适无痛苦,100%愿意接受必要的再检查.而与B组比较,C组麻醉效果更佳、操作时间更短、异丙酚用量及不适反应更少.结论:联合异丙酚、咪唑安定、东莨菪碱静脉麻醉用于内镜下治疗大肠息肉是舒适安全、有效.     

异丙酚联合局部浸润麻醉在小儿扁桃体摘除术中的应用

为观察异丙酚联合局浸在小儿扁桃体摘除术中的麻醉效果 ,将 34例患儿随机分为两组 ,Ⅰ组用芬太尼 1μg·kg-1、力月西 0 0 6mg·kg-1、异丙酚 2 5mg·kg-1诱导 ,术中以异丙酚 1～ 3mg·kg-1·h-1持续泵注维持 ,术始加用 0 5 %利多卡因局浸 ;Ⅱ组不加局浸 ,余用同样的方法诱导和维持。观察并比较两组麻醉前、诱导时、插管时、术始、术中及拔管时的MBP、HR、SPO2 及异丙酚平均用量的变化。结果 ,两组麻醉前、诱导时、插管时的MBP、HR及SPO2 变化不大 ,而术始、术中、插管时及平均用药量有差别 (P <0 0 5 )。显示 :异丙酚联合局浸用于小儿扁桃体摘除术的麻醉有术中更平稳、异丙酚用药量少的优点。     

异丙酚复合芬太尼、利多卡因用于无痛人工流产的临床观察

目的 观察异丙酚复合芬太尼、利多卡因静脉麻醉在无痛人工流产术中对患者HR、MAP、SpO2及清醒时间、注射部位疼痛情况的影响。方法 40例择期行无痛人流术的早期妊娠病人随机分成A、B两组。A组开放静脉后先注入利多卡因0．5mg／kg、芬太尼0．5ug／kg，1分钟后注入异丙酚2．5mg／kg，术中根据情况追加30～50mg异丙酚；B组开放静脉后直接注入异丙酚，用量同A组。分别监测两组在麻醉前1分钟、手术开始前、手术中HR、MAP、SpO2变化，并记录病人意识消失时间，清醒时间及注射部位疼痛发生率。结果 A组于手术中HR、MAP升高幅度明显低于B组（P〈0．05）；A组病人注射痛发生率明显低于B组（P〈0．05）；A组SpO2、意识消失及术毕清醒时间与B组相比无显著性差异（P〉0．05）。结论 芬太尼、利多卡因复合异丙酚静脉麻醉用于无痛人工流产术安全、有效，并且能减轻异丙酚引起的注射痛。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.