布比卡因复合舒芬太尼腰-硬联合麻醉在老年下肢骨折手术中的应用

目的:探讨布比卡因复合舒芬太尼腰-硬联合麻醉在老年下肢骨折手术中的应用。方法:将60例老年下肢骨折手术患者随机分为单纯布比卡因组（A组）,布比卡因复合舒芬太尼组（B组）,每组30例。A组给予布比卡因7.5 mg+0.9%氯化钠注射液0.5 ml,B组给予布比卡因7.5 mg复合舒芬太尼5 μg+0.9%氯化钠注射液0.4 ml。观察患者感觉阻滞起效时间、阻滞程度、持续时间、运动阻滞持续时间和改良Bromage评分,术中、术后瘙痒、恶心呕吐情况。结果:2组患者感觉阻滞起效时间差异无统计学意义（P>0.05）,与A组比较,B组感觉阻滞持续时间明显延长,感觉阻滞最高平面明显升高（P<0.01）,2组患者改良Bromage评分和运动阻滞持续时间差异均无统计学意义（P>0.05）,术中、术后不良反应差异均无统计学意义（P>0.05）。结论:小剂量布比卡因复合舒芬太尼腰-硬联合麻醉应用于老年下肢骨折手术较为安全有效。     

小剂量舒芬太尼复合布比卡因腰硬联合麻醉用于妊高征剖宫产术的临床观察

目的探讨小剂量舒芬太尼复合布比卡因腰硬联合麻醉用于妊高征剖宫产术的有效性及安全性。方法选择单胎,患有妊高征、子痫前期择期行剖宫产术的产妇60例,随机均分为三组,根据腰麻用药不同剂量及配方,分为D组(布比卡因7.5mg)、G组(布比卡因10mg)、H组(舒芬太尼5μg复合布比卡因7.5mg)。观察并记录各组麻醉前、麻醉后5min、10min、15min、30min的MAP、HR的变化;各组麻醉感觉阻滞起效时间、运动阻滞起效时间、麻醉最高平面、运动阻滞持续时间及肌松效果评价;记录新生儿出生后1min、5min的Apgar评分及各组胸闷、寒颤、恶心、呕吐、呼吸抑制的发生率。结果三组麻醉后5min的MAP、HR均较麻醉前降低,而G组较其它组下降更明显(P<0.05),其中12例需静注麻黄碱才能维持,且胸闷、寒颤、恶心、呕吐的发生率较D组、H组高。各组麻醉感觉阻滞起效时间、运动阻滞起效时间差异无显著性(P>0.05),D组有10例麻醉最高平面达不到手术要求,需硬膜外追加局麻醉药,与G组、H组比较差异有显著性(P<0.05)。各组新生儿出生后1min、5min的Apgar评分差异无显著性(P>0.05)。结论小剂量舒芬太尼5μg复合小剂量布比卡因7.5mg腰硬联合麻醉对妊高征患者血流动力学影响小,起效快,阻滞完善,肌松效果佳,运动阻滞持续时间短,不良反应少,患者感觉舒适,值得临床推广。     

腰麻复合小剂量舒芬太尼用于老年患者手术的临床观察

目的 观察布比卡因复合小剂量舒芬太尼用于老年患者下腹部或下肢手术腰麻的麻醉效果.方法 择期行下腹部或下肢手术的老年患者60例,ASAⅡ或Ⅲ级,年龄70～90岁,体重50～80kg.随机分为2组(n=30):L组(单纯布比卡因7.5mg)和LS组(布比卡因4.5 mg复合舒芬太尼5μg).蛛网膜下腔穿刺成功后,注入含糖浓度为6.7%的重比重混合局麻药1.5 mL,注入时间20 s.记录感觉阻滞起效时间、感觉阻滞最高平面、感觉阻滞持续时间、Bramage分级及副作用.结果 2组患者年龄、身高、体重、ASA分级比、手术时间等比较差异无显著性(P＞0.05).与L组比较,LS组患者感觉阻滞起效时间缩短,感觉阻滞持续时间延长(P＜0.01).L组运动阻滞程度强于LS组(P＜0.01).L组出现低血压、恶心呕吐的患者多于LS组(P＜0.01),而LS组有2例患者出现一过性轻微的瘙痒(P＜0.01).结论 小剂量布比卡因复合5μg舒芬太尼腰麻持续镇痛时间延长,能满足老年患者下腹部或下肢手术的麻醉需要,且副作用减少,可增加手术的安全性.     

小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用

目的探讨小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用效果。方法将2018年10月至2019年10月在原阳县人民医院实施无痛分娩的86例产妇按随机数表法分为对照组和观察组,各43例。对所有产妇实施腰硬联合麻醉,给予对照组产妇1.5 mL的10 g·L~(-1)盐酸罗哌卡因注射液缓慢推注,给予观察组产妇20μg枸橼酸舒芬太尼注射液及1 mL的7.5 g·L~(-1)盐酸罗哌卡因注射液缓慢推注。采用视觉模拟评分量表(VAS)比较两组镇痛前、镇痛后5 min、镇痛后30 min的疼痛程度。记录最大感觉阻滞平面、感觉阻滞起效时间、运动阻滞起效时间。结果镇痛后5、30 min,两组VAS评分均较镇痛前降低,观察组VAS评分低于对照组,差异有统计学意义(均P<0.05)。与对照组比较,观察组最大感觉阻滞平面较小,感觉阻滞起效时间和运动阻滞起效时间均较短,差异有统计学意义(均P<0.05)。结论在无痛分娩中联合应用小剂量罗哌卡因及舒芬太尼进行腰硬联合麻醉,麻醉质量高,镇痛效果好。     

氟比洛芬酯联合舒芬太尼用于食管肿瘤切除术后静脉镇痛

目的 观察胸科食管肿瘤手术后应用氟比洛芬酯复合舒芬太尼自控静脉镇痛的临床效果和安全性.方法 选取60例择期(术前ASA I～Ⅱ级)开胸行食管肿瘤切除术后病人,采用随机双盲方法 分为对照组、小剂量组及氟比洛芬酯与舒芬太尼联合用药组(联合用药组),每组20例.分别于术后6,12,24,48 h观察病人的VAS评分(视觉模拟评分)、Prince-Henry 评分、镇痛药消耗量(CAC)、镇静评分、不良反应(恶心、呕吐、呼吸抑制等),并于术前、术毕及其上述各时间点测量血浆皮质醇(Cor)值.结果 对照组与联合用药组比较,术后 6,12,24,48 h VAS评分、Prince-Henry 评分、CAC和Cor值比较差别均无统计学意义(P>0.05),且对照组、联合用药组上述各指标均小于小剂量组(P<0.05);小剂量组和联合用药组术后48 h内恶心、呕吐发生率明显少于对照组 (P<0.05).结论 氟比洛芬酯联合舒芬太尼用于开胸食管肿瘤切除术后静脉自控镇痛能减少舒芬太尼用量且镇痛效果与单纯较大剂量舒芬太尼相当,而术后应激反应、恶心、呕吐发生率较单纯应用舒芬太尼低.     

低比重罗哌卡因复合舒芬太尼腰-硬联合麻醉在高龄髋关节手术中的应用

目的探讨小剂量、低比重罗哌卡因复合舒芬太尼腰-硬联合麻醉(CSEA)在高龄单侧髋关节手术的麻醉效果及其安全性。方法 42例高龄髋关节手术患者,采用0.33%罗哌卡因复合舒芬太尼5μg低比重溶液行单侧腰-硬联合麻醉。记录感觉阻滞起效时间,最高阻滞平面,麻醉持续时间,Bromage运动阻滞评分和腰麻后5、10、20、30、40min平均动脉压(SBP),心率(HR),呼吸(RR),氧饱和度(SpO2)的变化及不良反应发生情况。结果手术侧感觉阻滞起效时间(2.2±1.3)min、最高平面T11(T10~T12),麻醉持续时间(78.2±19.3)min。Bromage评分:Ⅰ~Ⅱ级,腰麻后各时点血压、HR、RR平稳,SpO2为100%(吸氧),无低血压、呕吐发生。结论小剂量、低比重罗哌卡因复合舒芬太尼溶液行腰-硬联合麻醉阻滞效果确切,对心血管影响小,适合于高龄单侧髋关节手术。     

舒芬太尼复合不同剂量罗哌卡因蛛网膜下腔阻滞麻醉在剖宫产术中麻醉效果

目的:观察小剂量舒芬太尼复合不同剂量罗哌卡因蛛网膜下腔阻滞麻醉在剖宫产术中麻醉效果,探讨罗哌卡因理想剂量。方法:选择120例单胎、足月妊娠,需腰-硬联合麻醉下行子宫下段剖宫产的产妇,随机分为三组,A组、B组、C组,每组40例,选择L2~3间隙行腰-硬联合麻醉,腰蛛网膜下腔阻滞麻醉用药为舒芬太尼5μg复合0.75%罗哌卡因,罗哌卡因剂量分别为:A组1.1 ml(8.25 mg),B组1.0 ml(7.5 mg),C组0.9 ml(6.75 mg)。观察感觉运动神经阻滞的起效时间、阻滞平面、麻醉效果及不良反应。结果:三组患者麻醉起效时间差异无统计学意义。麻醉平面达T6~T8的例数,A组高于B组、C组(P<0.05);麻醉效果A组、B组高于C组(P<0.05);低血压、恶心呕吐的发生率A组高于B组、C组(P<0.05)。三组新生儿娩出后1 min和5 min的Apgar评分差异无统计学意义(P>0.05)。结论:舒芬太尼5μg复合0.75%罗哌卡因1.0 ml用于剖宫产蛛网膜下腔阻滞麻醉提供满意麻醉效果,血流动力学稳定,不良反应发生率低,是蛛网膜下腔阻滞中比较理想的剂量。     

左布比卡因复合舒芬太尼在下肢下腹部手术中的应用

目的：探讨左布比卡因复合舒芬太尼腰硬联合麻醉在下肢下腹部手术中的有效剂量及安全性。方法将2012年6月-2013年6月本院采用腰硬联合麻醉下行下肢下腹部择期手术患者90例随机分为三组各30例。A组为5mg/ml左布比卡因7mg＋舒芬太尼4μg,B组5mg/ml左布比卡因8mg＋舒芬太尼4μg,C组5mg/ml左布比卡因9mg＋舒芬太尼4μg,观察最高阻滞平面、麻醉持续时间、麻醉效果、生理指标变化及不良反应。结果 A组最高麻醉平面分别低于B、C组（P 〈0.05）。A组达最高阻滞平面时间长于B、C组（P 〈0.05）。三组感觉阻滞维持时间、运动阻滞维持时间及达Bromage3级时间均无统计学差异（P 〉0.05）,三组心动过缓、恶心、呕吐、寒战及术后头痛发生率均无统计学差异（P 〉0.05）。术后随访未发现有神经并发症。结论左布比卡因有效剂量为8-9mg,复合舒芬太尼腰硬联合麻醉可安全用于下肢下腹部手术。     

小剂量舒芬太尼-罗哌卡因行腰硬联合麻醉的临床观察

目的 探讨小剂量舒芬太尼-罗哌卡因腰硬联合麻醉在老年下肢骨科手术中的临床效果.方法 将行下肢骨科手术的患者45例随机分为3组,每组15例.Ⅰ组:罗哌卡因10 mg;Ⅱ组罗哌卡因7.5 mg 加舒芬太尼2.5 μg;Ⅲ组:罗哌卡因7.5 mg加舒芬太尼5 μg.均用生理盐水配成2.0 ml溶液,分别注入蛛网膜下腔.观察3组患者的血压、心率变化,有效镇痛时间及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应.结果所有患者麻醉镇痛完善.Ⅱ、Ⅲ组患者6、9、12、15、20 min的SBP、DBP均高于Ⅰ组(P<0.01),Ⅱ、Ⅲ组之间无差异;其他时间、血压比较则无统计学意义.Ⅱ、Ⅲ组患者运动神经阻滞持续时间及有效镇痛时间均高于Ⅰ组(P<0.01).Ⅰ组不良反应多于Ⅱ、Ⅲ组.结论 小剂量舒芬太尼-罗哌卡因腰硬联合麻醉对血流动力学影响小,有效镇痛时间延长,适合于老年下肢手术,但应注意与舒芬太尼剂量相关的皮肤瘙痒.     

舒芬太尼与吗啡用于下腹部手术术后硬膜外自控镇痛的临床观察

目的比较舒芬太尼与吗啡复合布比卡因用于下腹部手术术后硬膜外镇痛的疗效以及不良反应的发生情况。方法 92例下腹部手术患者随机分为吗啡组和舒芬太尼组,每组46例,均采取腰硬联合麻醉下完成手术,术后硬膜外导管连接镇痛泵。以视觉模拟评分法(VAS)评价镇痛效果,并观察恶心呕吐、皮肤瘙痒等不良反应。结果两组患者术后镇痛效果满意,镇痛效果差异无显著性(P>0.05),恶心呕吐及皮肤瘙痒的发生率吗啡组均高于舒芬太尼组,差异有显著性(P<0.05)。结论舒芬太尼与吗啡复合布比卡因用于下腹部手术术后硬膜外镇痛,均能取得良好的镇痛效果,但使用舒芬太尼不良反应的发生率更低,更加可行。     

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.