参附注射液对法乐四联症根治术患者心功能保护作用的研究

目的 :探讨参附注射液对体外循环下法乐四联症 (TOF)根治术患者的心脏保护作用。方法 :选择体外循环下行 TOF根治术患者 96例 ,随机分为参附组 (n=4 8)和对照组 (n=4 8) ,参附组麻醉前 30 m in静脉输入参附注射液 1ml/ kg,对照组输入等量生理盐水。观察术中血流动力学及脉搏血氧饱和度 (Sp O2 )变化 ,术中及术后血管活性药物的使用及术后康复时间。结果 :参附组术中平均动脉压 (MAP)及 Sp O2 高于对照组 ,心率(HR)、中心静脉压 (CVP)低于对照组 (P均 <0 .0 5 ) ;参附组术中及术后多巴胺、多巴酚丁胺、硝普钠、西地兰使用剂量低于对照组 (P均 <0 .0 5 ) ;参附组术后拔管时间、ICU留置时间短于对照组 (P均 <0 .0 5 )。结论 :参附注射液对体外循环下法乐四联症根治术患者的心功能有一定保护作用。     

脑电双频指数指导心脏体外循环手术麻醉的临床观察

目的观察脑电双频指数(BIS)指导心脏体外循环(CPB)手术麻醉的临床效果。方法选择2007年9月至2009年9月在我院行择期手术的先天性心脏病患者50例,分为BIS组和对照组各25例,BIS组予BIS监测控制异丙酚泵入速度使BIS值维持在45±5,对照组持续静脉泵入异丙酚2～3mg/(kg.h)。记录患者开放静脉通路时(T0)、麻醉诱导后10min(T1)、主动脉阻断后20min(T2)和主动脉开放后20min(T3)4个时点平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)及患者CPB时间、主动脉阻断时间、术后拔管时间、重症监护室(ICU)停留时间。结果两组患者各时点MAP、HR和CVP、心脏CPB时间及主动脉阻断时间差异均无统计学意义(P0.05);BIS组术后拔管时间和ICU停留时间短于对照组(P0.05)。结论在CPB手术麻醉中,采用BIS监控可以减少术后拔管时间及ICU停留时间,有利于患者的早期恢复。     

小儿中低温体外循环心脏手术期间血浆肾上腺髓质素的变化

目的　探讨小儿先天性心脏病心脏手术期间血浆肾上腺髓质素 (AM )的变化规律。方法　选择中低温体外循环 (CPB)心脏手术患儿 10例 ,分别于全麻诱导后 10min、阻断主动脉前即刻、阻断主动脉后5min、开放主动脉后 5min、术后 3h采集动脉血 ,采用特异性放射免疫方法测定血浆AM浓度。结果　CPB开始患儿血浆AM即逐渐增高 ,开放主动脉后血浆AM浓度显著增高 (P <0 .0 5 ) ,术后 3h进一步升高(P <0 .0 1) ,且净增值 (△AM)与CPB时间呈显著正相关 (r =0 .89,P <0 .0 1)。结论　小儿心脏手术期间血浆AM浓度增高 ,可能与拮抗心脏手术期间外周血管阻力增加或调节围术期的体液、电解质平衡稳态有关。     

参附注射液对冠脉架桥术患者心功能的保护作用

目的 :探讨参附注射液对体外循环下行冠脉架桥术患者的心脏保护作用及术后康复的影响。方法 :选择体外循环下行冠脉架桥术患者 90例 ,随机分为 2组各 45例 ,参附组麻醉前 3 0min静脉滴注参附注射液1ml·kg 1,对照组输入等量生理盐水。观察术中血流动力学变化、术中及术后血管活性药物的使用、术后康复时间。结果 :参附组术中平均动脉压、心率均高于对照组 ,中心静脉压低于对照组 (P <0 .0 5) ;参附组术中及术后多巴胺、多巴酚丁胺、硝酸甘油使用剂量低于对照组 (P <0 .0 5) :参附组术后拔管时间、ICU留置时间短于对照组 (P <0 .0 5)。结论 :参附注射液对体外循环下冠脉架桥术患者的心功能有一定保护作用 ,能加速术后的康复     

参附注射液预注在老年患者麻醉诱导期间的循环稳定作用

目的观察参附注射液（sF）在老年患者麻醉诱导期间对血流动力学的影响。方法选择全麻下老年手术患者200例,随机分为两组,参附组（SF组）和对照组（C组）各100例。SF组于麻醉诱导前15min静脉注射SF注射液100ml,C组静脉注射等量生理盐水,15min后开始麻醉诱导;两组均静脉注射维库溴铵0．12mg／kg,芬太尼4o．g／kg,异丙酚2mg／mg,于麻醉前静息状态下、插管即刻、插管后1min、3min、5min、10min、15min分别测定并记录收缩压（SBP）、舒张压（DBP）、心率（HR）等,对上述结果进行统计学分析。结果SF组患者在麻醉诱导及插管时血流动力学较为稳定,与C组比较差异有显著性（P〈0．05）。结论参附注射液预注在维持老年患者麻醉诱导期间血流动力学的稳定性方面有一定的作用。     

参附注射液改善心脏直视手术后疲劳综合征的作用

目的研究经体外循环（CPB）注入参附注射液（SFI）对二尖瓣置换术（MVR）后疲劳综合征（POFS）的作用。方法择期MVR患者50例随机分为5组,每组10例。Ⅰ、Ⅱ组分别于CPB预充液中加入SFI1．0ml／kg和1．5ml／kg;Ⅲ组在开放主动脉时经CPB注入SFI1．5ml／kg;Ⅳ组分别于CPB预充液和开放主动脉时经CPB注入SFI1．5mLCkg;V组（对照组）手术全程都不用SFI。分别于术前（T1）、术毕（T2）、术后3h（T3）、24h（T4）及48h（L）测定血清丙二醛（MDA）含量和起氧化物歧化酶（SOD）活性,在T1、T4和T5进行视觉模拟疲劳评分（VAFS）,并记录各组术后呼吸机脱离、重症监护室（ICU）滞留和术后住院时间。结果①Ⅲ、Ⅳ组脱机时间较短;Ⅳ组ICU滞留时间较短;Ⅱ、Ⅲ组和Ⅳ组术后住院时间均较Ⅴ组缩短。②T4时各组VAFS均较术前增高,Ⅲ、Ⅳ组较其他组低;L时只有Ⅴ组VAFs较术前明显增高。③各组术后MDA含量及SOD活性均较术前增高。而Ⅲ、Ⅳ组术后MDA含量较Ⅴ组低：Ⅳ组术后SOD活力高于Ⅴ组。结论①SFI可抑制心脏直视手术后炎症反应,增强机体抗炎能力,减轻POFS。②预充和开放主动脉时经CPB注入1．5ml／kgSFI具有较好抗POFS作用。     

老年冠心病胃癌手术麻醉诱导前应用参附注射液预处理对患者心脏的保护作用效果观察

目的观察分析老年冠心病患者胃癌手术麻醉诱导前应用参附注射液预处理的心脏保护作用效果。方法将2014年3月至2016年7月行胃癌切除术老年患者54例,随机平分为对照组和干预组。两组患者均行全麻,干预组患者在术前半小时静脉滴注1 ml/kg参附注射液(加入250 ml的5%葡萄糖注射液),对照组患者则在同一时间点静脉滴注250 ml 5%葡萄糖注射液。比较两组患者治疗前、治疗后24 h的心功能指标及治疗前、治疗后不同时间段的血清心肌肌钙蛋白(c Tn I)、肌酸激酶同工酶(CK-MB)水平,并统计患者手术后3 d内的心脏不良事件发生情况。结果两组患者治疗后的心功能指标、血清c Tn I和CK-MB水平均较治疗前明显升高,差异有统计学意义(P0.05),且干预组患者治疗后6 h、12 h、24 h的血清c Tn I水平、CK-MB水平及治疗后24 h左心射血分数、心排量、心脏指数均较同时段对照组优势显著(P0.05);同时干预组发生无症状心肌缺血2例(7.4%)明显少于对照组发生无症状心肌缺血8例(29.6%)(P0.05)。结论参附注射液对降低老年冠心病胃癌手术患者的血清c Tn I、CK-MB水平,提高患者心功能具有显著的临床疗效,降低患者术后不良心脏事件发生率,对患者心脏起到了较好的保护作用。     

参附注射液对体外循环患者cTnI水平的影响

目的：探讨参附注射液（SFI）对体外循环（CPB）心脏手术患者心肌肌钙蛋白Ⅰ（cTnI）水平的影响。方法：选择临床心内直视手术患者60例,随机分为对照组和参附预处理组（SFI组）组各30例,SFI组于CPB前予参附注射液在转机前以微泵注射,对照组按常规手术。分别记录术前、术中60min、120min、术后6h两组患者cTnI水平。结果：SFI组术中60min、120min、术后6h各时点cTnI均低于对照组,两组比较有显著性差异（P〈0.05）。结论：参附注射液对CPB患者心肌细胞再灌注有保护作用,值得临床推广应用。     

参附注射液拮抗吸入麻醉药对气管平滑肌的痉挛作用

目的　研究参附注射液对吸入麻醉对引起气管平滑肌痉挛的影响作用。方法　选择 1 2 0例气管内全身麻醉的患者。随机分为治疗组 (n=60 )和对照组 (n=60 ) ,治疗组患者在麻醉诱导后 ,行气管插管 ,记录机控呼吸的气管压力值 ,再静脉滴注参附注射液 2 ml/kg。手术结束前再记录机控呼吸道压力值。结果　手术结束前两组间气道压力值有显著差异 ,P<0 .0 5。结论　参附注射液能明显缓解或者拮抗吸入麻醉药对气管平滑肌的痉挛     

抑酞酶在体外循环炎症反应中的作用

目的 :研究体外循环下抑肽酶对炎症反应的影响。方法 :30例择期瓣膜置换术病人 ,随机分为对照组 (n1=10 ) ,负荷剂量使用抑肽酶组 (n2 =10 )和单次剂量使用抑肽酶组 (n3 =10 )。分别观察各时点IL - 6的活性 ,分别于术前、主动脉阻断前、主动脉阻断后 30分、主动脉开放 15分、 6 0分分别从桡动脉采血 5ml,测血浆中各时点IL - 6。结果 :对照组IL - 6各时点与术前相比 ,在主动脉开放 6 0分钟明显升高 (P <0 0 5 ) ,负荷剂量使用抑肽酶组各时点与术前相比 ,在主动脉开放 6 0分钟明显升高 (P <0 0 5 ) ,单次剂量使用抑肽酶组各时点与术前相比 ,主动脉阻断 30分钟、开放 15分钟、 6 0分钟明显升高 (P <0 0 5 ) ,同一时点负荷剂量使用组与对照组比较在主动脉开放 6 0分钟时差异有显著性 (P <0 0 5 )。结论 :负荷剂量使用抑肽酶用于体外循环时能有效抑制CPB诱发的促炎因子IL - 6的释放 ,而单次剂量使用抑肽酶用于体外循环时 ,不能有效抑制CPB诱发促炎因子IL- 6的反应。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.