腰麻-硬膜外联合麻醉在妇科腹腔镜手术中的应用

目的　比较腰麻 -硬膜外联合麻醉与静吸复合全麻用于妇科腹腔镜手术对BP、HR、SpO2 、PETCO2 的影响。方法　 4 0例妇科腹腔镜手术患者随机分成腰麻 -硬膜外联合麻醉组 (CSEA组 ) 2 0例 ,静吸复合全麻 (GA组 )2 0例。监测患者麻醉前 10分钟 ,气腹前 ,气腹后 10分钟、30分钟、术毕放气后 10分钟的BP、HR、SpO2 、PETCO2 ,记录各组数据。结果　①气腹后CSEA组和GA组较气腹前HR都明显增快 (p <0 .0 1) ,MAP明显升高 (P <0 .0 5 ) ;②CSEA组患者PETCO2 于气腹后明显上升 (p <0 .0 5 ) ,GA组无明显差异 ;③GA组麻醉后SpO2 较CSEA组高 (p <0 .0 1)。④CSEA组BP、HR、SpO2 、PETCO2 均在正常范围。结论　腰麻 -硬膜外联合麻醉用于妇科腹腔镜手术安全可靠 ,较静吸复合全麻简便、经济 ,是较理想的麻醉方法。     

腰麻联合硬膜外麻醉在妇科腹腔镜手术中的临床应用

目的探讨腰麻联合硬膜外麻醉应用于妇科腹腔镜手术的可行性。方法102例妇科腹腔镜手术患者随机分成腰麻-硬膜外联合麻醉组(CSEA组)51例,静吸复合全麻(GA组)51例,监测患者麻醉前、气腹前、气腹后10分钟、30分钟、术毕放气后10分钟的HR、RR、MAR、pH、SPO2、PETCO2,记录各组数据。结果腰麻联合硬膜外麻醉用于妇科腹腔镜手术患者生命体征平稳,无严重不良反应,且麻醉诱导时间及手术时间明显短于静吸复合全麻。结论腰麻-硬膜外联合麻醉用于妇科腹腔镜手术安全可靠、简便、经济,是较理想的麻醉方法。     

腰麻-硬膜外联合麻醉用于妇科腹腔镜手术临床观察

目的 比较腰麻－硬膜外联合麻醉和单纯硬膜外麻醉用于妇科腔镜手术对BP，HR，SPO2，PETCO2及麻醉效果，气腹充气量的影响。方法 50例妇科腹腔镜手术病人随机分粗要麻－硬膜外联合麻醉组（CSEA组，n=25例）和单纯硬膜外麻醉组（EA组，n=25例），监测患者于麻醉前，气腹前，气腹10min,30min及解除气腹后10min 5个时间占HR，BP，SPO2和PETCO2的变化，记录腹内压达1.17kPa时的气腹充气量及麻醉效果。结果 （1）气腹后HR，BP，PETCO2均明显变化（P＜0．05），EA组BP变化比CSEA组更明显（P＜0．05）；（2）CSEA组的气腹充气量明显多于EA组（P＜0．05）；（3）CSEA组的麻醉效果优于EA组（P＜0．05）。结论 腰麻－硬膜外麻醉用于妇科腹腔镜手术对循环影响小，麻醉效果优于单纯硬膜外麻醉，是较理想的麻醉方法。     

妇科腹腔镜手术不同麻醉方法对SPO2及PaCO2的影响

目的比较妇科腹腔镜手术不同麻醉方法对脉搏血氧饱和度(SPO2)及动脉血二氧化碳分压(PaCO2)的影响.方法选用腰麻、硬膜外及全麻3种麻醉方法,对36例腹腔镜下妇科手术患者在气腹前15 min、气腹后20min、放气后20min分别监测其SPO2及PaCO2变化.结果腰麻及硬膜外组在气腹后20min其SPO2较气腹前明显降低,PaCO2较气腹前明显升高,有显著性差异(P＜0.05),而全麻组变化不明显.结论腹腔镜下妇科手术采用全麻方法较安全.     

不同麻醉方法行妇科腹腔镜术临床观察

目的　探讨不同麻醉下妇科腹腔镜手术对呼吸、循环功能的影响。方法　妇科腹腔镜手术患者 6 0例 ,随机分成腰 -硬联合麻醉 (CSEA)Ⅰ组、硬膜外麻醉 (EA)Ⅱ组和气管内全麻 (GA)Ⅲ组各 2 0例。均为ASAⅠ -Ⅱ级。结果　Ⅰ、Ⅱ组麻醉后血压下降 ,与麻醉前相比有显著性差异 (P <0 .0 5 ) ,而气腹后 5分钟、30分钟Ⅰ组血压、心率则较为平稳。而Ⅱ组血压、心率则升高 ,与麻醉前相比有显著性差异 (P <0 .0 5 )。以麻醉前呼吸频率(RR)为基础值 ,Ⅰ、Ⅱ组气腹后 5分钟、30分钟 ,RR均明显增加 ,有显著性差异 (P <0 .0 5 )。Ⅲ组气腹后 5分钟、30分钟血压、心率则升高。结论　腰麻 -硬膜外阻滞用于妇科腹腔镜手术是一种安全有效的麻醉方法。但对有心肺疾病、年老体弱或肥胖的病人 ,以及手术难度大 ,估计气腹时间长者 ,宜选择气管内全麻。     

腰麻联合硬膜外麻醉下行妇科腹腔镜手术310例临床观察

目的 探讨腰麻联合硬膜外麻醉下行妇科腹腔镜手术的可行性. 方法 310例妇科腹腔镜手术患者全部采用腰麻联合硬膜外麻醉,术中静脉辅以镇静药,观察心电图(ECG)、无创血压(NBP)、血氧饱和度(SPO2)、呼吸(RR)、心率(HR)、呼气末二氧化碳(PETCO2 )情况.结果 除15例患者因麻醉平面达不到手术要求需加用静脉麻醉药外,其余患者均在腰麻联合硬膜外麻醉下顺利完成手术, 未出现呕吐、误吸等并发症.结论 腰麻联合硬膜外麻醉用于妇科腹腔镜手术时操作简单、安全可行.     

气管内全麻与硬膜外复合静脉麻醉用于妇科腹腔镜手术的效果比较

目的 比较气管内全麻与硬膜外复合静脉麻醉用于妇科腹腔镜手术的麻醉效果,以及对循环、呼吸的影响.方法 选择60例ASA Ⅰ～Ⅱ级掸期行妇科腹腔镜手术的患者,随机分为气管内全麻组(Ⅰ组)和硬膜外复合静脉麻醉组(Ⅱ组),每组30例.Ⅰ组常规气管插管静吸复合全麻,机械通气;Ⅱ组采用硬膜外复合静脉麻醉,保留自主呼吸.两组患者气腹期间均采用T体位,记录两组患者麻醉前、气腹后10 min、30 min、60 min、90 min及放气后5 min的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、分钟通气量(VE)、血氧饱和度(SpO2)、呼吸末二氧化碳分压(PETCO2)、清醒后的不适主诉和术者对麻醉的满意度等.结果 两组病人的麻醉效果及各时段的SpO2相比差异无显著性,然而气腹后与Ⅰ组相比,Ⅱ组病人HR及RR均增快(P＜0.05);当气腹至60min及90 min时,Ⅱ组病人的呼吸末二氧化碳分压(PETCO2)显著高于Ⅰ组及麻醉前(P＜0.01),其分钟通气量比Ⅰ组明显减小(P＜0.01),MAP显著下降(P＜0.01).结论 短时间的妇科腹腔镜手术可选择硬膜外复合静脉麻醉,但需要硬膜外阻滞完善,辅助用药合理.对于时间较长的手术,仍以气管内全麻为宜.     

全麻和硬膜外麻醉在妇科腹腔镜手术中的应用

目的 比较静、吸复合全身麻醉与连续硬膜外麻醉在妇科腹腔镜手术中的麻醉效果. 方法选择择期腹腔镜妇科手术患者60例,随机分成两组各30例.A组为气管插管静、吸复合全身麻醉组,B组为连续硬膜外麻醉组.两组患者入室后按常规分别给予全麻或硬膜外麻醉,比较两组麻醉的效果.常规监测心率(HR)、血压(Bp)、平均动脉压(MAP)、血氧饱和度(SpO 2)、呼吸频率(RR)、呼气末二氧化碳分压(P ETCO2).结果 气腹后3分钟、改变体位3分钟后,B组心率HR较麻醉前明显增快(P<0.05).两组病人在手术开始后PETCO2均逐渐升高,与麻醉前相比差异有显著性(P<0.05);两组间相比差异有显著性(P<0.05).各期血压变化不明显,脉搏血氧饱和度在连续硬膜外麻醉后即有所下降,吸氧后改善,气腹后增大吸氧量才能维持在正常范围,全身麻醉组则无此现象,组间比较有显著性差异(P<0.05).结论 气管插管静、吸复合全身麻醉是腹腔镜妇科手术最为理想的麻醉方法.     

不同麻醉方法下妇科腹腔镜手术CO2气腹对呼吸与循环功能的影响

目的 观察不同麻醉方法下妇科腹腔镜手术中CO2气腹对呼吸及循环功能的影响.方法 以抽签法将我院实施妇科腹腔镜手术患者82例随机分为2组,各41例,观察组1行腰-硬膜外联合麻醉,观察组2行气管插管全麻.结果 呼吸功能:不同时间段,2组SpO2对比均无统计学意义(P>0.05),气腹后及排气后PETCO2、Paw对比有统计学意义(P<0.05);循环功能:T2时段2组HR、SBP、DBP,T3时段2组DBP对比差异有统计学意义(P<0.05),其他时段2组的上述指标比较差异无统计学意义(P>0.05).结论 对于妇科腹腔镜手术CO2气腹患者,实施腰-硬膜外联合麻醉对呼吸及循环功能影响最小.     

硬膜外复合氯胺酮麻醉在小儿腹股沟斜疝腹腔镜手术中麻醉的有效性与安全性

目的探讨硬膜外复合氯胺酮麻醉在小儿腹股沟斜疝腹腔镜手术中的有效性与安全性。方法36例ASAⅠ～Ⅱ级择期腹股沟斜疝腹腔镜手术小儿随机分为3组,每组12例。分别采用硬膜外复合氯胺酮麻醉(A组)、硬膜外复合全身麻醉(B组)和单纯全身麻醉(C组)。持续监护小儿HR、MAP、SpO2、PETCO2,术前、术中、术后进行比较,并行组间比较,记录主要药物用量,评估麻醉效果,记录可能发生的并发症和不良反应。结果A组在气腹前后HR、MAP无明显变化,B组和C组HR、MAP明显升高(P<0.05),3组病人PETCO2气腹后较气腹前升高,且B组和C组升高较A组更明显(P<0.05),3组病人SpO2变化不明显。3组病人PETCO2气腹结束后恢复至气腹前水平的时间相似。无严重不良反应病例发生。结论硬膜外复合氯胺酮麻醉能为小儿腹股沟斜疝腹腔镜手术提供安全有效的麻醉,且降低患者经济负担。     

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.