小剂量氯胺酮与丙泊酚复合全麻在小儿气管异物取出术中的应用

①目的 观察小剂量氯胺酮与丙泊酚全麻用于小儿气管异物取出术的可行性.②方法 选择行气管异物取出术患儿42例,随机分为A、B两组,每组21例.A组采用羟丁酸钠联合氯胺酮全麻,B组采用小剂量氯胺酮、丙泊酚复合全麻.分别于麻醉前(T0)、支气管镜置入前(T1)、支气管镜置入时(T2)、退镜时(T3)、术毕10 分钟时(T4),记录SBP、DBP、HR、RR、SPO2 、苏醒时间、术中支气管痉挛、呛咳、术后舌后缀等情况.③结果 两组患儿麻醉后各时点变化差异无统计学意义(P>0.05).A组患儿HR、RR:T2、T3较B组明显减慢(P<0.05).B组术中呛咳、支气管痉挛较A组发生率明显下降,两组差异有统计学意义(P<0.05).B组术后舌后坠较A组明显减少,差异有统计学意义(P<0.05).B组苏醒时间较A组时间明显缩短,差异有统计学意义(P<0.05).④结论 小剂量氯胺酮、丙泊酚复合全麻应用于气管异物取出术,血流动力学稳定、苏醒迅速、术后呼吸系统并发症发生率低.     

丙泊酚靶控输注联合低浓度七氟烷诱导在婴幼儿气管异物取出术中的应用

目的 探讨丙泊酚靶控输注(TCI-P)联合低浓度七氟烷吸入诱导麻醉应用于小儿气管支气管异物取出术的疗效.方法 2009年1月至201 1年5月浙江温州医学院附属第二医院经确诊为气管异物的急诊患儿90例,年龄9 ～36个月,体质量8～17 kg,经医院伦理委员会批准,数字随机法分为A组、B组和C组,每组30例.A组为TCI-P联合低浓度七氟烷吸入诱导;B组为TCI-P复合氯胺酮诱导;C组为TCI-P复合芬太尼诱导;3组患儿术中均采用单纯TCI-P维持麻醉,观察3组的麻醉效果、并发症和患儿在手术室滞留时间及苏醒时间.结果 在硬支气管镜置入过程3组均存在一定程度的呛咳,其中发生重度屏气、呛咳需加深麻醉的病例A组为1例、B组7例、C组5例,A组明显优于B组(P＜0.05),但与C组比较差异无统计学意义(P＞0.05).B组、C组患儿置镜时丙泊酚靶浓度均明显高于A组(P＜0.01),且术中最低SpO2明显低于A组(P＜0.01),术中SpO2 ＜95％例数亦明显多于A组(P＜0.01).B组术毕喉鸣或舌后坠致呼吸困难发生数明显多于A组与C组(P＜0.05),且患儿术毕在手术室滞留时间、苏醒时间明显长于A组与C组(P＜0.01).结论 丙泊酚靶控输注联合低浓度七氟烷吸人麻醉是一种可控性强、安全、实用的婴幼儿支气管异物取出术的麻醉方法.     

静脉复合麻醉在小儿气管-支气管异物取出术中的应用

目的观察氯胺酮复合异丙酚麻醉在小儿气管-支气管异物取出术中的应用效果。方法选择53例气管异物小儿,采取氯胺酮、咪唑安定、异丙酚复合麻醉相结合,以支气管镜侧孔供氧,以保证患儿充分通气、供氧,确保患儿术中生命安全。结果所有患儿均安全完成手术,未发现喉痉挛等严重并发症。结论该麻醉方法是安全可行的气管-支气管异物取出术的麻醉方法。     

小儿支气管异物取出术的麻醉处理

目的 探讨小儿支气管异物取出术的麻醉处理方案.方法 回顾性分析112例小儿支气管异物取出术的麻醉处理.Ⅰ组,静脉注射丙泊酚,首剂量2 mg/kg,维持剂量4～8 mg·kg-1·h-1,辅以氯胺酮2 mg/kg;Ⅱ组,静吸复合麻醉,静脉注射氯胺酮2 mg/kg后,经面罩吸入七氟烷3%～4%;Ⅲ组,静脉注射τ-羟基丁酸钠50 mg/kg、氯胺酮2 mg/kg,术中追加氯胺酮每次1 mg/kg;所有患儿入睡后均以1%地卡因在咽喉部作喷雾表面麻醉;分别记录各组术中屏气呛咳、脉搏血氧饱和度(SpO2)降至90%以下、硬质支气管镜退出气道、气管插管以及喉水肿或喉痉挛等的发生率和苏醒时间.结果 Ⅲ组屏气呛咳、支气管镜退管以及喉痉挛或喉水肿的发生率均显著低于Ⅰ、Ⅱ组(P值均＜O.05).苏醒时间显著长于Ⅰ、Ⅱ组(P值均＜0.05).结论 小儿支气管异物取出术的麻醉选择以静脉注射τ-羟基丁酸钠、氯胺酮和1%地卡因局部表面麻醉为佳.     

雷米芬太尼复合丙泊酚静脉麻醉用于小儿气管异物取出术

目的研究比较雷米芬太尼复合丙泊酚静脉麻醉应用于小儿气管异物取出术的麻醉效果及安全性。方法选择48例气管异物患儿,随机分为A组(24例)和B组(24例),两组均静脉注射丙泊酚1~1.5 mg/kg后以80~150μg.kg-1.min-1速率持续输注。A组静脉注射雷米芬太尼后持续输注;B组靶控输注(TCI)。术中用KR-III(B)喷射呼吸机经支气管镜侧孔行高频喷射通气(HFJV)。术中增减雷米芬太尼用量调节麻醉深度。观察记录入室后、注射丙泊酚后2分钟、注射雷米芬太尼2分钟、置入支气管镜时、取异物时、术毕5分钟时点MAP、HR、SpO2、RR值;记录术中呛咳挣扎、喉痉挛、呼吸抑制、肌强直、心动过缓和术后恶心呕吐等发生率和术毕清醒时间、雷米芬太尼和丙泊酚用量。结果注射雷米芬太尼后SBP、HR A组较B组下降明显,在置镜、异物取出时A组较B组升高明显,雷米芬太尼用量A组明显多于B组,差异有统计学意义(P<0.05)。A组有8例患儿出现呼吸抑制,B组2例;A组有5例患儿出现呛咳屏气,B组有1例。结论雷米芬太尼靶控输注较持续输注靶复合丙泊酚全凭静脉麻醉用于小儿异物取出术,患儿术中生命体征更平稳,能保留患儿自主呼吸,术毕清醒迅速。     

小儿气管异物的麻醉管理

目的 比较两种小儿气管异物取出术的麻醉效果，探讨适宜的麻醉方法。方法 对60例发生气管异物的患儿，随机分为两组，采用不同麻醉方法，观察麻醉时间、手术时间、苏醒时间及术后并发症发生率。结果 两组间各项指标均有显著差异（P〈0.01）。结论 氯胺酮复合异丙酚结合表面麻醉用于小儿气管异物取出术是较为理想的麻醉方法。     

七氟醚与氯胺酮麻醉在小儿气管异物取出术中应用的比较

目的 比较七氟醚与氯胺酮应用在小儿支气管异物取出术中的差异,以寻求更适合小儿气管异物取出术的麻醉方法 .方法 选择年龄1-3岁患儿40例,随机分为七氟醚组(S)和氯胺酮组(K).观察两组患儿在麻醉诱导后HR、SPO2.R的变化情况,术后脱氧时间,苏醒时间.结果 七氟醚组诱导后HR、R明显比氯胺酮组诱导后变慢,SPO2明显高于氯胺酮组(P<0.05);七氟醚组术后脱氧时间、清醒时间均较氯胺酮组短(P<0.05).结论 对于行支气管异物取出术的患儿,由于七氟醚本身的特点,更适合小儿支气管异物取出术的麻醉.     

丙泊酚用于小儿气管异物取出术的比较

目的研究小儿气管异物取出术的麻醉方法。方法选择6岁以下气管异物小儿60例,随机分为两组,A组为丙泊酚复合氯胺酮组,B组为丙泊酚复合利多卡因表面麻醉组,每组30例。观察术中患儿生命体征、苏醒时间和不良反应。结果两组患儿术中呼吸频率、苏醒时间的比较差异有统计学意义（P〈0．01）,A组有屏气和恶心等不良反应发生。结论丙泊酚复合表面麻醉是较好的麻醉方法。     

小儿支气管异物取出术的麻醉体会

目的 观察氯胺酮与异丙酚复合静脉全麻行小儿支气管异物取出术的效果.方法 用1%的地卡因施行会厌部充分表面麻醉,置入支气管镜前,静注异丙酚2～3 mg/kg,术中以微量泵注射4～5 mg/(kg·h),术中根据患儿对手术的应激反应,间断注射氯胺酮0.5～1.0 mg/kg.结果 本组患者无需气管插管,无1例麻醉死亡,大部分患儿在停药后20～30 min离开麻醉恢复室.结论 氯胺酮合并异丙酚麻醉,是小儿支气管异物取出术的一种可靠的麻醉方法.     

异丙酚复合瑞芬太尼气管插管与复合氯胺酮非气管插管麻醉在烧伤手术中的比较

目的 比较异丙酚复合瑞芬太尼气管插管与复合氯胺酮非气管插管麻醉在烧伤手术中的特点.方法 60例择期烧伤手术病人,ASAⅠ-Ⅱ级,按序贯实验分为氯胺酮组(A组)和瑞芬太尼组(B组),每组30例.A组麻醉诱导用安定和氯胺酮,维持麻醉用微量泵持续输注异丙酚和氯胺酮,术中保留自主呼吸并用鼻导管给氧;B组麻醉诱导用安定、阿曲库铵、丙泊酚、瑞芬太尼,气管插管后行机械通气,维持麻醉用微量泵持续输注瑞芬太尼、丙泊酚、阿曲库铵.观察麻醉前、麻醉诱导后、手术开始时、术中45 min、术毕5 min各时点的平均动脉压(MAP)、HR和SpO2的变化以及术后苏醒时间和术中、术毕时出现的不良反应.结果 麻醉诱导后A组MAP明显增高(P＜0.05),而B组MAP显著下降(P＜0.05);2组比较,差异也有统计学意义P<0.05);麻醉诱导后A组SpO2明显下降(P＜0.05),而B组SpO2稍有增高(但P＞0.05);B组苏醒时间明显比A组短(P<0.01);A组术中易发生躁动、谵妄和呼吸抑制等不良反应.结论 异丙酚复合瑞芬太尼气管插管麻醉用于烧伤手术,呼吸循环稳定,苏醒及时,不良反应少,提高了麻醉的安全性,且便于麻醉管理.     

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.