小剂量舒芬太尼复合丙泊酚用于无痛人工流产术的临床观察

目的：评价小剂量舒芬太尼复合丙泊酚静脉麻醉在无痛人流术中的疗效和安全性。方法：选择自愿行人工流产术的患者80例,ASAⅠ～Ⅱ级妊娠4～8周,随机分为两组（每组40例）。观察组（A组）：0．1μg／kg舒芬太尼复合丙泊酚进行人工流产术麻醉;对照组（B组）：单纯应用丙泊酚进行人工流产术麻醉。观察MAP、HR、SpO2,记录丙泊酚的总剂量、意识恢复和定向力恢复时间、术中呼吸抑制和术后宫缩痛（采用VAS评分）的发生率。结果：B组MAP、HR及SpO2略有下降;A组MAP无明显变化,HR和SpO2均明显下降（P〈0．05）;A组丙泊酚总用量及意识恢复时间、定向力恢复时间均低于B组（P〈0．05）。结论：小剂量的舒芬太尼（0．1μg／kg）复合丙泊酚用于无痛人上流产术的麻醉,减少了丙泊酚的总用药量和呼吸循环抑制的发生,非常有效地减轻患者术后宫缩痛,缩短苏醒时间使麻醉更加平稳。     

小剂量舒芬太尼复合丙泊酚在无痛人工流产术中的应用

目的探讨小剂量舒芬太尼复合丙泊酚静脉麻醉在无痛人流术中的疗效和安全性。方法选择自愿行人工流产术的患者76例,随机分为观察组和对照组各38例,观察组给予0.1μg/kg舒芬太尼复合丙泊酚进行人工流产术麻醉,对照组单纯应用丙泊酚进行人工流产术麻醉,观察记录两组患者术前、术中平均动脉压(MAP)、心率、动脉血氧饱和度(SpO2),记录丙泊酚的总剂量、意识恢复和定向力恢复时间。结果观察组MAP无明显变化,心率和SpO2较治疗前均明显下降(P<0.05);对照组MAP、心率及SpO2略有下降;观察组丙泊酚总用量及意识恢复时间、定向力恢复时间均低于对照组,两组比较差异有统计学意义(P<0.05)。结论小剂量舒芬太尼复合丙泊酚用于无痛人流镇痛效果确切,呼吸、循环抑制轻微,总体效果优于单纯应用丙泊酚,值得进一步研究和推广。     

丙泊酚并小剂量芬太尼或舒芬太尼用于人工流产效果

目的 比较丙泊酚复合小剂量芬太尼、舒芬太尼用于人工流产的麻醉效果.方法 选择门诊ASA Ⅰ～Ⅱ级、自愿接受无痛人工流产手术的病人40例,随机分成丙泊酚复合芬太尼组(A组,n=20)和丙泊酚复合舒芬太尼组(B组,n=20).A组于丙泊酚给药前缓慢静脉注射芬太尼0.6 μg/kg,B组于丙泊酚给药前缓慢静脉注射舒芬太尼0.1 μg/kg.比较两组病人用药前、后平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏氧饱和度(SpO2),术中丙泊酚用量、病人意识消失和定向力恢复(用药结束至完全清醒)时间,术中呼吸抑制和术后发生宫缩痛的例数.结果 B组用药后MAP、HR、RR高于A组,丙泊酚用量少于 A组,差异均有显著性(t=2.043～7.430,P<0.05). A组5例病人术后发生宫缩痛,B组0例.两组病人SpO2和意识消失时间比较差异无统计学意义(P>0.05).B组定向力恢复时间明显短于A组(t=2.626,P<0.05).两组病人术中均无呼吸抑制.结论 丙泊酚复合小剂量芬太尼或舒芬太尼用于无痛人工流产术都是安全有效的,舒芬太尼的镇痛效果优于芬太尼.     

丙泊酚复合舒芬太尼用于无痛人工流产术的效果观察

目的观察舒芬太尼在无痛人流术中的应用效果。方法 300例行无痛人流术患者随机均分三组(n=100):F组(丙泊酚复合芬太尼)、R组(丙泊酚复合瑞芬太尼)、S组(丙泊酚复合舒芬太尼)。比较三组患者麻醉前后MAP、HR、SpO2的变化,术中体动、低血压、窦性心动过缓、术后宫缩痛的发生率及丙泊酚的用药量。结果麻醉后,三组MAP、HR、SpO2降低(P<0.05);R组丙泊酚用药量低于F组和S组(P<0.01);R组呼吸抑制的发生率高于F组和S组(P<0.05);S组术后宫缩痛发生率低于F组和R组(P<0.05)。结论舒芬太尼复合丙泊酚无痛人流副作用少、术后镇痛作用好。     

80例无痛人流麻醉用药观察

目的:观察比较丙泊酚分别复合芬太尼、瑞芬太尼、舒芬太尼在无痛人流术中临床应用效果。方法:选择ASAⅠ分级~Ⅱ级早孕行人工流产术病人80例,随机分为4组,每组20例。其中,Ⅰ组单纯应用丙泊酚,Ⅱ组丙泊酚复合芬太尼、Ⅲ组丙泊酚复合瑞芬太尼、Ⅳ组丙泊酚复合舒芬太尼。术中观察4组不同时点病人MAP、HR、SPO2的变化、术中肢体躁动情况及术毕清醒时间,术毕宫缩痛程度。结果:4组患者术后均对手术操作无记忆。Ⅰ组肢动较多(p<0.05),各组术中MAP、SPO2较麻醉前均有明显降低(p<0.05),瑞芬太尼组低氧血症发生率较其他3组高(p<0.05),术后VAS评分舒芬太尼组较其他3组低(p<0.05)。结论:舒芬太尼复合丙泊酚用于无痛人流手术麻醉镇痛效果好:肢动少、呼吸抑制轻、术后恢复好、且能有效抑制人工流产术后宫缩痛,是增强丙泊酚无痛人流麻醉效果的最佳配伍。     

丙泊酚复合小剂量舒芬太尼用于无痛人流临床观察

目的探讨丙泊酚复合舒芬太尼用于妇科门诊无痛人流的安全性和有效性。方法 ASAⅠ-Ⅱ级门诊无痛人流的检查患者80例,年龄18-42岁,体重44-78kg,随机分为两组,即丙泊酚+生理盐水组(P组)、丙泊酚复合舒芬太尼组(PS组),每组40例,各组在静脉推注丙泊酚前分别注入生理盐水2ml、舒芬太尼0.15-0.2ug/kg,待患者睫毛反射消失、呼之不应时放入窥阴器。人流过程中持续监测HR、MAP、SPO_2并记录丙泊酚的量,意识及定向力恢复时间、人流操作时间等。结果两组患者中HR、MAP、SPO_2与术前或术后相比有明显降低(P0.05)。意识恢复时间P组与PS组相比明显延长,差异有统计学意义(P0.05)。丙泊酚用量P组比PS组增加差异有统计学意义(P0.05)。结论丙泊酚复合小剂量舒芬太尼不仅可以减少丙泊酚的用量,有效降低呼吸抑制等副作用,而且能缩短苏醒时间,使麻醉更加平稳。     

丙泊酚应用于门诊无痛人工流产的临床观察

目的研究丙泊酚用于门诊无痛人工流产的麻醉效果。方法选择门诊人工流产患者150例,ASAⅠ~Ⅱ级,随机分为三组(每组50例)。A组:丙泊酚浓度为2mg/kg进行人工流产麻醉;B组:丙泊酚浓度为2.4mg/kg进行人工流产麻醉;C组:丙泊酚浓度为2.8mg/kg进行人工流产麻醉。观察平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2),记录意识消失时间、意识恢复和定向力恢复时间、术中呼吸抑制和术后宫缩痛的发生率。结果A、B组MAP、HR及SpO2均稍有下降,差异无统计学意义;C组MAP、HR均明显下降(P<0.05);A组和C组意识恢复时间、定向力恢复时间差异无统计学意义,但均长于B组(P<0.05);三组术后宫缩痛发生率差异无统计学意义。结论丙泊酚2.4mg/kg用于门诊无痛人工流产麻醉,患者术中麻醉满意,术后清醒迅速。     

舒芬太尼用于无痛人流麻醉的最佳剂量探讨

目的观察不同剂量舒芬太尼联用丙泊酚无痛人流的麻醉效果。方法选择100例行无痛人流患者,随机分成T1、T2、T3、T4,四组,每组各25例。3组分别静脉注射舒芬太尼0.05μg/kg、0.10μg/kg、0.15μg/kg、0.20μg/kg后,再缓慢推注丙泊酚2mg/kg。观察记录各组平均动脉压（MAP）、心率（HR）、呼吸（R）脉搏氧饱和度（SpO2）、丙泊酚总量、体动、呼唤应答时间、定向力恢复时间及不良反应（头晕、恶心呕吐）发生情况。结果四组给药前、给药后1min后及手术结束时MAP、HR变化无显著行差异（P〉0.05）;但给药后1min时,T3和T4组的R及SpO2较给药前明显降低（P〈0.05）。T4组呼吸应答时间、定向力恢复时间、呼吸抑制时间较其它3组显著延长（p〈0.05）,且恶心呕吐发生率最高。结论舒芬太尼0.10μg/kg与丙泊酚联合用于无痛人流手术的麻醉,镇痛效果好、不良反应发生率低,是增强丙泊酚无痛人流麻醉效果的最适临床剂量。     

丙泊酚联合舒芬太尼用于无痛人工流产的临床观察

目的：研究舒芬太尼联合丙泊酚用于门诊无痛人工流产麻醉的效果。方法：选择门诊人工流产ASA1～2级200例,随机分为两组各100例。A组：丙泊酚联合0．1μg／kg舒芬太尼进行人工流产麻醉。B组：丙泊酚联合芬太尼进行人工流产麻醉。观察MAP、HR、Sp02,记录丙泊酚的总剂量、意识消失时间、意识恢复时间和定向力恢复时间、术中呼吸抑制和术后宫缩痛的发生率。结果：A组术后宫缩痛发生率明显低于B组（X^2=15．34,P〈0．01）。结论：丙泊酚联合适当剂量的舒芬太尼（0．1μg/kg）用于门诊无痛人工流产麻醉,不仅减少了总用量,而且非常有效地抑制术中或减轻患者术后宫缩痛,且不影响清醒质量,从而提高患者的满意率。     

舒芬太尼联合丙泊酚用于无痛人流麻醉的效果及对人流后宫缩痛的影响

目的:研究和观察在无痛人流麻醉中使用舒芬太尼联合丙泊酚后对患者宫缩痛的影响和干预效果。方法:收集行无痛人流的患者共93例,根据患者入院日期的单双号数分为46例对照组和47例观察组,对照组患者使用芬太尼联合丙泊酚进行麻醉,观察组使用舒芬太尼联合丙泊酚进行麻醉,将两组患者的术后60 min时的意识状态评分、术后宫缩痛率进行观察和对比。结果:观察组患者的术后60 min时的意识状态评分明显高于对照组,观察组患者的术后宫缩痛率显著高于对照组(P均0.05)。结论:在行无痛人流患者的麻醉过程中,使用舒芬太尼联合丙泊酚的麻醉方式,能够有效抑制患者术后的宫缩痛,并使患者能够迅速恢复意识状态,值得推广应用。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.