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。     

不同麻醉下行腹腔镜胆囊切除术CO2气腹对呼吸循环的影响

目的：探讨两种麻醉方法下行腹腔镜胆囊切除术（LC）时CO2气腹对呼吸循环功能的影响是否一致；方法：ASAⅠ级－Ⅱ级LC患者156例，随机分成2组，其中全麻组80例硬膜外麻醉组76例，均连续监测记录围术期心率（HR）、血氧饱和度（SPO2）、平均动脉压（MAP）、呼气末二氧化碳分压（PETCO2）、呼吸频率（RR）；结果：全麻组：气腹后PETCO2、RR较气腹前明显升高（P＜0．01）；硬膜外组：气腹后MAP较气腹前明显降低（P＜0．01），RR及PETCO2较气腹前明显升高（P＜0．01），两种麻醉方法围术期SPO2、HR基本不变。结论：两种麻醉方法进行LC时，CO2气腹对PETCO2、RR均有不同程度的影响，但硬膜外组对MAP、PETCO2、RR影响较明显。     

腰麻-硬膜外联合麻醉应用于直肠癌根治术的临床观察

目的：探讨腰麻－硬膜外联合麻醉（CSEA）应用于直肠癌根治术的可行性，方法：选择24例ASAⅠ-Ⅱ级，行直肠癌根治术的病人，随机分为二组，每组12例，CSEA组于L2－3穿刺成功后，先向蛛网膜下腔注药，再向硬膜外腔置管，连续硬膜外麻（EA）组于T11－12及L3－4行硬外穿刺置管，观察两组病人麻醉前，后各时点的SBP、DBP及HR变化，两组镇痛及肌松效果。结果：CSEA组的镇痛和肌松效果优于EA组，同一时点两组SBP和DBP无显著差异，HR在10min和30min有显著差异（P＜0．05）。结论：腰麻－硬膜外联合麻醉应用于直肠癌根治术的镇痛和肌松效果优于连续硬膜外麻醉。     

腰硬联合与硬膜外麻醉30例效果观察

目的比较腰麻-硬膜外联合麻醉（CSEA）与单纯硬膜外麻醉（EA）应用于剖宫产的安全性及临床效果。方法选择ASAⅠ-Ⅱ级急诊行剖宫产的单胎足月妊娠产妇60例,随机分成CSEA组和EA组,每组30例。两组皆控制麻醉平面达T6-T8水平,监测并记录BP、HR、ECG、SPO2,麻醉起效时间,麻醉阻滞效果,麻醉至胎儿娩出时间（IDI）,新生儿Apgar评分及不良反应。结果CSEA组麻醉起效时间、完全阻滞时间、IDI、均明显短于EA组（P〈0．05）。CSEA组麻醉阻滞效果优于EA组,两组新生儿Apgar评分及不良反应无明显差异性。两组术后均未发生头痛。结论CSEA综合腰麻和硬膜外麻的优点,具有诱导快、阻滞完善、对循环呼吸干扰少、母婴安全的优点,更适用于急诊剖宫产麻醉。     

脊麻-硬膜外麻醉在子宫全切术中的应用

目的：比较脊麻-硬膜外麻醉与硬膜外麻醉在子宫全切术中的麻醉效果及安全性。方法：选择拟行子宫全切手术患者56例，ASAⅠ～Ⅱ级，随机分为脊麻-硬膜外（CSEA组）和硬膜外（EA组）。两缎均选择L2～3椎间隙硬膜外阻滞置管（CSEA组经脊麻针注入0．75％稚比卡因12～15mg后置管）。记录麻醉前（T1）麻醉后5min（T2）、10min（T3）及进腹探察（T4）和牵拉宫颈（T5）时的BP和HR：记录感觉阻滞最高平面及到达时间，首次局麻药用量及局麻药总甓，术中低血压，心动过缓及手术后并发症以及麻醉效果评价。结果：与EA组比较，CSEA组最高麻醉平面及最高平面出现时间，首次麻醉药用量，局麻药总量差异有统计学意义（P〈0.01），EA组进腹探查和牵拉富颈时HR较术前明显减慢（P〈0．05）；EA组进腹探查时SBP、DBP明显低于术前（P〈0．05），CSEA组麻醉效果优于EA组（P〈0.05），术后两组均无头痛及其他并发症。结论：CSEA组麻醉作用优于EA组，辅助以镇痛、镇静剂后患者舒适度商，仅次于全麻效果，与全麻相比大大减轻了病人的经济负担，也深受妇产科医师的青睐。值得在临床推广。     

腰麻-硬膜外联合阻滞麻醉对腹腔镜腹股沟疝修补术应激反应的影响

目的 观察腰麻-硬膜外联合阻滞麻醉和全身麻醉用于腹腔镜腹股沟疝修补术对血浆肾上腺素、去甲肾上腺素及血动力学的影响。方法 40例拟行腹腔镜经腹腔腹膜前网片腹股沟疝修补术患者随机分为两组：两点穿刺法腰麻-硬膜外联合麻醉（CSEA）组和全麻（GA）组，每组20例。监测麻醉前，手术开始前即刻，气腹后5min、30min、术毕30min各时点血浆NE、E浓度并记录HR、MAP值。结果 CSEA组各时点NE浓度无明显改变，手术开始前即刻及气腹后明显升高（P〈0.05），术后30min基本恢复；GA组气腹后NE及E均明显增加（P〈0．05），术后30min仍未恢复。手术开始前即刻CSEA组HR高于GA组（P〈0．05），气腹后CSEA组HR、MAP低于GA组。结论 腰麻-硬膜外联合麻醉较全身麻醉能较好地抑制腹腔镜腹股沟疝修补术的应激反应。     

10岁以上儿童腰麻-硬膜外联合麻醉的手术观察

为观察腰麻-硬膜外联合麻醉（CSEA）用于10岁以上儿童中下腹及下肢手术的麻醉效果.选择40例10岁以上行中下腹及下肢手术的患儿随机分成两组,CSEA组行腰-硬联合麻醉,EA组行硬膜外麻醉,术中辅助咪唑安定维持患儿睡眠,视麻醉效果辅加氯胺酮,术中监测患儿的BP、HR、ECG、SPO2、镇痛及肌松效果,随访患儿恢复情况.结果,CSEA组氯胺酮术中辅助用药量明显比EA组少（P＜0.01）;肌松效果达优的百分率CSEA组98.5%,EA组60%（P＜0.01）;两组术中MAP与麻醉前比均有下降（P＜0.05）;EA组在麻醉后30min时HR下降明显,与CSEA组间的差异有统计学意义（P＜0.05）;两组术中SPO2均在96%以上.认为CSEA用于10岁以上儿童中下腹及下肢手术具有起效快、血压平稳、无明显呼吸抑制、副作用少的特点,是一种临床可选择的儿童麻醉方法.     

妇科腹腔镜手术硬膜外麻醉和气管内插管全身麻醉的效果比较

目的比较硬膜外麻醉和气管内插管全身麻醉在妇科腹腔镜手术中的应用效果，方法选择择期妇科腹腔镜手术患者100例，ASAⅠ～Ⅱ级，随机分为硬膜外麻醉组（E组）和气管内插管全身麻醉组（G组），每组50例，E组选择L1,2和T11,12两点硬膜外穿刺，G组采用气管内插管全身麻醉。所有病人麻醉后，连续监测平均动脉压（MAP）、中心静脉压（CVP）、心电图（ECG）、脉搏血氧饱和度（SpO2）、心输出量（CO）、心率（HR）和呼气末二氧化碳分压（PETCO2）。记录两组患者CO2气腹前（T0），气腹后5（T1），10（T2），15（T3），30min（T4）及停气腹后5min（T5）的MAP，CVP，CO，HR，PETCO2。两组病人均在气腹前（T0），气腹后5min（T1），15min（T3），30min（T4）及停气腹后5min（L）经桡动脉抽血作血气分析和测血糖（GLU），并记录动脉血CO2分压（PaCO2）、酸碱值（pH）、碳酸氢根浓度（HCO3^-）、动脉血氧分压（PaO2）和血糖值（GLU）。结果E组气腹后5min，10min HR明显降低（P〈0．05），15min后恢复到气腹前水平，G组气腹后HR无明显变化（P〉0．05），两组间比较，差异无显著性；气腹后G组MAP显著升高（P〈0．05），至停气腹后5min仍未恢复到气腹前水平，而E组整个气腹期间MAP无明显变化或略低（P〉0．05），与G组比较差异有显著性（P〈0．01）；气腹后两组病人的CO均显著下降（P〈0．05），10min后开始回升，30min后恢复到气腹前水平（P〉0．05），两组间比较差异无显著性。结论妇科腹腔镜手术应用气管插管全身麻醉并不明显优于硬膜外麻醉，而硬膜外麻醉在降低气腹造成的循环高动力以及降低应激反应方面尚有一定的优越性。     

剖腹产病人腰硬联合麻醉与单纯硬膜外麻醉的比较

目的探讨剖腹产病人腰硬联合麻醉与单纯硬膜外麻醉在临床中的应用。方法随机将103例行剖腹产的产妇分为腰硬联合麻醉（CSEA）52例（占50.5%）和单纯硬膜外麻（EA）51例（占49.5%）两组。采取左侧卧位L2-3间隙行硬模外穿刺之后,EA组置入导管行硬膜外麻醉,CSEA组在蛛网膜下腔进行麻醉,并硬模外置入导管。同时对BP、SPO2、HR、ECG进行检测,观察SBP、麻醉用药量、麻醉平面、麻醉诱导到切皮时间、升压药用量、肌松效果和新生儿的评分。结果 CSEA组在麻醉用药量、麻醉诱导到切皮时间上明显好于单纯硬膜外麻（EA）组（P〉0.05）,其他情况没有显著差异（P〈0.01）。但CSEA组在用升压药数使用明显比EA组使用高。结论为此在预防低血压发生的情况下,相较于EA麻醉方式,将CSEA麻醉术应用于剖腹产在临床上效果更好,值得推广。     

椎管内复合麻醉用于剖宫产的临床观察

目的：比较硬膜外麻醉（EA）与脊麻硬膜外阻滞复合麻醉（CSEA）用于剖宫产的镇痛效果、胎儿娩出时间和对母体血流动力学和新生儿Apgar评分的影响。方法：180例产妇随机分成两组，每组各90例，分别行EA和CSEA，硬膜外腔注药均用1．73％碳酸利多卡因，用0．5％布比卡因1．5ml行脊麻。结果：从阻滞开始到手术的时间、胎儿娩出时间CSEA组明显短于EA组，有显著性差异（P〈0．05）。麻醉优良率CSEA组为100．0％，EA组为84．4％。新生儿1min Apgar评分两组比较，无显著性差异（P〉0．05）。麻醉用药量CSEA组明显少于EA组，有显著性差异（P〈0．01）。麻黄素使用CSEA组为20例（22．2％），EA组为16例（17．7％），两组无显著性差异。结论：CSEA兼有脊麻和硬膜外麻醉的优点，适用于剖宫产术。     

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.