全身麻醉诱导前星状神经节阻滞对气管插管患者循环系统的影响

【目的】研究观察左侧星状神经节阻滞(L-SGB)对高血压患者气管内插管期循环系统的影响。【方法】ASAⅡ~Ⅲ级择期上腹部手术的老年高血压患者30例,随机分为星状神经节阻滞组(SGB组)和非星状神经节阻滞组(NSGB组),每组各15例。SGB组在麻醉诱导前10 min采用第6颈椎气管旁穿刺法行L-SGB。记录入手术室后5 min(T0)、阻滞后10 min(T1)及插管后即刻(T2)、2 min(T3)、5 min(T4)各时点的SBP、MAP、HR,并计算RPP。【结果】NSGB组T2~T4时间点SBP、MAP、HR及RPP较本组插管前T0及T1时间点明显升高(P<0.05),SGB组T2~T4时间点SBP、MAP、HR及RPP较本组插管前T0及T1时间点变化不明显(P>0.05);NSGB组和SGB组在插管前T0及T1时间点比较各参数无明显差异(P>0.05),插管后T2~T4各时间点比较差异有统计学意义(P<0.05)。【结论】L-SGB可以有效抑制老年高血压患者气管插管期的循环反应。     

星状神经节阻滞在冠心病非心脏手术围术期的临床观察

目的:观察星状神经节阻滞(SGB)在冠心病非心脏手术围术期改善心肌氧供需平衡的效果。方法:将确诊合并冠心病、无近期心肌梗死的胃癌患者30例随机分为两组,A组右星状神经节阻滞(R-SGB)后全身麻醉;B组只行全身麻醉。两组患者术前和诱导、麻醉用药相同。观察记录气管插管时和手术开始10 min后血压(MAP)、心率(HR)、率压比积(RPP)以及心电图的变化。以SPSS11.5统计软件包进行数据处理。结果:A组在SGB后HR、MAP、RPP显著下降,与B组比较,麻醉前、插管即刻、术中10 min HR、RPP明显低下。结论:SGB能显著改善冠心病非心脏手术围术期的心肌氧供需平衡,从而提高手术的安全性。     

单侧星状神经节阻滞对冠脉搭桥患者围术期心血管反应的影响

目的:在冠脉搭桥患者的麻醉手术前附加单侧星状神经节阻滞,观察麻醉及手术过程中血流动力学变化。方法:选择在体外循环下行冠脉搭桥手术患者24例,随机分为星状神经节阻滞组(S组)与对照组(N组),每组12例,S组在麻醉前行右侧星状神经节阻滞,两组在麻醉方法和手术过程相同。记录并分析麻醉及手术过程中MAP、HR、RPP变化。结果:SGB组在气管插管、劈胸骨时点MAP与RPP明显低于N组(P<0.01),HR低于N组(P<0.05),在转流过程中MAP低于N组(P<0.05),在转流后RPP低于N组(P<0.05)。结论:单侧星状神经节阻滞能够减轻冠脉搭桥患者围术期心血管反应。     

星状神经节阻滞预防气管内插管期心血管反应的临床观察

目的 观察右侧星状神经节阻滞（R—SGB）对气管内插管期心血管反应的影响。方法 ASA Ⅰ～Ⅱ级择期上腹部手术患者40例，随机分为两组各20例。Ⅰ组为空白对照组，Ⅱ组为R—SGB组。记录入室（t0）、SGB后（t1）、气管插管后1min（t2）、3min（t3）、5min（t4）各时点的SBP、MAP、DBP、HR，并计算RPP。结果 Ⅰ组SBP、HR、RPP、MAP于插管后1、3、5min均显著升高，与插管前相比具有明显的差异（P〈0．01）；而Ⅱ组插管后各参数与插管前相比无统计学意义（P〉0，05），但插管后1、3、5min各时点的参数变化明显低于Ⅰ组（P〈0．01）。结论 R—SGB可以有效抑制气管插管期的心血管反应。     

单侧星状神经节阻滞对全麻气管插管循环反应的影响

选择27例ASAⅠ级择期上腹部手术患者,随机分成对照组、SGB组、SGB+F(芬太尼)组,每组9例。观察气管插管前后SBP、MAP、HR和RPP化。结果提示,SGB对气管插管循环反应有一定抑制作用。插管瞬间、插管后2min、4min与对照组有明显差异(P<0.01),SGB+F组则能基本消除气管插管时的循环反应。     

单侧星状神经节阻滞对全麻气管插管循环反应的影响

先择36例ASAI级择期上腹部手术患者，随机分成对照、SGB级、SGB＋F（前大尼）组，每组12例．观察气管插管前后SBP、MAP、HR和RPP普化，结果提示，SGB对气管插管循环反应有一定抑制作用．插管瞬间、插管后2min、5minSBP、MAP、HR，RPP反应程度明显低于对照组（P＜0．01），SGB＋F组则基本能消除气管插管时的循环反应．     

胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响

目的:对比观察胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响。方法:选择40例美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级、年龄19~66岁拟在经口双腔气管插管全身麻醉下施择期手术的胸外科患者,分别为常规全身麻醉诱导下直接喉镜双腔气管插管组(T组,20例)和常规全身麻醉诱导复合胸部硬膜外给予利多卡因后实施双腔气管插管组(E组,20例)。麻醉诱导后分别采用Macintosh直接喉镜实施经口气管插管操作,观察两组患者麻醉诱导前后及气管插管时和气管插管后5 min内的血压(blood pressure,BP)、心率(heart rate,HR)、二重指数(rate pressure product,RPP)和脑电双频指数(bispectral index,BIS)的变化,并记录气管插管时间。结果:麻醉诱导后,两组患者的BP和RPP均较麻醉诱导前明显降低。与麻醉诱导后相比较,气管插管后两组患者的BP、HR和RPP明显升高。与麻醉诱导前相比较,气管插管后E组患者BP明显降低,T组患者收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和平均动脉压(mean arterial pressure,MAP)明显升高,且持续时间约1 min。两组患者气管插管后HR均明显升高,T组患者HR增快持续约4 min,E组患者HR增快持续约1 min。与E组相比较,观察期内气管插管后T组SBP、DBP、MAP、HR和RPP均明显升高。与基础值相比,两组患者麻醉诱导后和气管插管后的BIS值均明显降低,且两组之间差异无统计学意义。与E组比较,观察期T组SBP大于基础值30%和RPP大于22 000的发生率明显较高,且E组中未见SBP大于基础值30%和RPP大于22 000的患者。结论:在双腔气管插管期间,硬膜外给予利多卡因可明显减轻插管导致的剧烈血流动力学变化,但对唤醒反应无影响。     

光导纤维支气管镜与直接喉镜经口气管插管对小儿血流动力学的影响

目的对比观察小儿全身麻醉诱导后采用光导纤维支气管镜(FOB)和直接喉镜(DLS)经口气管插管对血流动力学的影响.方法选择美国麻醉医师协会Ⅰ～Ⅱ级、择期整形外科手术的小儿43例,随机分为DLS组(n=20)和FOB组(n=23),常规静脉麻醉诱导后进行经口气管插管.监测麻醉诱导前后、气管插管时和气管插管后5 min内的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率收缩压乘积(RPP)的变化.结果DLS组气管插管时的SBP、HR和RPP比麻醉诱导后显著升高(P＜0.05),但气管插管时的血压、HR和RPP与麻醉诱导前相比差异无显著性,观察期(从静脉麻醉诱导开始至气管插管后5 min为止)内SBP、HR和RPP的最大值显著高于麻醉诱导前(P＜0.05).FOB组气管插管时的血压、HR和RPP比麻醉诱导前和麻醉诱导后显著升高(P＜0.05),观察期血压、HR和RPP的最大值显著高于麻醉诱导前(P＜0.05).观察期各对应时间点的SBP和RPP两组间差异无显著性.气管插管时的HR在FOB组显著高于DLS组(P＜0.05),但观察期内其他各时间点的HR两组间差异无显著性.观察期血压和HR的最大值及其达最大值的时间两组间差异无显著性.结论临床常用的全身麻醉深度不能有效抑制FOB经口气管插管在小儿引起的加压反应和心率增快反应.与DLS相比,FOB在预防小儿经口气管插管的心血管系统应激反应方面无明显优越性.     

瑞芬太尼与丙泊酚诱导后补注对围插管期血流动力学的影响

目的 观察瑞芬太尼与丙泊酚诱导后补注时插管期心血管的稳定作用.方法 拟行气管插管全麻病人227例,ASA分级Ⅰ～Ⅱ,麻醉诱导后SBP下降＜30％者187例,随机分为A、B、C三组,A组63例,B、C二各组62例.用瑞芬太尼1 μg/kg、丙泊酚1.5 mg/kg、维库溴铵0.1 mg/kg静脉注射诱导,2 min后A组直接气管插管,B组、C组分别补注瑞芬太尼0.2 μg/kg和丙泊酚诱导剂量的1/5,随后行气管插管,观察三组气管插管完成时即刻(T1)、3 min (T2)、5 min(T3),测量HR、SBP、DBP,并计算RPP;比较三组插管后四项指标的变化并与基础值(T0)比较.结果 与T0时相比,A组插管后T1、T2时的HR、SBP、RPP均明显增加(P＜0.05),而B、C二组插管后T1、T2时HR、SBP、RPP与T0时比较差异无统计学意义(P＞0.05);与A组比较,B、C二组插管后T1时的HR、SBP、RPP均明显下降(P＜0.05),而B组T1时的DBP与A组比较差异无统计学意义(P＞0.05);B、C二组间各时点HR、SBP、RPP比较差异无统计学意义(P＞0.05);T3时A、B、C三组的HR、SBP、DBP、RPP及与T0时比较差异无统计学意义(P＞0.05).结论 诱导后补注适量的瑞芬大尼或丙泊酚均可有效减轻气管插管时的心血管反应,对有高血压/缺血性心脏病的患者,丙泊酚较瑞芬太尼更利于心肌灌注.     

单侧星状神经节阻滞对冠脉搭桥患者围术期心血管反应的影响

目的：在冠脉搭桥患者的麻醉手术前附加单侧星状神经节阻滞，观察麻醉及手术过程中血流动力学变化。方法：选择在体外循环下行冠脉搭桥手术患者24例，随机分为星状神经节阻滞组（S组）与对照组（N组）。每组12例。S组在麻醉前行右侧星状神经节阻滞，两组在麻醉方法和手术过程相同。记录并分析麻醉及手术过程中MAP、HR、RPP变化。结果：SGB组在气管插管、劈胸骨时点MAP与RPP明显低于N组（P〈0．01），HR低于N组（P〈0．05），在转流过程中MAP低于N组（P〈0．05），在转流后RPP低于N组（P〈0．05）。结论：单侧星状神经节阻滞能够减轻冠脉搭桥患者围术期心血管反应。     

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.