支撑喉镜下声带息肉切除术的三种麻醉方法比较

目的探讨支撑喉镜下声带息肉切除术的三种麻醉方法的优缺点。方法135例声带息肉患者分成A,B,C 3组,每组45例。A组单纯双侧喉神经阻滞及环甲膜穿刺注入局麻药。B组气管内插管全身静吸复合麻醉。C组双侧喉神经阻滞及环甲膜穿刺注入局麻药后联合气管内插管全身静吸复合麻醉。麻醉后行支撑喉镜下声带息肉切除术。结果A组血流动力学变化较大,B组全麻用药量较大,清醒时间及麻醉时间较长,C组克服了A组与B组的不足。结论支撑喉镜下行声带息肉切除术采用神经阻滞及环甲膜穿刺注入局麻药后联合气管内插管全身静吸复合麻醉可以达到完全麻醉,效果较好,也同样适用于其他小手术。     

支撑喉镜下声带息肉切除术麻醉方法的改进

纤维支撑喉镜下行声带息肉切除术是近年来开展的新手术，因其麻醉的特殊性，国内有多种方法。本研究拟通过观察双侧喉上神经阻滞及环甲膜穿刺注入局麻药结合非气管插管全身麻醉在支撑喉镜下声带息肉切除术中对病人呼吸、循环、应激反应及苏醒状况的影响。     

支撑喉镜下喉显微手术麻醉中的特殊问题处理

目的:探讨不同麻醉方法对支撑喉镜声带手术的影响及特殊问题的处理.方法:选40例ASAI-Ⅱ级择期支撑喉镜声带手术患者,随机分成两组,每组20例.I组麻醉诱导前采用2%利多卡因2ml环甲膜穿刺或插管前雾化表面麻醉;Ⅱ组直接行全麻诱导.两组均用2%异丙酚1～2mg/kg,芬太尼100μg诱导后,给琥珀胆碱1.5mg/kg,顺利插入小型号Fr 6.0钢丝气管导管后接omida麻醉机通气.术中用2%异丙酚泵注和异氟醚吸入维持麻醉,问断单次给予芬太尼.术毕给予地塞米松.记录两组诱导插管和拔管前后及放喉镜时HR、BP、SpO2及PETO2血气的变化,并记录手术时间和麻醉恢复时间.结果:I组的插管、拔管及放置喉镜引起的心血管反应较Ⅱ组明显轻(P＜0.05);两组均无高碳酸血症及喉部并发症发生.结论:表面麻醉复合全麻是支撑喉镜下行声带手术的更好麻醉方法,能有效减轻气管插管及放置喉镜引起的心血管反应,也为该手术提供较好的操作空间,又保证良好的通气和安全性.     

气管内喷射通气用于喉显微手术

气管内喷射通气用于喉显微手术宋言珠，程保安，杨华（菏泽地区人民医院，２７４０３１）我院先后采用１８＃硬脊膜外穿刺针头经环甲膜刺入气管内和细导管经口插入气管内喷射通气，应用支撑喉镜行施喉显微手术９３例，取得良好效果，本组男３９例女５４例、年龄１５～６８...     

支撑喉镜下喉显微外科手术1040例分析

目的：对支撑喉镜下喉显微外科手术的临床应用进行分析。方法：经喉插管全身麻醉,支撑喉镜下应用喉显微外科手术技术切除病变,共治疗各种喉疾病１０４０例。结果：支撑喉镜下喉显微外科手术可将病变经喉内完整切除,术后经１ａ～２ａ随访,临床疗效良好。在１０４０例中,发音恢复正常８８４例、明显改善１４２例、１４例复发需再次手术。结论：显微镜下观察病变清晰,支撑喉镜下喉显微外科手术精度高,患创伤小。术前应注意适应证的选择和麻醉准备;术中要精确操作,避免遗漏;术后注意并发症的预防及处理。     

支撑喉镜激光治疗喉癌的麻醉配合

目的：探讨支撑喉镜下喉癌激光切除手术中的麻醉及避免各种并发症的方法。方法：１１例癌前病变及原位癌患者采用异丙酚复合肌松剂及高频喷射通气供氧全身麻醉；８例Ｔ１，Ｔ２期喉癌患者采用气管插管复合麻醉。     

经环甲膜穿刺置管引导气管插管8例

随着医疗卫生事业的发展 ,全麻手术病例的增多 ,偶可遇见由于多种原因致气管插管困难者。我院在 1996年 1月～2 0 0 0年 1月的四年中 ,气管插管全麻手术 496例 ,其中遇到气管插困难 8例 ,男 6例 ,女 2例 ,改作经环甲膜穿刺置管引导气管插管 ,均获成功 ,现报告如下 :1　具体方法常规准备硬膜外麻醉穿刺针一套 ,硬膜外麻醉导管一根 ,在气管插管不成功时 ,由助手紧急作颈部消毒 ,用 12号针尖于环甲膜处穿刺皮肤 ,以硬膜外穿刺针 ,经皮肤穿刺孔向气管腔内垂直穿刺 ,进入气管腔内 ,有明显的落空感后 ,即停止穿刺 ,拔出导管针内蕊 ,置入硬膜外麻醉…     

超声辅助下环甲膜穿刺在鼾症患者清醒气管插管中的应用

目的: 研究超声辅助下环甲膜穿刺在鼾症患者清醒经鼻气管插管中的应用效果。方法: 选择择期行全麻手术的鼾症患者60例,均为男性,年龄18～65岁,ASAⅠ或Ⅱ级。随机均分对照组、定位组和引导组。在浅镇静状态下,对照组应用体表解剖法行环甲膜穿刺,定位组应用超声定位法行环甲膜穿刺,引导组应用超声引导法行环甲膜穿刺,复合鼻咽部表面麻醉行清醒经鼻气管插管。记录插管时间,入室后(T0)、插管前(T1)、气管导管进入声门即刻(T2)以及插管后5 min(T3)的平均动脉压(MAP)、心率和Ramsay镇静评分(Ramsay sedation score,RSS),记录插管过程中患者的舒适度和耐受情况,记录并发症的发生并回访患者的满意度。结果： 与对照组、引导组比较,定位组的插管时间明显缩短(t=25.073和30.973,P<0.05)。与对照组比较,T2时定位组和引导组MAP、心率明显降低(P均<0.05),RSS明显升高(P<0.05)。与对照组相比,定位组和引导组患者舒适度评分和耐受性评分均明显降低,满意度更高,且插管并发症发生率明显降低(P<0.05)。 结论： 超声应用于环甲膜穿刺能够更好地满足清醒经鼻气管插管的需要,定位准确,患者更加舒适,耐受性好且并发症发生率低。     

超声引导喉上神经阻滞联合环甲膜穿刺在清醒气管插管中的临床应用

目的探讨超声引导喉上神经阻滞联合环甲膜穿刺在纤维支气管镜(纤支镜)引导清醒气管插管中的临床应用效果。方法选择需行清醒气管插管的全麻患者40例(ASAⅠ~Ⅱ级),按随机数字表法分为表面麻醉联合环甲膜穿刺组(传统组)和超声引导喉上神经阻滞联合环甲膜穿刺组(超声组),每组20例。记录患者麻醉前(T1)、气管插管时(T2)、插管后(T3)各时间段MAP、HR、Sp O2情况;记录呛咳、躁动以及恶心、呕吐等不良反应的发生情况和回访患者的满意度。结果两组患者T2和T3时的MAP、HR均明显高于T1(P0.05);与传统组比较,超声组T2和T3时MAP、HR明显降低(P0.05);且插管不良反应明显减少(P0.05),插管成功率及患者的满意度评分明显升高(P0.05)。结论超声引导下喉上神经阻滞联合环甲膜穿刺技术比传统口咽喉表面麻醉更适合困难气道患者清醒气管插管,患者的应激反应和接受度更好、并发症更少。     

经环甲膜喷射通气行喉显微手术护理体会

最近我室开展静脉复合麻醉配合环甲膜穿刺后高频喷射通气,在支撑喉镜下行喉显微手术,总结如下: 1 临床资料 静脉复合麻醉配合KR-Ⅱ型开放式喷射呼吸机,经环甲膜穿刺后高频喷射通气,在支撑喉镜下行喉显微手术共18例。男13例,女5例,年龄26～60岁,平均42岁。全部病例呼吸道通畅,其中声带息肉12例,声带小结2例,声带淀粉样变1例,其它3例。行声带息肉(或小结)等摘除或采用激光切割手术,术中出现皮下气肿3例,术后自行消失。     

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.     

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.     

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.