神经刺激器辅助定位在肌间沟臂丛神经阻滞中的应用

目的探讨应用神经刺激器辅助定位实施肌间沟臂丛神经阻滞的效果。方法对40例行上肢手术的患者随机分为2组,每组20例。Ⅰ组采用神经刺激器辅助定位,Ⅱ组采用异感定位。局麻药均为1%利多卡因﹢0.25%布比卡因混合液,剂量为体重〈50kg,给予20mL;体重〉50kg,给予30mL。局麻药中均含1∶20万的肾上腺素。结果Ⅰ组神经阻滞完全19例,阻滞不全1例。Ⅱ组神经阻滞完全14例,阻滞不全6例。神经刺激器辅助定位组神经阻滞的成功率显著高于异感定位组（P〈0.05）。结论应用神经刺激器辅助定位实施臂丛神经阻滞,比异感定位准确,阻滞成功率高。     

神经刺激器辅助定位实施臂丛神经阻滞20例临床体会

目的：探讨应用神经刺激器辅助定位实施臂丛神经阻滞的效果。方法：将40例行上肢手术的患者随机分为A、B两组,每组20例。A组采用神经刺激器辅助定位,B组采用异感定位。局部麻醉药均为0．5％布比卡因。结果：A组神经阻滞完全18例,阻滞不全2例;B组神经阻滞完全13例,阻滞不全6例,阻滞失败1例。A组神经阻滞的成功率显著高于B组,差异有统计学意义（P〈0．05）。结论：应用神经刺激器辅助定位实施臂丛神经阻滞比异感定位准确,阻滞成功率高。     

神经刺激仪在臂丛神经阻滞麻醉中的应用

目的探讨应用神经刺激仪辅助定位实行臂丛神经阻滞麻醉的临床应用效果。方法 60例拟行肌间沟臂丛神经阻滞的患者随机分为2组,每组30例。Ⅰ组采用神经刺激仪辅助定位,Ⅱ组采用异感定位,局麻药均为0.375%罗哌卡因和1%利多卡因混合液。结果Ⅰ组30例中麻醉效果优良者28例（成功率为93.3%）,Ⅱ组麻醉效果优良者21例（成功率为70%）,两组麻醉效果比较有显著性差异（P〈0.05）。结论应用神经刺激仪辅助定位实施臂丛神经阻滞麻醉,比异感定位准确,阻滞麻醉成功率高。     

自制“弯弧钝针”在臂丛神经阻滞应用的临床研究

目的：探讨“弧度弯针法”辅助定位行臂丛神经阻滞的效果。方法：150例上肢手术的患者随机分为3组各50例，Ⅰ组弧度弯针法。Ⅱ组传统异感引导法，Ⅲ组神经刺激器辅助定位法。均用0．375％罗哌卡因行肌间沟臂丛阻滞。结果：Ⅰ组的麻醉效果优良率明显高于Ⅱ组，麻醉效果差的病例数显著少于Ⅱ组，血肿发生率和膈神经麻痹发生率明显少于Ⅱ组，Ⅰ组和Ⅲ组比较各观察指标无明显差异。结论：“弧度弯针法”辅助定位行臂丛阻滞比异感方法定位准确，阻滞成功率高。     

神经刺激仪引导下腋路神经阻滞麻醉的临床观察

目的 探讨应用神经刺激仪辅助定位实行腋路臂丛神经阻滞麻醉的临床应用效果.方法 80例拟行腋路神经阻滞的患者随机分为2组,每组40例.I组采用神经刺激仪辅助定位,Ⅱ组采用异感定位,局麻药均为0.25%罗哌卡因0.4ml/kg.结果 Ⅰ组40例中麻醉效果优良者38例(成功率为95%),Ⅱ组麻醉效果优良者28例(成功率为70%),两组麻醉效果比较有显著性(P<0.01).结论 应用神经刺激仪辅助定位实施腋路臂丛神经阻滞麻醉,比异感定位准确,阻滞麻醉成功率高.     

神经刺激器在肌间沟臂丛神经阻滞中的应用

臂丛神经阻滞麻醉广泛用于患者上肢手术 ,臂丛神经阻滞成功的关键在于神经定位准确 ,神经刺激器的应用可满足这一需要。利用神经刺激器辅助定位行肌间沟臂丛神经阻滞可提高臂丛神经阻滞的成功率和质量 ,同时能避免为了寻找异感而引发神经损伤等并发症。现就利用神经刺激器辅助定位行臂丛神经阻滞的可行性进行分析总结。1　资料与方法选择上肢外科手术患者 3 5例 ,男 2 0例 ,女 15例 ,年龄 8～ 71岁 ,ASA I～ 级 ,无神经系统疾患。 3 5例患者均经肌间沟入路 ,用神经刺激器定位行臂丛神经阻滞。神经刺激器为德国贝朗公司生产的 STMUPL E…     

神经刺激器定位臂丛阻滞行肩部手术的临床观察

目的 探讨外周神经刺激器定位在行高位肌间沟臂丛神经阻滞麻醉进行肩部手术的临床应用效果，并与传统的肌间沟臂丛神经阻滞麻醉进行比对观察分析。方法 将预行肩部手术患者62例分为Ⅰ、Ⅱ两组，均使用神经刺激器定位，Ⅰ组采用传统的肌间沟臂丛神经阻滞麻醉，Ⅱ组采用高位肌间沟臂丛神经阻滞麻醉。局麻药物为0．5％罗哌卡因。完成阻滞后记录麻醉效果指标数据，进行统计学处理。结果 Ⅱ组患者中阻滞完全者占83．9％，阻滞不全者占16．1％，无阻滞失败；Ⅰ组患者中阻滞完全者占51．6％，阻滞不全者占35．5％，阻滞失败者占12．9％，两组神经阻滞评价差异极为明显（P〈0．01）。结论 使用外周神经刺激器。行高位肌间沟臂丛神经阻滞，能较好地满足肩部手术要求，是一安全、准确、简便的麻醉方法。     

神经刺激器定位仪在臂丛神经阻滞中的应用

目的：比较神经刺激器（PNS）定位技术与异感定位技术用于臂丛神经阻滞（BPB）的成功率。方法：选择上肢手术的病人40例,随机分为2组,Ⅰ组采用PNS定位。Ⅱ组采用BPB定位,局麻药均为1．3％利布合剂。结果：PNS定位组神经阻滞成功率显著高于异感定位（P〈0．01）。结论：PNS定位较异感定位更精确,阻滞成功率高。     

神经刺激器定位在臂丛神经阻滞麻醉中的应用

目的 比较外周神经刺激器定位技术与异感定位技术用于锁骨上入路神经阻滞麻醉的临床效果。方法 48例拟行锁骨上入路臂丛神经阻滞的患者，随机分为两组，分别采用神经刺激器定位(=24)和异感定位(n=24)方法，局麻药均使用0．5％的罗比卡因。结果 使用神经刺激器组在起效时间、感差时间、痛觉消失时间均长于异感定位组，二者在运动阻滞时间和镇痛时间无显著性差异。但神经刺激器组神经阻滞麻醉成功率明显高于异感定位组。结论 采用0．5％罗比卡因配合神经刺激器行锁骨上入路臂丛神经阻滞是一种安全、可靠的局部神经阻滞麻醉方法。     

神经刺激器辅助定位在臂丛神经阻滞中的应用

目的:观察采用神经刺激器辅助定位在臂丛阻滞中的麻醉效果和安全性.方法:随机选择行上肢手术患者88例,A组60例采用神经刺激器辅助定位,B组28例采用传统异感法与A组对照.结果:A组阻滞成功率为96.67%,B组阻滞成功率为78.57%,两者差异有显著性(P<0.05).全部患者术中无不良反应,术后随访无神经并发症.结论:神经刺激器辅助定位用于臂丛阻滞,操作方便,麻醉效果满意,与传统异感法相比,阻滞成功率高.     

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.