异氟醚复合拉贝洛尔控制性降压上颅脑手术中的应用

对２４例择期颅脑手术病人采用异氟醚复合拉贝洛尔控制性降压，并与单纯用异氟醚降压者进行了对比观察。病人随机分成单纯异氟醚降压组（Ｉ组）和异氟醚复合拉贝洛尔降压（Ⅱ组），每组１２例。结果显示，降压时Ⅱ组呼气末异氟醚浓度明显低于Ｉ组（Ｐ＜０．０１），血流动力学改变较Ｉ组轻。由此认为，异氟醚复合拉贝洛尔控制性降压用于颅脑手术可能优于单纯异氟醚降压。     

异氟醚或异氟醚复合拉贝洛尔控制性降压对肺内分流的影响

研究了异氟醚或异氟醚复合拉贝洛尔控制性降压对肺内分流的影响。２４例择期颅脑手术患者,随机分成两组：单纯异氟醚降压组和异氟醚复合拉贝洛尔降压组。患者的平均动脉压降低３０％左右,分别于控制性降压前、降压达预定值时、维持降压２０ｍｉｎ时和停止降压２０ｍｉｎ后抽取患者动脉血和混合静脉血进行血气分析,采用标准公式计算肺内分流。结果显示,降压期间两组患者的肺内分流较降压前有所增加,但无统计学意义。由此认为,异氟醚或异氟醚复合拉贝洛尔控制性降压对肺内分流的影响较小。     

异氟醚或异氟醚复合拉贝洛尔控制性降压对肺内分流的影响

研究了异氟醚或异氟醚复合拉贝洛尔控制性降压对肺内分流的影响。２４例择期颅脑手术患者，随机分成两组；单纯异氟醚降压组和异氟醚复合拉贝洛尔降压组。患者的平均动脉压降低３０％左右，分别于控制性降压前，降压达预定值时，维持降压２０ｍｉｎ时和停止降压２０ｍｉｎ后抽取患者动脉血和混合静脉血进行血气分析，采用标准公式计算肺内分流。结果显示，降压期间两组患者的肺内分流较降压前有所增加，但无统计学意义，由此认为，异     

艾司洛尔复合硝酸甘油控制性降压用于颅脑手术的疗效评价

目的：观察艾司洛尔复合硝酸甘油控制性降压用于颅脑手术的降压效果。方法：随机将60例病人分为两组：（Ⅰ组）单纯硝酸甘油组，（Ⅱ组）艾司洛尔复合硝酸甘油组，每组各30例。结果：Ⅱ组比Ⅰ组降压效果更理想，且无心率反射性增快。结论：艾司洛尔复合硝酸甘油控制性降压用于颅脑手术效果更理想。     

异丙酚和异氟醚复合麻醉对硝酸甘油控制性降压的影响

目的：评价异丙酚和异氟醚复合麻醉对硝酸甘油控制性降压的影响。方法：20例口腔颌面部择期手术病人随机分为两组：Ⅰ组（n=10）采用吸入异氟醚维持麻醉；Ⅱ组（n=10）采用微量泵持续输入异丙酚和吸入异氟醚维持麻醉。以0．01％硝酸甘油溶液使MAP降低30％。结果：Ⅱ组血压易于下降和维持，停止降压后MAP显著低于I组（P〈0．05），HR明显慢于I组（P〈0.01）；Ⅱ组硝酸甘油平均剂量显著低于I组（P〈0．01），硝酸甘油总量较I组减少54％；两组围术期尿量无明显差异。结论：异丙酚和异氟醚复合维持麻醉可增强硝酸甘油控制性降压的效果。     

硝酸甘油复合艾司洛尔用于择期颅脑手术控制性降压的效果观察

目的观察硝酸甘油或硝酸甘油复合艾司洛尔用于择期颅脑手术控制性降压的效果。方法40例择期颅脑手术患者,在吸入异氟醚维持麻醉下行手术,随机分为硝酸甘油组(Ⅰ组)和硝酸甘油复合艾司洛尔组(Ⅱ组),Ⅰ组20例,Ⅱ组20例,分别采用硝酸甘油或硝酸甘油复合艾司洛尔控制性降压至平均动脉压(MAP)55￣65mmHg,并维持30分钟,降压前、后监测(MAP)、心率(HR)、心指数(CI)的变化。结果单用硝酸甘油HR明显增快,CI无明显下降;合并用艾司洛尔(143.7±59.6)μg·kg-1·min-1,则减慢心率、降低心肌耗氧量,硝酸甘油用量减少34%,复压时间缩短39.3%。结论硝酸甘油复合艾司洛尔控制性降压用于吸入异氟醚麻醉下的择期颅脑手术患者的控制性降压效果优于单独使用硝酸甘油。     

硝普钠复合异氟醚控制性降压用于鼻内窥镜手术的临床研究

目的探讨硝普钠复合异氟醚控制性降压用于鼻内窥镜手术的可行性、安全性。方法将Ⅱ型Ⅱ期—Ⅲ型慢性鼻窦炎、鼻息肉病人50例随机分为对照组(A组)和全麻控制性降压组(B组),每组25例,两组病人均为ASAⅠ－Ⅱ级,控制性降压组采用气管内插管全麻下以硝普钠1ug／(kg．min)微量泵泵入及1．5～2％异氟醚持续吸入控制性降压,对照组采用局麻下手术。比较两组术中出血量、输液量、手术时间、平均动脉压 (MAP)、心率(HR)。结果与对照组比较两组术中出血量、输液量、手术时间、平均动脉压(MAP)、心率 (HR)有显著性差异(p＜0．05)。结论硝普钠复合异氟醚控制性降压用于鼻内窥镜手术效果显著、安全可靠,无单用硝普钠降压的副作用,出血量减少,手术时间缩短。     

鼻内镜手术中硝普钠复合艾司络尔和单纯硝普钠控制性降压的比较

目的 观察鼻内镜手术中，硝普钠复合艾司洛尔与单纯硝普钠控制性降压的比较。方法 40例ASAⅠ～Ⅱ级进行功能性鼻内镜手术的病人被随机分成两组，每组20例。Ⅰ组病人接受硝普钠和艾司络尔进行控制性降压，Ⅱ组只接受硝普钠进行控制性降压。麻醉诱导用咪唑安定、芬太尼、异丙酚、万可松，用1％～2％异氟醚 50％N2O维持。两组病人术中平均动脉压保持在60～65mmHg之间，Ⅰ组病人通过调整艾司络尔用量将心率维持在80～90次／min，根据Fromme术野质量评分表在手术开始后5、15、30、45min由同一术者进行术野质量评分。结果 Ⅰ组病人的术野质量评分明显低于Ⅱ组，其手术持续时间也少于Ⅱ组。结论 单纯应用硝普钠轻度控制性降压并不能改善鼻内镜手术术野质量、缩短手术时间，硝普钠复合艾司络尔是较理想的降压方法。     

控制性降压在鼻腔内窥镜手术中的应用

目的：观察异氟醚复合硝酸甘油在鼻腔内窥镜手术中的控制性降压效应。方法：将40例ASAⅠ～Ⅱ级鼻窦炎需行鼻腔内窥镜手术患者,随机分为A、B两组,均用异丙酚、芬太尼、维库溴胺进行麻醉,B组术中应用异氟醚复合硝酸甘油控制性降压,维持平均动脉压(MAP)在9．33～10．7 kPa。结果：异氟醚复合硝酸甘油控制性降压可减少异丙酚和芬太尼用量,易于维持控制性低血压状态,明显缩短手术时间和减少失血量,术中尿量正常,ECG示无心肌缺血改变,无反射性心动过速及反跳性高血压,术后清醒拔管,无精神智力异常。结论：异氟醚复合硝酸甘油控制性降压在鼻腔内窥镜手术中的应用是安全、有效的。     

观察颅脑手术中硝普钠-异氟醚控制性降压效果

控制性降压技术在颅脑手术中应用较广。异氟醚控制性降压因易于控制 ,副作用少等优点日益受到重视 ,但单纯用异氟醚降压仍然存在一些不足 ,若同时辅助应用一些血管扩张药物则可增强降压效果 ,减少其用量。本文旨在探索硝普钠复合异氟醚控制性降压的临床效果。1　资料与方法1.1　一般资料　择期神经外科手术患者 4 3例 ,ＡＳＡⅠ～Ⅱ级 ,男 2 3例 ,女 2 0例 ,年龄 (18～ 67)岁 ,平均 (4 0 .5± 15 .3)岁 ,体重 4 7～ 79ｋｇ ,平均 (5 2 .6±10 .3)ｋｇ。其中脑膜瘤 12例 ,垂体瘤 8例 ,胶质瘤 5例 ,听神经瘤 2例 ,动脉瘤 4例 ,后颅窝肿瘤 4例 …     

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.