血压正常产妇和子痫前期重度产妇腰硬联合阻滞麻醉剖宫产重比重布比卡因ED50的比较

目的：研究血压正常产妇和子痫前期重度产妇行剖宫产麻醉时重比重布比卡因的ED50。方法分别选择20例血压正常产妇和子痫前期重度产妇,均实施腰硬联合阻滞麻醉,鞘内重比重的布比卡因从10mg开始,采用Dixon序贯法,每次序贯剂量为1mg,每例均联合5μg的舒芬太尼,成功阻滞的标准定义为平面≥T6或患者无痛。结果血压正常产妇和子痫前期重度产妇鞘内重比重布比卡因择期剖宫产ED50相同（5.5mg;95%CI：4.9～6.0mg）。两组患者术中不良反应的发生率差异无统计学意义（均P＞0.05）,两组患者胎儿脐动脉pH、BE的差异有统计学意义（P＜0.05）。结论子痫前期重度产妇剖宫产腰麻联合硬膜外重比重布比卡因混合5μg舒芬太尼腰麻的ED50为5.5mg,与正常产妇剂量相似。     

血压正常产妇和重度子痫前期产妇剖宫产鞘内罗哌卡因ED_(50)比较

目的比较血压正常产妇和重度子痫前期产妇剖宫产罗哌卡因腰麻的半数有效量(ED_(50))。方法选择6 0例血压正常产妇(N组)和6 0例重度子痫前期产妇(P组),ASA分级为Ⅰ级或Ⅱ级,将每组患者均分为4小组(N1、N2、N3、N4,P1、P2、P3、P4),每小组15例,相应各组鞘内剂量分别为21、19、17及15 mg的罗哌卡因。选择L3~L4行腰硬联合穿刺,5 min后记录麻醉平面。麻醉有效标准:麻醉平面≥T6;术中患者无痛。无效标准:麻醉平面不能达到T6或术中患者疼痛。根据结果进行Probit分析,计算两组患者罗哌卡因腰麻的ED_(50)和ED9 5。观察各组术中及术后不良反应以及新生儿的Apgar评分和脐动脉p H。结果N组ED_(50)为15.449(95%CI,15.293~1 6.2 6 8),ED9 5为16.857(95%CI,15.971~16.965);P组ED_(50)为15.987(95%CI,15.492~16.809),ED9 5为1 7.3 9 5(9 5%CI,1 5.4 9 8~1 7.5 4 8)。两组ED_(50)比较,差异无统计学意义(P>0.05)。N1、N2,P1、P2组低血压的发生率高于其他各组,差异有统计学意义(P<0.05);其他不良反应发生率比较,差异无统计学意义(P>0.05)。两组患者胎儿脐动脉血p H比较,差异有统计学意义(P<0.05)。结论重度子痫前期产妇剖宫产腰麻罗哌卡因剂量与血压正常产妇接近。     

轻比重腰麻在重度子痫前期剖宫产中的应用观察

目的观察0.125%轻比重布比卡因腰麻硬膜外联合麻醉在重度子痫前期剖宫产的应用情况。方法20例拟行剖宫产的重度子痫前期孕妇均在腰硬联合麻醉下行剖宫产术,腰麻药0.125%布比卡因6~7 ml(7.5~8.75 mg),观察产妇血液动力学变化、麻醉效果及新生儿的Apgar评分。结果20例产妇均麻醉顺利,医生与患者对麻醉效果全部满意,注药后收缩压下降超过25%的有6例,经加快输液和静脉注射麻黄碱后血压迅速回升。新生儿1 min Apgar评分8分以上有19例,2分有1例,该患者术中发现有胎盘早剥和卒中,经新生儿抢救5 min评7分。结论0.125%轻比重布比卡因腰麻可安全应用于重度子痫前期剖宫产的麻醉。     

小剂量罗哌卡因复合舒芬太尼在重度子痫前期剖宫产术中的应用

目的探讨小剂量罗哌卡因复合舒芬太尼在重度子痫前期剖宫产术中的麻醉效果及其对母婴的影响。方法将择期行剖宫产术的重度子痫前期产妇40例随机分为2组,A组为罗哌卡因15mg,B组为罗哌卡因12mg复合舒芬太尼5μg。观察并比较两组麻醉效果、感觉及运动阻滞程度、不良反应,以及新生儿Apgar评分等。结果两组在最高感觉阻滞平面达T2、T4及T6的相应例数差别无统计学意义（P〉0.05）;两组改良Bromage评分3级例数相似（P〉0.05）,达改良Bromage评分3级所需时间A组少于B组（P〈0.05）;两组麻醉效果没有明显差别,均无麻醉效果差的情况发生（P〉0.05）;A组低血压发生的例数明显高于B组（P〈0.05）,恶心呕吐及寒战发生率差别无统计学意义（P〉0.05）,两组均无心动过缓及瘙痒发生;两组新生儿Apgar评分差别无统计学意义（P〉0.05）。结论罗哌卡因12mg复合5μg舒芬太尼在重度子痫前期剖宫产手术中,既能保证麻醉效果,且不良反应又少,值得临床推广应用。     

不同比重布比卡因腰麻用于产科麻醉的临床对比观察

目的：通过观察分析不同比重布比卡因腰麻应用于产科麻醉的临床效果,评价每种比重布比卡因的麻醉特点与应用价值。方法：选取我院妇产科2010年2月至2014年8月期间接收进行剖宫产的200例产妇作为临床布比卡因腰麻研究对象,所有产妇均采用蛛网膜下隙与硬脊膜外联合阻滞麻醉方式,完成穿刺后,根据布比卡因注射液比重的不同分为两个研究小组,分别为对照组和观察组。观察组产妇穿刺成功后注入0.5％布比卡因等比重液2ml,对照组产妇穿刺成功后注入0.5ml 布比卡因重比重液2ml。观察对比两组产妇麻醉平面情况以及血压脉搏变化情况。主要对比两组患者注射药物之后生命体征变化情况、不良反应状况以及产妇麻醉效果满意度等。结果：对照组与观察组麻醉效果均比较理想,有效避免了胎儿宫内缺氧的状况。观察组等比重的布比卡因对产妇血压的影响小于重比重布比卡因,差异明显,具有统计学意义（P ＜0.05）;麻醉用药之后观察组产妇不良反应发生率小于对照组,差异明显,具有统计学意义（P ＜0.05）,且观察组产妇使用麻黄碱的频率也低于对照组;观察组产妇麻醉满意度高于对照组,观察组产妇麻醉效果明显优于对照组,差异具有统计学意义（P ＜0.05）。结论：在接受剖腹产的产妇临床麻醉中,采用等比重的布比卡因注射液可取得较为理想的麻醉效果,对产妇的血压影响比较小,麻醉后的不良反应较少,能够避免胎儿宫内缺氧,麻醉安全性能极高,具有临床推广应用的价值。     

左旋布比卡因对不同体重产妇剖宫产术脊麻ED_（50）的研究

目的确定0.5%左旋布比卡因等比重溶液在肥胖产妇与非肥胖产妇脊麻中产生运动阻滞的半数有效量（ED50）,确定两类产妇运动阻滞的效价比。方法随机选择ASAI~II级择期剖宫产产妇50例,术中行腰硬联合麻醉（CSEA）,按体重指数（BMI）不同分为两组,每组产妇25例,肥胖组,BMI〉30kg/m2,正常组,BMI≤30kg/m2。脊麻给药剂量的选择用上下序贯法,首次剂量为0.5%左旋布比卡因6mg,下一次剂量视前一患者反应而定,1mg为药量增减梯度。根据脊麻给药后5min阻滞情况决定下例患者给药剂量,以Bromage和HMFS评分判定下肢运动阻滞是否有效,用Dixon和Massey公式和概率单位回归（Probit Regression）方法计算分析两组患者运动神经阻滞的ED50。结果用Dixon和Massey计算得出,0.5%左旋布比卡因在肥胖组和正常组产妇脊麻中产生运动神经阻滞的ED50分别为3.123mg（95%CI：2.738,3.563）和3.558mg（95%CI：3.325,3.872）,ED50的效价比为0.878（95%CI：0.614,1.023）;Probit回归分析得出肥胖组和正常组产妇ED50分别为3.010mg（95%CI：1.992,3.532）和3.441mg（95%CI：2.487,3.996）,ED50的效价比为0.875（95%CI：0.540,1.023）,左旋布比卡因对肥胖产妇的运动阻滞效应增强,与正常组相比,差异有统计学意义（P〈0.05）。结论 0.5%左旋布比卡因在肥胖产妇脊麻中,产生运动阻滞的效价强度大于正常体重产妇。     

子痫前期产妇行腰麻剖宫产时低血压发生率的研究

目的：观察子痫前期产妇行腰麻剖宫产时低血压的发生率。方法：选择择期腰麻下行子宫下段剖宫产手术的产妇共100例,分为子痫前期组(SE组)和正常产妇组(H组),每组50例。腰麻穿刺成功后,蛛网膜下腔注射0.75%罗哌卡因1.5 mL 加入 10 μg 芬太尼。记录产妇麻醉前(T0)、麻醉后 3 min(T1)、6 min(T2)、9 min(T3)、12 min(T4)、15 min(T5)、胎儿娩出时 (T6)、胎儿娩出后5 min(T7)、手术结束时(T8)的收缩压、舒张压、平均动脉压和心率;记录麻黄碱和去氧肾上腺素的使用量。 结果：SE组产妇麻醉后低血压的发生率为20%,明显低于H组(P ＜ 0.05),且在T1~T4时间点平均动脉压下降的百分比也低于 H组(P ＜ 0.05);SE组麻黄碱的使用量低于H组[(3.5±1.8)mg vs.(8.5±2.6)mg,P ＜ 0.05]。结论：子痫前期产妇在使用低剂量局麻药物复合阿片类药物进行腰麻剖宫产时低血压的发生率低于健康足月产剖宫产的产妇;加强麻醉管理,腰麻可安全用于子痫前期产妇。     

左旋布比卡因复合芬太尼腰硬联合麻醉在剖宫产手术中的效用

目的 观察不同剂量等比重左旋布比卡因复合芬太尼腰麻联合硬膜外麻醉（CESA）用于剖宫产手术的效用.方法 择期行单胎剖宫产手术患者60例,予CESA,腰麻液用脑脊液稀释的等比重左旋布比卡因复合芬太尼20μg混合液3ml,根据腰麻液左旋布比卡因不同剂量将患者随机分为A（7.5mg）、B（10mg）、C（12.5mg） 3组,每组20例.记录最高感觉阻滞平面和达最大运动阻滞时的改良Bromage评分,达到最高感觉阻滞平面时间和感觉阻滞持续时间、运动阻滞起效时间和运动阻滞恢复时间,观察术中疼痛程度和牵拉反应发生情况及需追加硬膜外药液情况.记录患者麻醉前后心率、血压变化及术中心动过缓、低血压的发生及麻黄碱和阿托品使用情况,记录瘙痒、恶心、呕吐、术后头痛等不良反应的发生情况及新生儿娩出后1、5min时的Apgar评分.结果 B组最高感觉阻滞平面和C组最高感觉阻滞平面、达最高感觉阻滞平面时间、感觉阻滞恢复时间、达最大运动阻滞时间及运动阻滞完全恢复时间与A组比较差异有统计学意义（P＜0.05）,C组的最高感觉阻滞平面与B组比较差异有统计学意义（P＜0.05）.A、B、C组麻醉后5、10min的MAP值与麻醉前即刻比较差异有统计学意义（P＜0.05）.C组围术期心动过缓、低血压的发生及麻黄碱、阿托品的使用情况与A组比较差异有统计学意义（P＜0.05）.C组发生恶心、呕吐的产妇与A、B组比较差异有统计学意义（P＜0.05）.结论 复合芬太尼20μg时7.5mg的左旋布比卡因腰硬联合麻醉用于剖宫产手术即能提供理想的麻醉效果,增加血流动力学的稳定性,建议复合芬太尼时适当减少左旋布比卡因的使用量.     

不同剂量布比卡因腰硬联合麻醉对剖宫产产妇血液流变学影响比较

目的比较不同剂量布比卡因腰硬联合麻醉对剖宫产产妇血液流变学的影响。方法选取2009年10月~2011年10月于本院进行采用腰硬联合麻醉进行剖宫产的84例产妇为研究对象,将其分为A组与B组,每组各42例。A组采用7.0 mg的0.75%布比卡因进行麻醉,B组采用9.0 mg的0.75%布比卡因进行麻醉,后将两组产妇不良反应发生率及麻醉前及麻醉后5、15、30 min的血液流变学指标进行检测及比较。结果 B组麻醉后5、15、30 min的各项血液流变学指标低于A组（均P〈0.05）,而两组患者不良反应发生率比较差异无统计学意义（P〉0.05）。结论 9.0 mg的0.75%布比卡因对剖宫产产妇的血液流变学影响更为明显,可显著改善产妇的血液循环状态,且安全性也较高,故更适用于剖宫产术。     

1%葡萄糖重比重腰麻用于剖宫产术中的可行性探讨

目的探讨葡萄糖浓度为1%的重比重腰麻用于剖宫产手术的可行性。方法将120例剖宫产手术患者随机分为A组和B组进行腰麻,分别注入不同配方的腰麻液。A组（重比重组,60例）：0.75%布比卡因1.2 c＋5%葡萄糖注射液0.5 mL＋脑脊液0.8 mL;B组：0.75%布比卡因1.2 mL＋脑脊液1.3 mL.观察2组麻醉镇痛质量、肌松效果、麻醉阻滞平面情况,术中低血压、恶心、呕吐等不良反应发生率,产妇术后头痛发生率。结果 2组产妇麻醉前后血压、心率变化情况,术中、术后并发症情况等比较差异无统计学意义（P〉0.05）。A组产妇麻醉镇痛质量、肌松效果较优,与B组比较差异有统计学意义（P〈0.01）;A组产妇经调整绝对平面均能达到T10,平面达T10的时间较B组短,术毕阻滞平面较高,与B组比较差异有统计学意义（P〈0.05或P〈0.01）。结论 1%葡萄糖重比重腰麻麻醉效果确切,麻醉平面可控性好,对血流动力学影响较小,不良反应少,用于剖宫产术安全有效。     

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.