熵指数监测在全凭静脉麻醉诱导期中的应用

目的:研究全凭静脉麻醉中新型麻醉深度监测仪熵指数在全麻诱导期的应用并与双频谱指数比较。方法:ASAⅠ~Ⅱ级择期腹部手术患者20例,入室后常规监测,然后异丙酚、维库溴铵、芬太尼快诱导气管插管,持续泵入异丙酚,间断推注维库溴铵和芬太尼维持麻醉。采用自身对照试验设计,对每例患者同时行熵指数(包括反应熵和状态熵)和双频谱指数监测,以睫毛反射消失、大声呼名和轻推肩膀无反应作为意识消失时点,于入室,睫毛反射消失前60s、前45s、前30s,睫毛反射消失即刻,后30s、后45s、后60s记录数据。结果:反应熵、状态熵和双频谱指数预测全麻诱导期意识消失的概率分别为0.938 6、0.931 2和0.914 9,三者没有统计学差异(P>0.05),预测概率与相应的脑电指数的Logistic回归方程分别为:ln Pk/(1-Pk)=20.724-0.267x、ln Pk/(1-Pk)=19.278-0.26x和ln Pk/(1-Pk)=23.865-0.348x;意识消失后反应熵和状态熵值继续下降并趋向等值23.4±6.5和23.9±6.4,最低值可达11~18,同时脑电波形出现抑制模式,而此时双频谱指数却无明显变化,维持于48.3±3.5之间。结论:在判断从有意识到无意识的转变上熵指数似乎比双频谱指数更灵敏,并且可以反映爆发抑制,监测麻醉过深。     

脑电熵指数分析用于七氟烷麻醉的镇痛监测

目的研究熵指数用于判断七氟烷麻醉时的体动反应并与双频谱指数比较。方法ASAⅠ～Ⅱ级择期腹部手术患者22例,按切皮有无体动反应分为体动组（9例）和非体动组（13例）。入室后常规监测,采用异丙酚、琥珀胆碱、芬太尼快诱导气管插管,持续吸入七氟烷,维持呼气末七氟烷浓度为1．0MAC,15min后开始手术,切皮前不用神经肌肉阻滞剂,如果发生体动,则按10％提高下一个患者七氟烷呼气末浓度,如果不动则按10％降低下一个患者七氟烷呼气末浓度。每例患者同时行两种脑电监测于以下时点记录数据：入室、切皮前60s、前30s、切皮后45s、后120s。结果熵指数值在两组之间有统计学差异（P〈0．05）,双频谱指数值在两组之间无统计学差异（P〉0．05）。反应熵和状态熵判断切皮有体动的截断值是76、75,相应的灵敏度／特异度是89％／91％、88％／92％;反应熵和状态熵判断切皮无体动的截断值是65、64,相应的灵敏度／特异度是88％／90％、89％／91％。结论熵指数可以用于七氟烷麻醉时体动反应有无的判断。     

熵指数在老年全身麻醉患者中的应用效果

目的:观察熵指数在老年患者全身麻醉中的应用效果。方法:80例实施全身麻醉(全麻)的老年患者,随机分为两组:熵指数组和对照组。熵指数组依据熵指数值调节异丙酚和瑞芬太尼输注速度,对照组根据患者血压、心率、来调节异丙酚和瑞芬太尼输注速度。记录两组患者插管前、插管时和切皮时的平均动脉压(MAP)与心率(HR),记录两组患者异丙酚用量、瑞芬太尼用量和术后苏醒时间。结果:熵指数组患者插管时、切皮时的血压、心率均比对照组的低,差异有统计学意义(P<0.05);熵指数组患者异丙酚和瑞芬太尼用量比对照组少,差异有统计学意义(P<0.05),而苏醒时间短于对照组,差异有统计学意义(P<0.05);此外,两组患者的不良反应发生率相当。结论:老年患者行全身麻醉时应用熵指数调控麻醉深度,可使患者血流动力学更稳定,患者麻醉药用量更少、苏醒时间更短。     

脑电近似熵与双频指数在意识消失时预测概率的比较

目的比较脑电非线性参数近似熵(ApEn)和双频指数(BIS)在异丙酚靶控输注(TCI)镇静时意识消失的预测概率(Pk).方法随机选择20例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级行择期下肢手术患者,硬膜外麻醉完善后,异丙酚TCI起始血药浓度为0.5μg/ml,然后以0.3～0.5μg/ml的梯度递增直至意识消失,再递减至意识恢复.每个靶浓度维持12min,双盲记录患者意识清醒·消失时的EEG非线性参数ApEn值和BIS值.计算ApEn和BIS对意识消失的Pk值,并进行比较.结果意识清醒和消失阶段,ApEn值分别为0.84±0.05,0.71±0.06,BIS值分别为80.2±6.2,67.3±7.9.ApEn、BIS对意识消失的Pk值分别为0.97±0.06、0.91±0.11,无显著性差异(P＞0.05).结论ApEn与BIS一样可有效地用于异丙酚TCI时意识反复消失-清醒的预测.     

熵指数监测麻醉镇痛的有效性

目的评价熵指数监测麻醉深度与反映伤害性刺激的效应。方法ASAⅠ-Ⅱ级择期手术患者45例,按照静注芬太尼剂量随机分为A组(1μg/kg)、B组(3μg/kg)和C组(5μg/kg)(n=15)。诱导开始先给予不同剂量芬太尼,3 min后靶控输注技术输注异丙酚,当其效应室浓度(CE)达3.5μg/mL时行气管插管,维持此浓度输注至切皮后5 min。记录静注芬太尼前及注射后2、3 min,异丙酚CE达1、2.5、3.5μg/mL时插管前、插管时及插管后1、3、5 min,切皮前及切皮后0.5、1、3、5 min各时点的反应熵(RE)、状态熵(SE)、心率(HR)和平均动脉压(MAP)。结果给芬太尼3 min后,三组RE和SE均较各自基础值减小,且均值随芬太尼剂量增大而减小;在插管时和切皮后0.5 min,三组RE和SE都明显升高,但插管后1 min与切皮后5 min均回落到刺激前水平;三组间RE和SE的波动在异丙酚CE达1.0μg/mL后已无差别。结论熵指数可以准确监测麻醉的镇静程度,但不能有效反映芬太尼对伤害性刺激的抑制程度。     

熵指数和脑电双频谱指数在判断意识上的比较

目的 比较熵指数在预测意识消失的趋势方面、肌电活动的影响方面和反映伤害性刺激方面与脑电双频谱指数(BIS)监测的差异.方法 选择30例行腹腔镜胆囊切除或妇科腹腔镜手术的全麻患者.麻醉诱导异丙酚的靶控血浆浓度均从4 μg/ml开始,每30 s进行一次警觉/镇静评分(OAA/S评分),直至患者意识消失(OAA/S评分≤1分),记录每次OAA/S评分即刻的熵指数(RE、SE)和BIS值.麻醉维持靶控输注异丙酚和瑞芬太尼,缝皮时停止输注.记录患者意识消失前后和意识恢复前后每30 s的熵指数和BIS值.结果 熵指数和BIS在意识消失前30 s与意识消失即刻比较显著降低(SE 78.1至67.3,RE 85.9至72.7,BIS 80.7至66.0,P均＜0.01).但是在意识恢复前30 s与意识恢复即刻比较,BIS虽然升高,但差异无统计学意义(66.6至71.6),而SE(65.3至75.4)和RE(73.4至89.2)的增高十分显著(P＜ 0.05,P＜0.01).SE、RE、BIS与OAA/S在诱导阶段相关系数(r)分别0.813、0.875、0.749(P＜ 0.01).SE、RE、BIS镇静深度Pk值分别为0.83±0.07、0.89±0.05、0.81±0.04.结论 熵指数与BIS在监测镇静深度和判断意识消失方面均能达到较好效果.但是在异丙酚麻醉恢复期的意识判断上熵指数(SE,RE)可能优于BIS.     

熵指数监测麻醉镇痛的有效性

目的 评价熵指数监测麻醉深度与反映伤害性刺激的效应.方法 ASA Ⅰ～Ⅱ级择期手术患者45例,按照静注芬太尼剂量随机分为A组(1μg/kg)、B组(3μg/kg)和C组(5μg/kg)(n=15).诱导开始先给予不同剂量芬太尼,3min后靶控输注技术输注异丙酚,当其效应室浓度(CE)达3.5μg/mL时行气管插管,维持此浓度输注至切皮后5min.记录静注芬太尼前及注射后2、3min,异丙酚CE达1、2.5、3.5μg/mL时插管前、插管时及插管后1、3、5min,切皮前及切皮后0.5、1、3、5min各时点的反应熵(RE)、状态熵(SE)、心率(HR)和平均动脉压(MAP).结果 给芬太尼3min后,三组RE和SE均较各自基础值减小,且均值随芬太尼剂量增大而减小;在插管时和切皮后0.5min,三组RE和SE都明显升高,但插管后1min与切皮后5min均回落到刺激前水平;三组间RE和SE的波动在异丙酚CE达1.0μg/mL后已无差别.结论 熵指数可以准确监测麻醉的镇静程度,但不能有效反映芬太尼对伤害性刺激的抑制程度.     

熵指数和脑电双频指数用于脑瘫患儿七氟醚麻醉时镇静深度监测的评价

目的:通过熵指数和脑电双频指数(BIS)在脑瘫患儿七氟醚麻醉时与镇静深度的相关性和预测作用,评价熵指数和BIS用于脑瘫患儿镇静程度监测的准确性.方法:选择ASA Ⅰ或Ⅱ级、5～15岁择期在全身麻醉下行选择性周围神经缩窄术的脑瘫患儿25例.经面罩吸入5％七氟醚和N2O/O2:70％/30％.记录清醒时改良警觉/镇静评分(mOAAS)各阶段的反应熵(RE)、状态熵(SE) 、BIS、无创血压(NIBP)、平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2).RE、SE、BIS与mOAAS评分的关系采用Spearman's等级相关进行分析.计算RE、SE、BIS、MAP、HR、SPO2对镇静深度的预测概率.结果:脑瘫患儿RE、SE 、BIS与mOAAS评分密切相关,明显优于MAP、HR、SPO2.RE、SE、BIS对镇静深度的预测概率(Pk)值明显高于MAP、HR、SPO2(P＜0.01).结论:RE、SE、BIS均可以在脑瘫患儿七氟醚-笑气麻醉中反应镇静深度.     

麻醉趋势指数预测靶控输注丙泊酚镇静深度的有效性分析

目的探讨麻醉趋势指数(NI)预测靶控输注丙泊酚麻醉患者镇静深度的有效性。方法 30例择期全身麻醉手术患者,美国麻醉医师协会(ASA)分级Ⅰ级或Ⅱ级,靶控输注丙泊酚麻醉诱导,初始丙泊酚效应室靶浓度(Ce)为1.5 mg.L-1,每10 min增加0.5 mg.L-1。每20 s行改良警觉/镇静(MOAA/S)评分,MOAA/S评分为0时结束试验。应用Narcotrend麻醉深度监测仪监测NI。记录不同MOAA/S评分时患者的心率(HR)、平均动脉压(MAP)、Ce及NI值。结果随着MOAA/S评分的降低,NI值逐渐降低,差异有统计学意义(P<0.01)。MOAA/S评分与NI呈正相关。NI的预测概率(Pk)>0.85,与Pk=0.50比较,差异有统计学意义(P<0.01)。结论 NI能够有效预测靶控输注丙泊酚麻醉患者的镇静深度。     

熵指数在老年患者七氟醚或丙泊酚靶控输注诱导中的应用

目的:探讨熵指数在老年患者七氟醚吸入或丙泊酚靶控输注诱导时的应用价值。方法:拟行气管插管全麻的老年患者40例,ASA Ⅰ~Ⅱ级,年龄≥65岁,随机分为七氟醚组(S组)和丙泊酚组(P组),分别以七氟醚吸入和丙泊酚靶控输注诱导,诱导期间调节熵指数维持在40~50,记录诱导、插管前后的血流动力学变化。结果:两组患者各项参数在诱导后均下降,气管插管后又上升,P组平均动脉压(MAP)在插管前明显低于S组(P<0.01),两组各时点的RE及SE数值无统计学差异,两组患者气管插管前后血流动力学增加值ΔHR、ΔMAP与熵指数增加值ΔSE、ΔRE之间没有相关性。结论:对于老年患者,熵指数可以反映七氟醚或丙泊酚靶控输注麻醉诱导时的麻醉深度,但不能准确预测气管插管时的心血管反应。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.