超声引导锁骨上臂丛阻滞不同浓度罗哌卡因对膈肌移动度的影响

目的观察超声引导锁骨上臂丛阻滞使用不同浓度罗哌卡因对同侧膈肌移动度和麻醉效果的影响。方法选择拟行锁骨上臂丛阻滞的择期上肢短小手术的患者30例。采用抽签法随机分为A、B和C3组,每组各10例．臂丛阻滞分别使用0．500％、0．375％和0．250％罗哌卡因,均为20ml。在高频超声引导下行锁骨上臂丛阻滞,观察臂丛起效时间和临床阻滞效果。用超声测定阻滞前后的同侧平静呼吸的膈肌移动度。结果A组患者的麻醉起效时间最短,而C组患者所需的麻醉起效时间最长（P〈0．01）。C组神经阻滞效果和麻醉效果显著差于A组和B组（P〈0．05）。A组患者在阻滞后5～90min期间膈肌移动度显著低于阻滞前,有5例患者膈肌无移动,处于完全麻痹状态。B组患者阻滞后5～30min、C组患者阻滞后5～20min时膈肌移动度显著低干阻滞前,均无膈肌完全麻痹病例。A组患者阻滞后膈肌移动度显著低于B、C组（P〈001）。结论超声引导的锁骨上臂丛阻滞采用0．375％罗哌卡因起效较快．麻醉效果好。对膈肌移动度影响较轻,是该径路合适的局麻药选择。     

小儿先天性心脏病介入治疗的麻醉体会

目的：总结小儿先天性心脏病介入治疗的麻醉处理方法。方法：384例患儿动脉导管未闭（PDA）封堵术115例,房间隔缺损（ASD）伞片封堵术135例,室间隔缺损（VSD）伞片封堵术134例。术前禁食4—6小时,麻醉前0．5小时肌注东莨菪碱0．01mg／kg。入室后持续监测呼吸、心率、血压、ECG、SPO,等生命体征。静注氯胺酮2mg／kg、咪达唑仑0．1mg／kg,穿刺点以0．5％利多卡因局部浸润麻醉;术中酌情间断追加氯胺酮1mg／kg、手术大于1小时,追加咪达唑仑0．05～0．1mg／kg维持麻醉。结果：全部患儿在局麻复合非气管内插管静脉麻醉下完成手术,效果满意。结论：非插管静脉全身麻醉复合局部麻醉应用于先天性心脏病介入治疗,并发症少,安全有效。     

静脉与硬膜外注射可乐定对胆囊切除术后膈肌功能的影响

目的　观察静脉与胸段硬膜外腔注射可乐定对胆囊切除术术后膈肌功能的作用。方法　在硬膜外麻醉下完成剖腹胆囊切除术 ,术后 2h麻醉平面消失患者入选 ,共 2 0例 ,分为硬膜外注射可乐定组 (E组 ,n =10 ) ,静脉注射可乐定组 (V组 ,n =10 )。E组经硬膜外导管注入可乐定 4 μg/kg ,加生理盐水至 8ml,V组静脉注射可乐定 4 μg/kg ,加生理盐水至 8ml。记录注药前、注药后 30min、2h膈肌功能评级 ,潮气量 (Vt)、呼吸频率 (RR)。 结果　E组患者硬膜外注射可乐定 30min后膈肌功能改善 ,RR减慢 ,Vt增加 ,V组静脉注射可乐定后上述指标无明显变化。结论　可乐定通过脊髓机制改善胆囊切除术后膈肌功能。     

八角枫硷对膈肌的松弛作用及新斯的明对抗作用的研究

八角枫硷0.5mg/kg体重快速注入麻醉猫的静脉内后,膈肌自主收缩停止,电刺激胫神经时胫前肌的机械收缩反应停止。同量八角枫硷缓慢注入静脉后,膈肌自主收缩良好,胫前肌的机械收缩反应却消失。将八角枫硷的剂量增加至0.75～1.1 mg/公斤体重而分次缓慢注入时胫前肌机械收缩反应消失,膈肌仍保留良好的自主收缩。     

不同潮气量机械通气对大鼠膈肌放电的影响

目的探讨不同潮气量机械通气对大鼠膈肌放电的影响。方法将24只SD大鼠随机分为大潮气量组(10 m L/kg)、小潮气量组(5 m L/kg)和对照组。大潮气量组和小潮气量组大鼠进行不同潮气量的容量控制通气4 h,对照组麻醉后进行自主呼吸。在0、2、4 h分别测定大鼠膈肌放电情况,并监测血压、经皮血氧饱和度(Sp O_2)及呼气末二氧化碳分压(Pet CO_2),分析大鼠膈肌放电在不同潮气量和通气时长下的变化趋势以及Sp O_2、Pet CO_2与膈肌放电之间的关系。结果与对照组比较,大潮气量组膈肌放电频率降低,膈肌放电面积增大,膈肌放电振幅×膈肌放电频率(A×R)差异无统计学意义;而小潮气量组膈肌放电频率及膈肌放电面积无显著差异,仅膈肌放电振幅×膈肌放电频率(A×R)明显升高。Sp O_2在对照组及大潮气量组有所下降,Pet CO_2在大潮气量组也有所下降,其余各指标没有显著变化。结论不同潮气量机械通气对大鼠膈肌放电的影响不同,小潮气量机械通气可以兴奋呼吸中枢,增强膈肌放电,而大潮气量则表现为抑制效应。     

腋下微创直切口行小儿胸外科手术58例报告

我院于2006年6月至2007年7月，对58例先天性心脏病、先天性右侧膈肌膨升等患儿采用腋下微创直切口行胸内手术，现报告如下。 1 资料与方法 1．1 一般资料 男30例，女28例。年龄6月～10岁，平均（5．6±4．9）岁。其中室间隔缺损（VSD）15例，房间隔缺损（ASD）13例，VSD合并ASD8例，动脉导管未闭（PDA）5例。先天性右侧膈膨升9例，先天性右下肺囊肿8例。手术前均进行充分的手术前准备。     

盐酸瑞芬太尼全身静脉麻醉在先天性唇腭裂手术中的应用

目的瑞芬太尼全身静脉麻醉用于先天性唇腭裂手术探索。方法择期行2岁以内小儿先天性唇腭裂手术53例，以瑞芬太尼1ug／kg与丙泊酚1．5～2mg／kg行麻醉诱导，气管插管后以瑞芬太尼0．2～0．3ug／kg／min速率微量泵持续输注，0．1％丙泊酚0．8～1．0mg／min，间断给以维库溴胺维持肌松，术中根据血流动力学状况和手术强度适当调控。结果麻醉诱导满意，术中0．2～0．3ug／kg／min瑞芬太尼维持麻醉，血流动力学稳定，术毕停止输注后作用消退快，麻醉恢复满意。结论瑞芬太尼全身静脉麻醉用于小儿唇腭裂手术效果满意，安全可行，停药后迅速苏醒，无需逐渐减量或提前停药，长时间使用无蓄积。     

小儿先天性膈疝的麻醉处理

目的总结小儿先天性膈疝手术的麻醉经验。方法回顾性分析36例小儿先天性膈疝手术的麻醉资料。结果36例麻醉过程较平稳，5例患儿术中血压轻度下降，经加快输血输液后回升，无麻醉死亡，均顺利完成手术。术后死亡3例，其中1例死于多脏器功能衰竭，2例术后肺膨胀不良死于呼吸衰竭。结论小儿先天性膈疝手术麻醉有其特殊性，应加强麻醉期的管理。     

肌松药在小儿气管异物取出术的麻醉应用

目的 探讨肌松药阿曲库铵用于小儿气管异物取出术的麻醉效果和安全性.方法 60例气管异物患儿,随机分为两组.无肌松麻醉组:静脉注射咪达唑仑0.05～0.1 mg/kg、依托咪酯0.2～0.3 mg/kg、芬太尼1～2 μg/kg,保留自主呼吸或面罩辅助呼吸;肌松麻醉组:在无肌松麻醉组的麻醉方法基础上加用阿曲库铵0.1～0...     

咪唑安定减少福尔利行人流术时肌阵挛发生的观察

目的　观察咪唑安定减少依托咪酯乳剂伍用芬太尼应用于人工流产术时肌阵挛的情况。方法　 10 0例 ,随机分为两组 :对照组予芬太尼 1μg/kg +依托咪酯乳剂 0 .1～ 0 .2mg/kg ;观察组予芬太尼 1μg/kg +依托咪酯乳剂 0 .0 5～ 0 .1mg/kg +咪唑安定 0 .0 3mg/kg ,观察麻醉效果、离院时间及肌阵挛发生率。结果　麻醉效果、离院时间两组间无显著性差异 (P >0 .0 5 ) ,而两组间肌阵挛发生率有显著性差异 ( P<0 .0 5 )。结论　咪唑安定可明显减少依托咪酯乳剂伍用芬太尼应用于人工流产术时肌阵挛的发生 ,且麻醉效果无影响。     

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.     

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.     

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.