气管内全麻与硬膜外复合静脉麻醉用于妇科腹腔镜手术的效果比较

目的 比较气管内全麻与硬膜外复合静脉麻醉用于妇科腹腔镜手术的麻醉效果,以及对循环、呼吸的影响.方法 选择60例ASA Ⅰ～Ⅱ级掸期行妇科腹腔镜手术的患者,随机分为气管内全麻组(Ⅰ组)和硬膜外复合静脉麻醉组(Ⅱ组),每组30例.Ⅰ组常规气管插管静吸复合全麻,机械通气;Ⅱ组采用硬膜外复合静脉麻醉,保留自主呼吸.两组患者气腹期间均采用T体位,记录两组患者麻醉前、气腹后10 min、30 min、60 min、90 min及放气后5 min的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、分钟通气量(VE)、血氧饱和度(SpO2)、呼吸末二氧化碳分压(PETCO2)、清醒后的不适主诉和术者对麻醉的满意度等.结果 两组病人的麻醉效果及各时段的SpO2相比差异无显著性,然而气腹后与Ⅰ组相比,Ⅱ组病人HR及RR均增快(P＜0.05);当气腹至60min及90 min时,Ⅱ组病人的呼吸末二氧化碳分压(PETCO2)显著高于Ⅰ组及麻醉前(P＜0.01),其分钟通气量比Ⅰ组明显减小(P＜0.01),MAP显著下降(P＜0.01).结论 短时间的妇科腹腔镜手术可选择硬膜外复合静脉麻醉,但需要硬膜外阻滞完善,辅助用药合理.对于时间较长的手术,仍以气管内全麻为宜.     

腰-硬联合麻醉在腹腔镜辅助下阴式全子宫切除手术中的应用

目的 探讨腰-硬联合麻醉在腹腔镜辅助下阴式全子宫切除手术中应用的可行性.方法 选择择期行腹腔镜辅助下阴式全子宫切除手术患者40例,随机分为两组,每组20例.Ⅰ组采用0.75%罗哌卡因1.5 ml腰硬联合麻醉,并辅以丙泊酚、芬太尼静脉全麻(观察组);Ⅱ组采用以丙泊酚为主的气管插管静脉复合全麻(对照组).于麻醉前(T0)、CO2气腹后10 min(T1)、30 min(T2)、术毕10 min(T3),记录各时点MAP、HR、SPO2、PETCO2.结果 与T0时比较,Ⅰ组各时点MAP、HR、SpO2差异无显著意义,Ⅱ组T1、T2时MAP、HR显著高于T0(P＜0.05);组间比较,Ⅱ组T1、T2时MAP、HR显著高于Ⅰ组同时点(P＜0.05);两组T1、T2时PETCO2显著高于T0时(P＜0.05).结论 腰-硬联合麻醉用于腹腔镜辅助下阴式全子宫切除手术中有效、安全,麻醉效果确切.     

硬-腰联合复合喉罩浅静脉麻醉用于妇科腹腔镜手术

目的 观察硬-腰联合复合喉罩浅静脉麻醉用于妇科腹腔镜手术中的可行性.方法 选取妇科腹腔镜手术90例,随机分为三组各30例.F组:硬-腰联合辅以面罩浅静脉麻醉;L组:硬-腰联合麻醉复合喉罩浅静脉麻醉;T组:气管插管全麻组.分别观察三组患者气腹后10min.和30min.及手术后5min分别记录血压(SBP)、心率(HR)、呼吸频率(f)、脉搏血氧饱和度(SPO2)、呼吸末二氧化碳(PETCO2)变化和苏醒时间及用药量情况.结果 T组的患者丙泊酚用药量明显多于L组和F组(p＜0.05).T组患者苏醒时间和拔管时间明显长于L组和F组,(p＜0.05).气腹后;F组SPO2下降明显p＜0.05,F组和L组HR、f增高p＜0.05.PET变化F组大于L组、T组(p＜0.051.结论 硬-腰联合复合喉罩浅静脉麻醉用于妇科腹腔镜手术是可行的,达到安全、无痛、苏醒快,用药少,是值得推广的麻醉方法.     

腹腔镜手术麻醉方法的安全性分析

目的 探讨不同麻醉方法在腹腔镜手术中的安全性与麻醉效果.方法 将给予妇科腹腔镜手术患者192例随机分为甲、乙两组,甲组给予腰-硬联合麻醉,乙组给予气管内插管全麻,比较两组麻醉方法的安全性与麻醉效果.结果 甲组在气腹后5min各项指标与乙组和治疗前相比均有显著性差异(P＜0.05＝.尤其是PETCO2在气腹后15min与乙组和治疗前相比差异显著(P＜0.05).pH:甲组气腹后5min、气腹后15min及放气后10min与麻醉前相比,P＜0.05.PaCO2:甲组气腹后5min、气腹后15min与麻醉前相比,P＜0.05.乙组的pH和PaCO2则无明显变化.结论 在妇科腹腔镜手术中给予气管内插管全麻较腰-硬联合麻醉安全可行.     

不同麻醉下行腹腔镜胆囊切除术CO2气腹对呼吸循环的影响

目的：探讨两种麻醉方法下行腹腔镜胆囊切除术（LC）时CO2气腹对呼吸循环功能的影响是否一致；方法：ASAⅠ级－Ⅱ级LC患者156例，随机分成2组，其中全麻组80例硬膜外麻醉组76例，均连续监测记录围术期心率（HR）、血氧饱和度（SPO2）、平均动脉压（MAP）、呼气末二氧化碳分压（PETCO2）、呼吸频率（RR）；结果：全麻组：气腹后PETCO2、RR较气腹前明显升高（P＜0．01）；硬膜外组：气腹后MAP较气腹前明显降低（P＜0．01），RR及PETCO2较气腹前明显升高（P＜0．01），两种麻醉方法围术期SPO2、HR基本不变。结论：两种麻醉方法进行LC时，CO2气腹对PETCO2、RR均有不同程度的影响，但硬膜外组对MAP、PETCO2、RR影响较明显。     

不同麻醉方式用于下腹部腹腔镜手术的探讨

目的 探讨不同麻醉方式用于下腹部腹腔镜手术的临床效应.方法 选择择期经腹腔镜行下腹部手术患者90例(ASAⅠ～Ⅱ级),随机分成3组,A组气管内插管静吸复合全麻组(n=30);B组一点法腰-硬联合麻醉组(n=30);C组二点法腰-硬联合麻醉组(n=30).监测患者心电图(ECG)、血压(SBP/DBP)、平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、并记录术后苏醒时间及患者麻醉效果及可能出现的不良反应.结果 3组患者术前一般情况相似,且麻醉前后、CO2气腹前后及手术结束时SBP、DBP、MAP、HR、SpO2、PETCO2变化均有所波动,但3组间比较差异无统计学意义(P＞0.05);B组、C组与A组相比术后苏醒时间快(P＜0.01);C组比B组麻醉效果更强,且患者不良反应较少(P＜0.01).结论 下腹部短时间(＜60 min)腹腔镜手术可酌情选择腰-硬联合麻醉,而二点法则具有起效迅速、镇痛及肌松完善、术中易于调节麻醉阻滞平面,术后恢复快的优点.不失为基层医院下腹部腹腔镜手术一种经济、实用、安全的麻醉方法,可在临床选用.     

丙泊酚复合芬太尼辅助硬膜外麻醉用于妇科腹腔镜手术

目的比较丙泊酚复合芬太尼辅助硬膜外麻醉与氯胺酮复合咪唑安定辅助硬膜外麻醉在妇科腹腔镜手术的应用.方法选择ASAⅠ～Ⅱ级心肺功能正常100例妇科腹腔镜下非全子宫切除术病人,随机分为两组,每组50例.对照组K组,氯胺酮复合咪唑安定组,实验室P组,丙泊酚复合芬太尼组.两组均选L1～2间隙施行连续硬膜外麻醉,试验剂量为2%利多卡因5ml,首次剂量为1%罗哌卡因10～15ml,控制硬膜外阻滞平面在T8～S4.两组患者均于气腹前、气腹后15min和气腹后30min均记录平均动脉压(MAP)、心率(HR)、呼吸频率(f)、血氧饱和度(SPO2)、呼气末二氧化碳分压(PETCO2)和潮气量(VT).同时记录两组患者术后头晕、头痛、恶心、呕吐等不良反应发生率.结果 K组患者HR于气腹后15min明显升高,P＜0.01,VT于气腹后15min明显下降,P＜0.05,f和PETCO2于气腹后15min、气腹后30min明显升高,P＜0.01.P组患者MAP于气腹后15min、30min明显下降,P分别＜0.05和＜0.01,HR于气腹后15min、30min明显下降,P＜0.01;VT于气腹后15min也下降,P＜0.05,f和PETCO2于气腹后15min、30min均明显升高,P＜0.01.与K组比较,P组患者MAP、HR于气腹后15min、30min明显低于K组,P＜0.01;P组患者PETCO2于气腹后15min明显高于K组,P＜0.05.与K组相比,P组不良反应发生率明显低于K组.结论丙泊酚复合芬太尼辅助硬膜麻醉.     

婴幼儿腹腔镜手术麻醉方法的选择

目的探讨非气管插管静脉全麻用于婴幼儿腹腔镜疝内环结扎术的可行性、安全性、实用性。方法60例行腹腔镜疝内环结扎术患儿，随机分为全麻插管组（Ⅰ组30例）和非插管组（Ⅱ组30例），连续监测HR、SPO2、PETCO2。结果两组气腹时HR均增快，但无统计学意义，放气后逐渐恢复至气腹前水平，Ⅱ组气腹后10min PETCO2明显高于麻醉前（P〈0．05）但尚在正常范围，组间比较亦无明显差异（P〉0．05）；Ⅱ组气腹后的PETCO：高于明显Ⅰ组，差异显著（P〈0．05）。结论非气管插管全麻在婴幼儿腹腔镜疝内环结扎术中是一种比较理想的麻醉方法之一。     

硬腰联合麻醉复合喉罩通气在妇科腹腔镜手术中的应用

目的探讨硬腰联合麻醉复合喉罩通气在妇科腹腔镜手术中应用的可行性。方法随机将36例患者分为硬腰联合麻醉复合喉罩组（Ⅰ组）、全麻组（Ⅱ组）、硬腰联合麻醉组（Ⅲ组）3组,每组12例。记录各组患者麻醉前后、气腹前后血压（BP）、心率（HR）等指标,观察麻醉效果及并发症发生情况。结果Ⅱ组 患者术中全麻用药量明显多于Ⅰ组,且术毕苏醒时间较Ⅰ组、Ⅲ组长,苏醒程度较差,在麻醉及气腹后Ⅱ组患者的BP和HR较麻醉前差异有统计学意义（P＜0.05或P＜0.01）,Ⅱ组的BP、HR在气腹后组间比较差异有统计学意义（P＜0.01）,Ⅰ组麻醉并发症较少。结论硬腰联合麻醉复合喉罩通气利于维持妇科患者腹腔镜手术中呼吸循环平稳,且安全可行。     

硬-腰联合复合喉罩浅静脉麻醉用于妇科腹腔镜手术

目的观察硬-腰联合复合喉罩浅静脉麻醉用于妇科腹腔镜手术中的可行性。方法选取妇科腹腔镜手术90例,随机分为三组各30例。F组：硬-腰联合辅以面罩浅静脉麻醉;L组：硬-腰联合麻醉复合喉罩浅静脉麻醉;T组：气管插管全麻组。分别观察三组患者气腹后10min.和30min.及手术后5min分别记录血压（SBP）、心率（HR）、呼吸频率（f）、脉搏血氧饱和度（SPO2）、呼吸末二氧化碳（PETCO2）变化和苏醒时间及用药量情况。结果T组的患者丙泊酚用药量明显多于L组和F组（p〈0.05）。T组患者苏醒时间和拔管时间明显长于L组和F组,（p〈0.05）。气腹后;F组SPO2下降明显p〈0.05,F组和L组HR、f增高p〈0.05。PET变化F组大于L组、T组（p〈0.05）。结论硬-腰联合复合喉罩浅静脉麻醉用于妇科腹腔镜手术是可行的,达到安全、无痛、苏醒快,用药少,是值得推广的麻醉方法。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.