舒芬太尼自控静脉镇痛在晚期癌痛治疗中的应用

目的观察舒芬太尼自控静脉镇痛（PCIA）治疗晚期癌痛的效果。方法将22例晚期癌痛患者随机分为舒芬太尼PCIA组及吗啡自控硬膜外镇痛PCEA组,各11例。PCIA组药物配方为舒芬太尼250g＋氟呱啶10mg＋托烷司琼10mg＋0.9%氯化钠溶液至250ml,PCEA组药物配方为吗啡12.5mg＋氟呱啶10mg＋罗哌卡因375mg＋0.9%氯化钠溶液至250ml。均采用电子自控泵,设定持续输注2ml/h,单次自控镇痛（PCA）给药0.5ml,锁定时间15min。镇痛24h后观察患者视觉模拟评分（VAS）、镇静评分（SS）、患者满意度及不良反应情况。结果两组VAS、SS评分及满意度比较差异均无统计学意义（〉0.05）,PCIA组不良反应发生率明显小于PCEA组,差异有统计学意义（〈0.05）。结论舒芬太尼PCIA给药具有安装简便、镇痛作用强及不良反应小的优点,是治疗晚期癌痛的有效方法。     

舒芬太尼自控皮下镇痛在晚期癌痛治疗中的应用与疗效观察

目的:观察舒芬太尼自控皮下镇痛在晚期癌痛治疗中的应用与疗效。方法:选取的观察对象为我院2017年6月-2018年3月收治的晚期癌痛患者40例,按照摸球法分为对照组(n=20)和研究组(n=20),对照组使用口服及肌注阿片类制剂镇痛,研究组使用舒芬太尼自控皮下镇痛,对2组疼痛改善效果进行比较。结果:治疗前2组VAS评分无统计学差异(P0.05);治疗后2d、1周、2周2组VAS评分进行比较,研究组均低于对照组,组间具有统计学差异(P0.05)。结论:晚期癌痛治疗中的应用舒芬太尼自控皮下镇痛效果良好,可有效缓解和减轻疼痛,值得临床借鉴和大力推广。     

术后不同方式应用舒芬太尼自控镇痛效果及安全性分析

目的 :比较与分析舒芬太尼用于妇科术后静脉与硬膜外自控镇痛效果及安全性。方法 :选取本院2012年10月~2014年3月期间所收治的136例经腹子宫切除术患者按照麻醉方式不同分组为对照组与观察组,各68例。对照组采用经硬膜外泵注舒芬太尼自控镇痛;观察组采用静脉泵注舒芬太尼自控镇痛。2组患者舒芬太尼负荷量为15μg。观察2组患者术后4、8、16、24、48h生命体征和舒芬太尼累积使用量及静止、活动状态下视觉模拟评分、镇静评分、不良反应。结果 :经研究发现,2组患者镇痛及镇静效果均较满意,且2组患者各个时间点生命体征和静止、活动状态下视觉模拟评分及镇静程度比较;2组患者皮肤瘙痒和呕吐等不良反应率比较。对照组各个时间点舒芬太尼累积使用量明显高于观察组;且术后48h,对照组舒芬太尼使用量明显高于观察组。结论 :相比经硬膜外泵注舒芬太尼自控镇痛来说,采用静脉泵注具有相当镇痛效果,且无明显不良反应,均具有镇痛效果好和安全性。但采用静脉泵注舒芬太尼累积使用量少,因此更值得研究与推广应用。     

舒芬太尼复合右美托咪定用于晚期癌痛患者PCSA的临床观察

目的:观察舒芬太尼复合右美托咪定用于晚期癌痛患者PCSA(皮下自控镇痛)的疗效。方法:将48例晚期癌痛患者随机分为对照组(A组)采用舒芬太尼200μg加托烷司琼10 mg加0.75%罗哌卡因20 ml;观察组B1组采用右美托咪定200μg加舒芬太尼200μg加托烷司琼10 mg加0.75%罗哌卡因20 ml;B2组采用右美托咪定200μg加舒芬太尼250μ加托烷司琼10 mg加0.75%罗哌卡因20 ml。三组均用生理盐水稀释至100 ml,均用无线电子镇痛泵PCSA,镇痛泵背景输注速度2 ml/h,自控给药剂量(PCA)0.5 ml,锁定时间15 min。记录6 h、12 h、24 h和48 h Ramsay镇静评分和视觉模拟评分(VAS),记录不良反应发生情况,PCA的按压次数和患者的综合满意度。结果:3组患者均能获得较好的镇痛效果,而且VAS评分B1、B2组均低于A组,Ramsay镇静评分,B1、B2组均高于A组,但B2组呼吸抑制明显高于A组、B1组,PCA按压次数A组明显多于B1、B2组,患者综合满意度B1组明显优于其他两组。结论:右美托咪定可增加舒芬太尼在晚期癌痛皮下自控镇痛中的效果,降低舒芬太尼的用量,提高患者满意度,降低不良反应,安全有效。     

舒芬太尼复合吗啡用于晚期癌症患者自控镇痛的效果观察

目的 评价舒芬太尼合剂用于晚期癌痛病人静脉自控镇痛的镇痛效果.方法 将60例癌症晚期患者随机分为两组：观察组（A组）自控镇痛泵中加入舒芬太尼150 μg、吗啡20 mg加生理盐水至150 mL;对照组（B组）自控镇痛泵中加入曲马多8 mg/kg、吗啡20 mg加生理盐水至150 mL.记录两组用药后的镇痛、镇静程度及头晕、恶心、呕吐等不良反应.结果 A组在使用后2、4、8、16、32 h的镇痛效果明显强于B组（P〈0.05）;B组的镇静评分在使用后2、4、8 h高于A组,有统计学差异（P〈0.05）;镇痛期间出现的不良反应无统计学差异（P〉0.05）.结论 舒芬太尼合剂用于晚期癌痛患者静脉自控镇痛的镇痛效果强于曲马多合剂,是一种较好的用药选择.     

帕瑞昔布对舒芬太尼复合曲马朵术后静脉镇痛效果的影响

目的 观察帕瑞昔布对舒芬太尼复合曲马朵术后静脉镇痛效果及不良反应的影响。方法全麻手术患者60例,随机分成3组,每组20例。I组术毕连接镇痛泵、II组术毕静脉注射帕瑞昔布0.8mg·kg^-1后连接镇痛泵、III组术毕静脉注射帕瑞昔布0.8mg·kg。后连接镇痛泵,术后6h时再静脉注射帕瑞昔布0.6mg·kg^-1。记录术后疼痛评分、镇静评分、PCA有效按压次数及不良反应。结果 II、III组的疼痛评分在术后各时点低于I组,III组低于II组（P＜O.05）。I组患者恶心呕吐、PCA有效按压次数高于II、III组,II组PCA有效按压次数高于III组（P＜0．05）;3组头晕发生率及镇静评分差异无统计学意义（P＞0．05）。结论舒芬太尼复合曲马朵术后静脉镇痛加用帕瑞昔布,能增强镇痛效果,术毕即刻及术后6h时两次给药法镇痛效果佳且不良反应少。     

蛛网膜下腔持续泵注吗啡治疗晚期癌痛

目的 观察6例晚期癌痛患者蛛网膜下腔持续泵注吗啡的镇痛效果。方法 吗啡2～4mg加生理盐水至100ml注入泵内连接于蛛网膜下腔导管持续泵注2ml／h。结果 6例镇痛效果确切，但有尿潴留等副作用，经处理可改善或消除。结论 蛛网膜下腔持续泵注吗啡是晚期癌痛患者较好的镇痛方法之一。     

舒芬太尼伍用氟比洛芬酯用于下肢骨科手术静脉的镇痛

目的比较下肢手术患者白控静脉镇痛（PCIA）中舒芬太尼与舒芬太尼伍用氟比洛芬酯的镇痛效果与不良反应。方法选择下肢手术术后行PCIA患者80例，用抽签法随机分为两组。舒芬太尼组（S组）给予（舒芬太尼100μg＋阿扎司琼10mg）／100ml；氟舒组（FS组）手术结束前30min给予氟比洛芬酯50mg，术后镇痛给予（舒芬太尼75μg＋氟比洛芬酯100mg＋阿扎司琼10mg）／100ml.两组PCIA泵的设置，维持量2ml／h，单次负荷剂量0．5ml，锁定时间15min。观察两组术后4、12、24、48h的镇痛、镇静评分和不良反应发生率。结果FS组术后镇痛及镇静评分好于S组。FS组药物不良反应发生率低于S组。结论舒芬太尼伍用氟比洛芬酯用于下肢骨科手术PCIA的镇痛效果优于单纯舒芬太尼，而不良反应明显降低，同时阿片类药物用量明显减少。     

蛛网膜下腔持续泵注吗啡治疗晚期癌痛

目的观察6例晚期癌痛患者蛛网膜下腔持续泵注吗啡的镇痛效果。方法吗啡2-4mg加生理盐水至100ml注入泵内连接于蛛网膜下腔导管持续泵注2ml／h。结果6例镇痛效果确切，但有尿潴留等副作用，经处理可改善或消除。结论蛛网膜下腔持续泵注吗啡是晚期癌痛患者较好的镇痛方法之一。     

静脉与硬膜外术后镇痛的对比观察

连续硬膜外术后镇痛的镇痛效果确切,但该技术的安全性是临床医生关注的问题。本文两组各行静脉与硬膜外术后镇痛,静脉给药组(PCIA)镇痛泵的配方为曲马朵(tramadol)800～1000 mg,氟哌利多(droperidol)5 mg,以0.9%NaCl稀释为100ml备用。硬膜外给药组(PCEA)镇痛泵配方为曲马朵     

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.