全麻下妇科腹腔手术二氧化碳气腹对动脉血气和呼气末二氧化碳分压的影响

目的 观察妇科腹腔镜手术（LSC）期间CO2气腹对患者动脉血气和呼气末二氧化碳分压（PETCO2）的影响。方法 选择妇科腹腔镜手术患者46例，ASAⅠ～Ⅱ级，于气腹前10min和气腹后15min、30min、以及放气后30min分别采取桡动脉血测定血气，同时记录PETCO2。结果 与气腹前10min比较，气腹后15min和30minPaCO2及PETCO2均显著增加（P〈0．05），pH值、PaO2等指标无明显变化（P〉0．05）；放气后30min各项指标均恢复到气腹前水平。结论 全麻妇科腹腔镜手术CO2气腹期间，PETCO2和PaCO2均明显升高，说明可能存在高碳酸血症和低氧血症，提示CO2气腹期间应充分供氧和加强对PETCO2监测。     

新生儿腹腔镜手术的麻醉管理

目的观察腹腔镜手术CO2气腹对新生儿呼吸循环功能的影响。方法选择24例ASAⅠ-Ⅱ级新生儿患者,根据手术方式不同分为腹腔镜组（A组）和开腹组（B组）,每组12例,所有患儿均行气管插管全麻,全程控制呼吸下进行手术;监测心率（HR）、平均动脉压（MAP）、脉氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）、气道峰压（PIP）、肺顺应性（PC）的变化,于不同时点做动脉血气分析。结果与气腹或开腹前比较,气腹或开腹后15、30、45min,A组患儿HR、MAP、PaCO2、PIP均明显升高（P〈0.01）,pH值、PC明显降低（P〈0.01）,B组无明显变化（P〉0.05）;气腹或开腹后A、B组间比较差异有统计学意义（P〈0.01）;术毕A、B组间比较差异无统计学意义（P〉0.01）。结论腹腔镜手术CO2气腹对新生儿呼吸循环影响较大,但只要术中加强呼吸管理,临床应用是安全的。     

妇科腹腔镜手术硬膜外麻醉和气管内插管全身麻醉的效果比较

目的比较硬膜外麻醉和气管内插管全身麻醉在妇科腹腔镜手术中的应用效果，方法选择择期妇科腹腔镜手术患者100例，ASAⅠ～Ⅱ级，随机分为硬膜外麻醉组（E组）和气管内插管全身麻醉组（G组），每组50例，E组选择L1,2和T11,12两点硬膜外穿刺，G组采用气管内插管全身麻醉。所有病人麻醉后，连续监测平均动脉压（MAP）、中心静脉压（CVP）、心电图（ECG）、脉搏血氧饱和度（SpO2）、心输出量（CO）、心率（HR）和呼气末二氧化碳分压（PETCO2）。记录两组患者CO2气腹前（T0），气腹后5（T1），10（T2），15（T3），30min（T4）及停气腹后5min（T5）的MAP，CVP，CO，HR，PETCO2。两组病人均在气腹前（T0），气腹后5min（T1），15min（T3），30min（T4）及停气腹后5min（L）经桡动脉抽血作血气分析和测血糖（GLU），并记录动脉血CO2分压（PaCO2）、酸碱值（pH）、碳酸氢根浓度（HCO3^-）、动脉血氧分压（PaO2）和血糖值（GLU）。结果E组气腹后5min，10min HR明显降低（P〈0．05），15min后恢复到气腹前水平，G组气腹后HR无明显变化（P〉0．05），两组间比较，差异无显著性；气腹后G组MAP显著升高（P〈0．05），至停气腹后5min仍未恢复到气腹前水平，而E组整个气腹期间MAP无明显变化或略低（P〉0．05），与G组比较差异有显著性（P〈0．01）；气腹后两组病人的CO均显著下降（P〈0．05），10min后开始回升，30min后恢复到气腹前水平（P〉0．05），两组间比较差异无显著性。结论妇科腹腔镜手术应用气管插管全身麻醉并不明显优于硬膜外麻醉，而硬膜外麻醉在降低气腹造成的循环高动力以及降低应激反应方面尚有一定的优越性。     

经腹腔与经腹膜后入路手术CO2气腹对患者血气的影响

目的：探讨经腹腔与经腹膜后入路手术CO2气腹对患者血气的影响。方法：选择美国麻醉师协会（ASA）分级I．Ⅱ级行后腹腔镜手术的泌尿外科病例和腹腔镜手术的普外科及妇科病例各50例,监测气腹前（TO）、气腹后30min（T1）、60min（T2）及气腹结束后30min（T3）动脉血气的变化。结果：两组患者组内气腹后30min、60min的pH较气腹前降低,PaC02较气腹前升高（P〈0．05）;组间后腹腔组气腹后30min、60min的pH降低和PaCO2升高较腹腔组更明显（P〈0．05）。结论：后腹腔人路手术CO2气腹对患者血气的影响更大,术中需加强呼吸管理和血气的监测。     

腹膜后腹腔镜手术CO2气腹对患者动脉血气的影响及对策

目的探讨腹膜后腹腔镜手术CO2气腹对患者动脉血气的影响及对策。方法选择40倒择期行泌尿外科手术患者,年龄22～60岁,ASAI～11级,随机分为经腹腔腹腔镜组（L组）,经腹膜后腹腔镜组（R组）,各20例。选择全身麻醉,分别在气腹前（T0）、气腹后30min（T1）、气腹后60min（T2）、解除气腹后30min（T3）抽取动脉血检测动脉血二氧化碳分压（PaCO2）、pH值,同时间点记录呼气末CO：分压（PETCO2）。T0至T1时点,两组患者均设定潮气量8ml／kg,呼吸频率12次／min;T1时点至机械通气结束,则依据T1、T2、L时点的PaCO2、pH及即时PETCO2,调节潮气量6～10ml／kg,呼吸频率12～18次／min。结果T1时点：R组PETCO2、PaCO2高于L组,pH值小于L组（P〈0．05）;T2时点：两组间PETCO2、PaCO2差异无统计学意义（P〉0．05）,R组pH值小于L组（P〈0．05）;T3时点：两组间PETCO2、PaCO2、pH值差异均无统计学意义（P〉0．05）,并恢复至T0水平。结论腹膜后腹腔镜手术CO：气腹对全身麻醉患者动脉血气的影响大,但通过加强术中监测,及时调整呼吸参数,进行适度过量通气,可以减轻该影响。     

不同麻醉方法用于妇科腹腔镜手术的效果观察

目的：比较全麻（GA）和腰-硬联合麻醉（CSEA）在妇科腹腔镜手术中的安全性和可行性。方法：将45例择期妇科腹腔镜手术患者按随机数字法分为GA组24例和CSEA组21例。比较两组不同时段MAP、HR及动脉血气分析情况．观察并记录两组不良反应、术后清醒时间及术后并发症的发生情况。结果：两组患者在气腹后30min的MAP、HR均较麻醉前明显增高（P〈0．01）,CSEA组在气腹后60min的MAP、HR仍较麻醉前高（P〈0．01或P〈0．05）,而GA组基本保持麻醉前水平。CSEA组气腹后30、60rain动脉血气pH值较麻醉前明显降低（P〈0．01）,PaCO2明显增加（P〈0．01）;而GA组pH、PaCO2较麻醉前改变不明显（P〉0．05）。GA组和CSEA组术中不良反应发生率分别为0．04％和0．19％,两组比较,差异有统计学意义（P〈0．05）。两组术后清醒时间比较,差异无统计学意义（P〉0．05）。两组术后均未出现与麻醉相关的并发症。结论：妇科腹腔镜手术中应用全麻能更好地控制机体的应激反应,是一种效果佳、实用可行的麻醉方法。     

不同通气方式对后腹腔镜手术患者PaCO2及肺内分流等的影响

目的探讨后腹腔镜手术中CO2气腹后能有效减少CO2蓄积、降低死腔通气比（VD／VT）及肺内分流（Qs／Qt）的通气方法。方法60例后腹腔镜手术患者按不通的通气参数分为A、B、c及D组,各15例,全身麻醉插管后行间歇正压通气（IPPV）,设定每分通气量（MV）均为140ml／kg,各组采用不同的呼吸参数。于气腹前、气腹后10、30、60min测定呼气末二氧化碳分压（PETCO2）、气道峰压（Pmax）、动脉血二氧化碳分压（PaCO2）及氧分压（PaO2）,并计算死腔通气比（VD／VT）及肺内分流（Qs／Qt）。结果各组气腹后各时点PaCO2、PETCO2、VD／vT及Qs／Qt差异均有统计学意义（均P〈O．05）;D组气腹后10、30、60min的PaCO：、PETCO：、VD／vT及Qs／Qt与A、B、c组差异均有统计学意义（均P〈0．05）;各组气腹后3个时间点Pmax与气腹前差异均有统计学意义（均P〈0．05）,气腹后组间Pmax比较,A组明显高于B、C、D组（均P〈0．05）,B组明显高于C、D（均JP〈0．05）。结论后腹腔镜手术中为减少CO2气腹对机体不利影响,建议IPPV时设定MV为140ml／kg,并采用快频率低潮气量（VT=7．8ml／kg、f=18次／s）的通气方式较好     

不同麻醉方法对腹腔镜胆囊切除患者的影响比较

目的比较全身麻醉与全身麻醉联合硬膜外麻醉对腹腔镜胆囊切除患者的影响。方法将100例腹腔镜胆囊切除患者随机分为A、B2组各50例,其中A组应用全身麻醉联合硬膜外麻醉,B组应用全身麻醉。观察2组手术前、气腹前、气腹后30min、手术放气后患者的血气分析、血液动力学以及术后唤醒时间、躁动发生例数。结果2组氧分压（arterial partial pressureof02,PaO2）麻醉前与其他各时点比较差异均有统计学意义（P〈0．05）,且气腹前、气腹30min2组比较差异均有统计学意义（P〈0．05）;2组二氧化碳分压（pressure of CO2 in artery,PaCO2）气腹前、气腹30min较麻醉前升高,2组比较差异有统计学意义（P〈0．05）。A组高、低切全血黏度,红细胞压积在麻醉后30min、90min均降低,差异有统计学意义（P〈0．05）,而B组只有麻醉后30min与麻醉前比较差异有统计学意义（P〈0．05）;麻醉90min后2组高、低全血黏度,红细胞压积比较差异均有统计学意义（P〈0．05）。A组血浆黏度在麻醉后30min下降,与麻醉前比较差异有统计学意义（P〈0．05）。A组纤维蛋白原在麻醉后30min时与麻醉前比较差异有统计学意义,而B组在麻醉后90min时高于麻醉前,且与同时期A组比较差异有统计学意义（P〈0．05）。2组唤醒时间与术后躁动例数比较差异均有统计学意义（P〈0．05）。结论全身麻醉联合硬膜外麻醉对患者呼吸、血液循环影响比单纯应用全身麻醉小,且术后唤醒时间短,并发症发生率减小,值得临床应用。     

右旋美托咪啶对腹腔镜胆囊切除患者CO2气腹时血糖和IL-6的影响

目的通过观察腹腔镜胆囊切除术患者CO2气腹前静脉给予右旋美托咪啶时血糖（Glu）和IL-6的变化,探讨该药能否减轻CO2气腹的应激反应。方法将择期行腹腔镜胆囊切除术40例患者,采用随机数字表法分为对照组（C组）和右旋美托眯啶（Dex）组（D组）,每组20例。D组在麻醉后手术切皮前10～15min静脉泵注Dex1．0ug／kg,其余用药两组均同。记录麻醉前30min（T1）、气腹前即刻（T2）、气腹压达12mmHg时（T3）、气腹压平衡（达12mmHg）后15min（T4）、手术结束关气腹即刻（L）的心率（HR）、平均动脉压（MAP）;并干T1、T4及T5时抽取血液标本,测定Glu和IL-6。结果C组在气腹期间HR、MAP均升高,与D组比较差异有统计学意义（P〈0．01）。D组HR、MAP在T5时较T3有显著升高（P〈O．01）,但与T1相比差异无统计学意义（P〉0．05）。D组GluT5高于T1,差异有统计学意义（P〈0．05）,组间比较T5低于C组,差异有统计学意义（P〈O．05）。IL-6：D组在T4、T5较T1升高,差异有统计学意义（P〈0．05）;组间比较D组T4、T5时低于对照组,差异有统计学意义（P〈0．01）。结论腹腔镜胆囊切除术患者麻醉中辅以Dex能有效减轻CO2气腹的心血管应激反应,抑制Glu和IL-6的升高,提高CO2气腹下腹腔镜手术患者围手术期的安全性。     

通气策略对腹腔镜手术病人肺内分流及氧合的影响

目的：观察不同潮气量（VT）、呼吸频率（F）、吸呼比（I：E）等通气参数对腹腔镜手术病人肺内分流及氧合情况的影响。方法：25例ASAⅠ～Ⅱ级全麻下择期腹腔镜手术患者随机分为3组,麻醉诱导药物相同,呼吸机参数VT=8ml／kg,F=15次／min,I：E=1：2。气腹后通气参数设定分别为A组VT=10ml／kg。F=12次／min,I：E=1：3;B组VT=6ml／kg,F=20次／min,I：E=1：2;C组同气腹前。分别于气腹前、后测定混合静脉血和动脉血血气,计算各组气腹前后的肺泡气动脉血氧分压差[P（A-a）O2]、呼吸指数（RI）、肺内分流（QS／QT）及氧摄取率（ERO2）。结果：气腹后C组RI增加（P〈0.05）,A、C两组的P（A-a）O2升高（P〈0．05）,ERO2下降（P〈0．05）,而QS／QT增加（P〈0．05）,尤以A组QS／QT,增加显著（P〈0.01）。但各组数据组间比较,差异无统计学意义（P〉0．05）。结论：A、B、C3种通气策略对腹腔镜手术病人的P（A-a）O2、QS／QT、ERO2和RI等方面的影响无大差别。     

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.