止痛注液泵持续静注5-Fu所致静脉炎的临床观察

目的探究止痛注液泵持续静脉推注化疗药5-Fu所致静脉炎的发生率。方法60例患者随机分为2组各30例。对照组按常规采用头皮针穿刺,将5-Fu500mg加入5%葡萄糖溶液500ml持续静滴4h,连续5d;实验组采用静脉留置针穿刺,将5-Fu750mg与0.9%氯化钠注射液40ml加入止痛注液泵持续24h推注,连续3d。2组病例均接受1个周期化疗。结果对照组静脉炎发生率56.7%(17/30),实验组20.0%(6/30),2组静脉炎的发生率比较差异有显著性。2组静脉炎的严重程度比较差异无显著性。结论采用止痛注液泵持续静脉推注化疗药5-Fu能有效地降低静脉炎的发生。     

不同部位静脉穿刺推注丙泊酚在无痛胃镜检查中的效果观察

目的探讨选择右手臂不同部位静脉穿刺对无痛胃镜检查中的穿刺一次成功率及推注丙泊酚疼痛程度的影响。方法选择在本院做无痛胃镜检查的450例门诊患者为研究对象,将其随机分成A、B、C三组,每组各150例。A组选择右手腕关节上3 cm至肘关节下5 cm的静脉为穿刺点;B组选择右手腕部和肘部的静脉为穿刺点;C组选择右手背静脉为穿刺点。比较三组的静脉穿刺一次成功率及推注丙泊酚时的疼痛程度。结果 A组的静脉一次穿刺成功率为96.67%,B组为61.33%,C组为75.33%,A组明显高于B组和C组,差异均有统计学意义(P0.05)。A组推注丙泊酚时的疼痛程度轻于B、C组,差异均有统计学意义(P0.05)。结论无痛胃镜检查时的最佳静脉穿刺部位为右手前臂静脉,不仅静脉穿刺一次成功率高,还减轻了推注丙泊酚时的疼痛程度,提高了患者满意度。     

肝癌肝移植术前和术中癌细胞血行转移与肿瘤分化、微血管侵犯相关性研究

目的:探讨检测血播散肝癌细胞内AFP-mRNA评估肝癌肝移植术前和术中微转移与肿瘤分化、微血管侵犯的相关性。方法:采用RT-PCR联合荧光标记探针杂交法定量检测30例血清AFP阳性肝癌肝移植患者术前、术中血播散肝癌细胞内AFP-mRNA,病理分析肿瘤分化程度及微血管侵犯。结果:30例肝癌肝移植术前与术中肺动脉、外周动脉、外周静脉、门静脉血中播散肝癌细胞内AFP-mRNA阳性率以及拷贝数有显著差异(P<0.05);术前、中肿瘤播散组与无肿瘤播散组的微血管侵犯有显著差异(P<0.01);术前肿瘤播散组与术前无肿瘤播散组肿瘤分化无显著差异(P>0.05);术中肿瘤播散组与术中肿瘤无播散组肿瘤分化有显著差异(P<0.01)。结论:RT-PCR联合荧光标记探针杂交法能够检测到肝癌患者血液中播散肿瘤细胞,并且以肺动脉血阳性率最高;肝移植手术过程可以引起肿瘤细胞播散,且与肿瘤分化、微血管侵犯相关。     

大鼠腹腔镜不同气腹模型的建立及对直肠癌细胞Colo-320种植转移的影响

目的 建立大鼠腹腔镜不同气腹模型,探讨其对直肠癌Colo-320细胞种植转移的影响.方法 64只裸鼠分为4组,即开腹组、二氧化碳(CO2)气腹组、N2气腹组、无气腹组,每组16只,术前30 min于每只裸鼠腹腔内注入1×107直肠癌Colo-320细胞,建立大鼠腹腔镜不同气腹模型,3周后每组取10只处死,观察腹腔及各脏器的成瘤情况,剩余6只观察生存时间.结果 腹腔镜不同气腹模型建立稳定,无大鼠死亡;各组裸鼠致瘤率:开腹组10/10、CO2气腹组10/10、N2气腹组9/10、无气腹组9/10,差异无显著性(p＞0.05);裸鼠腹腔内瘤结节数、不同脏器成瘤率无气腹组最低,与其余各组相比差异有显著性(P＜0.05),其余各组间差异无显著性(P＞0.05);各组裸鼠生存时间差异无显著性(P＞0.05).结论 通过技术改进能够建立稳定的大鼠气腹模型;与开腹手术相比,CO2气腹和N2气腹并不增加直肠癌细胞在腹腔内以及对各脏器的侵袭转移能力,对致瘤裸鼠的生存时间无影响,而无气腹腹腔镜在减少肿瘤细胞侵袭及转移有一定的作用.     

乌拉地尔对二氧化碳气腹下腹腔镜手术时血流动力学的影响

目的　探讨乌拉地尔在腹腔镜胆囊切除术(LC)中二氧化碳气腹建立时对血流动力学的影响。方法　选择ASAⅠ~Ⅱ级腹腔镜胆囊切除术病人60例,随机分为乌拉地尔组(A组,n=30)和对照组(B组, n=30)。A组于气腹时经静脉推注乌拉地尔0 3mg/kg。记录A组与B组患者气腹前5 分钟(T1),气腹时(T2),气腹后5分钟(T3),气腹后10分钟(T4),气腹后15分钟(T5)时SBP、DBP、MAP、HR的改变。结果　A组与B组在T1、T2时点各监测值无明显差异;气腹后B组内各时点监测值与T1比较,P<0 .05,或者P<0 .01,有显著性差异;A组各时点与T1比较,无明显差异;气腹后组间比较,B组各时点监测值比A组高,P<0. 05或者P<0 .01,有显著性差异。结论　乌拉地尔能有效的预防二氧化碳气腹时血流动力学的变化。     

经食道超声心动图监测下地氟烷对小儿血流动力学的影响

目的采用经食道超声心动图(TEE)监测幼儿腹腔镜疝气手术围术期心输出量(CO)的变化;与七氟烷、丙泊酚比较,观察地氟烷在手术麻醉中对患儿血流动力学的影响。方法将120例行腹腔镜疝气手术的患儿按随机数字表法分为3组,每组40例。术中镇静维持分别采用地氟烷、七氟烷、丙泊酚。记录3组患儿气管插管后5min(T1)、气腹后1min(T2)、气腹后5min改变体位时(T3)、气腹后10min(T4)、气腹结束后1min(T5)及气腹结束后5min(T6)各个时间点的CO、HR和MAP。结果 3组HR、MAP比较:T1时差异无统计学意义(P>0.05),T2—T4时增快(P<0.05),T5、T6时与T1时水平相当。3组患儿T1—T7时CO比较,差异无统计学意义(P>0.05)。结论对于60min内的腹腔镜手术,术中镇静采用地氟烷、七氟烷及丙泊酚均对患儿CO无明显影响。     

手术室护士对腹腔镜肿瘤手术中无瘤技术的认知与执行调查分析

目的:调查手术室护士对腹腔镜肿瘤手术无瘤技术的认知、执行情况及其相关影响因素,以便更好地落实无瘤技术。方法:对我院工作的69名手术室护士进行调查,包括腹腔镜肿瘤手术中无瘤技术的相关知识认知情况及手术中无瘤技术的执行情况。结果:手术室护士无瘤技术认知调查排在前3位的是无瘤技术的概念、肿瘤细胞在术中种植播散的途径、器械台上建立瘤区;排在后3位的是关闭气腹的方式、穿刺锥的选择和使用及气腹压力、流量、时间对肿瘤种植影响的机制。行为调查138次,排在前3位的是接取肿瘤标本的方式、手术切口的保护及肿瘤切除后更换器械、敷料、手套;排在后3位的是:器械台的分区(有瘤与无瘤)、术中器械的无瘤处理、CO2的加温加湿。结论:手术室护士对腹腔镜肿瘤手术中特有的无瘤技术掌握和执行有所欠缺,应加强对手术护士相关知识培训,更新理念,提高腹腔镜肿瘤手术无瘤技术执行力。     

葡萄糖酸氯已定抗菌透明敷贴治疗PICC置管穿刺部位感染的效果

目的探讨新型葡萄糖酸氯已定透明敷贴在治疗经外周静脉置入中心静脉导管(PICC)置管穿刺部位感染中的效果。方法选取72例PICC置管后穿刺点感染患者随机分为观察组和对照组,各36例。对照组常规碘伏湿敷后采用普通3M透明敷料固定穿刺点,观察组碘伏湿敷后采用新型葡萄糖酸氯己定抗菌透明敷料固定穿刺点。观察2组穿刺点感染改善效果。记录2组穿刺点愈合时间及换药次数。结果观察组穿刺点感染改善有效率97.22%(35/36),愈合时间(7.51±2.32) d,换药次数(1.82±0.81)次。对照组穿刺点感染改善有效率94.44%(34/36),愈合时间为(7.63±3.31) d,换药次数(2.32±1.12)次。2组穿刺点感染改善效果及愈合时间比较,差异无统计学意义(P> 0.05),观察组换药次数低于对照组,差异有统计学意义(P <0.05)。结论新型葡萄糖酸氯己定抗菌透明敷料能有效改善PICC置管后穿刺点感染症状,减少换药次数。     

不同静脉穿刺法对下肢深静脉顺行造影的效果研究

目的探讨大隐静脉逆心穿刺方法在下肢深静脉顺行造影中的效果。方法将228例患者（300例下肢）按时间段分为观察组（150例下肢）和对照组（150例下肢）,观察组在踝部上方5 cm处扎紧止血带,逆心穿刺踝部旁侧的大隐静脉;对照组向心穿刺拇指基底部旁侧的浅静脉或足背浅静脉远端。对2组的静脉穿刺一次成功率、推注造影剂时患者的疼痛感觉、下肢深静脉显影效果进行比较。结果2组静脉穿刺一次成功率、推注造影剂时患者的疼痛感觉对比,差异有显著性意义（P〈0.01）,下肢深静脉显影效果无显著性意义（P〉0.05）。结论下肢深静脉顺行造影时采用大隐静脉逆心穿刺方法可提高穿刺成功率,减轻患者的疼痛,降低了护理风险和护理人员工作强度。     

经导管肝动脉As2O3治疗兔VX2移植性肝肿瘤

目的 探讨As2O3经TACE途径给药治疗兔VX2移植性肝肿瘤的价值.方法 将具有VX2移植肝脏肿瘤的日本大耳白兔24只随机平均分成3组,每组8只.经TACE途径分别给予UFLP 1 ml+As2O3 2 mg (实验组Ⅰ)、UFLP 1 ml+As2O3 2 mg+ADM 1 mg(实验组Ⅱ)及UFLP 1 ml (对照组),比较观察3组荷瘤兔在TACE术前与术后3周肿瘤体积变化及瘤组织生长情况,对肿瘤、瘤周和正常组织进行TUNEL检测,观察细胞凋亡状况.结果 治疗后两实验组肿瘤体积缩小,此二组与对照组相比差异有统计学意义(P<0.05),二实验组之间比较差异无统计学意义(P>0.05);对照组肿瘤体积无明显变化.两实验组肿瘤细胞坏死率和凋亡率明显高于对照组.结论 As2O3经TACE途径给药能够有效抑制兔VX2移植性肝肿瘤生长,这种作用可能是通过增加肿瘤细胞坏死和凋亡来实现的.     

腹腔镜CO_2气腹对大肠癌血液转移的影响

目的探讨腹腔镜结直肠癌手术时建立CO_2气腹对肿瘤细胞血液转移的影响。方法选取60例经病理学确诊为结直肠癌患者,将患者按照随机数字表法分为腹腔镜组和开腹组。抽取2组患者术前、术中、术后的外周血样,采用巢式RT-PCR法检测血样中细胞角蛋白20(CK20)的表达,分析不同手术方式对患者外周血肿瘤细胞转移的影响。结果 2组患者外周血CK20mRNA术前、术中、术后不同时间组内、组间阳性表达率比较,差异均无统计学意义(P0.05)。2组患者的3年生存率比较无显著差异(P0.05)。结论腹腔镜CO_2气腹行腹腔镜结直肠癌切除手术不增加患者外周血CK20mRNA的阳性表达率。     

CO2气腹对结直肠癌细胞侵袭转移能力的影响

目的探讨CO2气腹对结直肠癌细胞侵袭转移能力的影响。方法99例结直肠癌患者分为腹腔镜手术组50例和开腹手术组49例,通过免疫组织化学方法检测2组患者结直肠癌手术组织标本中缺氧诱导因子-1α、β-链蛋白和E-钙黏蛋白的表达,并进行比较。结果腹腔镜组与开腹组患者手术标本中缺氧诱导因子-1a（72％与67％）、β-链蛋白（38％与47％）和B钙黏蛋白（50％与49％）的表达率比较差异无统计学意义（P〉0．05）;腹腔镜组与开腹手术组p链蛋白（68％与65％）和E-钙黏蛋白（66％与57％）在细胞膜中表达缺失差异无统计学意义（P〉0．05）。结论CO2气腹不影响缺氧诱导因子-1α的表达及β链蛋白和E-钙黏蛋白的表达及结合,可能不促进结直肠癌的侵袭转移。     

Efficacy and mechanism of action of sodium bicarbonate in the treatment of desipramine toxicity in rats

Alkalinization of the blood by administration of sodium bicarbonate or hyperventilation is widely recommended for treatment of cardiac toxicity due to tricyclic antidepressant overdose, yet its efficacy and mechanism of action are poorly defined. We studied the effects and possible mechanism of action of 1 M NaHCO3 on desipramine (DMI) toxicity in anesthetized, paralyzed rats. Administration of DMI (45 mg/kg i.p.) produced a mean increase in QRS duration of 142% and a mean decrease in mean arterial pressure of 46%. Treatments were administered i.v. 35 min after DMI and their effects were assessed 10 min later. NaHCO3 (1 M) at doses of 3 and 6 mEq/kg decreased mean QRS duration 15 +/- 5 and 24 +/- 6%, respectively (mean +/- S.D.) and was superior to no treatment (P less than .01). NaCl (1 M) was as effective as NaHCO3 in decreasing QRS duration, as was 1 M NaHCO3 supplemented with 48 mM KCl. Respiratory alkalosis and 10% mannitol did not decrease QRS duration. NaHCO3, NaCl and NaHCO3/KCl all produced comparable increases in mean arterial blood pressure. Respiratory alkalosis and mannitol did not increase mean arterial pressure, but did prevent the decline seen in control animals. Acidosis produced by ventilation with 10% CO2 exacerbated QRS prolongation due to DMI. In acidotic animals, NaHCO3 and NaCl were equally effective in reversing QRS prolongation and hypotension. Correction of respiratory acidosis by discontinuation of inhaled CO2 did not improve QRS duration or mean arterial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

CO2气腹对新生猪血液动力学及呼吸功能的影响

目的：建立新生猪气腹模型,观察CO2气腹中新生猪血液动力学及呼吸功能指标的变化规律。方法：新生猪共7头（7～14d,体质量2～4kg）。麻醉后监测心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心输出量（CO）、每搏输出量（SV）、全身血管阻力（SVR）、动脉血气（ABG）。监测时间为麻醉稳定后气腹开始前5min（T0）,气腹开始后15min（T1）、60min（T2）、120min（T3）,气腹结束后30min（T4）。结果：新生猪CO2气腹后CO、SV下降（P〈0.05）;MAP、SVR升高（P〈0.05）;HR、CVP无明显变化;PaCO2增高（P〈0.05）。伴有血pH下降,表现为呼吸性酸中毒。CO2气腹不引起新生猪动脉血氧分压下降。结论：CO2气腹使新生猪血液动力学发生改变,通气功能下降;健康新生猪在严密监测下可以耐受短时间气腹。     

Helium gas pneumoperitoneum can improve the recovery of gastrointestinal motility after a laparoscopic operation.

The use of laparoscopic surgery contributes to faster recovery of postoperative gastrointestinal motility. Several authors have demonstrated the benefits of laparoscopic surgery using carbon dioxide (CO2) pneumoperitoneum. However, there have been few investigations of the effects of other insufflation gases on gastrointestinal motility. The aim of this study was to investigate the effect of CO2 and helium pneumoperitoneum on the recovery of postoperative gastrointestinal motility. For this study, male Sprague-Dawley rats were divided into four groups: control, CO2 insufflation (10 mmHg), helium insufflation (10 mmHg) and open laparotomy for one hour. Arterial pH values and PaCO2 were measured after surgery. Gastrointestinal motility was evaluated by quantifying the distribution of markers placed into the stomach at the end of procedures until 24 hours after surgery. In the CO2 insufflation group, the arterial pH value was significantly lower than that of the helium insufflation group, and significant hypercapnia persisted until six hours after surgery. The gastric emptying and transit time was significantly prolonged in the CO2 group compared with the helium insufflation group. This study demonstrates that helium pneumoperitoneum can improve the recovery of postoperative gastrointestinal motility because of the reduction of hypercapnia and a tendency to suffer acidosis compared with CO2 pneumoperitoneum.     

腹腔镜胆囊切除术中二氧化碳气腹对肥胖患者呼吸和循环的影响

目的 探讨腹腔镜胆囊切除术中CO2气腹对肥胖患者呼吸和循环系统的影响。方法 择期行腹腔镜胆囊切除手术患者80例，其中体质量正常组（A组）20例，术中气腹压力设定为14mmHg；肥胖患者组（B组）60例，根据气腹压力不同又分为B，组（12mmHg）、B2组（14mmHg）和风组（15mmHg），每组20例。首先观察A组和B2组气腹前5min、气腹后10min，以及术毕10min时的各项血气指标，然后观察B1、B2和B3组在气腹前5min、气腹后10min，以及术毕10min时的各项血气指标和各组手术时间。结果 A组与B2组，两者分别与气腹前相比较：HR、SBP、DBP和PETC02明显上升（P〈0.01）。B2组与A组相比较，在气腹前5min，两者各指标间并无统计学意义；而在气腹后10min，B2组HR、SBP和PETC02明显增高（P〈0．01或P〈0．05），DBP、PH和SaO2指标间则无统计学意义。在B组中，各组分别与气腹前比较，HR差异有显著性（P〈0.01），而在PETCO2、SBP和DBP指标上，B1组与气腹前比较并无统计学意义，而B2和B3组则差异有显著性（P〈0.01）。在各组的组间比较中，B2和B3组与B1组相比，其HR、SBP、DBP和PETCO2各指标均有显著性增高（P〈0.01）。B2和风组的组间比较无统计学意义。手术时间比较三组间无统计学意义。结论 腹腔镜胆囊切除术中CO2气腹对肥胖患者呼吸和循环系统的影响较体重正常患者显著，术中如能选用低压气腹（12mmHg），则能明显减轻气腹对肥胖患者上述系统的影响。     

调整二氧化碳气腹压力对妇科腹腔镜手术后肩痛的影响

目的:探讨二氧化碳(CO2)气腹压力对妇科腹腔镜手术后肩痛的影响。方法:选取2013年1～6月我院行妇科腹腔镜手术患者80例,随机等分为两组,对照组常规手术,CO2气腹压力14 mmHg;试验组采取调节CO2气腹压力10 mmHg,观察两组颈肩痛发生情况和颈肩痛程度。结果:两组手术时间比较无统计学意义,试验组CO2用气量明显减少,颈肩痛发生率低于对照组。结论:合理调节气腹压力能有效减少CO2用气量,减轻妇科腹腔镜手术肩痛的发生率。     

二氧化碳气腹对肾上腺髓质素和降钙素基因相关肽的影响及其意义

目的 观察妇科CO2气腹腹腔镜手术前、中、后不同时间点血浆中肾上腺髓质素(ADM)和降钙素基因相关肽(CGaP)的动态变化规律.方法 选择我院行妇科腹腔镜手术患者47例,用放射免疫方法(RIA)测定麻醉前(TO)、气腹前10 min(T1)、气腹形成后10 min(T2)、30 min(T3)、60 min(T4)及解除气腹后30 min(T5)血浆中ADM和CGRP含量.结果 CO2气腹形成前后不同时间点ADM和CGRP水平差异经统计学分析均有统计学意义(F值分别为9.686、49.804,P均<0.01).血浆ADM和CGRP含量在麻醉前(TD)与气腹前10 min(T1)差异无统计学意义(P均>0.05);CO2气腹形成后10 min(T2)ADM开始下降(P<0.05),CGRP下降较幔,与气腹前相比无显著变化(P>0.05),随着气腹时间延长,30 min(T3)和60 min(T4)时血浆中ADM和CGRP水平显著低于气腹前(T1)(P均<0.01);解除气腹后30 min(T5),两者均恢复到T1水平.结论 妇科腹腔镜手术时CO2气腹是引起ADM和CGRP的降低的主要因素;ADM和CGRP降低对心脏内分泌功能的影响明显,心脏疾病和内分泌异常患者行CO2气腹手术要慎重.     

Tumor implantation during laparoscopy using different insufflation gases – an experimental study using cultured cancer cells

Recent work using an experimental model in our laboratory has shown that the likelihood of tumor implantation at laparoscopy port‐sites following laparoscopy might be influenced by the specific gas used for insufflation. In particular helium insufflation was associated with less port site metastases. The model entailed an inbred rat strain and a tumor cell suspension of mixed heterogeneity, native to the rat strain. To determine whether our previous findings could be reproduced using a different model, we investigated the effect of insufflation with either helium or carbon dioxide gas on the implantation of a purified cell suspension of cultured cancer cells. Thirty‐eight Dark Agouti rats were randomized to undergo a 40 minute period of laparoscopic insufflation with either helium or carbon dioxide (19 animals in each group/three different experiments). Three laparoscopy ports were placed and 2?×?10 ⁵ cultured mammary adenocarcinoma cells were introduced into the abdominal cavity at the beginning of the period of insufflation. The rats were killed nine days after surgery and the port sites and abdominal cavity were examined for presence of tumor. Rats undergoing helium insufflation were equally likely to develop port‐site metastases compared to rats undergoing carbon dioxide insufflation. There was, however, a predilection for port site metastases to develop at the port site used for camera placement in both groups. Because this port site accommodated a 2?mm laparoscope, it was associated with a larger wound than the other two port sites. Peritoneal tumor deposits elsewhere in the peritoneal cavity were more common following helium insufflation, compared to carbon dioxide. The outcome of this study is different to the results from previous studies using a heterogeneous tumor cell suspension in the same model in our laboratory, or elsewhere, with no advantages demonstrated for insufflation with helium gas. Purified cell suspensions could behave differently to a heterogeneous cell suspension of identical cancer cells in a port‐site implantation model, and other cells present within heterogeneous tumor suspension might influence the likelihood of metastasis. As reported previously, tumor implantation is more likely in larger port site wounds and this is independent of the insufflation gas.     

Brain pH effects of NaHCO3 and Carbicarb in lactic acidosis

The effects of iv sodium bicarbonate (NaHCO3) and Carbicarb, an experimental buffer, were compared in a rat model of lactic acidosis induced by controlled hemorrhage and asphyxia. Although both NaHCO3 and Carbicarb were effective at alkalinizing the arterial blood in this model, NaHCO3 administration resulted in a rise in PaCO2 where Carbicarb did not (+9 +/- 2 vs. +2 +/- 2 torr at 2 min after infusion, p less than .01). Moreover, NaHCO3 resulted in a small decrease in intracellular brain pH as measured with P-31 nuclear magnetic resonance where Carbicarb afforded intracellular brain alkalinization (-0.03 +/- 0.01 vs. +0.08 +/- 0.02 pH units at 2 min, p less than .01). If these data are confirmed clinically, Carbicarb may offer advantages over NaHCO3 under conditions of fixed or limited ventilation.