经胸微创封堵治疗心室间隔缺损的学习曲线

目的 通过评估食管超声(TEE)引导下经胸微创封堵治疗心室间隔缺损(VSD)不同阶段的手术效果,探讨该技术的学习曲线.方法 回顾性分析2007年4月至2008年10月由同一手术组连续完成的60例TEE引导下经胸微创封堵治疗VSD患者的病历资料.按手术时间先后顺序依次分为4组(A、B、C、D组),每组15例,比较各组手术时间、术中出血量、中转开胸率、手术并发症以及术后住院时间,分析不同阶段的手术效果.结果 各组平均年龄、性别、体重及VSD类型等差异均无统计学意义(P＞0.05).A、B、C、D组手术时间分别为(29.6±9.6)、(27.4±9.2)、(20.0±8.2)和(17.1±7.2)min,A组和B组均明显长于C组和D组(均P＜0.01),而C组和D组之间差异无统计学意义(P=0.366);A、B、C、D组术中出血量[(59.7±13.4)m1],明显多于C组[(40.3±7.4)ml和(36.3±8.9)ml],A组和B组均明显多于C组和D组(P＜0.01),而C组和D组之间差异无统计学意义(P=0.287);手术并发症、中转开胸率以及术后住院时间比较,差异均无统计学意义(P＞0.05).结论 经胸微创封堵治疗VSD的学习曲线大约为30例.

Abstract：

Objective To evaluate the clinical results of minimally invasive transthoracic device closure of ventricular septal defect (VSD) without cardiopulmonary bypass (CPB) under transesophageal echocardiography (TEE) guidance and to analyze the learning curve of this kind of operation. Methods Clinical data of a consecutive series of 60 VSD patients from April 2007 to October 2008 were reviewed. The patients were divided equally into 4 groups ( group A, B, C, D, n = 15 in each group). The operative time, quantity of bleeding, ratio of converting to intracardiac repair, complications and hospital stay were compared among the 4 groups. Results There was no difference among the 4 groups in terms of age, gender, body weight and the type of VSDs ( P ＞ 0.05). While the operative time in group A (29.6 ± 9.6) min and group B (27.4 ± 9.2) min were significantlylonger than that in group C (20.0 ± 8.2 min, P ＜ 0.01 ) and group D ( 17.1 ± 7.2 min, P ＜ 0. 01 ), there was no difference between group C and D (P=0.366). The quantity of bleeding in group A (59.7 ± 13.4)ml and group B (54.3 ±9.9)ml were more than that in group C (40.3 ± 7.4ml, P ＜ 0. 001 ) and group D ( 36.3 ± 8.9 ml, P ＜ 0. 001 ), but no difference was shown between group C and D ( P= 0.366). No difference was shown regarding complications, ratio of converting to intracardiac repair, and hospital stay between the 4 groups. Conclusion The learning curve of minimally invasive transthoracic device closure of VSD without CPB under TEE guidance is approximately 30 cases.     

参芎注射液联合七叶皂苷钠治疗急性胰腺炎的临床观察

目的 了解参芎注射液及七叶皂苷钠对急性胰腺炎(AP)患者血浆内皮素浓度的影响及其改善微循环的作用.方法 将87例AP患者完全随机分为对照组20例、单用组33例、联合组34例.3组均采用常规治疗,单用组加用参芎注射液治疗,联合组加用参芎注射液和七叶皂苷钠治疗,观察各组腹痛、腹部压痛、血尿淀粉酶及内皮素等变化情况.结果 单用组和联合组腹部压痛消失、肠道功能恢复、血尿淀粉酶和影像学恢复时间及平均治疗时间均短于对照组(P＜0.05);联合组肠道功能恢复、血尿淀粉酶和影像学恢复时间及平均治疗时间均短于单用组(P＜0.05).单用组和联合组患者治疗后血浆内皮素浓度[(64.79±7.58)ng/L、(47.80±7.14)ng/L]明显低于治疗前[(104.77±6.57)ng/L、(103.41±7.53)ng/L](P＜0.05).结论 在常规治疗的基础上联合应用参芎注射液、七叶皂苷钠治疗AP具有良好的临床疗效,值得临床推广.

Abstract：

Objective To study clinical effects of Shenxiong injection and aescinate in the treatment of acute pancreatitis,and to understand the effect of Shenxiong injection and aescinate on the concentration of plasma endothelin(ET) in patients with acute pancreatitis(AP). Methods Eighty-seven cases of AP patients were randomly divided into group A(20 cases) and the control group B(33) and group C(34). A group had conventional therapy,B group had the conventional treatment plus Shenxiong injection and C group had conventional treatment plus Shenxiong injection and aescinate. The plasma concentrations of ET were mensurated with radiation immunoassay(RIA). Results The pain disappearance time had no significant difference(P ＞0.05) among the three groups.The time of abdominal tenderness disappearance,intestinal function recovery,hematuria amylase recovery,imaging recovery and average hospitalization were shorter in B group and in C group than those in control group(A group)(P ＜0.05). The plasma ET concentrations after treatment were significantly lower than that before treatment in group B and C(P＜0.05). Conclusions The therapy based on the conventional treatment combined with Shenxiong injection and aescinate has good curative effect in patients with acute pancreatitis.     

异氟醚预处理对心肺转流冠状动脉搭桥手术患者的心肌保护作用

目的 观察异氟醚预处理对心肺转流(CPB)冠状动脉搭桥手术(CABG)患者心肌的保护作用.方法 CABG患者20例,随机均分为异氟醚预处理组(A组,CPB开始前持续吸入1.5MAC异氟醚10 min,然后洗脱10 min)和对照组(B组,不行异氟醚预处理),分别于麻醉后(T1)、主动脉开放后15 min(T2)、CPB结束后2 h(T3)和24 h(T4)检测血清降钙素基因相关肽(CGRP)、血管内皮素(ET)和心肌钙蛋白(cTnI).结果 T2、T3和T4时,两组CGRP明显高于T1(P＜0.01),但T2、T3时A组高于B组(P＜0.05);T2、T3时,两组ET均明显高于T1 (P＜0.01),但A组低于B组(P＜0.05);T2、T3和T4时,两组cTnI均高于T1 (P＜0.01),但T3和T4时,A组明显低于B组(P＜0.01).结论 异氟醚预处理能减少心肌的缺血-再灌注损伤.     

脱细胞真皮基质和聚丙烯补片修补大鼠腹壁疝的实验研究

目的 探讨复合消蚀法制备的脱细胞真皮基质(ADM)和聚丙烯补片(Marlex网)修补大鼠腹壁疝的应用价值.方法 用全厚猪皮制备ADM,选用SD雄性大鼠45只,完全随机分为腹壁疝组7只、Marlex网组10只和ADM组28只,观察3组术后1周时有无腹壁疝的发生,术后第5周Marlex网组和ADM组随机选取6只用于抗张力试验.结果 术后1周时,ADM组与Marlex网组腹壁疝发生率均明显低于腹壁疝组(分别为0.04%、0.00%、100.00%,P＜0.01),但ADM组与Marlex网组差异无统计学意义(P＞0.05).将单独ADM片与Marlex网行抗张力试验,Marlex网的抗张力远高于ADM[(417±44)N比(111±27)N,P＜0.01].但植入体内5周后,ADM-筋膜组织的抗张力高于Marlex-筋膜组织[(103±27)N比(71±19)N,P＜0.05].结论 复合消蚀法制备的ADM可能比聚丙烯补片更适合作为疝修补材料.

Abstract：

Objective To study the value of porcine acellular dermal matrix(ADM) made by complex maceration and Marlex mesh as ventral hernia-repairing material. Methods ADM was made from the full thick skin of the back of swines by complex maceration. The male SD rats were randomly divided into three groups including ventral hernia group(n =7), ADM group(the ventral hernia repaired by ADM, n =28) and Marlex mesh group (the ventral hernia repaired by Marlex mesh group, n = 10). The occurrence of ventral hernia was observed on postoperative 1 week. Six rats were respectively selected from the Marlex group and ADM group and tension resistance at 5weeks after surgery was observed. Results The occurrence of ventral hernia in ADM group and Marlex mesh group was significantly lower than that of ventral hernia group(0.04%, 0.0%, 100.0%, P ＜ 0. 01 ) in postoperative 1week, but there was no difference between ADM group and Marlex mesh group ( P ＞ 0.05 ). Marlex had a significantly higher breaking strength than ADM[(417 ±44)N vs( 111 ±27)N,P ＜0.01]. But 5 weeks after surgery, the tension resistance of ADM-fascial interface was higher than that of the Marlex-fascial [( 103 ± 27 ) N vs(71 ± 19 ) N,P ＜ 0. 05]. Conclusion As a material of repairing ventral hernia, ADM prepared by the complex maceration may be superior to Marlex mesh.     

安氟醚麻醉下牵拉胆囊对心肌ATP酶、ET、NOS的影响

目的 研究安氟醚麻醉下牵拉胆囊对心肌ATP酶、ET、NOS的影响。方法 健康家兔24只，随机分为A、B、C三组，A组对照组，B组吸入安氟醚达0．65MAC，C组吸入安氟醚达1．3MAC。暴露胆囊，坠以100g重物牵引10分钟。迅速开胸，取心肌组织测定ATP酶、内皮素(ET)、一氟化氯合成酶(NOS)。结果 三组心肌细胞的Na^2 —K^ ATPase、Mg^2 -ATPase差异元显著性，C组的Ca^2 -ATPase明显低于A组(P＜0．05)，B组、C组的ET明显低于A组(P＜0．05)。结论 安氟醚麻醉下牵拉胆囊可抑制了心肌细胞Ca^2 -ATPase和ET的释放。     

中西医结合治疗腰椎间盘突出症的临床研究

Objective To investigate the curative effect of western combined with traditional Chinese medicine in treatment of acute lumbar disc herniation.Methods 200 patients with lumbar disc herniation were randomly divided into western combined with traditional Chinese therapy group(group A) and western medicine group(group B) ,each group 100 cases.B group was conducted with the general anti - inflammatory, dehydration, nerve pain and nutritional therapy,and A group was given the traditional Chinese medicine treatment on the base of B group.After 3 weeks treatment, the curative effect, VAS score and hospital stay were observed.Results A total effective rate 90.0% in group A was higher than B group 73.0% ( x2 = 3.987 ,P < 0.05); The scores of VAS after treatment 4 weeks[(1.1 ±1.23、0.9 ±0.6)/point]were lower than before treatment[(8.6 ± 1.43,8.8 ± 1.382)/point]in two groups(t =2.301,2.335,all P<0.05) ;The scores of VAS after treatment 3d and 1 week in group A[(5.5 ±0.92) point,(2.7±1.14) point] were lower than group B[(8.2 ±0.59) point,(5.3 ±0.91) point] (t =2.405,2.435,all P<0.05);The hospital days(20.1 ±3.5)d in group A was significantly lower than group B(27.6 ±4.3)d( t = 2.314,P <0.05).Conclusion Western combined with traditional Chinese medicine had better clinical efficacy in teatrent of patients with acute lumbar disc hemiation.     

B型利钠肽检测在急诊呼吸困难病因鉴别中应用价值的探讨

目的 探讨B型利钠肽(BNP)在急诊呼吸困难病因鉴别中的应用价值.方法 测定155例急诊呼吸困难患者血浆BNP浓度,并与超声心动图左心室射血分数(LVEF)及E/A值进行相关性分析.以不同BNP浓度为临界值,计算其诊断心源性呼吸困难的敏感性及特异性.结果 心源性呼吸困难组BNP浓度[(764±275)ng/L]与LVEF及E/A值呈明显负相关,且明显高于非心源性呼吸困难组[(113±59)ng/L](P＜0.01).以BNP浓度100、300、500 ng/L为临界值,其诊断心源性呼吸困难的敏感性分别为100.0%、92.2%、80.0%;特异性分别为73.9%、90.8%、100.0%.结论 BNP检测用于急诊呼吸困难病因初步筛查具有重要意义,低水平的BNP临界浓度(＜100 ng/L)有助于排除心源性呼吸困难,高水平的BNP(＞500 ng/L)临界浓度有助于确定心源性呼吸困难,BNP浓度区间100～500 ng/L对于诊断和排除心源性呼吸困难都有一定局限性.

Abstract：

Objective To explore the value of plasma brain natriuretic peptide (BNP)level in differentiating etiology of dyspnea in emergency patients. Methods The plasma BNP levels in 155 emergency patients with dyspnea were assayed. The correlation between BNP levels and left ventricular ejection fraction(LVEF) and E/A respectively. Sensitivity and specificity in differentiating etiology of dyspnea were calculated based on different levels of BNP. Results The BNP levels in cardiogenic dyspnea group were negatively correlated with LVEF and E/A respectively (P ＜ 0.01). They were also significantly higher than those in noncardiogenic dyspnea group (P ＜ 0.01).The sensitivity in diagnosing cardiogenic dyspnea at different critical BNP levels (100 ng/L,300 ng/L,500 ng/L)was 100.0%,92.2%,80.0%,and the specificity was 73.9%,90. 8%,100.0% respectively. Conclusions Plasma BNP level has significant value in preliminarily differentiating etiology of patients with dyspnea. Lower BNP level (＜ 100 ng/L) is helpful in excluding cardiogenic dyspnea and higher BNP level (＞500 ng/L) is helpful in confirming cardiogenic dyspnea. However,BNP level between 100 ～ 500 ng/L isdeficient in confirming and excluding cardiogenic dyspnea.     

孟鲁司特治疗及预防2～5岁儿童哮喘的疗效观察

目的 观察孟鲁司特在2～5岁儿童哮喘防治中的效果.方法 66例2～5岁学龄前哮喘患儿完全随机分为治疗组与对照组,各33例.治疗组在常规治疗的基础上加用孟鲁司特,对照组给予辅舒酮气雾吸入,疗程均3个月.结果 急性发作期治疗组疗效优于对照组[症状缓解时间:(4.26±1.57)d比(5.83±1.62)d;肺部体征消失时间:(3.84±1.31)d比(5.25±1.12)d;P＜0.01];急性发作期治疗后患儿外周血嗜酸粒细胞计数治疗组较对照组降低[(0.36±0.12)×109/L比(0.51±0.15)×109/L],差异有统计学意义(P＜0.05);治疗组较对照组复发次数少、无症状时间长、再次发作的病情轻(均P＜0.05).结论 孟鲁司特依从性好,对于2～5岁学龄前儿童轻中度哮喘治疗及预防疗效显著.

Abstract：

Objective To explore the curative and preventive effect of montelukast in 2-5 years old asthmatic children. Motheds Sixty-six cases were randomly assigned as group A (were treated with fluticasone propionate inhalation) and group B (were administrated orally at montelukast). They were treated with routine treatment.The total course of two groups were three month. Results The curative effect of group B was significantly better than that of group A in acute attack of asthmatic children. The relapse, sympto-matic stage, relapse pathocure of group B were significantly better than that of group A. There was significant difference between treatment before and treatment after (symptoms disappearing) that EC of asthmatic children( P ＜0.05 ), There were some differences between group B ahd group A that there were less times that symptoms appeared after treatment. It was a long time that symptoms disappeared. Conclusion The clinical experiments show that montelukast has dramatic efficacy for the 2-5 years old children with low-grade or moderate asthma without any side effects.     

父母陪护下喉罩吸入七氟醚联合骶麻在小儿尿道下裂成形术中的应用

目的 探讨父母陪护下喉罩吸入七氟醚联合骶麻的方式在小儿尿道下裂成形术中的应用.方法 将患几分为A、B组各40例,A组采用父母陪护下喉罩吸入七氟醚联合骶麻,B组则采用氯胺酮麻醉联合骶麻,统计两组患儿术中平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度、苏醒时间、出室时间、术中体动反应、呛咳屏气、术后躁动、恶心与呕吐,患儿家属和医护人员的满意度.结果 A组各个时间点的MAP和HR比B组平稳(P＜0.05).A组的苏醒时间、出室时间明显比B组短[(11.5±2.3) min vs.(17.6±6.4) min,(17.9-± 1.9) min vs.(33.1±3.2)min](t=4.236,6.339;P＜0.05).A组术中体动反应和呛咳屏气的发生率也明显比B组低(5.0％vs.30.0％,2.5％ vs.27.5％)(x2=15.632,22.354;P＜0.05).A组患儿家属满意度比B组高(100.0％vs.85.0％; x2=3.014,P＜0.05).结论 父母陪护下喉罩吸入七氟醚联合骶麻的方式可以使血流动力学指标更加平稳,苏醒时间和出室时间更短,麻醉不良反应更少,患儿家属满意度更高.     

银杏叶提取物对糖尿病大鼠肾脏基质金属蛋白酶2表达的影响

目的 观察银杏叶提取物(GbE)对雄性SD糖尿病大鼠肾脏基质金属蛋白酶2(MMP-2)和Ⅳ型胶原表达的影响,从而探讨银杏叶对糖尿病肾病的保护机制.方法 24只链脲佐菌素诱导的SD大鼠完全随机分成糖尿病对照组(DM组)和GbE组,并以12只正常雄性SD大鼠作为正常对照组(NC组).分别于4、8周后,观察各组大鼠体重、肾重、随机血糖、尿蛋白排泄率等生化指标,并用免疫组化和逆转录聚合酶链反应方法 观察糖尿病大鼠肾脏MMP-2及Ⅳ型胶原的表达.结果 糖尿病大鼠的随机血糖、体重、肾脏/体重明显下降,尿白蛋白排泄率明显升高[DM组(31.59±4.59)mg/24 h比NC组(8.74±2.08)mg/24 h,P＜0.05],GbE组糖尿病大鼠尿白蛋白排泄率[(21.38±3.86)mg/24 h]较DM组有所下降(P＜0.05).8周时,与正常对照组相比,DM组大鼠肾小球MMP-2蛋白的表达水平明显下降[(0.49±0.07)mg/24 h比(0.15±0.04)mg/24 h,P＜0.05],而GbE组DM组大鼠肾小球MMP-2蛋白的表达水平[(0.48±0.07)mg/24 h]较DM组无明显下降(P＞0.05);DM组大鼠Ⅳ型胶原的表达水平较NC组明显升高[(3.48±0.54)mg/24h比(1.68±0.51)mg/24 h],而GbE组糖尿病大鼠较NC组无明显升高[(2.55±0.50)mg/24 h比(1.68±0.51)mg/24 h].结论 GbE可通过抑制糖尿病大鼠MMP-2过表达,进而对糖尿病肾病发挥保护作用.

Abstract：

Objective To study the effect of ginkgo biloba extract (GbE) on the expression of matrix metalloproteinase (MMP)-2 in kidneys of diabetic rates and to analyze the protecting mechanism of GbE on diabetic nephropathy. Methods Totally 24 SD rats of diabetic nephropathy induced by streptozotocin were randomly divided into two groups: diabetes group and treatment group with GbE, and 12 rats with placebo therapy were enrolled as the normal control group. Rats were killed after 4 ～ 8 weeks treatment and the expression of MMP-2 and type Ⅳ collagen were studies by immunohistochemistry and RT-PCR. Results In diabetic rats, blood sugar, weight and kidney/body weight ratio were decreased significantly and the excretion of 24 hour urinary protein was increased significantly compared to the diabetes group. But the excretion of 24 hour urinary protein was improved in GbE group ( P ＜0.05 ). The expression level of MMP-2 protein and mRNA was decreased significantly in renal glomduri of diabetic rats ( P ＜ 0.05 ) but showed no changes in GbE treatment group compared to diabetes group( P ＞ 0.05 ). The expression level of type Ⅳ collagen was significantly increased in diabetic rats( P ＜0.05 ) but showed no changes in GbE group( P ＞0.05). Conclusion GbE can improve diabetic nephropathy by inhibiting the expression of MMP-2 in diabetic Rat.     

雾化吸入地塞米松对肺损伤的影响

目的 探讨雾化吸入地塞米松(Dexamethasone)对盐酸(HC1)所致急性肺损伤(ALI)循环及呼吸功能的影响.方法 24头健康家猪,随机分为A、B、C三组,每组8头.麻醉及相关操作后记录平均动脉压(NAP)、平均肺动脉压(MPAP)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)及肺顺应性作基础值,经气管导管向肺内注入0.1 mol/L的HCI溶液,直至PaO2＜13.3 kPa并持续30 min.A组维持原来的机械通气(间歇正压通气,IPPV),B组进行0.69 kPa呼气末正压通气,C组进行0.69 kPa PEEP通气基础上雾化吸入Dexamethasone,观察4 h.分别于Au前(T0)、Au时(T1)及Au后1h(T2)、2 h(T3)、3 h(T4)and 4 h(T5)记录上述指标.结果 三组MAP在ALI后均明显下降并维持在12 kPa(P＞0.05).三组MPAP在ALI后明显升高,A、B二组MPAP一直保持在(4.24±0.52)kPa(P＞0.05),而c组则明显下降至(3.22±0.25)kPa,较A、B组明显降低(P＜0.05).B、C两组的PaO2在13分组后较A组明显升高(P＜0.05),C组又明显高于B组(P＜0.05).A、B组PaCO2明显高于C组,A组又高于B组(P＜0.05).B、C组顺应性明显好于A组(P＜0.05),B、C组之间无差异(P＞0.05).结论 雾化吸入地塞米松能改善HCI所致ALI的呼吸功能,并在维持NAP平稳的情况下降低肺动脉压.     

异氟醚对老年患者顺式阿曲库铵肌肉松弛效应的影响

目的 观察异氟醚对老年患者顺式阿曲库铵肌肉松弛效应的影响.方法 60 例美国麻醉医师协会Ⅱ级行择期手术的老年患者,随机数字表法分为两组,每组30例.丙泊酚组持续输注丙泊酚4～6 mg/（kg·h）,依据需要静注芬太尼维持麻醉;异氟醚组1.0 MAC异氟醚吸入,依据需要静注芬太尼维持麻醉.记录肌松起效时间、作用时间、术中维持速率、T1 25%、75%恢复时间、TOF比值恢复到70%的时间及恢复指数.结果 异氟醚组起效时间[（231.32±25.48）s]及恢复指数[（14.83±3.42）min]与丙泊酚组[（237.41±31.33）s、（13.07±3,74）min]差异无统计学意义,异氟醚组作用时间[（42.37±5.32）min]、T1 25%、75%恢复时间[（53.94±8.20）min、（70.78±7.65）min],明显长于丙泊酚组[（29.46±4.73）min、（41.31±6.43）min、（55.74±6.19）min,P＜0.05],异氟醚组术中维持速率[（88.32±13.25）μg/（kg·h）],明显小于丙泊酚组[（115.64±17.52）μg/（kg·h）].结论 异氟醚能显著延长老年患者顺式阿曲库铵的作用时间及恢复时间,减小术中维持速率,但对恢复指数无明显影响.     

喉罩保留自主呼吸全麻联合臂丛神经阻滞在小儿上肢手术中的应用效果

目的 探讨喉罩保留自主呼吸全麻联合臂丛神经阻滞在小儿上肢手术中的应用效果.方法 选择2014年8月-2016年10月收治的行上肢手术的患儿90例,根据麻醉方法分为联合组、喉罩全麻组与气管插管全麻组,每组30例.联合组给予喉罩保留自主呼吸全麻联合臂丛神经阻滞,喉罩全麻组和气管插管全麻组分别给予喉罩全麻和气管插管全麻.比较3组术前(T0)、插入气管导管或置入喉罩即刻(T1)、切皮时(T2)、手术开始后0.5h(T3)、术毕时(T4)血流动力学指标、麻醉起效时间、麻醉用药量及并发症发生情况.结果 联合组、喉罩全麻组T1、T2、T4心率及T1 ～4平均动脉压均明显低于气管插管全麻组(P＜0.05).联合组苏醒时间均短于气管插管全麻组和喉罩全麻组,联合组疼痛出现时间晚于气管插管全麻组与喉罩全麻组,丙泊酚、瑞芬太尼用量少于喉罩全麻组与气管插管全麻组(P＜0.05).联合组和喉罩全麻组并发症发生率低于气管插管全麻组(P＜0.05).结论 喉罩保留自主呼吸全麻联合臂丛神经阻滞具有血流动力学稳定、苏醒快、麻醉药物用量少、并发症少等特点.     

异氟烷吸入复合罗哌卡因骶管阻滞在小儿斜疝手术中的应用

目的 探讨异氟烷吸入复合罗哌卡因骶管阻滞在小儿腹股沟斜疝手术中的应用效果.方法 120例腹股沟斜疝患儿在腹腔镜下行鞘状突高位结扎术,随机将患儿分为A、B、C三组,A组为单纯异氟烷吸入麻醉组,B组为单纯罗哌卡因骶管阻滞麻醉组,C组为异氟烷吸入复合罗哌卡因骶管阻滞麻醉组,观察并记录患儿术中血流动力学变化( MAP、HR、SpO2),比较三组患儿术中麻醉效果、术后苏醒时间、麻醉药用量及麻醉不良反应发生情况.结果 异氟烷吸入复合罗哌卡因骶管阻滞麻醉组患儿术中血流动力学稳定,手术麻醉效果满意,均优于A组和B组患儿(均P＜0.05);术后苏醒时间、麻醉药用量及麻醉不良反应事件与A组和B组差异均有统计学意义(均P＜0.05).结论 异氟烷吸入复合罗哌卡因骶管阻滞麻醉应用于小儿腹股沟斜疝高位结扎术,有利于呼吸、循环的管理及术后苏醒,是小儿下腹部手术较为理想的麻醉方法.     

地佐辛复合右美托咪定在清醒患者纤维支气管镜气管插管术中的应用

目的 探讨地佐辛复合右美托咪定在重症医学科清醒患者纤维支气管镜气管插管术中的镇痛镇静效果及安全性.方法 将本科2015年1月至2016年12月180例需行气管插管机械通气的清醒患者采用随机数字表法分为A、B、C三组,各60例.A组静脉泵注咪达唑仑0.1 mg/kg;B组静脉泵注地佐辛0.1 mg/kg+咪达唑仑0.05 mg/kg;C组静脉泵注地佐辛0.1 mg/kg+右美托咪定1μg/kg.观察并比较插管前(T1)、插管时(T2)、插管后10 min(T3)患者心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、指端血氧饱和度(SpO2)以及插管过程中患者躁动情况(MAAS评分)、气管插管后10 min患者的镇静效果(Ramsay评分)、转入时疾病严重程度评分(APACHEⅡ评分).结果 3组T3时间点HR均较T1时间点显著下降[A组:(99.0±5.2)次/min比(101.2±7.6)次/min,P＜0.05;B组:(97.3±6.1)次/min比(103.0±9.5)次/min,P＜0.05;C组:(94.4±7.2)次/min比(100.0±8.8)次/min,P＜0.05].3组RR在T2时间点均较同组T1时间点显著下降[A组:(27.1±2.6)次/min比(28.5±3.6)次/min,P＜0.05;B组:(26.3±2.8)次/min比(28.1±3.3)次/min,P＜0.05;C组:(25.1±3.5)次/min比(27.6±3.1)次/min,P＜0.05].B组T3时间点MAP较同组T1、T2时间点下降[(71.2±8.8) mmHg(1 mmHg=0.133 kPa)比(74.3±8.0) mmHg,P＜0.05;(71.2±8.8) mmHg比(74.3±8.8) mmHg,P＜0.05].C组T2时间点MAP较同组T1、T3时间点下降[(68.4±8.1) mmHg比(73.2±6.3),P＜0.05;(68.4±8.1) mmHg比(72.8±7.6) mmHg,P＜0.05].T1时间点,3组HR、RR、MAP差异无统计学意义(均P＞0.05).T2时间点,C组MAP较A、B两组显著下降[(68.4±8.1)mmHg比(73.6±8.6),P＜0.05;(68.4±8.1) mmHg比(74.3±8.8) mmHg,P＜0.05].T3时间点,C组HR较A、B两组显著下降[(94.4±7.2)次/min比(99.0±5.2)次/min,P＜0.05;(94.4±7.2)次/min比(97.3±6.1)次/min,P＜0.05].插管过程中B、C两组MAAS评分均显著低于A组[(3.2±1.0)比(3.9±1.0),P＜ 0.05;(3.0±1.0)比(3.9±1.0),P＜0.05],但B、C组间差异无统计学意义(P＞0.05).气管插管后10 min,A组Ramsay评分显著低于B、C两组[(2.4±0.9)比(2.7±0.9),P＜0.05;(2.4±0.9)比(2.8±0.9),P＜0.05],但B、C两组比较差异无统计学意义(P＞0.05).结论地佐辛复合咪达唑仑或右美托咪定较单纯使用咪达唑仑可显著改善清醒患者气管插管的耐受性并提高镇静效果;地佐辛复合右美托咪定用于清醒患者气管插管镇痛镇静效果确切.     

丙泊酚或异氟醚对重度脑损伤患者Barthel指数的影响比较

目的 比较丙泊酚或异氟醚麻醉对硬膜外血肿重度脑损伤患者Baahel指数的影响.方法 行硬膜外血肿清除术重度脑损伤患者84例,随机分为A、B两组,每组42例;两组麻醉诱导方式相同,麻醉维持:A组靶控输注丙泊酚2.5～3.0μg/ml(血药浓度),B组吸入异氟醚1.5％～2.0％,两组均靶控输注瑞芬太尼4 ng/ml(效应室浓度);记录两组患者麻醉前(T0)、诱导后2 min(T1)、插管后10min(T2)、30 min(T3)心率(HR)、动脉血二氧化碳分压(PaCO2)、动脉血氧(CaO2)、血氧饱和度(SaO2)以及S100B蛋白浓度,评价术后1个月两组Barthel指数.结果 诱导后A组HR为(76.41±12.49)次/min、CaO2为(111.98± 15.64) ml/L,诱导后B组HR为(82.34±12.45)次/min,CaO2(109.41±17.12)ml/L,与A组比较,HR显著升高,CaO2显著降低(均P＜0.05);术后两组S100B蛋白浓度均有上升,但A组[(1.25±0.78)μg/L]显著低于B组[(1.61±0.42)μg/L],P＜0.05;A组术后Barthel指数优良率为57.14％,较B组的30.95％高(P＜0.05).结论 丙泊酚较异氟醚对重度颅脑损伤患者能降低脑氧代谢率,减少脑神经损伤,更具有脑保护作用.     

右美托咪定喷鼻对小儿室间隔缺损封堵术前镇静镇痛及术后躁动的影响

目的 观察右美托咪定(Dex)术前喷鼻在小儿室间隔缺损封堵术前镇静镇痛及术后躁动的影响.方法 择期行室间隔缺损封堵术的患儿共90例,年龄2～6岁,采用随机数字表法分成3组,每组30例.A、B和C组分别于麻醉诱导前30 min以咪达唑仑0.2 mg/kg、Dex 1.0μg/kg或2.0μg/kg喷鼻.记录3组基础值(T0)、给药后5 min(T1)、给药后15 min(T2)、给药后25min(T3)、麻醉诱导后10 min(T4)、手术开始后30min(T5)、术毕(T6)及术后30 min(T7)时的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)及脑电双频指数(BIS).于T0～3时对3组患儿进行警觉与镇静评分(OAA/S评分),记录3组患儿与家长分离时镇静情绪评分和静脉穿刺接受程度评分.记录3组患儿术后躁动评分及其他不良反应发生率.结果 与A组比较,C组T2～3时OAA/S评分[(5.6±0.7)vs.(4.5±0.9),F=24.43,P＜0.0001;(4.8±0.7)vs.(3.5±1.0),F=36.67,P＜0.0001]均降低,且T2～3、T6～7时HR、MAP及BIS均降低(P＜0.05).与A组和B组比较,C组患儿与家长分离时镇静情绪评分[(2.3±0.5)、(2.4±0.6)vs.(3.3±0.7),F=29.67,P＜ 0.000 1]及静脉穿刺接受程度评分[(1.9±0.6)、(2.1±0.7)vs.(3.2±0.8),F=35.19,P＜ 0.000 1]均升高,而麻醉诱导时间[(69.8±5.7)s、(72.3±6.8)s vs.(53.6±4.9)s,F=113.9,P＜0.000 1]、苏醒时间[(15.3±2.9)min、(13.5±2.6) min vs.(8.3±1.9) min,F=77.91,P＜0.000 1]和术后躁动评分[(2.9±0.7)、(3.1±0.6) vs.(1.6±0.7),F=56.92,P＜0.000 1;(2.3±0.6)、(2.5±0.7) vs.(1.5±0.6),F=26.53,P＜0.000 1;(2.1±0.4)、(2.3±0.5)vs.(1.3±0.3),F=64.13,P＜ 0.000 1]均减少.B组和C组患儿喷鼻刺激发生率均低于A组(0.0％、10.0％ vs.40.0％,x2=18.720,P＜ 0.000 1).结论 Dex (2.0μg/kg)术前喷鼻用于小儿室间隔缺损封堵术能提供更为满意的术前镇静效果,发挥较好的术后镇静和镇痛效应,并更有效地降低术后躁动的发生率.     

早发型重度子痫前期分型与围产结局的关系

目的探讨早发型重度子痫前期的分型与围产结局的关系。方法80例早发型重度子痫前期患者以孕34周发病时间为界,分为早发突发型组（A组）14例和早发渐进型组（B组）66例,对两组患者的一般临床资料、并发症发生情况、围产结局及胎盘抑制素A、胎盘激活素A进行分析比较。结果80例中,早发突发型14例（17．5％）明显低于早发渐进型的66例（82．5％）（x^2=3．989,P〈0．05）;A组并发症发生率100．0％（14例）,明显高于B组的27．3％（18例）（x^2=3．789,P〈0．05）;A组围生儿存活率27．3％,明显低于B组的79．3％（X^2=3．789,P〈0．05）;A组胎盘抑制素A、胎盘激活素A表达分别为（589．24±16．96）、（485．06±17．58）,明显高于B组的（459．36±13．05）、（338．29±11．23）（t=2．424、2．439,均P〈0．05）;胎盘抑制素A、胎盘澉活素A表达水平与24h尿蛋白定量呈正相关（r=0．62、r=0．59,均P〈0．05）。结论早发突发型重度子痫前期患者临床上有不可预测性,其围产结局不良。     

喉罩麻醉与气管内插管麻醉的临床分析

目的观察喉罩麻醉与气管内插管麻醉用于乳腺癌手术的安全性和可行性。方法40例行择期乳腺癌根治术患者,ASA分级均为Ⅰ～Ⅱ级,随机分为喉罩组（A组）和气管导管组（B组）,每组20例。观察和记录两组患者麻醉前（T0）、插管或放置喉罩后即刻（T1）、插管或放置喉罩后5min（T2）、术后拔管或喉罩后即刻（T3）、拔出导管或喉罩后5min（L）的SBP、DBP、HR和SpO2。观察和随访两组患者拔管期不良反应和术后麻醉相关并发症。结果B组T1、L的SBP、DBP、HR显著高于A组（P〈0．05）;B组拔管期躁动、呛咳和术后咽痛明显高于A组（P〈0.05）。结论与气管插管全麻相比,喉罩通气全麻用于乳腺癌根治术血流动力学更平稳,麻醉相关并发症更少。     

肥厚型心肌病磁共振钆剂延迟增强与心电图 QTe/RR的关系

摘要：目的 探讨肥厚型心肌病（HCM）磁共振钆剂延迟增强与动态心电图QTe/RR斜率的关系。方法 将本院 2016 年 1 月—2017 年 6 月接诊的 96 例 HCM 患者,根据心脏磁共振扫描（CMR）是否出现钆剂延迟增强（LGE）分为 LGE阳性组和LGE阴性组。采用评分法评估LGE阳性组患者LGE透壁程度。所有受试者行24 h动态心电图检查, 计算心率（HR）、QT间期及QTe/RR斜率。分析LGE阳性组总LGE评分与QTe/RR斜率之间的相关性,分析LGE透壁 程度和QTe/RR斜率与患者预后的关系。结果 CMR结果显示LGE阳性51例（53.13%）,LGE阴性45例（46.87%）; LGE阳性组与LGE阴性组左心室射血分数（LVEF：0.412±0.092 vs. 0.508±0.083）、左心室舒张末期容积［LVEDV（mL）： 173.91±43.68 vs.148.52±31.77］及左心室舒张末期后壁厚度［LVPWD（mm）：13.26±2.81 vs. 12.15±2.37］比较差异有统 计学意义（t分别为5.301、3.219、2.077,均P＜0.05）;LGE阳性组QT间期（ms：439.67±25.82 vs. 411.53±31.66）、QTe/RR 斜率（0.20±0.05 vs. 0.16±0.03）均高于 LGE 阴性组（t 分别为 4.794、4.674,均 P＜0.05）;LGE 阳性组总 LGE 评分为 （26.37±7.52）分,与QTe/RR斜率呈正相关（r=0.742,P＜0.001）;LGE阳性组室性心律失常、心源性猝死等不良反应发 生率高于LGE阴性组（17.65% vs. 4.44%,c2=4.107,P＜0.05）;总LGE评分、QTe/RR斜率与患者室性心律失常、心源性 猝死有关（P＜0.05）。结论 HCM患者LGE程度与QTe/RR斜率显著相关,综合评估两项指标可能更有助于HCM预 后判断