预扩容在麻醉前应用的临床效果观察

目的评价预扩容技术应用于麻醉前病人的安全性和实用性。方法60例行择期妇科手术的病人随机分为羟乙基淀粉组(H组)和复方乳酸钠组(L组),每组30例。麻醉前按15mL/kg·h的速度分别输入6%羟乙基淀粉注射液(H组)15mL/kg和复方乳酸钠注射液(L组)15mL/kg。术中监测MAP,HR,CVP,SpO2,分别于稀释前、稀释后测定HCT,Hb,pH,TEG变化。结果L组术中MAP和HR的下降明显大于H组(P<0.05),H组的血流动力学稳定。H组的CVP稀释后明显升高(P<0.01),但在正常范围内。H组的HCT,Hb在稀释后明显低于L组(P<0.01)。H组扩容后pH值显著下降(P<0.01)。扩容后L组R时间、K时间均缩短(P<0.05),两组扩容后TEG中的α角度增大(P<0.05),扩容后H组TEG中的Ma值减少(P<0.05)。结论预扩容技术能安全有效地使围术期病人保持循环稳定,并提高病人对失血的耐受性,减少异体输血,值得临床推广。     

老年患者术前用6%羟乙基淀粉容量治疗的安全性

目的:用6%羟乙基淀粉液术前实施容量治疗,观察对老年病人血流动力学和凝血功能的影响,探讨 用于老年病人的可行性。方法:44例择期手术老年患者,ASAⅠ-Ⅱ,凝血功能和血红蛋白正常。随机分实验组 (H组)和对照组(L组),各22例。实验组用15mL/kg量输入6%羟乙基淀粉1h;对照组按15mL/kg量,1h内输 入乳酸林格氏液。观察麻醉期间病人HR、MAP和CVP等血流动力学指标和APTT、PT、Hb、Hct、Plt等指标的变 化。结果:实验组输液后的CVP较输液前升高(P<0.05),CVP最高升至1.53kPa(15.3cmH20),MAP变化平 稳,两组比较有显著性差异(P<0.05)。实验组输液60min后APTT、PT较输液前延长(P<0.05),但组间比较 无显著性差异(P>0.05)。输液后的Hb、Hct、Plt较输液前有不同程度下降,组间比较有明显差异(P<0.05) 结论:6%羟乙基淀粉液15mL/kg量术前容量治疗可安全用于全麻下老年手术患者,增加了血容量储备,减少 麻醉诱导期的循环系统功能变化,对凝血功能影响较少。     

羟乙基淀粉液预扩容在老年人髋关节置换手术麻醉中的应用

目的 :观察 6 %羟乙基淀粉预扩容对老年髋关节置换患者术中循环变化的预防效应及凝血功能的影响。方法 :4 0例择期手术患者 ,随机分实验组 (H组n =2 0 )和对照组 (L组n =2 0 )。麻醉前用 0 .3mL·kg-1·min-1速度分别输入 6 %羟乙基淀粉 (H组 )和乳酸林格氏液 (L组 ) ,30min后开始行腰 -硬联合麻醉。 6 0min后两组均改用0 .15mL·kg-1·min-1速度输注乳酸林格氏液至术毕。术中连续监测SBP、DBP、MAP、HR及SpO2 ,于输液前、输液后和术毕检测部分凝血活酶时间 (APTT)和凝血酶原时间 (PT)。结果 :H组麻醉后及术中血压和心率较平稳 ,MAP和HR的下降程度明显低于对照组 (P <0 .0 5 )。H组与L组输液后和术毕的APTT、PT较术前均延长 ,组间比较差异无显著 (P >0 .0 5 )。结论 :应用 6 %羟乙基淀粉麻醉醉前预扩容能有效预防麻醉及手术引起的循环明显变化 ,对患者凝血功能无明显影响 ,提高病人对手术失血的耐受力。     

羟乙基淀粉预扩容用于硬膜外麻醉剖宫产术的临床观察

目的观察在硬膜外麻醉剖宫产术中使用羟乙基淀粉预扩容的临床效果。方法选择硬膜外麻醉下剖官产手术200例,随机分为2组（n=100）,A组给予羟乙基淀粉200/0.5氯化钠注射液500 ml进行预扩容,B组给予乳酸钠林格注射液500ml进行预扩容。术中监测血压（MAP）、心率（HR）、新生儿评分和产妇仰卧位综合征发生情况。结果术中A、B组最高HR值和最低SBP值比较差异有统计学意义;B组仰卧位综合征发生率高于A组,差异有统计学意义,术中新生儿评分差异无统计学意义。结论在硬膜外麻醉剖宫产术中使用羟乙基淀粉200/0.5氯化钠注射液预扩容是可行的,有利于术中血流动力学的稳定。     

高渗氯化钠羟乙基淀粉40注射液预防高龄患者腰硬联合麻醉后低血压的临床观察

目的 观察预注高渗氯化钠羟乙基淀粉40注射液(HSH,霍姆)对高龄患者腰硬联合麻醉后低血压的预防效果.方法 选择择期行腰硬联合麻醉70岁以上患者80例,随机分为两组,在麻醉前分别输注高渗氯化钠羟乙基淀粉40注射液250ml(观察组),乳酸钠林格氏液500 ml(对照组).监测麻醉前及蛛网膜下腔阻滞(腰麻)后5、10、20 min的收缩压(SBP)、舒张压(DBP),观察输液前及输液后30 min后的电解质、血红蛋白(Hb)、红细胞比容(Hct),并记录麻醉后使用麻黄碱的例数、剂量.结果 观察组在麻醉后各时段SBP、DBP的下降明显低于对照组(P<0.05),两组患者的电解质(Na+、Cl-)在腰麻后无明显改变,观察组Hb和Hct稍低于对照组.观察组麻醉后使用麻黄碱的例数、剂量明显少于对照组.结论 采用预注高渗氯化钠羟乙基淀粉40注射液(霍姆)能有效预防高龄患者腰硬联合麻醉后的血压下降,维持血流动力学的稳定,对电解质无明显影响,并有轻度血液稀释作用.     

麻醉诱导期间输注乳酸林格氏液或羟乙基淀粉氯化钠注射液扩容效应的观察

目的 评价不同麻醉诱导期间输注晶体液乳酸林格氏液和胶体液羟乙基淀粉氯化钠注射液(万汶)对扩容效应的影响.方法 择期上腹部手术病人90例,ASA Ⅰ-Ⅱ,分为3组,Ⅰ组为硬膜外麻醉乳酸林格氏液组,Ⅱ组为全身麻醉乳酸林格氏液组,Ⅲ组为全身麻醉万汶组.麻醉诱导后扩容采用乳酸林格氏液20 mL/kg或万汶8.5 mL/kg恒速输注,30 min内输完;动态测定血红蛋白(Hb)及红细胞压积(Hct),并记录尿量和血流动力学变化,利用物质守恒定律评价扩容效应以及液体保留率和血流动力学的稳定性.结果 Ⅲ组的扩容效应、液体保留率均高于Ⅰ组和Ⅱ组(P＜0.05),扩容后Ⅲ组的平均动脉压(MAP)稳定性优于Ⅰ组和Ⅱ组(P＜0.05);而Ⅱ组的扩容效应、液体保留率高于Ⅰ组,MAP稳定性优于Ⅰ组(P＜0.05).结论 全身麻醉可提高输注液体的扩容效应和血流动力学的稳定性.     

预扩容在腰硬联合麻醉前应用的临床观察

目的 观察预扩容用于腰硬联合麻醉前对血压、心率的影响.方法 麻醉前分三组分别给予羟乙基淀粉(M组)5-7m l/k g,乳酸钠林格氏液(N组)5-7m l/k g,然后行腰硬联合麻醉穿刺术,对照组(K组)静脉开放后即刻行腰硬联合麻醉穿刺.记录麻醉前和麻醉后5min的BP、HR并比较.结果 M组和N组的SBP、DBP均有所下降,HP有所增加,两者无明显差别.K组与M组N组相比较SBP、DBP下降程度有统计学意义(P<0.05),K组患者HR上升程度明显大于M组和N组(P<0.05).结论 腰硬联合麻醉前预输乳酸钠林格氏液和羟乙基淀粉有较好的扩容作用,易于稳定血压、心率.     

高渗氯化钠羟乙基淀粉40对行经尿道前列腺电切手术老年良性前列腺增生患者电解质的干预作用

目的研究高渗氯化钠羟乙基淀粉40对行经尿道前列腺电切术(TURP)的老年良性前列腺增生患者电解质的干预作用。方法将60例择期行TURP术的老年良性前列腺增生患者分为乳酸钠林格注射液组和羟乙基淀粉组,每组30例。乳酸钠林格注射液组患者静脉滴注乳酸钠林格注射液;羟乙基淀粉组患者于电切开始后30 min按4 mL.kg-1体质量静脉滴注高渗氯化钠羟乙基淀粉40;随后均用乳酸钠林格注射液维持容量。于输液前、电切开始后30 min和术毕取静脉血检测血电解质K+、Na+、Cl-浓度;统计术中冲洗液用量、手术时间、静脉输液总量;手术前、后秤体质量,计算体质量差。结果 2组冲洗液量、术中输液量及手术时间比较差别均无统计学意义(P>0.05)。乳酸钠林格注射液组血浆K+浓度电切开始后30 min及术毕时低于输液前(P<0.01),羟乙基淀粉组血浆K+浓度术毕时低于输液前(P<0.05),2组间血浆K+浓度比较差别无统计学意义(P>0.05)。乳酸钠林格注射液组血浆Na+浓度电切开始后30 min及术毕时低于输液前(P<0.05),羟乙基淀粉组血浆Na+浓度电切开始后30 min时低于输液前(P<0.01),术毕时则高于输液前(P<0.01);术毕时血浆Na+浓度羟乙基淀粉组明显高于乳酸钠林格注射液组(P<0.01)。2组电切开始30 min时Cl-浓度均低于输液前(P<0.05);术毕时羟乙基淀粉组Cl-浓度高于乳酸钠林格注射液组(P<0.05)。羟乙基淀粉组患者术后体质量增加明显高于乳酸钠林格注射液组(P<0.05)。结论高渗氯化钠羟乙基淀粉40对维持行TURP术老年良性前列腺增生患者血浆Na+浓度有积极作用,有利于减少稀释性低钠血症的发生。     

60%羟乙基淀粉对CSEA患者围术期液体治疗的有效性和安全性评价

目的 评价6%羟乙基淀粉(6%HES,200/0.5)预扩容的有效性和安全性.方法 60例择期手术患者(ASA Ⅰ～Ⅱ级,年龄20～60岁)随机分为6%HES组(H组)和复方乳酸钠组(R组),每组各30例,所有患者均采用CSEA.麻醉前30min以15mL/(kg·h)的速度输入6%HES或复方乳酸钠溶液,输液1h后以50mL/h的滴速维持滴注.术中连续监测平均动脉压、心率、脉搏血氧饱和度,并于各时间点行动脉血气、酸碱平衡和电解质分析.结果 扩容后R组MAP、HR和SpO2无明显改变,H组MAP明显上升.两组PH、HCO-3、BE于扩容后轻度下降(P<0.05),血浆Na+、K+、Ca2+无显著性差异,H组扩容后Hot、Hb下降,且H组比R组明显(P<0.05).结论 6%HES作为容量替代治疗用品是安全有效的,但是输入6%HES后可导致轻度的代谢性酸中毒,应予重视.     

中老年髋关节置换术预输注羟乙基淀粉预防低血压的临床应用

目的 观察预输注负荷量羟乙基淀粉在中老年髋关节置换术中预防低血压的效果。方法 选择31例择期行髋关节置换术的病人,随机分为预输注羟乙基淀粉组(D组)和预输注乳酸钠林格氏液组(F组)。麻醉前分别预输注负荷量为500ml,观察术中患者的MAP,HR波幅及30min最低值以及麻黄碱用量情况。结果 两组病人基础MAP,HR相似。麻醉后低血压发生率F组高于D组。麻黄碱应用例数F组高于D组,D组未出现类过敏反应,肾功能损害及凝血障碍。结论 预输注负荷量羟乙基淀粉在中老年髋关节置换术中可有效预防低血压等不良反应的发生。     

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.