6％羟乙基淀粉行急性超容血液稀释对血电解质及酸碱平衡的影响

目的探讨6％羟乙基淀粉溶液（HES,200／0．5）行急性超容血液稀释（AHHD）对机体血电解质及酸碱平衡的影响。方法选择20例20—40岁、ASAⅠ～Ⅱ级择期五官科手术插管全麻患者,以6％HES15ml／kg扩容行中度血液稀释。于AHHD前、AHHD后、手术结束时测定Het、Hb、血电解质及酸碱平衡指标进行比较。结果AHHD后、手术结束时Hct、Hb较AHHD前显著降低,AHHD后Hct、Hb分别下降了23．1％和21．4％,达到中等程度血液稀释状态;AHHD后血K^＋浓度下降了13．65％,血Ca^2＋浓度也明显下降了39．80％．但均在正常范、围内;AHHD前、后pH值及血Na^＋浓度变化差异均无统计学意义。结论6％HES溶液行AHHD能有效地使Hct及Hb下降至靶水平．同时维持了机体血电解质的稳定及酸碱平衡,是一种安全有效的AHHD方法。     

术前急性超容性血液稀释（AHHD）对术后安全性的临床观察

目的：术前急性超容性血液稀释（AHHD）对术后安全性的临床观察。方法：选择ASAI—II级、FEVI％I-Ⅱ级、无肝肾功能损害手术患者共140例,其中70例作术前急性超容性血液稀释（AH—HD）,70例为对照组。观察AHHD前（T0）,AHHD完毕（T1）,术毕（T2）,术后第一天（T3）血流动力学、血常规、血气分析、凝血四项、及电解质变化,两组分别统计术后48h内低血压、心律失常、急性心力衰竭、急性呼吸衰竭、出血、肝肾功能损害发生例数。结果：AHHD组与对照组之间在血流动力学方面,T2中HR、MAP变化明显（P〈0．05）,T1中CVP变化明显（P〈0．05）;AHHD组与对照组之间在血常规方面,T1中Hb与Hct变化明显（P〈0．05）;AHHD组与对照组之间在电解质及血气分析方面,T1中K＋与Ca2＋变化明显（P〈0．05）;AHHD组与对照组之间在凝血功能变化,T1中PT、APTT、FIB变化均明显（P〈0．05）,T2中APTF及T3中FIB两组之间均有差异（P〈0．05）。术后48h各并发症中,AHHD能明显减少肝肾功能损害的发生（P〈0．05）。结论：AHHD是预防外科术中出血量多,麻醉实施的一种节约用血的方法。通过临床对照研究,对术后安全性无明显影响,故值得在临床实践中推广。     

琥珀酰明胶注射液行术前急性超容性血液稀释的临床研究

目的：观察琥珀酰明胶注射液（佳乐施）对手术前急性超容性血液稀释（AHHD）病人的MAP、CVP、HR、SpO2、凝血机制以及尿量的影响和血液保护的实施。方法：选择ASA I-Ⅱ级全麻手术病人40例，于输注佳乐施前，输液后10、20、30、60min记录MAP、CVP、HR、SpO2和次日取深静脉血分别测定红细胞压积（Hct）、血小板（PLt）、血红蛋白（Hb）、凝血酶原时间（PT）、部分凝血酶原时间（APTT）并观察有无过敏反应，进行统计学处理。结果：接受AHHD的病人，MAP、HR、CVP、尿量等在输注佳乐施后10、20min比输注前均增加（P＜0．01，SpO2无变化，30及60min后渐恢复到输注前水平（P＞0．01），Hb、Hct、PLt均比AHHD前低（P＜0．01），PT、APTT均在正常范围内（P＞0．01）。结论：用琥珀酰明胶注射液施行AHHD后病人的上述指标波动在正常范围内，说明术前对病人行AHHD是可行的，也是麻醉手术中治疗和预防低血压时替代血液的理想药品。     

急性高容量血液稀释对肝癌手术病人电解质及酸碱平衡的影响

目的 探讨6％羟乙基淀粉液术前行高容量血液稀释（AHH）对肝癌手术病人内环境变化的影响。方法ASAⅠ～Ⅱ级肝癌患者30例，随机分为试验组（V组）和对照组（C组），其中V组麻醉诱导前快速输注万汶15ml／kg，C组输注乳酸钠林格液，方法同V组。监测平均动脉压（MAP）、心率（HR）和中心静脉压（CVP）；记录术中出血量和输液量；分别于稀释前（T1）、稀释后即刻（T2）、术毕（T3）、术后3h（T4）进行血气分析及检测血清电解质。结果pH、HCO3^-、BE在T2时V组均有所降低，与C组比较差异有统计学意义（P〈0．05）。血清Na^＋在T2-T4V组有轻度上升；C组在T2下降，与C组比较差异有统计学意义（P〈0.05）；V组血浆K^＋在T2、T，与C组比较差异有统计学意义（P〈0．05）；V组血浆Cl^-在T2时间点升高（P〈0．05）；两组Cl^-于T3、T4均升高（P〈0．05）。结论AHH对肝癌手术病人机体电解质及酸碱平衡有影响。     

急性血液稀释法测定血容量的可行性研究

目的临床验证急性血液稀释（AH）法测定血容量的可行性。方法选择20例择期全身麻醉的手术患者,分别采用急性血液稀释法和^99mTc标记红细胞法对患者某一时刻的血容量进行测定,评估这两种方法测定结果的相关性,并观察急性血液稀释法对患者血流动力学的影响。结果急性血液稀释法与^99mTc标记红细胞法有高度相关性（r=0．986,P〈0．01）;急性血液稀释法测定血容量的值较^99mTc标记红细胞法测定血容量值偏大（242．5±77．7）ml,测定结果差异有统计学意义（P〈0．01）。AH后心率、平均动脉压、中心静脉压的变化范围分别为71～90次／min、68—90mmHg、5—10cmH2O,均在其对应正常值范围之内。结论急性血液稀释法是一种准确、简便、快速、较安全的血容量测定方法。     

琥珀酰明胶注射液行急性超容血液稀释对血电解质及酸碱平衡的影响

目的探讨琥珀酰明胶注射液行急性超容血液稀释(AHHD)对机体血电解质及酸碱平衡的影响.方法选择20例40-60岁、ASAⅠ-Ⅱ级择期骨科全髋关节置换手术插管全麻患者,以琥珀酰明胶20ml/kg扩容行中度血液稀释.于AHHD前、AHHD后、手术结束时测定HCT、Hb、血电解质及酸碱平衡指标.结果 AHHD后、手术结束时HCT、Hb较AHHD前显著降低,AHHD后HCT、Hb分别下降了23.1%和21.4%,达到中等程度血液稀释状态;AHHD后血K+浓度下降了13.65%,血Ca2+浓度也明显下降了39.80%,但均在正常范围内;AHHD前、后pH值及血Na+变化差异均无统计学意义.结论琥珀酰明胶注射液行AHHD能有效地使HCT及Hb下降至靶水平,同时维持了机体血电解质的稳定及酸碱平衡,是一种安全有效的AHHD方法.     

CATS和CellSaver自体血回收机对骨科手术中回收血液流变学及其质量的影响

目的：分析2种自体血回收机在骨科手术中的回收血液流变学指标[红细胞最大变形指数（DImax）、聚集指数（AIm‐ax）、渗透脆性、红细胞压积（Hct）、血红蛋白（Hb）]和血液质量（Hct、Hb、血电解质及 pH值）以及自体血回输后患者体内 Hct、Hb、血电解质及pH值的变化,为临床自体血回收提供参考。方法骨科手术患者76例分为A组（使用CATS）和B组（使用Cell Saver）;采集自体血检测DImax、AImax、渗透脆性、Hct、Hb、血电解质、pH值及输自体血前、后、术后24 h取患者静脉血并分别检测Hct、Hb、血电解质、pH值。结果 A组DImax低于B组（P＜0．05）,两组与参考值比较差异均无统计学意义（P＞0．05）;两组AImax比较差异无统计学意义（P＞0．05）,但均明显低于参考值。A组红细胞渗透脆性曲线较B组右移。各指标与其对应参考值比较差异均有统计学（P＜0．05）。A组自体血Hct、Hb、K＋明显高于B组,Na＋明显低于B组,各指标与其对应参考值比较差异均有统计学意义（P＜0．05）。两组自体血pH值均偏碱性。输自体血前、后即刻、术后24 h两组间机体血 Hct、Hb、K＋、Na＋、pH值差异均无统计学意义（P＞0．05）。两组输自体血后机体血Hct与Hb、Na＋明显高于输自体血前（P＜0．05）。结论骨科手术中2种自体血回收机所得到的自体血在流变学指标及其血液质量皆无明显差异,自体血回输后对机体内环境也无明显影响,2种自体血回收机的性能较为安全。     

万汶／乳酸林格氏液对子宫肌瘤患者血液动力学和酸碱平衡的影响

目的比较子宫肌瘤患者输注万汶（130／0．4，6％羟乙基淀粉）／乳酸林格氏液时对血液动力学和动脉血酸碱平衡的影响。方法50例择期子宫肌瘤手术患者，ASAⅠ—Ⅱ级，随机分为万汶组（V组，n=25）和乳酸林格氏液组（L组，n=25），分别经静脉20min内快速输注万汶或乳酸林格氏液10ml／kg，随后两组均按2ml／kg·h的速度输注乳酸林格氏液。记录静脉输注开始时及开始后20、40、60min各时间点SBp、DBp、HR、CVP及部分动脉血气分析结果（pH、BE、Hb、Lac^-1、Cl^-1）。结果与基础值相比，CVP在输注开始后两组均显著上升（P〈0．05），且V组CVP升高显著（P〈0．05）；在观察各时间点上SBp、DBp和HR两组均无显著差异。pH、BE和Hb在输注开始后即轻度下降（P〈0．05），但L组的pH在扩容后60min、Hb在扩容后40min基本恢复至基础值；V组Cl^-1和I，组Lac^-1在扩容后显著上升（P〈0．05），但V组Cr在扩容后60min基本恢复至基础值。结论快速输注万汶或乳酸林格氏液均可有效扩容，两者相比万汶扩容效果更好更持久。     

中分子羟乙基淀粉急性高容量血液稀释在骨科手术中的应用

①目的探讨急性高容量血液稀释在手术中对骨科手术患者的影响。②方法选取预计术中出血量大于500mL的ASA—Ⅰ级骨科手术患者60例，随机分为息性高容量血液稀释组和对照组．每组各30例。急性高容量血液稀释组（AHH组）于麻醉后30分钟给患者输入15—20mL的6％中分子羟乙基淀粉液，使机体血容量扩大20％-30％，减少血液有形成分的丢失。时照组按常速补液。术中监测ECG、HR、SPO2、CO2、MAP、CVP、PT、CT、KPIT、Hct。术中记录出血量、尿量、输血量。最后对以上数据进行统计分析。③结果中分子羟乙基淀粉急性高容量血液稀释在骨科手术中不影响患者的凝血功能，PT、CT、KPIT在稀释前后及与时照组（C组）比较无统计学意义（P〉0．05）。Hct值AHH组稀释后比稀释前下降明显（P〈0．01），稀释后30分钟与60分钟比较无差异。AHH组比C组手术结束时Hct值较高（P〉0．05）。出血量两组对比无统计学差异（P〉0．05），手术开始后24小时内输血量AHH组（260±97）mL比C组（373±149）mL减少（P〉0．01）。④结论中分子羟乙基淀粉急性高容量血液稀释有效地提高患者对围术期失血的耐受性，可安全用于全髋置换、脊柱骨折内固定等出血量多的骨科手术患者，并明显减少此类患者的术中异体血输入量，是一种有效血液的保护措施。同时对患者血流动力学、凝血功能等指标无明显不良影响。     

急性血液稀释对孕产妇失血性休克术中循环及凝血功能的影响

目的：研究急性血液稀释在孕产妇失血性休克中对循环及凝血功能的影响。方法：选择孕产妇合并失血性休克患者50例，随机分为对照组（Ⅰ组）和急性等容性血液稀释（ANH）组（Ⅱ组），每组25例。Ⅱ组于麻醉后、手术之前，在15～25min内经颈内静脉加压输入RLS及6％HES15～30ml／kg（晶：胶=1：1），使血容量迅速恢复。Ⅰ组除外血液稀释，其余处理同Ⅱ组。组间和组内比较各时点血流动力学、Hct、Hb、PLT、输血量及凝血功能等的变化。结果：血液稀释完成即刻（T1），11组各生命指征与入室时、（T0时点）比较，差异有非常显著性（P〈0．01），显示休克生命征明显缓解；T1时点Ⅱ组各生命征与Ⅰ组比较，休克生命征缓解，有非常显著性差异（P〈0．01）。Ⅱ组Hb、Hct和PLT、APTT、PT、FiB在T1时点较T0时点差异有非常显著性（P〈0．01），显示血液明显稀释；输血量Ⅱ组明显少于Ⅰ组（P〈0．01）。结论：急性血液稀释能迅速缓解孕产妇合并失血性休克患者的休克生命征，对凝血功能的影响并不影响患者的抢救成功率和治愈率，值得临床推广。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.