高频喷射通气时组胺致肺损伤犬动脉血CO2分压的估计

作应用测定５－８次常频呼吸后Ｐｅｔｃｏ２的方法，探讨高频喷射通气（ＨＦＪＶ）时组胺致肺损伤犬Ｐａｃｏ２与Ｐｅｔｃｏ２的关系。结果表明，在通气频率分别为６０及１００次／ｍｉｎ时，Ｐａｃｏ２较Ｐｅｔｃｏ２均显升高（Ｐ＜０．０１）。Ｐａｃｏ２与Ｐｅｔｃｏ２呈显正相关（ｒ＝０．８０，Ｐ＜０．０１）。结果提示，测定５－８次常频呼吸后的Ｐｅｔｃｏ２不能准确地反映ＨＦＪＶ时组胺致肺损伤犬Ｐａｃｏ２的变化。     

高频喷射通气时麻醉犬动脉血二氧化碳分压的估计

高频喷射通气时麻醉犬动脉血二氧化碳分压的估计孙喜庆，吴兴裕，张立藩（应用与系统生理学研究室）关键词高频喷射通气；呼气末二氧化碳分压；狗中图法分类号Ｒ６１４呼气末二氧化碳分压（Ｐｅｔｃｏ２）能较准确地反映动脉血二氧化碳分压（Ｐａｃｏ２）的变化，具有无创...     

单肺通气犬呼气末和动脉血二氧化碳分压相关性研究

目的 探讨单肺通气（ＯＬＶ）期间呼气款二氧化碳分压（ＰｅｔＣＯ２）与动脉血二氧化碳分压（ＰａＣＯ２）的相关关系。方法：以５只成年犬为实验动物,制造单肺通气模型,连续监测９种单肺通气模式下的ＰｅｔＣＯ２Ｔ ＰａＣＯ２。结果：ＰｅｔＣＯ２和ＰａＣＯ２之间采用简单相关分析存在显著性相关（Ｐ〈０．０５）,而用多元相关方法分析两者间无显著相关性（Ｐ〉０．１）结论：认为在ＯＬＶ期间,ＰｅｔＣＯ２受诸多因素影响     

高频喷射呼吸机常频通气的疗效评价

目的：高频喷射呼吸机常频通气的应用，可进一步改善肺内气体交换，本研究评价常频通气对呼吸衰竭动脉血气的影响。方法：３１例无自主呼吸的患者，用高频喷射呼吸机持续、常频、控制呼吸，通气频率１６～２０次／ｍｉｎ，持续通气时间１２～７２ｈ。结果：通气１ｈ后ＰａＯ２（１５．９２±２．５０）ｋＰａ，ＰａＣＯ２（５．９０±０．７６）ｋＰａ；通气２４ｈ后ＰａＯ２（１４．７６±３．２１）ｋＰａ，ＰａＣＯ２（６．１１±０．８４）ｋＰａ。在Ⅱ型呼吸衰竭，常频与高频通气交替应用比单用高频通气辅助呼吸，其提高血氧分压的疗效优越（Ｐ＜０．００１），且可防止高碳酸血症。结论：合理选用常频通气，可进一步提高疗效     

慢性阻塞性肺病呼吸衰竭者潮气末二氧化碳分压的监测

对２０例正常人、２０例慢性阻塞性肺病（慢阻肺）及２５例慢性阻塞性肺病呼吸衰竭（慢阻肺呼衰）患者进行潮气末二氧化碳分压（ＰｅｔＣＯ２）和动脉血二氧化碳分压（ＰａＣＯ２）对比研究，并与死腔气量／潮气容积（ＶＤ／ＶＴ）和气道阻力（Ｒａｗ）进行相关分析。结果表明，正常组及慢阻肺组ＰａＣＯ２和ＰｅｔＣＯ２间无明显差异（Ｐ＞０．０５），ＰｅｔＣＯ２可反映ＰａＣＯ２变化。慢阻肺呼衰者ＰａＣＯ２和ＰｅｔＣＯ２间有明显差异，其中ＰｅｔＣＯ２较ＰａＣＯ２低，平均相差达２．１３ｋＰａ±１．２６ｋＰａ（Ｐ＜０．０１）。故在慢阻肺呼衰时ＰｅｔＣＯ２不能反映ＰａＣＯ２变化，此时如以ＰｅｔＣＯ２来估计ＰａＣＯ２是不可靠的。慢阻肺呼衰时ＰａＣＯ２－ＰｅｔＣＯ２之差异与ＶＤ／ＶＴ（ｒ＝０．８１，Ｐ＜０．０１）和Ｒａｗ相关（ｒ＝０．４２，Ｐ＜０．０５）。     

不同频率时高频喷射通气膈神经电位的影响

目的：研究麻醉犬高频喷射通气（１５０次／ｍｉｎ、３００次／ｍｉｎ和６００次／ｍｉｎ，驱动压０．５ｋｇ／ｃｍ＾２）和常频机械通气（１６次／ｍｉｎ，驱动压０．５ｋｇ／ｃｍ＾２）对膈神经动作电位的频率、幅度和持续时间的影响。方法：用电生理方法测定高频喷射通气时膈神经电位的变化。结果：常频机械通气和高频喷射通气（１５０次／ｍｉｎ和３００次／ｍｉｎ）后，膈神经动作电位的幅度无显著改变（Ｐ＞０．０５）。高频喷射通气（６００次／ｍｉｎ）ｌ５ｍｉｎ，膈神经动作电位幅度显著增大（Ｐ＜０．０５）。通气５和１５ｍｉｎ，膈神经动作电位的放电频率显著降低（Ｐ＜０．０１）。停止常频机械通气１５ｍｉｎ，膈神经动作电位的持续时间显著缩短（Ｐ＜０．０５）。结论：中等频率的高频喷射通气比高频率的高频喷射通气的效果好。     

老年人腹腔镜胆囊切除术的麻醉及PetCO2与PaCO2的关系

目的：探讨老年人腹腔镜手术较理想的麻醉方法；ＣＯ２气腹时呼气末ＣＯ２分压（ＰｅｔＣＯ２）与动脉血ＣＯ２分压（ＰａＣＯ２）相互变化的关系。方法：全部采用全麻。术中连续监测ＰｅｔＣＯ２，在手术不同时期进行动脉血气分析。结果：气腹后ＰｅｔＣＯ２与ＰａＣＯ２均数的差异（Ｐ〉０．０５）；与气腹前比较，均有显著性差异（Ｐ〈０．０５）。气腹前后Ｐ（ｅｔ－ａ）ＣＯ２的比值无显著性差异。结论：采用异丙酚、复合芬太尼     

慢性阻塞性肺病呼吸衰竭者潮气末二氧化碳分压的监测

对２０例正常人，２０例慢性阻塞性肺病（慢阻肺）及２５例慢性阻塞性肺病呼吸衰竭（慢阻肺呼衰）患者进行了潮气末二氧化碳分压（ＰｅｔＣＯ２）和动脉血二氧化碳分压（ＰａＣＯ２）对比研究，并与死腔气量／潮气容积（ＶＤ／ＶＴ）和气道阻力（Ｒ）进行相关分析，结果表明，正常组及慢阻肺组ＰａＣＯ２和ＰｅｔＣＯ２间无明显差异（Ｐ〉０．０５），ＰｅｔＣＯ２可反映ＰａＣＯ２变化。慢阻肺呼衰者ＰａＣＯ２和ＰｅｔＣＯ２间有明     

腹腔镜胆囊切除术对呼吸循环功能的影响

目的 观察腹腔镜胆囊切除术时ＣＯ２气腹对呼吸循环功能的影响。方法 腹腔镜胆囊切除术患者２１例,经静脉诱导作气管内插管后行间歇正压通气,保持呼气末ＣＯ２分压（ＰｅｔＣＯ２）在４．０￣５．３ｋＰａ,监测Ｂｐ、ＨＲ、Ⅱ导联ＥＣＧ、中心静脉压（ＣＶＰ）、潮气量（ＴＶ）、分钟通气量（ＭＶ）、气道峰压、脉搏氧饱和度（ＳｐＯ２）、ＰｅｔＣｏ２、肺顺应性和动脉血气分析。分别在麻醉前、控制呼吸１５ｍｉｎ（ＣＯ２气腹     

呼吸衰竭的新疗法─一体外隔肌起博

本文报告我院１９９３年－１９９５年收治的１１例肺心病呼吸衰竭，应用体外隔肌起博（ｅｘｔｅｒｎ８Ｊｄｉ－ａｐｈｒａ８ｍｐａｃｉｎｇＥＤＰ）临床及实验室综合分析，男９例女２的，年龄５０－7２岁。入院时血气分析ｐＨ７．１５士０．１1氧分压（ＰａＯｚ）８０．５士１４．２二氧化碳在分压（ＰａＯｚ）７８．２士１３．６１碳酸氢根３０．５士６．２ｍｍｏｌ/L；剩余碱５．６３土４．2ｍｍｏｌ/L；入院后除给予吸氧、袂痰，平喘，抗感染等常规治疗外，外用ＥＤＰ。剌激频率中４ＯＨｚ，脉冲宽度０．3ｍｓ；脉冲幅度２０－７5ｖ；剌激时间为一秒；呼吸频率次／分；６０分钟为一疗程。结果１１例右者症状均得到改善。动脉血ＰａＯ２升高１５土４．5ｍｍＨｇ，ｐａＣＯ２平均下降１３．５士３．２ｍｍＨｇ。上述结果表明，ＥＤＰ作为治疗在慢性阻寨性肺疾患呼吸衰竭的一种新方法，具有简单是易行，疗效可靠，易于推广等优越性。     

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.