微泵法持续硬膜外阻滞用于老年病人的临床研究

目的 观察微泵法持续硬膜外阻滞用于老年病人的有效性和安全性.方法 选取经腹前列腺切除术的老年病人30例,年龄70～85岁,ASAⅡ～Ⅲ级,随机分为微泵法持续硬膜外阻滞组和传统连续硬膜外阻滞组,每组15例.观察并记录麻醉前和给药后5、10、15、20、25、30、45、60、75、90 min平均动脉压(MAP)、心率(HR),记录各时点MAP、HR低于基础值30%以下及HR降到60次/min以下的例数.同时观察2组术中阿托品、麻黄素的使用情况及麻醉效果.结果 2组麻醉后MAP均较基础值明显降低(P＜0.01),自注入局麻药后20min内2组MAP的降低幅度比较及麻醉前后HR变化差异无统计学意义,但在中后期麻醉维持期间,微泵法持续硬膜外阻滞组MAP降低幅度明显小于传统法连续硬膜外阻滞组(P＜0.05),麻醉经过也相对平稳.微泵法持续硬膜外阻滞组使用麻黄素、阿托品例数均少于传统法硬膜外阻滞组,麻醉效果也优于传统硬膜外阻滞组,但2组差异无统计学意义.结论 微泵法持续硬膜外阻滞和传统连续硬膜外阻滞均对老年病人的循环功能产生一定的影响,但微泵法持续硬膜外阻滞较传统硬膜外阻滞影响小,可调节性强,麻醉经过也相对平稳,更适合于高龄的老年病人.     

0.75%罗哌卡因用于胆囊切除术时硬膜外麻醉的临床观察

目的　探讨罗哌卡因用于胆囊切除术时硬膜外麻醉的临床应用。方法　随机选择ASAⅠ～Ⅱ级病人 60例 ,分为 0 75 %罗哌卡因组 (Ⅰ组 )和 2 %利多卡因组 (Ⅱ组 ) ,分别于T9～ 10 行硬膜外穿刺置管 ,试探剂量 5ml ,10～ 15min后追加 8ml,记录阻滞平面及节段数 ,HR、SpO2 、BP(MAP)、镇痛效果评价、肌肉松弛和用辅助药氟芬合剂的情况。结果　两组使用氟芬合剂例数、SpO2 值变化情况、镇痛效果、肌肉松弛满意度及副作用的发生率比较无显著性差异 (P >0 0 5 ) ;使用麻黄碱例数和阿托品例数有显著性差异 (P <0 0 5 ) ,Ⅱ组多于Ⅰ组 ;在阻滞节段数方面有显著性差异 (P <0 0 1) ,Ⅰ组明显多于Ⅱ组。结论　 0 75 %罗哌卡因用于胆囊切除术硬膜外麻醉其镇痛效果、肌松程度和副作用的发生率约等于 2 %利多卡因 ,对HR及BP(MAP)影响较小 ,阻滞平面明显宽于 2 %利多因 ,不抑制呼吸     

异丙酚复合硬膜外麻醉对静脉用麻黄素升压反应的影响

目的　观察异丙酚复合硬膜外麻醉对静脉用麻黄素升压反应的影响。方法　 2 0例ASAⅠ～Ⅱ级择期行上腹部手术的病人 ,分别于入室清醒时、异丙酚诱导插管后、异丙酚复合硬膜外麻醉后均静脉用麻黄素0 .1mg kg ,观察病人心率 (HR)、收缩压 (SBP)、舒张压 (DBP)、平均动脉压 (MAP)的变化。结果　麻黄素使清醒病人的心率显著增快 (P <0 .0 5 ) ;MAP短暂升高 ,而异丙酚麻醉后 ,麻黄素对病人心率影响不大 ,但升压反应明显增强 (P <0 .0 5 )。与单纯异丙酚麻醉相比 ,异丙酚复合硬膜外麻醉时 ,麻黄素的升压反应并无明显差别 (P >0 .0 5 )。结论　异丙酚增强麻黄素的升压反应 ,麻黄素拮抗异丙酚复合硬膜外麻醉所致低血压是有效可行的     

连续腰麻与联合腰麻硬膜外麻醉用于子宫切除术病人的比较研究

目的 :在子宫切除术病人中 ,比较连续腰麻及联合腰麻硬膜外麻醉的麻醉效果及两种麻醉方法对血流动力学的影响。方法 :子宫切除术病人 6 0例 ,随机分为连续腰麻组 (CSA组 )和联合腰麻硬膜外麻醉组 (CSEA组 )。CSA组蛛网膜下腔首量注入 0 .5 %的重比重布比卡因 2ml,然后分次小剂量追加布比卡因直至阻滞平面达T8以上 ;CSEA组先行T1 2 ～L1 间隙硬膜外腔穿刺向头侧置管用于术中麻醉维持 ,然后L2 - 3蛛网膜下腔注入同浓度、同比重的布比卡因 3ml。分析两种椎管内麻醉的阻滞效果和蛛网膜下腔用药后血流动力学的变化。结果 :阻滞平面达T8时CSA组的局麻药用量 (2 .5ml)明显少于CSEA组 (3ml) (P <0 .0 5 )。CSEA组阻滞平面达T8的时间 (5 .6min)明显早于CSA组 (10min) (P <0 .0 5 ) ,CSEA组达最高阻滞平面的时间和下肢运动完全阻滞的时间也明显早于CSA组 (P <0 .0 5 )。CSA组血压自蛛网膜下腔用药后 2 5min起出现显著性下降 ,而CSEA组血压下降出现在 15min时 (P <0 .0 5 ) ,两组病人血压下降的最大幅度有明显差别 (P <0 .0 1)。结论 :在子宫切除术病人中 ,采用小剂量分次给药的CSA法可以减少局麻药的用量 ,能提供可靠、可控性好的阻滞平面 ,并且对血流动力学的影响小     

反射消失法判断幼儿硬膜外麻醉平面的可行性

目的　通过对比 ,选择较为科学、有效的评价硬膜外麻醉的手段。方法　 1～ 3岁ASAⅠ～Ⅱ级小儿下腹、下肢、足手术 6 0例 ,先肌注氯胺酮 5mg/kg ,再行硬膜外麻醉 ,给 0 .8～ 1.2 %利多卡因 (含肾上腺素 5ug/ml) 4ml试验量 ,5min排除腰麻 ,追加量 ,使首次量达 8mg/kg。 15min后 ,用反射消失法和针刺法测定阻滞平面。 结果　反射法均能较准确测定出相应阻滞平面 ,而针刺法仅 1/ 3(2 0 / 6 0 )病人测出 (P <0 .0 1) ,而且此 2 0例病人针刺法比反射消失法推出的阻滞平面略高 (P >0 .0 5 )。结论　氯胺酮基础麻醉后进行硬膜外麻醉时 ,通过测定反射消失推断相应脊神经阻滞平面来评价硬膜外麻醉效果是切实可行的     

兴安盟地区蒙古族心肌梗塞患者发病主要危险因素临床分析

目的:探讨兴安盟地区蒙古族心肌梗塞患者发病的主要危险因素。方法:采用横断面调查,分析147例蒙古族和548例汉族心肌梗塞住院患者的临床和实验室资料。结果:兴安盟地区蒙古族心肌梗塞平均年龄(62.97±12.28)岁,低于汉族患者(66.23±12.45)岁(P<0.05);蒙古族患者饮酒比例(44.9%)高于汉族患者(36.7%)(P<0.05);蒙古族患者的吸烟比例(32.00%)高于汉族患者(27.60%)(P<0.05);蒙古族患者甘油三酯的水平高于汉族患者(P<0.05);蒙古族患者血压水平高于汉族患者(P<0.05)。结论:与汉族比较,兴安盟地区蒙古族心肌梗塞患者发病年龄提前,长期大量饮酒,吸烟,脂代谢异常及高血压可能是其主要危险因素。     

全麻复合胸段硬膜外对食道癌三野根治术血液动力学的影响

目的　观察单纯全麻与全麻复合胸段硬膜外阻滞对食道癌三野根治术血液动力学的变化。方法　将3 0例ASAⅠ～Ⅲ级食道癌择期手术病人随机分为两组 :A组为全麻复合胸段硬膜外阻滞 (GA +EA ,15例 ) ;B组为单纯全麻 (GA ,15例 )。B组静注咪唑安定、芬太尼、异丙酚、维库溴铵诱导后气管插管 ,A组先行胸段硬膜外穿刺置管注药后再行气管插管 ,分别监测A、B两组插管后、术中、拔管后MAP、HR、CVP、PETCO2 各项参数变化。结果　A组MAP下降、HR减慢与麻醉前比 (P <0 .0 5 ) ;B组MAP、HR上升 (P <0 .0 5 ) ;A组MAP、HR、CVP、PETCO2 均低于B组 (P <0 .0 1)术中、术后ECG异常变化B组均大于A组 (P <0 .0 5 )。结论　食道三野手术全麻复合胸段硬膜外阻滞围术期血流动力学较单纯全麻稳定 ,但应注重血容量补充。     

不同剂量胸段硬膜外阻滞加七氟醚麻醉对开胸手术病人血流动力学的影响

目的 :探讨不同剂量胸段硬膜外阻滞加七氟醚麻醉对开胸手术病人血流动力学的影响。方法 :根据胸段硬膜外腔注入 1 33%利多卡因 - 0 1 6 %地卡因混合液剂量的不同 ,随机将病人分为A、B、C、D　 4组 ,每组 1 0例。A组为对照组单纯七氟醚麻醉 ,B、C、D组硬膜外腔在诱导前 1 0min分别注入 5ml、1 0ml、1 5ml利地混合液。结果 :单纯七氟醚麻醉 (A组 )插管和拔管时血压明显高于麻醉前 (P <0 0 1 )和硬膜外组。术中血压平稳 ,但心率明显高于麻醉前 (P <0 0 1 )和硬膜外组 (P <0 0 1 )。硬膜外组在诱导后及术中心率保持平稳与麻醉前无明显差异 (P >0 0 5 )。结论 :对于开胸手术病人 ,施行硬膜外阻滞加七氟醚麻醉 ,硬膜外腔用药量不宜过多 ,5～ 1 0ml血液动力学较稳定。     

老年高危病人硬膜外阻滞联合全身麻醉的相关处理

目的:评价小剂量低浓度硬膜外阻滞复合全麻应用于老年高危病人手术的可行性。方法:35例老年高危病人,ASAⅡ～Ⅳ级,根据病人手术部位选择硬膜外穿刺,注入1 5%～1 7%利多卡因4～6mL ,5～1 0min ,测定阻滞平面加局麻药,使阻滞平面在控制需要范围。全麻诱导用咪唑安定0 1mg·kg- 1,芬太尼3～5μg·kg- 1,爱可松0 2mg·kg- 1。全麻维持根据临床情况选用0 1mg %芬太尼加4mg %维库溴铵输注5～1 5mL- 1·h- 1,间断注入维库溴铵维持肌松。多功能监护仪监测心血管功能,术前切皮后和手术结束时测定血浆血管紧张素和血糖。结果:硬膜外阻滞复合全麻应用于老年高危病人的手术,麻醉诱导时血压下降,经过补充液体后可纠正。结论:硬膜外阻滞复合全麻用于老年患者行手术血流动力学较为稳定,应激反应小,全麻药用量和术后躁动减少。但是老年高危病人注意用小剂量、低浓度的局麻药。插管时异丙酚用量要减少。     

罗哌卡因高位硬膜外阻滞实施乳腺癌根治术

目的 :观察罗哌卡因高位硬膜外阻滞用于乳腺癌根治术的效果。方法 :将择期行乳腺癌根治术的患者 ,随机分为 0 .2 5 %罗哌卡因组 (R组 )和 1%利多卡因 0 .1%的卡因 (L组 )。均选择T2～ 3或T3～ 4 行一点硬膜外穿刺 ,先注入 5ml试验量 ,5min后无异常R组注入 2 0～ 2 5ml,L组注入 10～ 15ml,测定阻滞平面 ,麻醉平面满意后开始手术。监测指标包括HR、SP、DP、MAP、ECG、SpO2 、感觉阻滞平面、麻醉起效时间、麻醉质量评定和麻醉期间的不良反应。结果 :两组一般情况、ASA分级、手术时间均无明显差异。感觉阻滞平面范围、脊神经阻滞节段数有明显差异。麻醉起效时间R组明显慢于L组。结论 :罗哌卡因高位硬膜外阻滞能完全满足乳腺癌根治术的麻醉要求     

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.