右美托咪啶对冠心病患者非心脏手术期间的心肌保护效应

目的 评价右美托咪啶对冠心病患者非心脏手术期间的心肌保护效应.方法 选择行上腹部手术的冠心病患者80例,性别不限,年龄43～76岁,体重52～80 kg,ASA分级Ⅱ或Ⅲ级,NYHA 分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为2组(n=40):对照组(C组)和右美托咪啶组(D组).D组麻醉诱导前10 min静脉注射右美托咪啶负荷剂量1μg/kg,继之以0.4μg·kg-1·h-1的速率维持至术毕,C组给予等容量生理盐水.两组术中维持BIS值40～49.于麻醉诱导前和术毕时取血样,测定血清IL-6、TNF-α、cTnI和糖原磷酸化酶BB(GP-BB)的浓度,记录术中心血管不良反应的发生情况.结果 与C组比较,D组血清IL-6、,TNF-α、cTnI及GP-BB水平明显降低,心动过缓发生率升高,心动过速和心肌缺血发生率降低(P<0.05).结论 右美托咪啶对冠心病患者非心脏手术期间可产生心肌保护效应,其机制可能与抑制促炎性细胞因子释放有关.

Abstract：

Objective To evaluate the myocardial protective effect of dexmedetomidine during non-cardiac surgery in patients with coronary heart disease.Methods Eighty ASAⅡor Ⅲ patients with coronary heat disease (NYHA Ⅱ or Ⅲ)aged 43-76 yr weighing 52-80 kg scheduled for elective upper abdominal surgery were randomly divided into 2 groups(n=40 each)：control group(group C)and dexmedetomidine group(group D).Anesthesia was induced with etomidate 0.25 mg／kg,sufentanil 0.5 μg／kg and vecuronium 0.1 mg／kg.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1μg/kg was injected intravenously 10 min before induction followed by infusion at 0.4 μg·kg-1·h-1 until the end of operation in group D.While equal volume of normal saline was given in group C.BIS was maintained at 40-49.Blood samples were taken before induction and at the end of operation for determination of serum concenlrations of IL-6,TNF-α,cardiac troponin Ⅰ(cTnI)and glycogen phosphorylase BB(GP-BB).The adverse cardiovascular events were recorded during operation.Results The serum concentrations of IL-6,TNF-α,cTnI and GP-BB and incidences of tachycardia and myocardial ischemia were significantly lower,while the incidences of bradycardia highcr in group D than in group C (P<0.05).Conclusion Dexmedetomidine Can exert the myocardial protective effect during non-cardiac surgery in patients with coronary heart disease and the mechanism may be related to the inhibition of the release of pro-inflammatory cytokines.     

细针吸流式细胞术在腮腺肿块定性诊断中的价值

采用流式细胞术（ＦＣＭ）对４４例腮腺肿块细针吸取物进行测定分析，并按国际参考标准进行定性诊断，诊断结果与光镜下细胞学及病理学诊断结果进行比较分析。结果表明ＦＣＭ法对４４例腮腺肿块中的实际癌瘤阳性检出率、敏感度明显高于细胞学诊断法，提示ＦＣＭ法具有敏感性高、指标客观、重复性好、结果可靠等优点，在有条件单位或用细胞学不易诊断定性时可采用ＦＣＭ法来完成腮腺肿块的术前定性诊断。     

自拟健脾通窍汤治疗肺脾气虚型变应性鼻炎患儿的临床研究

目的探讨采用自拟健脾通窍汤治疗肺脾气虚型变应性鼻炎患儿的疗效及对炎症因子的影响。方法选取2017年4月—2019年4月本院治疗的125例肺脾气虚型变应性鼻炎患儿作为研究对象,按照随机数字表法将其分为对照组和观察组。对照组62例患儿予以氯雷他定片治疗,观察组63例患儿联合自拟健脾通窍汤辅助治疗。连续治疗4周后,比较2组患儿临床疗效、中医证候积分、炎症因子水平及复发率、不良反应发生情况。结果治疗后,观察组患儿血清IL-6、TNF-α及hs-CRP水平、中医证候积分、复发率显著低于对照组(P<0.05),临床治疗总有效率明显高于对照组(P<0.05)。结论采用自拟健脾通窍汤治疗肺脾气虚型变应性鼻炎患儿可显著缓解患儿临床症状,降低炎症因子水平,提高临床疗效,且安全性好、复发率低,值得推荐。     

老年骨质疏松椎体压缩性骨折行经皮穿刺椎体成形术的护理体会

目的 探讨老年骨质疏松椎体压缩性骨折患者行椎体成形术的护理特点,以提高护理质量.方法 对芜湖市第一人民医院2009～2010年收治的老年骨质疏松椎体压缩性骨折患者行椎体成形术患者,术前实施有效心理护理及手术体位的训练.术后加强一般护理、并发症的护理及康复训练.结果 10例患者均安全完成手术,无并发症发生,10例患者均治愈、好转出院.结论 对于行椎体成形术的老年患者,有效、合适的护理对于增加手术疗效、预防并发症及早日康复有着重要意义.     

硫酸氢氯吡格雷在长期颈内静脉置管患者中的临床应用

目的探讨硫酸氢氯吡格雷在尿毒症长期颈内置管患者中的合理应用。方法分析尿毒症长期颈内静脉置管患者在服用与未服用硫酸氢氯吡格雷患者中出现的导管堵塞、静脉血栓形成中的差异。探讨其在临床中的应用。结果共20例患者平均年龄(56±10.2)岁,10例服用硫酸氢氯吡格雷治疗,10例未服用硫酸氢氯吡格雷治疗,服用硫酸氢氯吡格雷治疗者半年内未有导管堵塞、静脉血栓形成者,未服用硫酸氢氯吡格雷治疗者半年内出现导管堵塞者2例,静脉血栓形成者3例。结论硫酸氢氯吡格雷在尿毒症长期颈内静脉置管患者中预防导管堵塞、静脉血栓形成中有重要作用。     

245例门诊病人中药咨询调查与分析

随着生活水平的提高 ,人们的自我保健意识逐渐增强 ,对选择就医和用药越来越重视 ,更加看好中药的疗效和安全性。为了更好地为临床和病人服务 ,我院自 2 0 0 1年 9月开展了中西药物咨询工作。现就其中的 2 4 5例中药咨询进行分析。1　方　法自 2 0 0 1年 9月开始 ,我院在门诊候诊厅设立了药物咨询处 ,由 2名副主任药师、2名主管药师和 1名药师 (5人中有 3名执业药师 )轮流在此为患者提供药物咨询服务。从 2 0 0 1年 9月到 2 0 0 2年 6月底 ,共接受咨询 10 2 8人次。其中包括医务工作者的咨询 4 9人次 ,病人咨询 979人次。病人的咨询中包括2 …     

补肾调经颗粒治疗人工流产手术后月经过少临床观察

目的观察补肾调经颗粒治疗人工流产手术后月经过少的临床疗效。方法将人流术后月经过少患者60例随机分为两组,治疗组予补肾调经颗粒,对照组予八珍颗粒。结果治疗组临床疗效及子宫内膜厚度的改善均优于对照组。结论补肾调经颗粒治疗人流术后月经过少疗效较好,且安全可靠。     

113例70岁以上老年口腔颌面部肿瘤临床分析

为探讨老年头颈肿瘤患者的治疗特点,我们对1976年～1985年两院口腔科住院的138例70岁以上的113例口腔颌面部肿瘤患者的临床资料分析讨论。临床资料一、年龄70～75岁92例(81.4%),76～80岁16例(14.2%),80岁以上5例(4.4%)。二、性别男性73例,女性40例。男女之比为1.8:1. 三、良性11例,恶性102例,良恶之比0.11:1。四、肿瘤部位及病理分类鳞癌67例(口腔粘膜     

医学生临床实践教学中存在的问题及对策

临床实践是培养优秀医学人才的重要环节。文章通过临床实践带教工作，论述当前的临床实践工作存在一些问题，探讨提高临床实践教学的对策。     

右美托咪啶对冠心病患者非心脏手术期间的心肌保护效应

Objective To evaluate the myocardial protective effect of dexmedetomidine during non-cardiac surgery in patients with coronary heart disease.Methods Eighty ASAⅡor Ⅲ patients with coronary heat disease (NYHA Ⅱ or Ⅲ)aged 43-76 yr weighing 52-80 kg scheduled for elective upper abdominal surgery were randomly divided into 2 groups(n=40 each)：control group(group C)and dexmedetomidine group(group D).Anesthesia was induced with etomidate 0.25 mg／kg,sufentanil 0.5 μg／kg and vecuronium 0.1 mg／kg.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1μg/kg was injected intravenously 10 min before induction followed by infusion at 0.4 μg·kg-1·h-1 until the end of operation in group D.While equal volume of normal saline was given in group C.BIS was maintained at 40-49.Blood samples were taken before induction and at the end of operation for determination of serum concenlrations of IL-6,TNF-α,cardiac troponin Ⅰ(cTnI)and glycogen phosphorylase BB(GP-BB).The adverse cardiovascular events were recorded during operation.Results The serum concentrations of IL-6,TNF-α,cTnI and GP-BB and incidences of tachycardia and myocardial ischemia were significantly lower,while the incidences of bradycardia highcr in group D than in group C (P<0.05).Conclusion Dexmedetomidine Can exert the myocardial protective effect during non-cardiac surgery in patients with coronary heart disease and the mechanism may be related to the inhibition of the release of pro-inflammatory cytokines.