重症瓣膜置换术的麻醉处理

本文总结了60例重症瓣膜置换术的麻醉处理，提出了重症病例的判断标准，讨论了急诊瓣膜置换的指征，认为加强术前心肌氧供需平衡的调节和治疗，术中加强心肌保护，心脏复跳后并发症的处理及血管活性药物的正确使用是手术成功的重要保证。     

百为坦(氯雷他定)致过敏性反应1例

百为坦主要成分为氯雷他定,可选择性地拮抗外周组织胺H1受体,主治过敏性鼻炎、荨麻疹,临床应用中引起过敏性反应少见。患者,男,28岁,因过敏性鼻炎来我院就诊。给予百为坦(三门峡赛诺维制药有限公司生产,批号20041003)10mg,qd,po;呋麻液,滴鼻,tid。两天后,病人出现面色潮红,四肢、胸部、腹部可见红斑,并融合成片,伴有全身瘙痒等症,来院就诊。因以前滴用呋麻液无不良反应,在服药期间饮食与平时无异,确诊为百为坦过敏。嘱立即停用百为坦,给予肌内注射苯海拉明20mg,静脉注射地塞米松10mg加生理盐水20ml,qd。三天后红斑基本消退,改口服马来酸氯…     

蚯蚓液外涂治疗带状疱疹15例

笔者于2004年8月-2006年10月间，采用自制蚯蚓液外涂治疗带状疱疹15例，疗效满意，现报道如下。 1临床资料 15例均为门诊带状疱疹患者，男6例，女9例；年龄最小23岁，最大68岁，平均43岁；病程最短1d，最长15d；发于腰部10例，胸部3例，背部2例。     

龙葵碱体外诱导人结肠癌SW480细胞凋亡及其对相关因子的影响

  目的：观察龙葵碱对人结肠癌SW480细胞凋亡及ERK/MEK、PI3K/AKT信号通路中相关因子的影响。  方法：SW480结肠癌细胞培养后共设5组,分别为空白对照组、培养液对照组及龙葵碱不同剂量(4、8、16 mmol/L)组,各组进行相应干预。采用MTT法检测龙葵碱对结肠癌细胞株的增殖作用,流式细胞法检测龙葵碱对结肠癌细胞凋亡的影响,RT-PCR及Western blotting法检测龙葵碱处理的SW480细胞中ERK/MEK和PI3K/AKT的表达水平。  结果：MTT生长曲线显示,龙葵碱能抑制结肠癌SW480细胞株增殖。流式细胞仪检测显示,龙葵碱能够促进SW480的凋亡。RT-PCR结果显示,龙葵碱可以抑制ERK1/2 mRNA的表达。Western blotting结果表明,龙葵碱可以降低MEK/ERK和PI3K/AKT信号通路中相关蛋白的表达。  结论：龙葵碱可以抑制结肠癌细胞增殖,其对肿瘤的诱导凋亡作用可能是通过MEK/ERK和PI3K/AKT信号途径实现的。     

患者耐受喉罩或气管导管时七氟烷的麻醉深度

Objective To compare the effects of patient's tolerance to laryngeal mask airway (LMA) and tracheal tube (TT) on the appropriate level of sevoflurane anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients aged 30-60 yr weighing 50-70 kg undergoing elective thyroid or breast surgery were randomly divided into 2 groups (n=40 each):LMA group and TT group.Anesthesia wag induced with propofol 1.6mg/kg,fentanyl 3μg/kg and recuronium 0.6mg/kg.LMA or tracheal tube was inserted,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of 1.5%-3.0% sevoflurane and 50% N2O in O2 in group LMA,and with 2.5%-5.0% sevoflurane and 50% N2O in O2 in group TT.The flow of O2 and N2O was 0.7-1.0L/min,and the concentration of sevofluranee was adjusted to maintain AAI at 15-25.ECG,HR,MAP,SpO2,PETCO2,AEP and end-tidal sevoflurane concentration were continuonsly monitored.The end-tidal sevoflurane concentration was recorded at 1,5 and 10 min after LMA/TT was placed (T1-3),at 1h after skin incision (T4) and at the end of operation before removal of LMA or extubation (T5).The recovery time of consciousness,adverse cardiovascular events and adverse reactions were recorded.Results The end-tidal sevoflurane concentration was significantly lower,the recovery time of consciousness and removal of LMA or extubation time were shorter,and the incidence of adverse cardiovascular events and adverse reactions was lower in LMA group than in TT group.Conclusion At the same depth of anesthesia (AAI 15-25),sevoflurane concentration is significantly lower in LMA group than in TT group,with fewer complications and smaller cardiovascular reaction.