瑞芬太尼在老年人腹腔镜手术麻醉中的应用

目的观察瑞芬太尼复合静脉麻醉的效果，为老年患者临床应用提供依据。方法气管插管全身麻醉下腹腔镜老年患者胆囊切除手术60例，随机分为瑞芬太尼组（RF）、芬太尼组（F）；诱导用咪唑安定0．08mg·Kg^-1，丙泊酚1mg·Kg^-1，瑞芬太尼1ug·Kg^-1（RF组）或芬太尼4ug·Kg^-1（F组），阿曲库铵0．8mg·Kg^-1气管插管后接麻醉机行间隙正压通气，术中持续泵注瑞芬太尼0．3ug·Kg^-1·min^-1（RF组）或芬太尼0．04ug·Kg^-1·min^-1（F组）加丙泊酚（0．06-0．08）mg·Kg^-1·min^-1，阿曲库胺8ug·Kg^-1·min^-1，手术结束前10min停药。观察平均动脉压（MAP）、HR、自主呼吸恢复时间、呼之睁眼时间及拔管时间。结果插管后即刻和插管后5min两组间MAP、HR差异极为显著，RF组明显低于F组，术后恢复情况RF组患者呼吸恢复时间、呼之睁眼时间及拔管时间明显短于F组。结论瑞芬太尼复合静脉麻醉，用于老年患者腹腔镜手术效果优良，苏醒快，恢复好，但停药后很快感到疼痛，需提前予以镇痛。     

氯沙坦对脑缺血再灌注损伤大鼠血脑屏障通透性和MMP-9表达的影响

目的：观察血管紧张素Ⅱ受体阻断药氯沙坦对大鼠局灶性脑缺血再灌注损伤后血脑屏障通透性和基质金属蛋白酶-9（MMP-9）表达的影响。方法：采用血管内栓线阻断法制备大鼠局灶性脑缺血再灌注损伤模型, 于脑缺血2h、再灌注24h后测定脑组织含水量、伊文斯蓝（EB）含量, 免疫组织化学方法测定MMP 9表达。结果：脑缺血2h、再灌注24h, 大鼠脑组织含水量及EB含量增加, MMP-9呈现高表达。 而氯沙坦组脑组织含水量、 EB含量及MMP-9表达明显低于脑缺血再灌注组（P＜0.05）。 结论：氯沙坦通过降低脑缺血再灌注大鼠基质金属蛋白酶 9的活性及血脑屏障通透性, 从而发挥其脑缺血再灌注损伤的保护作用。     

分娩体位对分娩影响的临床观察

目的探讨孕妇采用不同体位分娩的临床效果。方法将符合入选条件的160例初产妇按其分娩时采用的体位分为A组（对照组）和B组（观察组）各80例，观察并比较两组宫缩乏力、胎位不正及非医疗干预分娩的情况，观察并比较两组中非医疗干预分娩的产程。结果观察组中宫缩乏力、胎位不正发生率均明显低于对照组（依次p〈0．01、p〈0．02），非医疗干预分娩率明显高于对照组p〈0．01，非医疗干预分娩的总产程及第一、二产程明显短于对照组p〈0．01，第三产程无显著性差异p〉0．05。结论采用观察组的体位分娩能缩短产程，降低分娩时胎位不正及宫缩乏力的发生率，提高非医疗干预分娩率。     

非霍奇金淋巴瘤组织中Survivin的表达及细胞凋亡检测

目的:检测非霍奇金淋巴瘤组织中Survivin的表达及肿瘤细胞凋亡情况.方法:应用免疫组化S-P法观察50例非霍奇金淋巴瘤和30例淋巴结炎性病变组织中Survivin的表达水平,应用TUNEL检测上述组织中细胞凋亡情况,并分析2者间的关系.结果:淋巴结炎、B细胞淋巴瘤组和T细胞淋巴瘤组中Survivin阳性表达率分别为:46.67%、73.33%、85.00%,差异有统计学意义(P＜0.05);在Survivin阳性表达B、T细胞淋巴瘤组织中,细胞凋亡指数分别是0.73±0.45和0.85±0.37,明显低于Survivin阴性表达的细胞凋亡指数(1.60±0.48和1.48±0.39).结论:在非霍奇金淋巴瘤的发生发展过程中Survivin表达引起的凋亡抑制可能有一定的作用,可作为淋巴结炎与B、T细胞淋巴瘤鉴别诊断的参考指标.     

Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging

Background Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD) may be associated with myocardial ischaemia. The clinical outcome in patients with surgical treatment for symptomatic myocardial bridging remains undetermined. This study assessed the middle- and long-term results of surgical treatment for symptomatic myocardial bridging. Methods From 1997 to 2006, 37 463 patients received selective coronary angiography in the Fuwai Cardiovascular Hospital, Beijing, China. Of these, 484 patients had angiographic diagnosis of myocardial bridging. Of the 484 patients, 35 underwent surgery for treatment of myocardial bridging with significant systolic arterial compression. Among the surgical treatment patients, 24 presented with other cardiac disorders, and the remaining 11 symptomatic patients with isolated myocardial bridging were included in the follow-up study. Results The angiographic prevalence of myocardial bridging was 1.3% in this study. The coronary angiographies of the 11 patients revealed myocardial bridging in the middle segment of LAD causing systolic compression ≥75% (ranging from 75% to 90%). The mean age of patients was 48.4 years. Surgical myotomy was performed in 3 patients and coronary artery bypass grafting (CABG) in 8 patients. Eight patients were operated on with an off-pump approach and 3 with a cardiopulmonary bypass technique after median sternotomy. Conversion to on-pump CABG surgery was necessary in 1 patient because of perforation of the right ventricle. The left internal mammary artery was used in all patients with CABG. The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death or other major in-hospital complications. All of the patients were followed up clinically. The median follow-up was 35.3 months (range: 6 to 120 months). Nine patients were free from symptoms and one of them continued taking beta blockers. The remaining 2 patients with myotomy had atypical chest pain. One received coronary angiography again and no stenosis was found two years after operation; while exercise testing was performed in the other patient and revealed no evidence of myocardial ischaemia. None of the patients sustained a myocardial infarction or other major adverse cardiac events (death or vessel revascularization) during follow-up.Conclusions Myocardial bridging is a relatively common angiographic finding. Surgical myotomy or CABG should be limited to patients who are refractory to oral medication. Surgical relief of myocardial ischaemia due to systolic compression of intramyocardial coronary arteries can be accomplished with low operative risk and excellent middle- and long-term results.     

Randomized controlled trial of the absorbency of four dressings and their effects on the evaporation of burn wounds

Background Wound dressings are divided into traditional and new types. The new dressings are thought to accelerate wound healing. The purpose of this study was to supplement the scanty data on the absorbency of the new dressings and their effects on evaporation from the burn surface. Methods The water absorption rate of four dressings (carbon fiber dressing, hydrogel dressing, silver nanoparticle dressing, and vaseline gauze) were measured by the immersion-weight gain method. A total of 120 inpatients with 10% superficial partial-thickness burn wounds were randomly assigned to four groups, each with 30 participants. Carbon fiber dressing, hydrogel dressing, and silver nanoparticle dressing were used in groups A, B, and C as the primary dressing, and traditional vaseline gauze was used in group D as the control. Multi-spot evaporation from normal skin and naked wound, and from wounds covered with each of the four dressings was measured post-burn on days 1, 3, 5, and 7 by an EP-I evaporimeter under conditions of 21ºC –22ºC ambient temperature and 74%–78% humidity. Results The absorption rates of the four dressings were 988% with carbon fiber dressing, 96% with silver nanoparticle, 41% with vaseline gauze, and 6% with hydrogel. Evaporation from the naked burn wounds was about 1/3 higher than from normal skin (P<0.01). Compared with wounds without applied dressing, evaporation from dressed wounds decreased and was time-dependent (P<0.01). The evaporation of wounds with carbon fiber dressing was the lowest ((13.40 ± 2.82) ml∙h(-1)∙m(-2), P<0.01) on day 1 post-burn, compared with the other groups. Conclusion All four dressings have water retention capacity while carbon fiber dressing has the highest absorption rate and shows the best containment and evaporation from the burn wound.     

Osteopontin gene polymorphism in association with systemic lupus erythematosus in Chinese patients

Background Osteopontin (OPN) is one kind of cytokine which can play a number of roles in promoting activation of T lymphocyte, regulating balance between Th1 and Th2, participating in cell-induced immunologic response and stimulating B lymphocyte to express multi-clone antibodies. Some researches have showed that OPN may be involved in the pathogenesis of systemic lupus erythematosus (SLE). The aim of this study was to investigate possible association of a single nucleotide polymorphism（SNP）at position 9250 in exon 7 of the OPN gene (OPN gene 9250) with SLE in Chinese patients.Methods Totally 158 patients (18 males and 140 females) fulfilled the revised criteria for SLE by the American College of Rheumatology in 1982 and 180 healthy volunteer controls (34 males and 146 females), all from the south of China, consented to participate in the study. OPN gene 9250 polymorphism was detected by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).Results The frequency of TT genotype of the OPN gene 9250 was significantly lower (52.5% vs 70%, P<0.05) and the frequency of TC genotype of the OPN gene 9250 was significantly higher (43.7% vs 29.4%, P<0.05) in SLE patients than in controls. There were significant differences in OPN gene 9250 allele and phenotype frequencies between the SLE patients and controls (P<0.05). When the SLE patients and controls were separated into men and women, significant differences of frequencies were noted in TT genotype, TC genotype and allele of the OPN gene 9250 in women (P<0.05) but not in men (P>0.05). Conclusions OPN gene 9250 polymorphism appears to be associated with susceptibility to SLE in Chinese Han ethnic population.     

妊娠期肝病的诊断与治疗进展

妊娠期肝病约占妊娠的3％，对母婴危害较大。正确判断孕周和发病时期对疾病的种类作出正确的诊断，是最重要的治疗措施。[第一段]     

大学英语词汇教学探索

本文着重强调词汇在大学英语教学中的重要性,探讨了大学英语词汇教学的内容及核心,并且根据自己的教学实践,阐述了有效的词汇教学方法不仅能极大促进学生对词汇的记忆和掌握,同时还有助于提高学生其他方面的能力.