异丙酚静脉全麻复合硬膜外腔阻滞麻醉期间CO2气腹对血流动力学和氧耗的影响

OBJECTIVE: To investigate the effects of intraperitoneal CO2 insufflation on the hemodynamics, oxygen consumption (VO2) and carbon dioxide production (VCO2) during intravenous anesthesia with propofol in combination with epidural block. METHODS: Intratracheal intubation was performed after rapid induction of anesthesia and mechanical ventilation was given. Maintenance of anesthesia was achieved using continuous intravenous propofol infusion (2 mg/kg/h) ?N2O inhalation and intermittent epidural administration. Indices of hemodynamics and respiratory function were collected 5 min before induction, 1 min before CO2 insufflation, and 5, 10, 20, 30, 40, 50, 60 min after the start of insufflation and 5 min after the termination of insufflation. RESULTS: The mean arterial pressure (MAP), heart rate (HR), end-tidal PCO2 (P(ET)CO2), VO2 and VCO2 1 min before insufflation were markedly reduced(P<0.01), compared with those recorded before induction. MAP and HR did not undergo any conspicuous changes during CO2 insufflation and 5 min after insufflation termination. Compared with that 1 min before insufflation, PETCO2 was significantly increased 20 min after the start of insufflation (P<0.01), and subsequently carried on the increase though of a lesser scale. VO2 and VCO2 gradually rose after the start of insufflation, and VO2 presented a significantly elevation (P<0.01) 10 min after the insufflation while VCO2 did not show this marked increase(P<0.05) till 20 min after the insufflation in comparison with the levels before insufflation. Subsequently, VO2 continued to rise and VCO2 also retained the increase but of smaller magnitude. CONCLUSION: Intravenous propofol anesthesia combined with epidural block assisted by well-managed excessive ventilation before insufflation can alleviate the adverse effects of CO2 insufflation on respiratory and circulatory systems.     

慢性老年精神分裂症患者认知功能及其与日常生活能力的比较研究

目的 :了解慢性老年精神分裂症患者认知功能和日常生活能力状况 ,探讨此类患者在额叶执行功能和记忆方面的神经心理功能障碍及其特征。方法 :采用简易智力状态检查 (MMSE)、日常生活能力量表 (ADL)、威斯康星卡片分类测验 (WCST)及韦氏记忆量表 (WMS)对 31例慢性老年精神分裂症和 31例正常对照组进行比较研究。结果 :慢性老年精神分裂症组MMSE得分明显低于正常对照组 (P <0 .0 1) ;而该组ADL总分明显高于正常对照组(P <0 .0 5 )。除非持续错误外 ,慢性老年精神分裂症患者的威斯康星卡片分类测验和韦氏记忆量表的各项测验成绩均差于对照组 (P <0 .0 5 )。结论 :慢性老年精神分裂症患者认知功能的障碍决定了患者日常生活能力的减退 ;这类患者有明显的额叶执行功能障碍和记忆障碍     

单能量X线测定骨密度的初步分析

目的：了解温州地区人群不同年龄组骨质疏松患病率及同年龄组男女骨质疏松患病的差异，强调早期预防治疗老年人及绝经期妇女骨质疏松的重要性，方法：应用单能量X线（SXA）骨密度仪测量246例正常人的右跟骨骨密度，结果：男性大于60岁组较小于60岁组骨密度（BMD）降低明显（P＜0．05）；女性50岁以上组与小于50岁组相比，BMD下降差异有极显性（P＜0．01）；各年龄组男女相比，男性BMD明显高于女性（P＜0．05）。结论：女性骨质疏松症的发病大多以绝经后为主，雌激素在维持骨量方面具有重要的作用。SXA检测的跟骨含95％小梁骨，能较好地确定骨质疏松的风险水平，且其具有价廉、简便，快捷，较准确等特点，故不失为一种较好的临床筛查手段。     

从文体学角度鉴赏《礼物》一文

大学英语第一册第三课《礼物》是一篇故事短文 ,文中语言简单 ,词汇量少。学生能够在没有教师的指导下掌握文章的主要内容 ,但这并不意味着读懂该篇文章。对文本作深层的理解 ,掌握作者的写作目的 ,是大学英语精读的学习目的和要求。如何帮助学生达到对文本的真正的理解 ,这是一个一直来值得我们研究的问题。针对该文的简洁语体 ,笔者试着从文体学角度进行分析 ,在实际教学过程中 ,取得了较好的效果。在一定程度上提高了学生语篇理解和鉴赏能力。笔者试从文体语言、文体结构和修辞手段三方面分析该文的文体结构。1　文体语言1 .1　故事叙述…     

保留肾单位手术治疗早期小肾癌21例临床分析

OBJECTIVE: To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma. METHODS: Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0 cm, with a mean of 2.8 cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4 cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T(1), 4 in stage T(2), and 1 in stage T(3). Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection. RESULTS: All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients. CONCLUSION: As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4 cm in T(1) and T(2) stages of localized unilateral tumor with normal contralateral kidney.     

建立一种新的多药耐药的诱导方法

目的建立裸鼠原位肝癌耐药模型。方法培养肝癌细胞系HepG2,建立裸鼠的皮下肿瘤,形成“供瘤鼠”。开腹直视下将瘤块种植于裸鼠的肝包膜下建立原位肝癌模型,通过表阿霉素间歇腹腔化疗,建立裸鼠原位肝癌耐药模型。用体检、B超、CT、剖腹探查监测肝内瘤块生长情况。用逆转录聚和酶链反应(RT-PCR)和免疫组织化学方法检测肿瘤耐药基因mdrl-mRNA和p-gp蛋白的表达。结果(1)模型建立无手术死亡(0/25),种植成瘤率为88%(22/25),补种3例全部成功,耐药诱导成功率为80%(16/20);(2)诱导组mdrl-mRNA和P-gp蛋白的表达均明显高于对照组,分别约是对照组的23倍和13倍。结论成功地建立了与临床肝癌相似的裸鼠原位肝癌耐药模型,为进一步研究肝癌多药耐药基因的诊断和逆转提供了良好的动物平台。     

矢状窦旁巨大脑膜瘤显微手术26例

[目的]探讨上矢状窦旁巨大脑膜循的显做手术设计与中央静脉、上矢状窭的处理方法，[方法]26例矢状窦旁巨大脑膜瘤经充分的术前准备、没汁手术方案，行显做手术全切或次全切除术．同时对受累的中央静脉、上矢状窦、硬脑膜及颅骨均做了相应处理。[结果]手术切除肿瘤达到SimpsonⅠ级15例，SirepsonⅡ级9例，SimpsonⅢ级2例。遗留颅骨缺损6例。术后双下肢瘫痪（肌力Ⅰ～Ⅱ级）4例，经高压氧治疗1～3个月后均恢复正常。[结沦]术前通过脑血管造影（DSA）技运动区功能磁共振（fMRI）检查设计详尽的手术方案，采用显做外科技术切除上矢状窦旁巨大脑膜瘤并妥善处理受累的中央静脉、上矢状窦对病人预后至关重要。     

硬膜外镇痛分娩法的临床观察

随着医学科学的发展,人们生活水平的提高，人们一直在寻找一种安全有效的分娩镇痛方法，以减轻分娩的痛苦。我科自2005年开展硬膜外镇痛术，取得了良好的效果，现报告如下。     

多层螺旋CT胸部低剂量扫描对气道三维重建的应用研究

目的:比较低剂量与常规剂量条件下中央气道三维重建图像的差别,探讨低剂量螺旋CT扫描进行中央气道三维重建的可行性。材料和方法:32例病例行低剂量(50mAs)平扫及常规剂量(195mAs)平扫(1例)及增强扫描(31例),将两组原始数据分别普通算法及高分辨算法重叠重建出4组横断面图像,并进行气道SSD及VR重建,由两名放射科医师分析4组图像的质量、支气管显示情况、支气管病变检出情况,将结果进行统计学分析。结果:①图像质量:两组剂量间SSD图像质量无明显差异,高分辨重建图像质量≥普通算法重建图像质量;VR图像质量两种剂量之间无明显差异,高分辨算法图像质量≥标准算法重建图像质量。②支气管显示:两名医生评价结果均表明对段以上支气管显示方面无论SSD图像还是VR图像,低剂量与常规剂量组以及两种算法图像之间均无明显差异。③病变检出:无论SSD还是VR图像4组图像对支气管病变的检出无差异。④剂量差别:低剂量扫描比常规剂量扫描辐射剂量大大降低(13.6～3.6mGy)。结论:与常规剂量扫描相比,低剂量薄层扫描气道三维重建图像质量、对中央气道显示及病变检出都无明显差异,而病人接受的辐射剂量却大大降低,因此低剂量薄层扫描气道三维重建可以代替常规剂量重建图像应用于临床气道病变显示。     

恶性肿瘤并发皮肤瘙痒症5例临床分析

作者认为恶性肿瘤引起的瘙痒有二种特点:(1)患者难以忍受;(2)抗组织胺药物无效。