硬膜外复合吸入全麻用于肝叶切除3 858例总结

目的：考察硬膜外复合吸入全麻用于肝叶切除手术的优缺点，以探讨较为理想的肝脏手术麻醉方法。方法：比较硬膜外复合吸入全身麻醉（n=3858)，单纯硬膜外麻醉（n=100)及单纯全麻（n=100)患者行肝叶切除术中生命体征，麻醉药用量及术后苏醒情况的差异。结果：硬膜外复合全麻组在诱导期对心率，血压影响较大，但一定量的麻黄素即可纠正，该法可明显减少阿曲库铵，芬太尼及吸入麻醉药的用量，硬膜外复合全麻组早期清醒拔管，很少发生烦躁，术后较长时间内无切口痛，结论：持续硬膜外复合吸入全麻用于肝吸切除手术优于单纯硬膜外麻醉及单 纯全麻，是肝脏手术麻醉比较理想的方法。     

高渗氯化钠羟乙基淀粉40注射液高容量血液稀释对大鼠肝脏缺血再灌注损伤的影响

Objective To investigate the effects of hypervolemic hemodilution (HH) with hypertonic saline plus hetastarch solution 40 injectio on hepatic ischemia-reperfusion (I/R) injury in rats. Methods Thirty male Wistar rats weighing 300-350 g were randomly divided into 3 groups ( n = 10 each): group I sham operation (group S); group II I/R and group Ⅲ HH. Partial liver ischemia was produced by clamping hepatic portal vein and left arteria hepatica for 30 min with atraumatic mini-clamp, followed by 2 h of reperfusion in I/R group and HH group. In HH group the animals were infused hypertonic saline plus hetastarch solution 40 injectio 10 ml/kg through vena caudalis over 30 min and then hepatic I/R was performed IS min after the infusion.The animals were killed at 2 h of reperfusion. The left liver was removed and blood sample was taken from inferior caval vein for determination of (1) serum alanine amino transferase (ALT) and aspartate amino transferase (AST) activities; (2) superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content in the liver; ( 3 ) microscopic examination. Results The serum ALT and AST activities and MDA content in the liver were significantly higher, SOD activity in the liver significantly lower after hepatic I/R and pathological changes in the liver severer in group I/R and HH than in group S. The serum ALT and AST activities and MDA content in the liver were significantly lower, SOD activity in the liver significantly higher after hepatic I/R and pathological changes in the liver milder in group HH than in group I/R. Conclusion Hypervolemic hemodilution with hypertonic saline plus hetastarch solution 40 injectio can ameliorate hepatic I/R injury by decreasing oxygen free radical production in rats.     

6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.     

紫外-原子吸收法检测动物组织中的络结合物

铬是一种常见的环境污染毒物 ,铬主要通过呼吸道和皮肤进入机体 ,主要对肝、肾组织造成损害 ,而 6价铬的毒性高于 3价铬。肝肾组织中存在一种与铬特异性结合 ,分子量约为 150 0D的低分子铬结合物 (Lowmolecularweightchromiumbindingsubstance ,LMCr) 〔1〕。为研究生物标志物铬化合物在肝、肾组织中的存在形式及对肝、肾组织的损害作用 ,我们进行了实验研究。现将结果报告如下。1　材料与方法1 1　动物分组　健康雄性Wistar大鼠 (由中南大学动物学部提供 ) 50只 ,体重 (2 60± 2 0 ) g ,随机方法分为对照组和铬染毒组 ,每组 2 5只。1 2…     

对两种排班方法效果的应用研究

合理排班是提高工作效率的有效方法之一，也是护理管理研究的目标之一，我院内一科在2005年-2007年先后施行了两种排班方法，取得了明显效果，现将其介绍如下。1资料与方法1．1资料我院为二级甲等医院，内一科主要收治神经系统，呼吸系统、心血管系统、内分泌系统疾病及儿科病人，平均病人数为25例～35例；护士长1人，护士9人；其中主管护师1人，护师5人，护士4人，年龄为20岁～40岁。     

口腔门诊护理绩效考核管理的体会

总结了口腔门诊护理绩效考核管理的经验,包括成立绩效考核领导小组,绩效考核与分配的方法,考核标准。认为在口腔门诊护理管理中实施绩效管理,能提高病人的满意度,激发护理人员的工作热情和情绪。     

小剂量泼尼松联合加巴喷丁治疗带状疱疹急性期疼痛临床研究

带状疱疹(herpes zoster)是一种皮肤科常见疾病,发病常伴有不同程度神经痛.本研究以小剂量泼尼松和加巴喷丁治疗带状疱疹急性期疼痛,评价疼痛缓解效果. 1 资料与方法 1.1 病例选择 2011年8月至2012年6月本院门诊或住院患者84例,男47例,女37例,年龄28~81岁,平均(50.7±14.2)岁,入选标准:①符合带状疱疹诊断;②发病7天内(以出现皮疹或疼痛为始),未接受任何治疗;③年龄＞18岁;④患者具有自我认知能力,能提供可靠信息.排除标准:①已知对治疗药物过敏者;②合并消化道溃疡、重度糖尿病、严重心脑血管等疾病者;③精神病或老年痴呆患者;④未能完成治疗观察者.     

PVP治疗合并COPD的胸腰椎压缩性骨折患者术后肺功能改善的研究

目的研究经皮椎体成形术(PVP)治疗慢性阻塞性肺疾病(COPD)合并骨质疏松性单节段胸腰椎压缩性骨折患者肺功能变化。方法对38例COPD合并单节段骨质疏松性胸腰椎压缩性骨折患者进行了椎体成形术,分别测量术前及术后1周、3月及12个月后患者肺功能、VAS评分及活动能力评分,统计分析患者术前、术后的变化。结果 PVP术后患者VAS评分及活动能力评分降低,术后1周显著降低,并且随着时间推移评分逐渐降低。患者手术前后肺活量(VC)、用力肺活量(FVC)、第一秒钟用力呼气容积(FEV1)及最大分钟通气量(MVV)间差异存在显著性(P<0.05)。术前及术后VAS评分与活动能力评分改善值之间,VAS评分与各肺功能指标改善值之间存在显著正相关性(P<0.05)。结论 PVP术后COPD的单节段骨质疏松性胸腰压缩性骨折患者疼痛明显缓解,活动能力及肺功能得到改善。     

乌司他丁对大鼠肝脏缺血再灌注损伤后炎性反应的影响

目的:探讨乌司他丁(ulinastatin,UTI)预处理对大鼠肝脏缺血再灌注(ischemia reperfusion,IR)损伤后炎性反应的影响,并研究高迁移率蛋白B1(high mobility group box 1,HMGB1)在UTI预处理机制中的作用。方法:采用SD大鼠70%肝脏IR损伤模型,即在肝脏缺血45min后再灌注2h。将40只大鼠随机为4组,分别为0.9%氯化钠对照组(对照组,n=10)、UTI预处理组(UTI组,n=10)、UTI+HMGB1拮抗剂组(UTI+Anti-HMGB1组,n=10)和乌司他丁+HMGB1诱导剂组(UTI+rHMGB1组,n=10)。比较各组大鼠在IR后血清中丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)的水平;采用酶联免疫吸附试验检测各组大鼠血清中肿瘤坏死因子α(tumornecrosis factor-alpha,TNFα)和白细胞介素1(interleukin 1,IL1)的水平;对各组大鼠的肝组织进行HE染色观察其病理学改变;采用免疫组织化学染色方法检测各组大鼠肝组织中HMGB1蛋白的表达水平。结果:与对照组相比,UTI组在IR后血清中ALT、AST均显著降低(P<0.05)。UTI+rHMGB1组IR后血清TNFα、IL1水平与对照组相比无显著差异(P>0.05);UTI组和UTI+Anti-HMGB1组IR后血清TNFα、IL1水平与对照组相比均显著降低(P<0.05)。肝组织病理显示,UTI组和UTI+Anti-HMGB1组的肝细胞坏死和中性粒细胞浸润显著轻于对照组和UTI+rHMGB1组。免疫组织化学染色显示,UTI组和UTI+Anti-HMGB1组肝细胞HMGB1表达程度显著低于对照组(P<0.05)。结论:UTI预处理可以显著抑制大鼠肝IR损伤后肝细胞中HMGB1的表达水平以及下游炎症因子的水平,从而减轻IR损伤;HMGB1诱导剂可逆转UTI的肝保护作用。     

颈椎间盘射频热凝消融术联合医用三氧注射治疗颈性眩晕

目的评价颈椎间盘射频热凝靶点消融术联合医用三氧注射治疗颈性眩晕的疗效。方法颈性眩晕患者33例,在C型臂引导下经皮穿刺至椎间盘靶点,先行射频热凝靶点消融术,每个靶点分别从70、80、90℃各热凝1次,每次60S,然后90℃再治疗120s。然后每个椎间盘注射60μg／ml的三氧气体4～10ml。术后1周、1个月、1年时采用视觉模拟评分法（VAS）及改良MacNab法进行疗效评价。结果术后1年内VAS评分与术前比较差异有统计学意义（P〈0．05）。术后1周、1个月与1年时优良率比较差异无统计学意义（P〉0．05）。结论射频热凝靶点消融术联合医用三氧注射治疗颈性眩晕,是一种安全、有效和微创的治疗方法。