上腹器官簇移植术实验中血流动力学及血生化的变化

目的:观察上腹器官簇移植术实验中血流动力学及血生化变化。方法:杂种猪32只。随机分为供体组和受体组,无肝期行体外静脉转流。测定术中的血流动力学和血生化指标。结果:(1)术中血流动力学在无肝期初期及开放后早期时间内有明显的波动,心输出量、血压、肺动脉压和肺毛细血管楔压下降,心率加快;(2)转流在一定程度上稳定血流动力学;(3)生化变化:开放前行肝冲洗的8例,血钾仅轻度升高;未作冲洗的6例,则血钾明显升高;(4)开放后均有不同程度的代谢性酸中毒。结论:上腹器官簇移植术,机体血流动力学及血生化均有改变,特别是在肝移植阶段明显。其它器官移植期处理也应考虑肝移植后续作用的影响。     

16例胸膜间皮瘤临床分析

１６例胸膜间皮瘤，其中１例有石棉接触史，占６．１７％；＞４０岁者占８１．５％。主要临床表现为胸痛、气短、咳嗽、低热和胸腔积液，临床上易误诊为结核性胸膜炎、肺癌胸膜转移等。胸部ｘ线检查及胸部ＣＴ对该病的诊断有帮助，大都有特征性表现。确诊靠针刺胸膜活检及开胸活检。胸膜间皮瘤的治疗主要采用手术、放疗和化疗，对于局限型治疗首选手术切除。肿瘤的良、恶性、疾病的分期及治疗与预后有一定关系。     

类风湿因子IgM-RF、IgG-RF和IgA-RF的临床意义分析

目的　探讨 3种类风湿因子 (RF)诊断类风湿关节炎 (RA)、反映病情活动度和疗效的临床意义。方法对关节痛 /关节炎 (A组 )、确诊的RA (B组 )、其它免疫结缔组织病 (C组 )患者和正常人 (D组 )共 6 18例用酶联免疫法进行 3种RF的动态检测并随访观察。结果　 4组人群中 3种RF的阳性率和浓度以B组最高 [IgM RF为 92 4 % ,(182 5± 5 1 4 )IU/ml;IgG RF为 6 7 8% ,(2 2 9 7± 75 6 )IU/ml;IgA RF为 78 8% ,(2 35 8± 80 7)IU/ml],组间比较依次为B组 >A组 >C和D组 (均为P <0 0 5 )。B组中高活动期RA患者的 3种RF浓度明显高于其它 3组 (P <0 0 5 ) ,IgM RF和IgA RF在稳定期和低活动期较高活动期均明显降低 (均为P <0 0 5 ) ,而IgG RF变化无显著性。随访 3～ 18个月 ,A组中最后确诊为RA的比率以 3种RF同时阳性者最高 (10 0 0 % ) ,2种RF同时阳性者次之(90 9%～ 93 3% ) ,以单一RF作比较则IgG RF >IgA RF >IgM RF阳性者。结论　早期诊断RA以IgM RF的敏感性最高 ,以IgG RF的特异性最高 ,任何 2种以上RF阳性可提高RA诊断的可靠性 ,RF浓度可作为判断RA活动度及药物治疗效果的指标之一。     

Risk factors of acute pancreatitis]

A total of 689 operative cases of acute necrotic pancreatitis (ANP) were collected from 42 hospitals all over the country by the ANP Cooperative Study Group in the years of 1987 to 1989. General data, laboratory findings, pathology of the pancreas and the type of surgical treatment were analysed according to the outcome of the patient. The results showed that 37% of the cases were related to cholelithiasis, the highest incidence was in age above 60, and female patients were predominant and with higher mortality. Laboratory findings at admission, WBC greater than 20,000/mm3, Hb greater than 15 g%, blood sugar greater than 200 mg%, serum bilirubin greater than 5 mg%, BUN greater than 20 mg%, and serum calcium less than 7 mg% were related to the markedly elevated mortality rate. Operative findings noted in patients with bloody or cloudy peritoneal fluid, necrotic changes up to 75% of the pancreas, more than 2 areas of extrapancreatic involvements and resection of a large portion of the pancreas was found to be necessary were all related to a higher mortality. And emergency operations performed within 24 hours after the onset of the disease was also related with a highest mortality rate.     

Laparoscopic nephrectomy in a porcine model.

Laparoscopic nephrectomy was performed in 15 male pigs, the procedure was successful in 14. Extraction of the intact kidney through a 5-cm lower abdomen incision was done in 7 animals; complete destruction and evacuation of the kidney was accomplished by a round-knife suction device through a 1-cm port in another 7 pigs. Grossly, the specimen consisted of sausage-like tubular renal tissue and a small amount of tissue debris. Pathology revealed that the glomerular and tubular structures were well preserved, no interstitial hematoma could be found. Four ports were usually used, one 1-cm umbilical camera port, one 0.5-cm port for ureter traction, and two 1-cm working ports along the midclavicular line. All the pigs recovered uneventfully. The average operation time was 3 h 20 min. The application of endo-GIA (United States Surgical Corporation) for renal hilum reduced the operative time to 2 h 20 min. Complications included renal vein tear during endoclip application and cutting in the first case, mild subcutaneous emphysema in 2 cases. This first pig received exploratory laparotomy for the repair and ligation of the renal vein. No more major complications occurred with increasing experience. From this porcine experiment, we conclude that the combination of laparoscopy, a tissue destroyer and an endobag for the entrapment of kidney seem to be a promising technique for clinical nephrectomy.     

Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia

PURPOSE: During clinical monitoring, vecuronium appeared to reduce the rapidly extracted auditory evoked potentials index (A-line ARX index or AAI) to some extent. A prospective and randomized study was designed to analyze this phenomenon. METHODS: Forty adult patients undergoing elective surgery were studied. After tracheal intubation, anesthesia was maintained with an end-tidal isoflurane concentration (F(ET)ISO) of 1.0% for 20 min, then a 10-mL dose of either vecuronium 0.05 mg*kg(-1), 0.1 mg*kg(-1), 0.2 mg*kg(-1) or saline was administered in a randomized, double-blind design. The AAI and bispectral index (BI(hx)) were monitored throughout the study and analyzed off-line. RESULTS: BI(hx) was unaltered after the administration of saline or vecuronium. The mean of the averaged (per patient) AAI values recorded from two minutes to ten minutes after the administration of saline or vecuronium 0.05 mg*kg(-1) did not differ significantly from the corresponding mean recorded from 15 min to 20 min after F(ET)ISO maintained 1.0% (P = 0.678, 0.169), however after the administration of vecuronium 0.1 mg*kg(-1) or 0.2 mg*kg(-1), AAI was reduced from 18.3, 18.0 to 14.8, 13.4 (P = 0.016, 0.017). CONCLUSIONS: Neuromuscular block with vecuronium reduces AAI in patients during steady state anesthesia without surgical stimuli, while BI(hx) is unaltered. The cut-off values of AAI for events should be determined according to the level of neuromuscular blockade when monitoring the depth of anesthesia/sedation.     

梅花髓内针和交锁髓内钉治疗股骨干骨折的比较

目的 :比较梅花髓内针和交锁髓内钉治疗股骨干骨折的疗效。方法 :采用梅花针和交锁髓内钉内固定治疗股骨干骨折共 70例 ,比较两组的固定方法、术后处理、愈合时间、肢体与关节功能恢复情况、适应症的选择以及交锁髓内钉的应用体会。结果 :随访 10月～ 2 4月 ,骨折全部愈合 ,梅花针组 4 7例 ,平均愈合时间 7.5个月 ;交锁髓内钉组平均愈合时间 6 .5个月。肢体关节功能恢复 :梅花针组术后肢体成角畸形 15°2例 ,占 4 % ;膝关节活动 <70°3例 ,占 6 %。交锁髓内钉组 ,无成角畸形 ,膝关节活动均恢复正常。结论 :梅花髓内针最好的适应症是股骨干峡部的短斜或横行新鲜骨折 ;交锁髓内钉适应症较广泛 ,可用于所有的股骨干新鲜和陈旧性骨折 ,愈合时间较梅花针短 ,功能恢复良好 ,疗效明显优于梅花髓内针。     

Herbst矫治器和Twin-block矫治器治疗骨性Angle Ⅱ~2错的X线头影测量对比研究

目的:探讨铸造夹板式Herbst矫治器和Twin-bolck矫治器矫治Angle Ⅱ2类错的机制和效果。方法:随机选取30例骨龄为FG-G期恒牙列Angle Ⅱ2类错患者,随机分为治疗组(Herbst矫治器组)和对照组(Twin-block矫治器组),其中治疗组15例,采用铸造夹板式Herbst矫治器矫治:对照组15例,采用Twin-blokc矫治器治疗。治疗组和对照组的所有患者均在治疗前、后拍摄头颅定位侧位片,进行矫治前后、颌、面矢状向和垂直向上的头影测量分析,并做统计学处理。结果:两组患者均达到了磨牙中性关系,前牙达到正常的覆盖、覆关系,但是治疗组的疗程明显的短于对照组。结论:Herbst矫治器和Twin-block矫治器均能有效地矫治Angle Ⅱ2类错;但前者在刺激下颌骨生长、促进下颌骨前移等骨性变化以及在患者面型的改善方面明显的优于后者。     

玉郎伞提取物对大鼠自发性高血压的影响

目的：研究玉郎伞提取物(YLS)对自发性高血压大鼠(SHR)及正常大鼠血压(BP)的影响。方法：应用颈动脉插管测压法，连接MS2000多媒体生物信号记录系统测定静注YLS前及药后20s、30s、lmin、2min、5min时的收缩压(SP)、舒张压(DP)、平均动脉压(MP)。结果：YLS使SHR及正常大鼠血压明显降低(P＜0．01)，降压作用维持时间较短，给药后5min血压基本恢复正常；YLS对去甲肾上腺素(NA)和异丙肾上腺素（ISO)的作用无明显影响。结论：YLS对正常大鼠及SHR血压有明显的降低作用。