绵毛黄芪苷和苦玄参苷的中枢抑制作用

报道了绵毛黄芪苷(SK)及其同类结构苦玄参苷(PIA)给予昆明种式BLC_(57)/1小鼠50mg/kg腹腔注射能明显延长硫贲妥钠的睡眠时间,用扭体法或热板法证实同量SK或PIA静脉注射能产生明显的镇痛作用。用格斗试验证实:同量SK或PIA腹腔注射可使小鼠格斗试验次数明显减少。提示两种苷可能具有中枢镇静、镇痛和安定作用;此类中枢抑制作用说明四环三萜皂苷类具有药用价值的前景。     

小叶锦鸡儿的药理作用

小叶锦鸡儿１ｇ／ｋｇ，０．５ｇ／ｋｇ灌胃给药明显地提高小鼠热痛阈（Ｐ＜０．００１），减少酒石酸锑钾所致的小鼠扭体反应次数（Ｐ＜０．０１），对抗二甲苯所致小鼠耳壳炎症（Ｐ＜０．０１），抑制蛋白加热变性（Ｐ＜０．０１），明显地降低氯仿诱发的小鼠室颤发生率。     

围手术期肠外营养支持在胃癌根治术的应用

1986～1988年的胃癌扩大根治术221例及根治性全胃切除术19例非肠外营养(N-TPN)支持为对照组,与1991～1993年的198例及61例施行TPN治疗为实验组进行对比。N-TPN组术后并发症总发生率为7.2％,TPN组则为2.0％;全胃切除术并发症发生率分别为31.6％和4.9％(P<0.01)。吻合口瘘发生率N-TPN组分别为2.7％和10.5％,而TPN组则均为0.0％(P<0.01)。膈下脓肿发生率N-TPN组为31.6％和15.8％,而TPN组则为1.5％和3.3％(P<0.05)。但本研究是回顾性的,所以要有待进行前瞻性的、对照的、随机的大范围研究。     

THE ROLE OF P_1-PURINERGIC RECEPTORS IN THE SPINAL MECHANISMS OF ACUPUNCTURE ANALGESIA

It has been extensively proved that electro-acupuncture elicit analgesia in bothextensive areas and local region via supraspinal structures and spinal cord.The present investigationwas to study the role of P_1-purinergic receptors in the spinal mechanisms of weak electroacupuncture-induced analgesia.Leg withdrawal latency(LWL)to noxious radiant heat focused on the ankle regionwas used to assess the effects of acupuncture and that of P_1-purinergic(adenosine)receptor antago-nists,theophylline and caffeine on the electro-acupuncture(EA)analgesia.EA prolonged the LWLby 16.7%±20.3%,with an after-effect lasting about 15 min.Both theophylline and caffeineblocked the EA-induced prolongation of LWL in a dose-dependent manner at the doses of 1.6-16 mg/kg.These results suggest that P_1-purinegic receptor is involved in the spinal mechanisms of weak EAproduced analgesia in the rat.     

Diagnosis and management of severe atherosclerosis of the ascending aorta and aortic arch during cardiac surgery: focus on aortic replacement

Objective: Severe atherosclerosis of the ascending aorta and arch frequently causes difficulties during heart operations, hindering surgical manoeuvres and potentially leading to systemic embolism. The aim of our study was to assess the safety and effectiveness of replacing the atherosclerotic ascending aorta in this setting. Methods: Aortic atherosclerosis was characterized by epiaortic ultrasonographic scanning in 90.1% of 1927 consecutive adult patients undergoing cardiac operations, and by computed tomographic chest scanning in selected cases. Thirty-six of the 152 patients requiring major derangements from our standard practice due to aortic atherosclerosis underwent replacement of the ascending aorta and constitute the study group. Replacement of the aorta was extended to the arch in 13 cases (36.1%). It was associated with single or multiple valve surgery in 34 patients (94.4%) and with coronary revascularization in 30 (83.3%). Two patients (5.6%) underwent coronary bypass grafting without valve surgery. A cryoablation procedure was associated in three patients with permanent atrial fibrillation. Deep hypothermic circulatory arrest was employed in 34 patients (94.4%), while proximal aortic disease allowed conventional distal crossclamping in 2 cases. The risk of operative mortality was estimated by the logistic EuroSCORE both with and withholding the variable ‘surgery of the thoracic aorta’. All survivors were followed-up for 1–41 months (16 ± 12). Results: Two patients died in the hospital (5.6%) and two during follow-up, for a cumulative survival of 91.3% and 85.6% at 1 and 3 years, respectively (hospital deaths included). The hospital death rate compared favourably with the expected estimates of 25.5% (p < 0.05) and 10.3% (p = 0.67) obtained by the EuroSCORE full model and without ‘aortic surgery’, respectively. In-hospital adverse neurologic events occurred in six patients (16.7%), including stroke in one patient (2.8%) and neurocognitive disturbances in five (13.9%), although they were all transient and cleared before discharge. Excess bleeding required re-exploration in four patients (11.1%), and one more patient underwent emergency grafting for acute postoperative coronary occlusion. Ten patients (38.5%) were intubated for longer than 24 h. Conclusion: Despite significant perioperative morbidity, replacement of the severely atherosclerotic aorta is worth consideration to avert expectedly higher death and stroke rates.     

63例CT导引下经皮肺穿刺活检术的围手术期护理

目的：探讨CT导引下经皮肺穿刺活检术围手术期的护理程序及注意事项。方法：对我院2007年11月至2009年7月63例行CT导引下经皮肺穿刺活检术的患者实施术前、术中、术后护理及健康指导等围手术期护理程序。结果：实施围手术期护理程序后,患者焦虑程度明显减轻,并发症明显减少,术后恢复良好,患者均安全度过围手术期。结论：认真落实护理程序各阶段的护理措施,是减少CT导引下经皮肺穿刺活检术围手术期意外和各种护理并发症的关键。应用围手术期护理程序可提高手术的护理质量,减少术后并发症,为患者迅速康复奠定良好的基础。     

新法加工附子与附片抗炎镇痛作用比较研究

目的：比较新法加工附子在总生物碱高于附片13倍时，其抗炎、镇痛的效果是否有差异。方法：通过小鼠热板法、扭体法、小鼠耳廓肿胀法和大鼠足趾肿胀法进行镇痛和抗炎作用比较。结果：二者对热板法小鼠的痛阈值均无提高．均能减少酒石酸钾所致小鼠扭体次数．对二甲苯所致小鼠耳廓肿胀和角叉菜胶所致大鼠足趾肿胀具有抑制作用。但二者之间比较差异无显著性。结论：新法加工附子保存了其原有疗效，但和总生物碱无量效相关性，其中是否有新的活性成份，有待进一步研究探讨。     

国产重组人脑钠素与硝普钠用于心脏手术围术期处理的对比研究

目的 对重组人脑钠素（rhBNP）用于心脏手术围术期处理的可行性、安全性和有效性进行初步观察，并与硝普钠的作用进行比较。方法 选择择期心脏手术病人22例，随机分为rhBNP组（B组）和硝普钠（SNP）组（s组），每组11例。比较rhBNP与SNP对病人血流动力学和肝肾功能的影响。结果 与给药前和S组比较，B组用药后15、30、60、120和180min各点心输出量增加显著（P〈0．05，P〈0．01）；B组与给药前比较，给药后即刻、15、30和60min时点外周血管阻力下降显著（P〈0．05）；给药后即刻、15和30点与S组比较，下降显著（P〈0．05）。B组肺毛细血管楔压（PCWP）与用药前比较，用药后即刻、15、30、60、120和180min下降显著（P〈0．05，P〈0．01）；与S组比较，给药后30、60、120和180min差异有统计学意义（P〈0．05，P〈0．01）。S组PCWP与用药前比较，用药后60min、120min和180min下降显著（P〈0．05）。B组与输注rhBNP前以及S组比较，平均动脉压、心率和中心静脉压差异均无统计学意义。输注rhBNP后病人24h尿量明显增加。用药过程中以及30d后进行电话随访，未见药物不良反应。结论 rhBNP用于心脏手术围术期处理是可行的，具有改善心功能和稳定循环的作用。     

老年股骨颈骨折围手术期的治疗分析

目的探讨老年人股骨颈骨折的治疗及围手术期的处理。方法回顾性分析2003年1月～2006年12月手术治疗的201例老年股骨颈骨折患者资料，其中男51例，女150例，年龄60～98岁，平均78．2岁。按Garden分型，Ⅱ型20例，Ⅲ型86例，Ⅳ型95例。采用多枚中空螺钉固定、Morre型人工股骨头置换术或双极人工股骨头置换手术进行治疗。结果本组患者平均住院10～14d，5～7d即能早期下床活动，住院期间及术后1年内无一例死亡。85％患者获得8个月～4年（平均2年）的随访，功能恢复按Harris评分，优良率为85％。结论老年人各脏器机能衰退，多同时合并各种内科疾病，手术治疗存在风险，但老年人股骨颈骨折的手术治疗仍能取得满意疗效。     

术中磁共振影像神经导航手术的麻醉管理

目的 探讨术中磁共振(iMR)影像神经导航辅助神经外科手术的麻醉管理.方法 22例神经外科手术患者采用核磁兼容或核磁可用的麻醉材料和设备,在全身麻醉(静吸复合或全凭静脉麻醉)下行iMR影像神经导航辅助颅内肿瘤切除术,术中监测心率、有创血压、脉搏血氧饱和度、呼气末二氧化碳分压、七氟醚浓度、中心静脉压以及动脉血气.结果 22例患者肿瘤的全切率从60.0%提高到86.4%.术中患者iMR扫描次数2～5次,手术时间延长1～3 h,术中未发生与麻醉和iMR相关的并发症和意外事件.结论 在iMR影像神经导航下行颅内肿瘤切除术的围术期麻醉处理中关注iMR影像神经导航外科相关的信息、手术室应用环境、麻醉技术和药物的选择以及围术期管理对患者的安全是重要的.