阈下氯胺酮伍合异丙酚在肿瘤病人全麻诱导期对心血管系统的影响

目的：评估预注氯胺酮预防异丙酚在肿瘤病人全麻诱导插管期所致血压下降的作用。方法;２６例肿瘤择期手术全麻病人,随机分为Ｐ组和Ｋ＋Ｐ组各１３例,分别用工分太尼３μｇ／ｋｇ、异丙酚２ｍｇ／ｋｇ及氯胺酮０．８ｍｇ／ｋｇ,芬太尼３μｇ／ｋｇ,划丙酚２ｍｇ／ｋｇ,异丙酚２ｍｇ／ｋｇ行全麻诱导。比较两组病例在诱导前后及气管插管后收缩压（ＳＢＰ）、平均动脉压（ＭＡＰ）、舒张压（ＤＢＰ）和心率（ＨＲ）的变化。结果：     

阻塞性睡眠呼吸暂停综合征与呼吸循环系统疾病的相关性

阻塞性睡眠呼吸暂停综合征(OSAS)是一种常见的睡眠呼吸障碍性疾病,由于其病理生理改变可以累及全身各系统,近几年国内外的研究集中在OSAS与全身系统疾病的关系上,目前已有多项研究证实OSAS是多种心血管系统疾病及呼吸系统疾病的独立危险因素。基于国内外OSAS的发展现状,通过归纳总结OSAS相关呼吸循环系统疾病的临床特征、首选治疗方法及相关基础研究,为临床诊断及综合治疗提供依据。     

Etiologic and Pathogenetic Study of Mental Retardation with Multiple Congenital Anomalies

Etiology and pathogenesis of MCA/MR in 1,023 patients (618 male; 405 female) with mental retardation were studied. Of 1,023 patients, there were 563 cases (317 male; 246 female) with MCA (55%). Among the MCA patients, there were 303 (156 male; 147 female) whose primary etiology was clarified (53.8%). Among the 260 patients with MCA/MR of unknown etiology, there were 23 with recognizable syndromes of unknown etiology and 7 previously reported by us as possibly having a new malformation syndrome. We had 569 patients with mental retardation of unknown etiology including 236 (41.5%) who were involved with MCA.     

Some relationships of contrasting emotions to cardiovascular disorders

Although the central nervous system is critically involved in the regulation of blood pressure, the relationship of anxiety to hypertension remains unclear. However, anxiety is closely related to various habits that affect the cardiovascular system: diet, weight, alcohol, eating and drinking, cigarette smoking, caffeine and life events. There is a high prevalence of mitral valve prolapse in subjects with anxiety disorders, but there is little evidence for a common genetic factor. A number of psychosocial factors are significantly related to the individual risk of CHD and the Type A behavior pattern (TABP) relates certain personality and behavioral characteristics that are important in this respect.     

黑龙江省心血管病人群监测10年（1984—1993）资料分析

本文系在黑龙江省城乡确定社区内的２５岁－７４岁年龄组８０１２４７人进行为期１０年的心血管病人群监测结果。人口死因的前两位为心（脑）血管病和恶性肿瘤。并发现１０年来总死亡率、心血管病残废率、冠心病死亡率、脑卒中死亡率、脑卒中２８日内病死率有明显下降趋势。     

Hemodynamic effects of high-frequency oscillatory ventilation in severe pediatric respiratory failure

Objective To assess the hemodynamic effects of high mean proximal airway pressures (Paw) during high-frequency oscillatory ventilation (HFOV) in non-neonatal pediatrics patients with severe respiratory failure.Design Prospective and retrospective study.Setting Pediatric ICU in a university-affiliated hospital.Patients 8 non-neonatal pediatric patients with severe respiratory failure ventilated with HFOV at our institution between July 1991 and February 1994. All patients had a pulmonary artery catheter.Interventions HFOV.Measurements and results Higher Paw was required during HFOV to obtain adequate lung expansion during the first 24 h (median 20.9 cmH₂O, range 16.9–30.0 cmH₂O in CMV, versus median 30.0 cmH₂O, range 21.0–33.0 cmH₂O in HFOV,p=0.008), resulting in improved oxygenation as evaluated by alveolar-arterial oxygen difference (median of 557.2 mmHg, range 360.4–607.8 mmHg in CMV, versus median of 410.5 mmHg, range 282.9–550.2 mmHg after 24 h of HFOV,p=0.03). The only observed effect on the cardiovascular system was a decrease in heart rate (median of 162, range 129–178 in CMV, versus median of 142, range 104–195 after 24 h of HFOV,p=0.03). Oxygen delivery, cardiac index, mean systemic arterial blood pressure, and pulmonary and systemic vascular resistances did not change significantly before and after HFOV in the patients as a group, although in one case a decrease in cardiac index and oxygen delivery was observed.Conclusions High-Paw HFOV must be used cautiously, but seems to have no discernible adverse effects on the cardiovascular system in most patients.     

An anatomical variation of the thoracodorsal artery with comments on flaps based on the axillary artery

Summary A rare variation of the axillary artery is presented. On routine anatomical dissection in one male cadaver the thoracodorsal artery was found to originate from the acromiothoracic artery independently from the circumflex scapular artery. Numerous flaps based on the branches of the axillary artery have been described. As a result of this case, and a review of the literature to gain further knowledge of anatomical variations, it is advised that preoperative angiography is indicated prior to utilizing flaps from this area.     

Epibatidine binding sites and activity in the spinal cord

Epibatidine has been shown to be the most potent nicotinic agonist in several neuronal nicotinic receptor preparations. Similar to other nicotinic agonists, intrathecal (−)-epibatidine elicits dose-dependent increases in pressor, heart rate and pain responses in rats, as well as an increase in latency to withdraw from a noxious thermal stimulus. The latter response requires higher doses and is of shorter duration, suggesting interaction with multiple subtypes of spinal nicotinic receptors. In the present study, we relate the binding properties of (±)-[³H]epibatidine in spinal cord membrane preparations to the cardiovascular and behavioral responses. Unlike (−)-[³H]cytisine or (−)-[³H]nicotine, (±)-[³H]epibatidine reveals two sites; the ratio of high affinity to low affinity sites is 2:1. The rank ordering of potencies of the nicotinic agonists in displacing (±)-[³H]epibatidine binding from spinal cord membranes correlates with the potencies in eliciting cardiovascular and behavioral responses upon spinal administration. The nicotinic receptor antagonists, α-lobeline, dihydro-β-erythroidine and methyllycaconitine, also displayed similar rank ordering of potencies in displacing (±)-[³H]epibatidine, (−)-[³H]cytisine or (−)-[³H]nicotine binding to spinal nicotinic receptors. Virtually all the nicotinic analogs exhibited a Hill coefficient of less than one in competing with (±)-[³H]epibatidine to spinal cord membranes indicating their interaction with at least two classes of binding sites. Intrathecal (−)-epibatidine, in addition to eliciting an initial and subsequently a sustained pressor and tachycardic response, also exhibited a transient intervening bradycardia which coincided temporally with the duration of the analgesia. Repeated administration of (−)-epibatidine desensitized its responses as well as the cardiovascular and behavioral responses to spinal nicotine and cytisine. Intrathecal α-lobeline showed selectivity for blocking the analgesic response, whereas methyllycaconitine exhibited selectivity for the pressor and irritation responses. The NMDA receptor antagonist, AP-5, inhibited the pressor, tachycardic and irritation responses elicited by intrathecal (−)-epibatidine, confirming a role for spinal excitatory amino acids released by the nicotinic agonist. © 1997 Elsevier Science B.V. All rights reserved.