早产低体质量儿产妇在妊娠期的外周血、龈沟液炎性因子浓度对照分析

目的对照分析早产低体质量儿(PLBW)产妇在妊娠期外周血、龈沟液(GCF)炎性因子浓度分析。方法选择2013年3月—2014年1月在解放军第202医院妇产科住院分娩PLBW的产妇31例为观察组,对照组29例为同期住院、分娩正常体质量儿的产妇。两组对象均在分娩前接受了外周血及GCF中的炎性细胞因子(IL-1、IL-6和IL-10)检测。结果观察组产妇的外周血及GCF处的IL-1、IL-6浓度均明显高于对照组,而IL-10浓度则显著低于后者(P<0.05或P<0.01)。结论观察组产妇在妊娠期的外周血及GCF处的炎性细胞因子变化明显,应制定相应的口腔抗炎方案。     

老龄鼻窦炎患者鼻内镜手术的围手术期处理

目的：总结老龄鼻窭炎患者进行鼻内镜手术的围手术期处理的经验，以降低手术风险。提高安全性。方法：回顾性分析76例经鼻内镜手术治疗的老龄鼻窦炎患者的病例资料，总结鼻内镜手术的围手术期处理，包括药物选择、麻醉方式、术中、术后心电和血氧监护等。结果：所有患者均未出现严重并发症，安全度过围手术期。结论：老龄鼻窭炎患者经过有效的围手术期处理，即选择合适的用药、彻底的术中止血、良好的术后监护等，可以有效降低鼻内镜手术并发症的发生率。获得良好的手术效果，提高老龄患者的生活质量。     

骶骨肿瘤切除术围手术期康复护理

目的 探讨一期前后联合入路行骶骨肿瘤切除加内固定术围手术期康复护理的作用。方法 对15例骶骨肿瘤患者术前进行针对性心理疏导、胃肠道准备、会阴括约肌收缩和扩展训练；术后严密舰察生命体征及神经功能变化，加强康复锻炼指导。结果 经2～37个月随访，除1例患者因肿瘤肺转移死亡，其余病例术后近期疗效满意，局部症状缓解。大小便正常。结论 围手术期康复护理在骶骨肿瘤切除加内固定术后的恢复及功能重建中至关重要，能有效减少并发症的发生。     

4例肠系膜上动脉综合征患儿围手术期护理

目的肠系膜上动脉综合症患儿围手术期护理。方法我科于2002年～2005年间收治4例肠系膜上动脉综合症患儿，行十二指肠空肠吻合术。通过术前心理护理及指导正确卧位，加强营养充分调理，纠正水和电解质平衡失调，备血及留置胃管洗胃。术后密切观察生命体征，保持胃管通畅，合理应用抗生素，加强基础护理，预防各种并发症发生，正确指导卫生宣教。结果四例患儿临床症状均消失，切口愈合良好，无感染及肠瘘等并发症发生，痊愈出院。结论术后正确有效的护理方法有利于预防并发症促进早日康复。     

盐酸乌拉地尔预防全麻拔管期血压升高的临床观察

目的 探讨盐酸乌拉地尔用于预防全麻拔管期血压升高的效果。方法 选60例ASAⅠ-Ⅱ级无明显高血压病史的全麻患者分为对照组、用药组。用药组拔管前5分钟注射盐酸乌拉地尔0．6mg／kg，观察并比较两组患者平均动脉压（MBP）和心率（HR）的变化。结果 与对照组相比，注射盐酸乌拉地尔后，MBP下降差异有显著性意义（P〈0．05），HR差异无显著性意义（P〉0．05）。结论 全麻拔管前用盐酸乌拉地尔可预防拔管时血压升高，并且对心率无明显影响。     

米非司酮治疗围绝经期功能性子宫出血的疗效

目的:观察米非司酮治疗围绝经期功能性子宫出血的临床疗效。方法:80例确诊为围绝经期功能性子宫出血患者,口服米非司酮12.5 mg,连服6个月,观察子宫大小、内膜厚度、月经恢复情况及血清激素水平。结果:所有患者用药期间均闭经,其中33例直接进入绝经期,其余停药后28~70 d,平均42 d恢复月经,15例月经稀发、量少。用药前子宫内膜(5.8±0.2)mm与用药后(2.7±0.3)mm比较有显著性差异(P<0.05);用药前后子宫大小无明显差异(P>0.05)。治疗6个月后血清激素检查显示促卵泡生成素(FSH)、黄体生成素(LH)、孕激素(P)、雌二醇(E2)水平均有明显降低。结论:米非司酮可有效抑制子宫内膜生长,治疗围绝经期功能性子宫出血效果满意。     

心脏移植术后肾功能衰竭的围手术期处理(附2例报告)

目的报告2例原位心脏移植术后肾功能衰竭的发生及治疗经过,探讨其围手术期处理的初步经验和要点.方法我院自2000年12月一2002年12月共对4例终末期心脏病患者施行同种异体原位心脏移植术,4例均为男性,采用标准原位心脏移植术,术后应用三联免疫治疗的方法抗排异.结果4例患者均获得手术成功,术后未发现超急性排斥反应或急性排斥反应,2例术后1周左右并发急性肾功能衰竭,应用床边连续肾脏替代(CRRT)治疗后,1例存活22d,1例完全康复,随访半年患者心功能恢复Ⅰ～Ⅱ级(NYHA),生活质量良好.结论心脏移植手术后肾功能损害较常见,围手术期的肾功能保护非常重要,如符合手术指征,及早手术治疗是抢救成功的关键.     

Frequency-Dependent Electrophysiological Effect of Ibutilide on Human Atrium and Ventricle

Most of the class III antiarrhythmic agents developed in recent years blocks the rapid component of delayed rectifier potassium current (IKr). IKr blocker shows reverse use-dependency and also may cause torsades de pointes at slower heart rate. Ibutilide fumarate, a novel class III antiarrhythmic agent, increases window Na(+) current at the action potential plateau phase. We studied the rate-dependent effect of ibutilide on the electrophysiological parameters of human atrium and ventricle. Franz catheter and a pacing catheter were placed closely in the high right atrium and right ventricular apex to record monophasic action potentials (MAP) during pacing at cycle length (PCL) of 600 ms and 350 ms in eight patients who underwent electrophysiological study. MAP duration of right atrium (RA-MAPD) and right ventricle (RV-MAPD), effective refractory period of RA and RV (RA-ERP and RV-ERP), intra-atrial conduction time (IACT) and intra-ventricular conduction time (IVCT) were measured before and after intravenous administration of ibutilide (0.01 mg/kg up to 1mg). A conduction time from RA pacing spike to distal coronary sinus potential was used to measure IACT, while QRS duration of surface ECG during RV pacing was used to measure IVCT. Ibutilide prolonged RA-MAPD by 60 ms at PCL 600 ms and by 53 ms at PCL 350 ms; RV-MAPD by 48 ms at PCL 600 ms and by 55 ms at PCL 350 ms. Ibutilide did not affected RA and RV-ERP/MAPD ratio, IACT, and IVCT. Ibutilide prolongs MAPD and ERP of human atrium and ventricle without reverse use-dependency.     

吸入全麻和吸入全麻联合硬膜外麻醉对胃癌根治术患者清醒时MAC的影响

目的:比较吸入全麻和吸入全麻联合硬膜外麻醉对术后清醒时M AC和S tew ard苏醒评分的影响。方法:30例择期行胃癌根治术的患者,随机分成两组:吸入全麻组(全麻组)和吸入全麻联合硬膜外麻醉组(联合组),每组15例。联合组硬膜外给予1.6%利多卡因12~14 m l,两组均采用异丙酚2 m g/kg和琥珀胆碱1.5 m g/kg诱导插管,用维库溴铵、异氟醚维持麻醉,两组异氟醚用量相同。手术结束时快速洗出体内异氟醚,进行S tew ard苏醒评分。结果:全麻组清醒M AC为(0.40±0.06)%,S tew ard苏醒评分4.10±0.04;联合组清醒M AC为(0.25±0.05)%,S tew ard苏醒评分为4.70±0.05。结论:吸入麻醉联合硬膜外麻醉术后清醒时M AC降低,S tew ard苏醒评分高。     

Seasonal fluctuations of phlebotomine sand fly populations (Diptera: Psychodidae) in the urban area of Marrakech, Morocco

Phlebotomine sand flies (Diptera: Psychodidae) were collected continuously, using sticky traps, during 1 year from October 2002 to September 2003, in an urban area of Marrakech city (Morocco). A total of 3277 specimens were collected belonging to five species. Phlebotomus (Phlebotomus) papatasi (54.6%) is the predominant species followed by Sergentomyia (Sergentomyia) minuta (20%), S. (S.) fallax (11.3%), P. (Paraphlebotomus) sergenti (10.3%) and P. (Larroussius) longicuspis (3.8%). Data analyses showed a mono-modal annual pattern for P. sergenti and a bi-modal one for the other species. P. papatasi, the proven vector of Leishmania major in Morocco, was active throughout the year. This species did not diapause in this region. P. papatasi population peaked in June and November, which relating to the periods of risk in this area. Its preferred temperature ranged between 32 and 36 degrees C but no significant correlation was found between its density and the temperature. Considering the high density and long activity period of P. papatasi, the area of Marrakech should be regarded as a potential focus for L. major. This suggests the need for a continuously surveillance to prevent risk of zoonotic cutaneous leishmaniasis.