异丙酚静脉全麻复合硬膜外腔阻滞麻醉期间CO2气腹对血流动力学和氧耗的影响

OBJECTIVE: To investigate the effects of intraperitoneal CO2 insufflation on the hemodynamics, oxygen consumption (VO2) and carbon dioxide production (VCO2) during intravenous anesthesia with propofol in combination with epidural block. METHODS: Intratracheal intubation was performed after rapid induction of anesthesia and mechanical ventilation was given. Maintenance of anesthesia was achieved using continuous intravenous propofol infusion (2 mg/kg/h) ?N2O inhalation and intermittent epidural administration. Indices of hemodynamics and respiratory function were collected 5 min before induction, 1 min before CO2 insufflation, and 5, 10, 20, 30, 40, 50, 60 min after the start of insufflation and 5 min after the termination of insufflation. RESULTS: The mean arterial pressure (MAP), heart rate (HR), end-tidal PCO2 (P(ET)CO2), VO2 and VCO2 1 min before insufflation were markedly reduced(P<0.01), compared with those recorded before induction. MAP and HR did not undergo any conspicuous changes during CO2 insufflation and 5 min after insufflation termination. Compared with that 1 min before insufflation, PETCO2 was significantly increased 20 min after the start of insufflation (P<0.01), and subsequently carried on the increase though of a lesser scale. VO2 and VCO2 gradually rose after the start of insufflation, and VO2 presented a significantly elevation (P<0.01) 10 min after the insufflation while VCO2 did not show this marked increase(P<0.05) till 20 min after the insufflation in comparison with the levels before insufflation. Subsequently, VO2 continued to rise and VCO2 also retained the increase but of smaller magnitude. CONCLUSION: Intravenous propofol anesthesia combined with epidural block assisted by well-managed excessive ventilation before insufflation can alleviate the adverse effects of CO2 insufflation on respiratory and circulatory systems.     

氧苏辅助治疗精神分裂症的疗效观察

目的探讨氧苏辅助治疗精神分裂症的临床疗效及不良反应。方法将66例住院精神分裂症患者随机分为维思通合并氧苏治疗组(A组)与维思通治疗组(B组)，并对临床资料进行分析，在治疗前、第2、4、6周末分别应用简明精神病评定量表(BPRS)和副反应量表(TESS)，评定其临床疗效及不良反应。结果两者在疗效上有显著性差异，不良反应无显著性差异。结论氧苏治疗对精神分裂症有良好的辅助治疗作用。     

肿瘤乏氧组织显像剂的研究进展

乏氧组织显像剂能选择性地滞留在乏氧组织或细胞中,通过无创性的核医学正电子发射体层摄影术/单光子发射计算机体层摄影术可评价实体肿瘤缺氧状态.一些显像剂适宜进行乏氧显像并能很好地反映肿瘤乏氧及其程度等情况,这些信息在肿瘤的临床诊断决策中起到重要作用.     

Ⅱ型呼吸衰竭2种给氧方法疗效对比观察

目的随机将35例肺源性心脏病Ⅱ型呼吸衰竭病人分为观察组（18例）和对照组（17例）,用不同的流量给氧进行疗效对比观察。方法对照组给予持续低流量给氧,观察组在此基础上行短期高流量（4.0～4.5L/min）给氧,测定治疗前后PaO2及PaCO2,比较2组给氧效果。结果治疗后2组PaO2均高于治疗前,观察组治疗后PaO2明显高于对照组,PaCO2变化则不明显。结论提示持续低流量加短期高流量给氧方法疗效优于单纯持续低流量给氧。     

甲氧苄氨嘧啶—PVP共沉淀物的研究

本工作用差示扫描量热法(DSC)研究甲氧苄氨嘧啶与PVP溶剂法制备的共沉淀物,表明已不存在甲氧苄氨嘧啶晶体。用x射线衍射法研究了1:12共沉淀物,证明无甲氧苄氨嘧啶的晶体衍射峰。经分光光度法测定结果,1:12共沉淀物比原药的溶解度大28.3倍。     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

医院变压吸附式制氧设备的使用和管理

本文结合医院情况简述了变压吸附式制氧设备的安装质量控制、安全操作和维护保养,指出变压吸附式制氧是今后医院制氧方式的一个发展方向.