高血压病史对体外循环冠脉搭桥术后早期预后的影响

目的 :了解高血压病史对体外循环下冠脉搭桥术后早期预后的影响。方法 :对高血压和非高血压行体外循环下冠脉搭桥术年龄大于60岁的冠心病患者65例术前和术后早期的临床资料进行分析。结果 :与非高血压患者相比 ,患高血压的病人冠脉搭桥术后心律失常的发生率增高 ,术后30min动脉氧分压与吸入氧浓度 (PaO2/FiO2)比值明显低下 ,机械通气时间明显延长 ,术后24h内胸腔引流量明显增加 ,术后大剂量多巴胺 (>10μg·kg-1·min -1)应用率及重症监护时间无显著性差异。结论 :高血压病史使患者冠脉搭桥术后早期肺功能下降、心律失常发生率增高、出血倾向增加 ,提示维持高血压患者围手术期血压的正常有利于改善患者预后     

Direct gamete uterine transfer in patients with tubal absence or occlusion

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used. Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram-and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration. Results: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation. Conclusions: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.     

食管异物摘取术的麻醉选择

为探讨食管异物摘取术的麻醉方法，提高手术效果，对７２例食管异物患者采用强化表面麻醉法和气管内插管麻醉法进行了手术和对比观察。７２例异物均取出顺利，无严重并发症发生。资料显示：两种麻醉各具优越性，前者适用于年龄较大的儿童和成人，后者适用于食管异物并呼吸困难的小儿。     

Does Previous Salpingectomy Improve Implantation and Pregnancy Rates in Patients with Severe Tubal Factor Infertility who are Undergoing In Vitro Fertilization? A Pilot Prospective Randomized Study

Objective: To evaluate the implantation rate and pregnancy rate (PR) in patients with severe tubal factor infertility who were undergoing IVF. Patients who had undergone salpingectomy were compared with those who had not.

Design: A prospective randomized study.

Setting: A department of obstetrics and gynecology at a university hospital.

Patient(s): Thirty patients who previously had undergone salpingectomy and 30 patients who had not undergone salpingectomy before IVF treatment.

Intervention(s): Laparoscopy with or without salpingectomy followed by IVF with the use of combined GnRH agonist and hMG therapy in a long stimulation protocol.

Main Outcome Measure(s): Embryo implantation rate and ongoing PR per transfer. The cumulative PRs were compared for the two groups of patients.

Result(s): After the first IVF attempt, the implantation rate was 10.4% in the group with salpingectomy and 4.6% in the group without salpingectomy. For all IVF attempts, the respective embryo implantation rates in the two groups were 13.4% and 8.6%. The ongoing PR per transfer was 34.2% in the group with salpingectomy compared with 18.7% in the group without salpingectomy. After four IVF attempts, the probability of becoming pregnant was greater in the group of patients with salpingectomy (75%) than in the group without salpingectomy (63%).

Conclusion(s): Previous salpingectomy in patients with severe tubal factor infertility who are undergoing IVF seems to increase the embryo implantation rate and the PR per cycle of IVF. This monocentric study must be followed by other similar studies to allow for a metaanalysis and confirm this clear trend with definitive evidence.     

中药配合经阴输卵管插管注射甲氨喋呤治疗输卵管妊娠临床观察

探讨透视下经阴输卵管妊娠囊表面注射甲氨喋呤(MTX),配合口服异位汤,静脉用丹参注射液的方法,治疗输卵管妊娠的近期与远期效果及适应症。结果:10例患者8例成功。近期疗效:治疗后8例患者阴道流血时间平均9.7天;恢复排卵时间19.71天;治疗后22天血β-hCG降至正常,同时B超见输卵管妊娠包块直径<1.6cm。远期疗效:8例患者5例未避孕,4例获得宫内妊娠(4/5)。其中2例足月分娩,出生儿智力、发育及健康状况均正常。     

Comparison of a new video-optical intubation stylet versus the conventional malleable stylet in simulated difficult tracheal intubation

Handling and efficacy of a new video-optical intubation stylet were assessed in a simulated difficult tracheal intubation setting and compared with a conventional malleable stylet. Forty-five anaesthetists performed 10 tracheal intubations using both techniques. Laryngoscopy was performed by the observer, who created a grade 3 view according the classification by Cormack and Lehane. The time taken to place the tracheal tube and the final tracheal tube positions were documented. Mean (SD) intubation time for the video-optical stylet was 20.4 (7.7) s and for the malleable stylet 10.2 (3.3) s (p<0.01). With the video-optical stylet the trachea was correctly intubated in all 225 attempts; with the malleable stylet 44 (19.6%) oesophageal and 44 (19.6%) endobronchial intubations occurred (p<0.01). The video-optical intubation stylet enabled us to recognise inappropriate tracheal tube positions and to correct them immediately. This equipment can be considered a reliable and effective tool for management of the difficult airway.     

A literature review of the prehospital use of neuromuscular blocking agents by air medical personnel to facilitate endotracheal intubation

Air medical personnel in the United States have used neuromuscular blocking agents to facilitate endotracheal intubation in the field for more than a decade. This literature review examines 15 studies to investigate their experience and explores the following specific areas: the intubation success rate in patients who did or did not receive these agents, the intubation success rate of air medical personnel before and after they incorporated these agents into their practice, the neuromuscular blocking agents and adjunct medications used by air medical personnel, and the disposition of patients who could not be intubated after an agent was given. The data suggest that, overall, air medical personnel use these agents safely and effectively. Suggestions are offered for future studies, including examining ground time when agents are used to facilitate intubation, complications of their use in this setting, and the use of simulators to train personnel in the administration of these medications.     

未破裂型输卵管妊娠腹腔镜手术和剖腹手术的临床研究

目的　比较腹腔镜和剖腹手术在保守性治疗未破裂型输卵管妊娠的效果。　方法　选取经临床或腹腔镜确诊的输卵管峡部、壶腹部或伞部妊娠的未破裂型住院病例 ,分成腹腔镜手术和剖腹手术 2组进行保守性手术治疗 ,2组各 112例 ,记录术前病史体征、术中和术后情况 ,并随访其术后 1年内的妊娠结局。　结果　腹腔镜组术中出血量 (30 .6± 13.8) m l、手术时间(4 1.3± 11.2 ) m in、排气时间 (11.5± 5 .3) h、抗生素应用时间 (2 .6± 2 .1) d、术后最高体温 (36 .8± 0 .4 )℃、术后住院时间 (4 .3± 1.2 ) d及术后 3个月后子宫输卵管造影 (hystero salpingo graphy,HSG)通畅率 83.9% (78/ 112 ) ,明显优于剖腹组 (P<0 .0 5 ) ;腹腔镜组和剖腹组术后血β- HCG恢复正常时间分别为 (9.6± 5 .1) d、(10 .2± 4 .9) d;术后发生持续性宫外孕率分别为 (6 .3% ,5 .4 % )、术后 1年内的宫内妊娠率分别为 (87.9%、 76 .5 % )及宫外孕发生率分别为 (12 .6 % ,2 3.5 % ) ,2组间差异无显著 (P>0 .0 5 )。　结论　腹腔镜保守治疗未破裂型输卵管妊娠具有手术时间短、出血少、术后恢复块、 HSG通畅率高     

不同麻醉诱导下小儿气管插管时的心血管应激反应

目的用随机对照前瞻性研究方法,比较小儿气管插管时心血管反应,评价不同麻醉诱导方式对插管时应激反应的抑制作用.方法68例1～6岁的患儿被随机分成P、PF及PFI组,P组静脉注射硫喷妥钠5 mg/kg;PF组先静脉注射芬太尼3 μg/kg,再静脉注射硫喷妥钠5 mg/kg;PFI组先静脉注射芬太尼3μg/kg,再静脉注射硫喷妥钠5 mg/kg,同时吸入3%异氟醚.所有患儿由同一位医师进行气管插管,记录其麻醉前以及插管前后的心率和血压.结果插管后P组的心率和血压最高,不仅显著高于插管前,还显著高于基础值（P＜0.05）.PF组插管后的心率和血压虽然也高于插管前,但低于P组,而且与基础值比较没有显著性差异.PFI组插管后的血压仅略高于插管前,但比基础值低（P＜0.05）,在3组中最低（P＜0.05）,且升幅最小（P＜0.05）,其收缩压和舒张压的升幅分别为11%和26%.结论给患儿插管时联合应用硫喷妥钠、芬太尼和异氟醚,心血管反应最小,提示其可以较好地抑制插管所至的应激反应.     

光导纤维支气管镜经口和经鼻气管插管患儿心血管反应的比较

目的比较小儿光导纤维支气管镜(FOB)经口和经鼻气管插管的心血管反应。方法选择美国麻醉医师协会(ASA)身体状态分级为Ⅰ级、在全身麻醉下施择期整形外科手术的患儿65例,随机分为经口组(n=36)和经鼻组(n=29)。在常规静脉麻醉诱导后实施FOB气管插管。测定麻醉诱导前(基础值)、后,气管插管时和气管插管后5 min内(测定间隔为1 min)血压(BP)和心率(HR),记录气管插管时间。结果经鼻组气管插管时间显著长于经口组(P<0.05)。FOB气管插管导致两组BP和HR均比麻醉诱导前基础值显著升高(P均<0.05)。与经口组相比,气管插管致BP增高和HR增快反应在经鼻组较轻,持续时间较短。经口组气管插管时BP和HR及观察过程中BP和HR最大值均显著高于经鼻组(P均<0.05)。结论FOB经口和经鼻气管插管均可引起小儿BP和HR显著升高,但FOB经鼻气管插管时心血管反应较FOB经口气管插管时轻。