白内障超声乳化术及手术配合23例

目的 :介绍超声乳化术治疗早期白内障的优越性及巡回护士在手术过程中的配合要点。方法 :对 2 3例 2 5只眼的手术临床资料作回顾性分析。结果 :术后一周视力≥ 0 .5者 2 2例 ,0 .3以下者 3例。影响视力主要是术前诊断有弱视、陈旧性虹膜炎等症。结论 :使用超声乳化仪治疗早期白内障手术简便、安全、可靠 ,并需巡回护士在手术中的密切配合     

（S）—（一）—α—苯乙胺萃取过程的研究

提出采用萃取法回收苯乙胺的工艺方案,考察了多种萃取剂的萃取性能,确定了氯仿作萃取剂的操作条件。根据实验和计算表明本方案苯乙胺的萃取收率可达９７％以上,苯乙胺的总回收率可达８７％以上。     

加热法人心肌钙蛋白T的提取与纯化

目的以加热法从人左心室肌组织中提取并纯化心肌肌钙蛋白Ｔ（ＣＴｎＴ）。方法取新鲜人左心室肌经捣碎、淬取、加热、透析后提取ＣＴｎＴ,以ＤＥＡＥ５２柱层析纯化。结果经ＳＤＳ－ＰＡＧＥ凝胶电泳初步鉴定,每１００ｇ左心室肌经此法可得１１．７９ｍｇＣＴｎＴ纯品,纯化后的ｃＴｎＴ为单一条带,分子量为３７ＫＤ。结论本法提取ＣＴｎＴ步骤简单,纯度尚可,可做抗原使用。     

The effect of technology on the indications for cataract surgery

Before the introduction of modern ophthalmic surgical technology following World War II, cataract extraction was easier and safer to perform if the cataract was far advanced (mature) and both eyes were involved. The surgeon was constrained from early surgery by the frequency of severe complications, the long convalescent period, and the distortions of aphakic glasses. Now it is easier to perform phacoemulsification and implant lenses in the early stages of cataract formation when the nucleus is soft and the posterior lens capsule has not been weakened with age. Also, modern small-incision extracapsular cataract extraction has a low rate of complications and a short convalescent period. It is feasible to extract a clear lens or one with minimal opacifications and have a grateful patient. The surgeon is capable of improving the refractive state of the eye by selecting the power of the intraocular lens. These facts have led to instances where cataracts have been extracted that were responsible for minimal or no symptoms. This revised version was published online in July 2006 with corrections to the Cover Date.     

白内障术后视力相关因素的分析

对白内障术后３个月裸眼视力≥０．８者４６６例,包括术后第一天裸眼视力≥０．８者１９９例进行统计分析,发现在同等条件下,３．５ｍｍ小切口ＰＨＡＣＯ术优于６ｍｍ切口ＰＨＡＣＯ术,更优于ＥＣＣＥ术;术前视力与术后裸眼视力正相关,患者年龄与术后视力负相关。     

高度近视白内障小切口超声乳化摘除术

目的：探讨经透明角膜隧道对高度近视白内障患者行超声乳化摘除术的可行性及手术技巧。方法：对２１６例高度近视合并白内障患者,经角膜缘隧道切口行超声乳化吸出,并植入软性或硬性人工晶体。对超声乳化能量、时间、负压及术后视力、散光及并发症进行观察。结果：采用较低能量、中度真空压力及中低档流速行超声乳化吸出,术后视力≥０．８者１４３例,≥０．５者４９例。术前近视力≥０．８者,术后远视力常较佳。术前及术后散光３．０ｍｍ切口组无统计学差异,５．５ｍｍ切口组有统计学差异。未见明显严重并发症。结论：透明角膜超声乳化联合软性或硬性人工晶体植入,是高度近视白内障较理想的手术方式。     

白内障超声乳化,玻璃体切除及人工晶体植入联合手术的疗效

目的：探讨白内障超乳化摘除,睫状体平坦部下班体切割及人工晶体囊袋内植入联合手术的疗效及安全性。方法：对玻璃体视网膜病普合并白内障１８例（１８眼）施行该联合手术。其中糖尿病性视网膜病变,玻璃体出血伴白内障１０例;视网膜分枝静脉阻塞,玻璃体出血伴白内障４例;视网膜静脉周围炎,玻璃体出血伴白内障３例及特发性视网膜１例,术后随访２～１３个月（平均９月）。结果：术后视力均有不同程度提高。１２眼（６７％）术后     

Cerebral vasoconstriction in comatose patients resuscitated from a cardiac arrest?

Objective To determine the role of cerebral vasoconstriction in the delayed hypoperfusion phase in comatose patients after cardiac arrest.Design Prospective study.Setting Medical intensive care unit in a university hospital.Patients 10 comatose patients (Glasgow Coma Score 6) successfully resuscitated from a cardiac arrest occurring outside the hospital.Measurements We measured the pulsatility index (PI) and mean blood flow velocity (MFV) of the middle cerebral artery, the cerebral oxygen extraction ratio and jugular bulb levels of endothelin, nitrate, and cGMP during the first 24 h after cardiac arrest.Results The PI decreased significantly from 1.86±1.02 to 1.05±0.22 (p=0.03). The MFV increased significantly from 29±10 to 62±25 cm/s (p=0.003). Cerebral oxygen extraction ratio decreased also from 0.39±0.13 to 0.24±0.11 (p=0.015). Endothelin levels were high but did not change during the study period. Nitrate levels varied widely and showed a slight but significant decrease from 37.1 mol/l (median; 25th–75th percentiles: 26.8–61.6) to 31.3 mol/l (22.1–39.6) (p=0.04). Cyclic guanosine monophosphate levels increased significantly from 2.95 nmol/l (median; 25th–75th percentiles: 2.48–5.43) to 7.5 nmol/l (6.2–14.0) (p=0.02).Conclusions We found evidence of increased cerebrovascular resistance during the first 24 h after cardiac arrest with persistent high endothelin levels, gradually decreasing nitrate levels, and gradually increasing cGMP levels. This suggests that active cerebral vasoconstriction due to an imbalance between local vasodilators and vasoconstrictors plays a role in the delayed hypoperfusion phase.     

Aerosolized prostacyclin and inhaled nitric oxide in septic shock — different effects on splanchnic oxygenation?

Objectives To compare the effects of inhaled nitric oxide and aerosolized prostacyclin (PGI₂) on hemodynamics and gas exchange as well as on the indocyanine-green plasma disappearance rate and gastric intramucosal pH in patients with septic shock.Design Prospective, randomized, interventional clinical study.Setting Intensive care unit in a university hospital.Patients Sixteen patients with pulmonary hypertension and septic shock according to the criteria of the ACCP/SCCM consensus conference all requiring norepinephrine and/or epinephrine to maintain mean arterial blood pressure above 65 mmHg.Methods and interventions Patients were randomly assigned to receive either nitric oxide or aerosolized prostacyclin. Nitric oxide was inhaled using a commercially available delivery system, prostacyclin was administered with a modified ultrasound nebulizer. Both nitric oxide and prostacyclin were incrementally adjusted to obtain a 15% decrease of mean pulmonary artery pressure. Hemodynamics and gas exchange as well as indocyaninegreen plasma disappearance rate and gastric intramucosal pH were determined at baseline after 90 min in steady state, after 90 min of nitric oxide inhalation or prostacyclin aerosol administration had elapsed in stable conditions, and after 90 min in stable conditions after nitric oxide or prostacyclin with-drawal.Results Both inhaled nitric oxide and aerosolized prostacyclin selectively reduced the mean pulmonary artery pressure from 35±4, 30±4 mmHg (p<0.05) and 34±4 to 30±3 mmHg (p<0.05) respectively; after removal of nitric oxide and prostacyclin, the mean pulmonary artery pressure returned to the baseline values. Systemic hemodynamics remained unaltered during the vasodilator treatment. While the mean PaO₂ was not significantly influenced, it increased in 4/8 of the NO- and 3/8 of the PGI₂ — treated patients. Neither of the drugs influenced indocyanine-green plasma disappearance rate, but prostacyclin — unlike nitric oxide — significantly increased gastric intramucosal pH (from 7.26±0.07 to 7.30±0.05,p<0.05) which remained elevated in four of these patients after prostacyclin removal, and decreased the arterial-gastric mucosal pressure of carbon dioxide gap from 19±6 to 15±4 mmHg (p<0.05).Conclusions Our data suggest that aerosolized prostacyclin — unlike nitric oxide — has similar beneficial effects on splanchnic perfusion and oxygenation as intravenous prostacyclin without detrimental effects on systemic hemodynamics. The different effects of prostacyclin and nitric oxide might be explained by the longer half-life of prostacyclin associated with a certain spillover into the systemic circulation.Presented in part at the Masterclass Symposium Sepsis in the ICU, Maastricht, June 27–29, 1995