老年2型糖尿病脑动脉狭窄相关性危险因素分析

目的分析老年2型糖尿病脑动脉狭窄相关性危险因素。方法对本院行全脑DSA检查有动脉狭窄的100例老年缺血性脑血管病患者分为两组：2型糖尿病组和非糖尿病组，检测空腹血糖（FPG）、胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白-胆固醇（LDL-C）、空腹胰岛素（FINS）、高密度脂蛋白-胆固醇（HDL-C）、血纤维蛋白原（FIB）、胰岛素抵抗指数（HOMA-IR），并进行分析对比。结果（1）糖尿病患者脑动脉狭窄的病变与NDM比不论其血管累及支数及弥漫性方面均存在明显差异。（2）糖尿病组患者FPG、TC、TG、LDL-C、FINS、FIB、HOMA-IR明显高于非糖尿病组，差异有统计学意义（P〈0．05），HDL-C低于非糖尿病组，差异有统计学意义（P〈0．05）。结论老年2型糖尿病患者脑动脉狭窄比非糖尿病患者更广泛，这与糖尿病患者血脂代谢紊乱、胰岛素抵抗指数、高血糖、血纤维蛋白原升高有关。     

Determination of the median effective dose (ED50) of bupivacaine and ropivacaine unilateral spinal anesthesia

Background

Unilateral spinal anesthesia (USpA) has been reported to potentiate spinal anaesthesia and is used in geriatric patients. The purpose of this study was to determine the median effective dose (ED₅₀) of 0.5% hypobaric bupivacaine and 0.5% hypobaric ropivacaine USpA for geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery.

Methods

A total of 60 geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery were enrolled in this study. The patients were randomized into 2 groups to receive either intrathecal 0.5% hypobaric bupivacaine USpA (group B) or 0.5% hypobaric ropivacaine USpA (group R). Effective anesthesia was defined as a T10 sensory blockade level maintained for more than 60 min, and a Bromage score of 3 on the operation side within 10 min after injection with no additional epidural anesthetic required during surgery. The ED₅₀ of 0.5% hypobaric bupivacaine and 0.5% hypobaric ropivacaine was calculated using the Dixon and Massey formula.

Results

No significant differences were found between the two groups in terms of demographic data. The ED₅₀ of 0.5% hypobaric bupivacaine USpA was 4.66 mg (95% confidence interval CI 4.69–4.63 mg) mg and that of 0.5% hypobaric ropivacaine USpA was 6.43 mg (95% CI 6.47–6.39 mg) for geriatric patients undergoing hip replacement surgery.

Conclusion

We find the ED₅₀ were lower, and the ED50 of 0.5% hypobaric bupivacaine and ropivacaine was 4.66 mg (95% CI 4.69–4.63 mg) and 6.43 mg (95% CI 6.47–6.39 mg), respectively, for USpA in geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery.

     

内镜技术治疗慢性胰腺炎的临床应用价值

目的探讨内镜在慢性胰腺炎治疗中的临床应用价值。方法回顾性分析2002-2004年内镜治疗慢性胰腺炎患者33例的临床疗效。所有慢性胰腺炎病例均经临床检查、实验室检查、CT、超声及ERCP确诊。根据患者的情况采取单独或联合进行经内镜胰管括约肌切开（EPS）、乳头括约肌切开（FAT）、胰管内支架（PS）、胰石取出、鼻胰引流（ENPD）、胰管狭窄扩张等治疗措施。结果18例行EPS，27例行FAT，6例行网篮或气囊取胰石，13例行PS，5例行ENPD，9例行胰管扩张，1例巨大假性囊肿经胃壁穿刺放置内支架引流。33例中29例治疗后腹痛消失或明显减轻。治疗后复查实验室检查及影像指标均有明显改善。结论内镜技术联合应用治疗慢性胰腺炎是一种较安全、低创伤、有效的方法。