非右房肥大的P波高电压(附39例临床分析)

本文报告39例临床上除外右房肥大的P波高电压,此种P波高电压主要见于冠心病及急性颅脑疾患,二者之和占76.9%。其形态64%与肺性P波相同。产生的机制可能与结间束传导阻滞、中枢调节机能受累、交感神经兴奋性增高等有关。     

Morphologische Wirkung von Adrenalin und Insulin auf Knochenkapillaren nach Rezeptorenblockade

In three groups of six mice each, the α- and β-receptors were blocked by phentolamine and propranolol. The mice in the three groups then received an intravenous bolus injection of saline solution, epinephrine, and insulin, respectively. Cortical bone capillaries from the tibia diaphysis were submitted to transmission electron microscopy (TEM). The lumen and endothelium were measured and the results compared. Significant changes were only noted in the endothelium after the administration of insulin. These findings suggest that there are also insulin receptors in bone. Furthermore, they support previous findings in similar studies with epinephrine.     

Laktatazidose: eine Komplikation beim querschnittgelähmten Polytrauma

Large-dose methylprednisolone has been advocated to lessen neurologic deficits in spinal cord injury for nearly a decade despite confounding statistical results in the Second National Acute Spinal Cord Injury Study (NASCIS-2). Recent retrospective studies found lack of significant functional improvement, increases in the incidence of infectious complications and an increase in ventilated and intensive care days in steroid-treated groups. We report on five cases with severe hyperglycemia and nonketotic metabolic acidosis in otherwise non-diabetic patients with multiple blunt injuries and an associated spinal cord injury. Those adverse effects were induced by epinephrine and aggravated by methylprednisolone. We conclude that high-dose methylprednisolone should be avoided in multiple injured or otherwise compromised patients potentially needing catecholamine support.     

心肺复苏早期应用氨茶碱与传统方法的比较研究

目的：探讨心肺复苏（CPR）早期应用氨茶碱的临床意义。方法：将100例心脏骤停（CA）患者，随机分成观察组（肾上腺素＋氨茶碱组）、对照组（肾上腺素组），对照组按照传统CPR方法。静脉注射肾上腺素；观察组在传统方法的基础上早期加用氨茶碱静注。对两组在6h、24h存活率及正常出院方面进行统计学分析。结果：（1）两组在性别、年龄、疾病构成方面无统计学差异（P〉0．05）；（2）两组在肾上腙素剂量、开始使用时间、直流电除颤等方面比较无统计学差异（P〉0.05）；（3）观察组6h存活率与对照组比较有显著性差异（P〈0．05）；两组24h存活率无统计学差异，但在正常出院方面观察组略优于对照组。结论：（1）早期使用氨茶碱可提高6h存活率，正常出院略优于单使用肾上腺索组（对照组）；（2）早期使用氨茶碱可能对最终生存率有益。     

Epinephrine‐supplemented local anesthetics for ear and nose surgery: Clinical use without complications in more than 10,000 surgical procedures

Introduction: Local anesthetics supplemented with epinephrine are generally regarded as contraindicated for surgical procedures involving the fingers, toes, penis, outer ear and the tip of the nose [ 1 ], but epinephrine is essential if automated tumescence local anesthesia (Auto‐TLA) is used. Materials and methods: Infiltration anesthesia supplemented with 1 : 200,000 epinephrine was used from 1985 – 1997 in our department, while Auto‐TLA supplemented with 1 : 1.000,000 epinephrine was introduced in 1997 for all surgical procedures involving the ear or nose. During this period, 10,201 patients underwent surgery at these locations. In addition, dermal blood flow was analyzed by acral photoplethysmography (APPG) and laser Doppler flowmetry (LDF) in the right ear lobe of five normal volunteers and during epinephrine supplemented Auto‐TLA. Results: Epinephrine‐induced complications were not observed in a single patient. Cosmetic skin flap surgery was performed in 4,953 of these patients. Even in patients with extended surgical procedures that took up to one to two hours and that included extensive skin flaps or skin grafts, we observed no increase in complications when compared to procedures performed either under general anesthesia or local anesthesia without epinephrine supplementation. Measuring blood perfusion of the earlobe showed a 69 % reduction of LDF and a 42 % reduction of arterial inflow (APPG) immediately following anesthesia. Conclusion: Epinephrine supplementation of local anesthetics does not block blood perfusion in the ear and did not induce organ, tissue or flap necrosis. Local anesthesia with epinephrine supplementation is therefore safe for acral areas such as the ear or nose. Despite the relatively small influence on blood perfusion, epinephrine supplementation results in a relatively bloodless operating field and longer effectiveness of local anesthesia. The relative absence of blood in the operating field of the ear and nose significantly reduces the duration of surgery and increases the healing rate, as less electrocautery is needed.     

心肺复苏时大剂量肾上腺素的应用（附42例报告）

为了提高心肺复苏的成功率，近年来，我们对心脏骤停病人分别给常规剂量与大剂量肾上腺素进行抢救，结果表明，大剂量肾上腺素能使自主循环迅速恢复，自主呼吸恢复率及生存率也较常规组高，笔者认为，在心肺复苏时，目前推荐的标准剂量太小，早期应用大剂量是安全的，但更大的剂量还需进一步研究。     

心搏骤停心肺复苏中若干问题的探讨

目的探讨影响心搏骤停(CA)心肺复苏(CPR)有效率的因素。方法回顾性分析87例CA患者心肺复苏的临床资料,包括年龄、心搏骤停前基础疾病、电除颤开始时间、CPR开始时间、CPR持续时间、人工呼吸开始时间等。结果87例CA行心肺复苏患者中,49例复苏有效(56.3%),38例复苏失败(43.7%);复苏有效组与复苏失败组患者的病因分布、年龄、电除颤开始时间、CPR开始时间、CPR持续时间间差别均有显著性意义(P<0.05),人工呼吸开始时间间差别无显著性意义(P>0.05);肾上腺素首次应用剂量为1mg,以后重复时增加剂量,复苏有效组中有21例应用,复苏失败组中有9例应用。结论原发疾病、患者年龄、电除颤开始时间、CPR开始时间、CPR持续时间是影响CA患者CPR有效率的重要因素;立即建立人工循环并将肾上腺素用量与用药时机有效结合是提高CPR有效率的关键措施。     

牛磺酸抗肾上腺素诱发Langendorff家兔心脏心律失常的作用

本实验采用Langendorff家兔心脏观察了牛磺酸抗肾上腺素诱发心律失常的作用.实验发现10~(-5)～10~(-4)mol/L的牛磺酸不仅能减少肾上腺素诱发心律失常发生率,而且能延长诱发心律失常潜伏期和缩短心律失常持续时间的作用.     

EFFECT OF MOXIBUSTION ON CATECHOLAMINE

Objective: To investigate whether moxibustion affects the secretion of catecholamine as a-drenalin, noradrenaline and dopamine. Methods: Twenty Wistar rats were allocated to two groups. One was moxibustion-group (10 rats), and the other was non-moxibustion-group (10 rats). Four ignited moxa-cones were applied to bilateral "Shenshu" (肾俞 BL 23). When a moxa-cone burned out, another one was replaced. At the end of each experiment, blood sample (2 mL/rat) was collected from the heart for assaying plasma adrenalin, noradrenaline and dopamine contents with high pressure liquid chromatography. Results: The presented results showed that plasma adrenalin and noradrenaline contents of moxibustion-group are significantly higher than those of non-moxibustion-group (P<0.01). However, there is no significant difference of dopamine between moxibustion- and non-moxibustion- groups (P >0.05). Conclusion: These results demonstrated that moxibustion stimulates the secretion of adrenaline and noradrenaline in normal rats.     

糖尿乐胶囊降血糖作用的实验研究

目的:观察糖尿乐胶囊的降糖作用。方法:采用正常动物及糖尿病模型动物对糖尿乐的降糖作用进行观察。结果:糖尿乐可降低正常小鼠及大鼠的血糖含量,并可使正常大鼠血清胰岛素水平及肝糖原含量升高;可使肾上腺所致高血糖大鼠血糖明显降低,肝糖原含量明显增加;对四氧嘧啶所致的小鼠和大鼠高血糖均有明显的抑制作用;还能改善大鼠糖耐量。结论:糖尿乐胶囊具有明显的降血糖作用。