喉罩通气全凭静脉麻醉在纤维支气管镜检查术中的应用

目的 观察喉罩通气全凭静脉麻醉应用于纤维支气管镜检查术的临床效果和安全性.方法 拟行纤维支气管镜检查或治疗的患者75例,ASA I～III级,随机分为对照组(表面麻醉组,35例)和喉罩组(喉罩通气全凭静脉麻醉组,40例).观察两组患者麻醉诱导前(T0)、插入喉罩控制通气后(T1)、检查中(T2)、检查后(T3)各时间点的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2);并记录检查时间,麻醉清醒时间,检查期间不良反应及术后医、患的满意度.结果 与对照组相比,喉罩组患者在T2时间点的MAP、HR较低(P<0.05),SpO2在T2时间点则高于对照组(P<0.05).在T3时间点,喉罩组患者的MAP仍较对照组低(P<0.05).两组在检查时间上无差异(P>0.05);麻醉清醒时间(17.67±3.69)min,喉罩组患者的满意度高于对照组.结论 喉罩通气全凭静脉麻醉用于纤维支气管镜检查术,安全、舒适、内镜医师操作方便,具有良好的临床应用前景.     

喉罩对腹腔镜胆囊切除术全麻患者应激反应的影响

目的 评价全麻喉罩通气对患者应激反应的影响.方法 选择40例全麻腹腔镜胆囊切除术患者随机均分为全麻喉罩组(Ⅰ组)和气管插管组(Ⅱ组).监测BP、HR、ECG、SpO2、PETCO2,并于诱导前(T0)和诱导后3 min(T1)、6 min(T2)、10 min(T3)抽血查血浆皮质醇的浓度.结果 Ⅱ组T1、T2时的HR、MAP及血浆皮质醇水平明显高于T0时和Ⅰ组(P＜0.05).结论 全麻喉罩通气用于腹腔镜胆囊切除术患者,应激反应明显轻于气管插管.     

雷米芬太尼复合硝酸甘油控制性降压对神经外科手术患者应激反应的影响

目的: 观察神经外科手术中雷米芬太尼复合硝酸甘油行控制性降压的效果及其对应激反应的影响.方法: 30例ASAⅠ～Ⅱ级择期行神经外科手术患者,随机分为观察组(雷米芬太尼复合硝酸甘油)和对照组(硝酸甘油组),每组15例.分别采用雷米芬太尼复合硝酸甘油、硝酸甘油行控制性降压,两组均将平均动脉压(MAP)降至60～70 mmHg并维持.观察两组患者控制性降压前和降压后MAP、心率(HR)、心输出量(CO)的变化,检测麻醉诱导前(T0)、控制性降压前即刻(T1)、维持降压15 min(T2)和停降压15 min(T3)的血糖值、血浆皮质醇浓度、血浆肾上腺素、去甲肾上腺素和多巴胺浓度.结果: 与T0和T1比较,T2、T3时间点两组MAP均显著降低(P＜0.05或P＜0.01),而CO无明显变化;对照组控制性降压期间HR较降压前明显增快(P＜0.01),而观察组HR则无明显改变,观察组降压期间HR显著低于对照组(P＜0.05或P＜0.01).与T0比较,T1、T2、T3时间点对照组血糖明显升高(P＜0.05或P＜0.01),而观察组各时间点血糖则无明显改变;与T0 和T1时间点相比较,T2时间点对照组血浆去甲肾上腺素、肾上腺素浓度均显著升高(P＜0.05或P＜0.01),T2时间点观察组血浆去甲肾上腺素、肾上腺素浓度均显著低于对照组(P＜0.05).结论: 神经外科手术中雷米芬太尼复合硝酸甘油行控制性降压能有效抑制机体的应激反应,对血流动力学影响轻微.     

观察地佐辛用于腹腔镜下胆囊切除术全麻喉罩诱导的临床疗效

目的 探讨不同剂量地佐辛用于腹腔镜下胆囊切除手术全麻喉罩通气道诱导的临床效果和安全性.方法 选择择期行腹腔镜下胆囊切除手术患者80例,ASA Ⅰ～Ⅱ级,随机分为4组各20例.以地佐辛用量不同分D1组、D2组及D3组;芬太尼组(F组),静脉注射芬太尼3μg/kg,以上均用丙泊酚2mg/kg,罗库溴胺0.8 mg/kg诱导,BIS值下降至40～60时转入喉罩.观察诱导前(T0)、喉罩置入前(T1)、喉罩置入即时(T2)及置入后1、3、5min(T3、T4及T5)各时点的平均动脉压(MAP)和心率(HR)的变化.结果 4组患者麻醉诱导后各时点BP、HR较诱导前的基础值均降低(均P＜ 0.05)置入喉罩操作时各指标均高于较置入前(均P＜0.05).D1组T2、T3及T4的MAP和HR明显高于F组(均P＜0.05); D2组在各时点MAP和HR与F组相比无明显差异(P＞0.05);D3组T1、T2、T3、T4 HR比D2组和F组有明显下降,但均在正常范围内(P＞0.05).结论 地佐辛可用于全麻喉罩通气道诱导,能达到有效的麻醉深度,维持全麻插喉罩诱导期间血压和心率的稳定剂量为0.15 mg/kg.     

可弯曲喉罩用于小儿扁桃体摘除术气道管理的效果

目的 评价可弯曲喉罩用于小儿扁桃体摘除术患者的安全性和有效性.方法 择期行扁桃体摘除术患儿30例,年龄2～10岁,体质量10 ～ 50kg,ASA分级Ⅰ～Ⅱ级,采用随机数字表法均分成两组:喉罩组和气管插管组,每组15例.麻醉诱导:喉罩组使用咪达唑仑0.1 mg/kg、丙泊酚3 mg/kg、舒芬太尼0.5μg/kg,气管插管组加用顺式阿曲库铵0.15 mg/kg.麻醉维持:两组均使用丙泊酚6 ～ 10 mg/(kg·h)、瑞芬太尼0.2 ～ 0.5 μg/(kg·min)静脉泵注.记录麻醉诱导前(T0)、麻醉诱导后(T1)、置入喉罩或气管导管即刻(T2)、置入开口器及手术开始即刻(T3)、手术结束时(T4)和拔除喉罩或气管导管即刻(T5)的心率(heart rate,HR)、平均动脉血压(mean arterial pressure,MAP),并于T0、T2T3、T5采集血样测量血糖和皮质醇浓度;记录麻醉药物用量、液体出入量、麻醉时间、自主呼吸恢复时间、拔管时间、麻醉苏醒时间;并记录置入喉罩或气管插管的首次成功率和总成功率、麻醉恢复期间并发症(躁动、胃胀气、呛咳、喉痉挛等)发生情况.结果 与气管插管组比较,喉罩组患儿自主呼吸恢复时间、拔除喉罩时间、苏醒时间明显缩短(P＜0.05);与T1比较,气管插管组T2的HR、MAP明显升高(P＜0.05),而喉罩组差异无统计学意义,气管插管组T2、T5时刻的HR、MAP明显高于喉罩组(P＜0.05);喉罩组术后呛咳发生率明显降低(P＜0.05).结论 可弯曲喉罩用于小儿扁桃体摘除术应激反应小,并发症少,安全有效,值得在临床推广应用.     

欧普乐喉罩在预计困难插管患者中的临床应用

目的 比较研究丙泊酚靶控诱导(血浆靶浓度为6μg/mL)和七氟醚吸入诱导(8%的吸入浓度)下置入欧普乐喉罩在预计困难气管插管患者中应用的可行性与安全性.方法 选择择期全身麻醉手术患者40例,男32例,女8例,ASA Ⅰ、Ⅱ级,患者随机分成2组,每组20例,其中I组为丙泊酚靶控诱导组,Ⅱ组为七氟醚吸入诱导组.观察并记录患者入室平静后(T1)、置喉罩前(T2)、置喉罩后即刻(T3)的MAP、HR和SpO2等生理指标以及诱导时间、一次性置入成功率、置入喉罩所花时间、诱导时和置入后的各种相关并发症.结果 丙泊酚组患者麻醉诱导后较诱导前MAP和HR均明显降低(P＜0.05);丙泊酚组患者麻醉诱导后较七氟醚组患者麻醉诱导后MAP和HR均明显降低(P＜0.05);两组各时点SpO2比较差异无统计学意义(P＞0.05);丙泊酚组患者的一次性置入成功率高于七氟醚组患者(P ＜0.001),诱导时间及置入时间均少于七氟醚组患者(P＜0.001);失败率两组间无统计学差别(P＞0.05);但丙泊酚组患者诱导时和置入时的呼吸暂停发生率均高于七氟醚组患者(P＜0.05),且丙泊酚组有较高的注射痛发生率.结论 保留自主呼吸的丙泊酚靶控诱导和七氟醚吸入诱导均能为困难气道处理提供较为安全和理想的欧普乐喉罩置入条件;丙泊酚组较七氟醚组能提供较快的诱导时间和较好的置入条件.     

SLIPA喉罩在高血压患者腹腔镜胆囊切除术麻醉中的应用

①目的 探讨SLIPA喉罩应用在高血压患者腹腔镜胆囊切除麻醉术中的可行性和安全性.②方法 腹腔镜胆囊切除术高血压患者60例,ASAⅠ～Ⅲ级.随机均分成SLIPA喉罩组(S组)和气管插管组(T组).在麻醉诱导前(T0)、麻醉诱导后(T1)、插管/喉罩即刻(T2)、插管/喉罩后5min(T3)、气腹即刻(T4)、气腹后10min(T5)、拔管/喉罩即刻(T6)、拔管/喉罩后5min(T7),记录心率(HR)、平均动脉压(MAP)、气道峰压(Ppeak)、脉搏血氧饱和度(SPO2)及呼吸末二氧化碳分压(PETCO2).记录两组麻醉时间、气腹时间、拔管/喉罩时间、苏醒时间及患者相关并发症.③结果 T2 、T6时T组的HR、MAP明显高于S组(P<0.05).两组患者HR、MAP在T2 、T6时明显高于T0时(P<0.05).T4 、T5时两组患者Ppeak明显高于T2时(P<0.05).T5时两组患者PETCO2明显高于T2时(P<0.05).T组患者拔管时呛咳及术后咽喉不适、咽痛明显多于S组(P<0.05).T组患者拔管/喉罩时间、苏醒时间明显长于S组(P<0.05).④结论 SLIPA喉罩适用于高血压患者腹腔镜胆囊切除术的麻醉,易于维持血流动力学稳定,应激反应轻微,并发症少.     

喉罩在全麻下颅内动脉瘤填塞术中的应用

目的 比较应用喉罩与气管导管两种气道管理方式对颅内动脉瘤介入微弹簧圈填塞手术患者术中血流动力学影响,评价喉罩在该手术中应用的安全性与优越性.方法 选取颅内动脉瘤填塞术患者40例,随机分为喉罩喉罩组和气管插管气管插管组,记录麻醉诱导前(T0)、诱导后(T1)、置入时(T2)、置人后5 min(T3)、填塞弹簧圈时(T4)、拔出气管导管或喉罩时(T5)、拔出后5 min(T6)的MAP、HR的变化值.记录术中两组血压波动,使用升降压药物及苏醒期躁动情况.结果 在T2、T5、T6时点,气管插管组MAP、HR明显升高(P＜0.05),且与同时点的喉罩组比较有统计学差异(P＜0.05).与喉罩组比较,气管插管组术中升压药的使用及苏醒期躁动发生率明显增加(P＜0.05).结论 在颅内动脉瘤填塞术中使用喉罩,具有麻醉诱导及苏醒期血流动力学稳定、应激反应轻、安全性好、术后躁动发生率低的优点.     

腰骶丛神经阻滞后喉罩通气全身麻醉在老年股骨颈骨折髋关节置换术中的应用

目的:探讨超声引导下腰骶丛神经阻滞后喉罩通气全身麻醉在老年股骨颈骨折患者髋关节置换术中的应用价值。方法:选取126例拟行髋关节置换术的老年股骨颈骨折患者,按照随机数字表法将其分为观察组与对照组各63例。对照组给予喉罩通气全身麻醉,观察组行超声引导下腰骶丛神经阻滞后喉罩通气全身麻醉。比较两组围手术期血流动力学[心率(HR)、平均动脉压(MAP)]水平、术中麻醉药物用量,统计两组不良反应发生率。结果:观察组T2、T4时的MAP及HR水平均低于对照组,差异有统计学意义(P<0.05);对照组除T3时刻外其他各时间点的MAP水平与T0时刻相比,对照组各时间点的HR水平与T0时刻相比,差异均有统计学意义(P<0.05);观察组仅T4时刻的MAP水平与T0时刻相比,差异有统计学意义(P<0.05),观察组仅T1、T3时刻的HR水平与T0时刻相比,差异有统计学意义(P<0.05);观察组术中丙泊酚、瑞芬太尼、苯磺顺阿曲库铵用量均少于对照组,差异有统计学意义(P<0.05);观察组术后不良反应发生率为4.76%(3/63),低于对照组的17.46%(11/63),差异有统计学意义(P<0.05)。结论:超声引导下腰骶丛神经阻滞后喉罩通气全身麻醉,有利于稳定老年股骨颈骨折髋关节置换术患者围手术期血流动力学,并可减少术中麻醉药用量,进而有利于降低不良反应发生率。     

髂筋膜阻滞联合喉罩在老年患者髋部骨折术中的临床应用

目的 探讨髂筋膜阻滞联合喉罩在老年患者髋部骨折术中的应用效果.方法 回顾性分析2018年1月至2019年12月于本院行全髋置换术、股骨头置换术、PFNA内固定术的70例老年患者的临床资料,根据麻醉方法的不同分为对照组与观察组,每组35例.对照组实施气管插管全身麻醉,观察组实施髂筋膜腔阻滞联合喉罩全身麻醉.比较两组血流动力学变化情况、术后疼痛评分、恢复室滞留时间、拔管时间、舒芬太尼用量及不良反应发生率.结果 麻醉诱导前、麻醉诱导后,两组MAP、HR比较差异无统计学意义;置入即刻、拔除即刻,观察组MAP、HR均低于对照组(P<0.05).术后2、12、24 h,观察组VAS评分均低于对照组(P<0.05).观察组恢复室滞留时间、拔管时间均短于对照组,舒芬太尼用量少于对照组(P<0.05).观察组不良反应发生率为5.71％,低于对照组的22.86％,差异有统计学意义(P<0.05).结论 老年髋部骨折患者实施髂筋膜腔阻滞联合喉罩全身麻醉镇痛效果显著,苏醒更快,可促进患者尽早拔管,减少舒芬太尼使用剂量,不仅能保持血流动力学的稳定性,还能减少不良反应的发生.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.