老年妇科手术患者的临床特点及围术期处理

目的总结老年妇科手术患者的临床特点及围术期处理措施。方法选取2015年1~12月在该院进行妇科手术的56例老年患者作为老年组(年龄≥60岁),同时选取同一时期采取妇科手术治疗的62例非老年患者作为非老年组(年龄<60岁),并分析两组手术前后临床特点,同时总结老年妇科手术患者围术期处理措施。结果两组恶性肿瘤疾病和术后合并疾病发病率比较差异有统计学意义(P<0.05),两组并发症发生率比较差异无统计学意义(P>0.05)。结论老年患者以妇科恶性肿瘤疾病为主,且多数术后合并各种并发症,因此掌握老年妇科手术治疗的临床特点,围术期做好术前准备和术后护理干预,有助于提高患者对麻醉和手术的耐受力,减少术后并发症的发生以及死亡率。     

依托咪酯和丙泊酚在老年颅脑手术中的麻醉诱导效果

目的探究临床应用依托咪酯和丙泊酚在老年颅脑手术麻醉诱导中的效果。方法选取老年颅脑手术患者120例,采用随机分组法分为实验组和对照组,每组60例。实验组予以依托咪酯和丙泊酚联合麻醉,对照组予以依托咪酯联合七氟烷联合麻醉。检测两组手术麻醉前后灰质血流量、心率、血氧饱和度(SPO_2)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)变化情况。结果两组围术期灰质血流量、SPO_2无明显变化(P0.05);两组术前、术后心率、SBP、DBP差异无统计学意义(P0.05),而实验组术中心率、SBP、DBP均比对照组平稳,差异有统计学意义(P0.05);两组术前MAP差异无统计学意义(P0.05);两组手术中MAP差异有统计学意义(P0.05);两组术后2 h MAP差异有统计学意义(P0.05)。结论依托咪酯联合丙泊酚应用在老年颅脑手术麻醉诱导中的效果明显,安全性高,术后无严重不良反应的发生,也能保持各指标稳定,更适合用于老年颅脑手术麻醉诱导。     

术前饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响

目的 探讨术前2 h饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响。方法 选择择期行胸腔镜下肺叶切除术的老年病人60例，随机分为2组，每组30例。对照组术前常规禁食，试验组在麻醉诱导前2 h饮用5%葡萄糖水4 mL/kg,入室后采用超声检查2组病人的胃窦部，测量半卧位下胃窦部横截面积(cross-sectional area, CSA),计算胃容量(gastric volume, GV)、胃容量与体质量的比值(GV/W),评估2组病人反流误吸风险。行桡动脉有创动脉血压监测，记录T1(入室后5 min)、T2(麻醉诱导后3 min)、T3(手术开始时)、T4(手术进行1 h)、T5(手术结束时)、T6(术后2 h)及T7(术后6 h)的SBP、平均动脉压(MAP)及心率(HR),比较2组病人围术期SBP降幅>20%超过30 s的发生率，记录2组病人围术期麻黄碱和去甲肾上腺素的使用率、使用量及病人的术后情况。结果 2组病人麻醉诱导前半卧位下CSA、GV及反流误吸风险差异无统计学意义(P>0.05);试验组在T2和T5时刻的MAP高于对照组(P<0...     

瑞芬太尼复合丙泊酚靶控输注在老年妇科腹腔镜手术麻醉中的应用

目的探讨瑞芬太尼复合丙泊酚靶控输注在老年妇科腹腔镜手术麻醉中的应用效果及对患者血流动力学的影响。方法选取择期妇科腹腔镜手术的120例老年患者为研究对象,随机分为观察组和对照组,每组60例,观察组采用瑞芬太尼复合丙泊酚靶控输注麻醉,对照组采用芬太尼静脉复合麻醉,比较两组患者麻醉效果和血流动力学情况。结果 1观察组患者麻醉起效时间、睁眼时间、拔管时间均显著低于对照组(P<0.05);2对照组患者插管后1 min、气腹10 min HR、SBP、DBP明显增高(P<0.05),观察组患者麻醉诱导前、插管后麻醉诱导前、插管后1 min、气腹10 min、术中30 min、术毕30 min,HR、SBP、DBP组内比较差异均无统计学意义(均P>0.05),麻醉前、中、后血流动力学平稳。结论瑞芬太尼复合丙泊酚靶控输注在老年妇科腹腔镜手术麻醉中起效快,安全性高,有助于保证麻醉过程中血流动力学稳定。     

依托咪酯静脉泵注对腹腔镜胆囊切除术老年患者早期认知功能和血流动力学的影响

目的探讨依托咪酯静脉泵注对腹腔镜胆囊切除术老年患者早期认知功能和血流动力学的影响。方法拟全麻下行腹腔镜胆囊切除术的90例老年患者,随机分为对照组和试验组各45例。对照组给予右美托咪定进行麻醉维持,试验组静脉泵注给予依托咪酯进行麻醉维持。记录并比较两组麻醉时间、术中出血量、手术时间及拔管时间。于手术前1 d(T'0)、手术后第1天(T'1)、手术后第3天(T'2)及手术后第7天(T'3)时评价并比较两组MMSE评分。于入手术室后(T0)、麻醉诱导后(T1)、气管插管后即刻(T2)、气管插管后2 min(T3)、腹腔充气时(T4)、切除胆囊时(T5)及手术完毕时(T6)记录并比较两组心率(HR)、平均动脉压(MAP)、收缩压(SBP)及舒张压(DBP)。结果两组麻醉时间、术中出血量、手术时间及拔管时间比较,差异均无统计学意义(P0.05)。两组T'0、T'3时MMSE评分比较,差异均无统计学意义(P0.05);试验组T'1、T'2时MMSE评分均明显高于对照组(P0.05)。对照组T1时HR、MAP、SBP及DBP均明显高于T0时(P0.05),在T2、T3、T5及T6时的SBP、DBP均明显低于T1时(P0.05);试验组T0～T6各时间点的HR、MAP、SBP及DBP均保持较为稳定,与T0时比较差异均无统计学意义(P0.05)。试验组T1、T4时HR、MAP、SBP及DBP均明显低于对照组(P0.05);试验组T3时MAP、SBP、DBP,T5时HR、MAP、DBP,T6时SBP水平均显著低于对照组(均P0.05)。结论依托咪酯静脉泵注能够明显改善老年腹腔镜胆囊切除术患者的早期认知功能和血流动力学稳定性。     

神经阻滞麻醉对老年心脏患者下肢手术围术期心血管并发症的影响

目的:观察后路腰丛联合坐骨神经阻滞用于并发心脏病的老年患者行下肢手术的临床麻醉效果,探讨该方法是否能降低患者围术期心血管并发症的发生率。方法: 拟行择期膝关节镜手术并发心脏疾患的老年患者60例,随机分为两组,每组30例,其中A组采用常规腰硬联合麻醉;B组采用神经刺激器定位辅助后路腰丛联合坐骨神经阻滞。记录手术中不同时间点的平均动脉压（MAP）、心率（HR）变化,感觉、运动阻滞起效和维持时间,术后镇痛效果及术后72 h的心血管不良事件发生率。结果: 两组患者麻醉前后HR变化组间比较无明显统计学差异,A组患者麻醉后MAP呈下降趋势,在麻醉后10 min及15 min,MAP明显低于B组患者（P<0.05）,在其余时间点两组间无明显统计学差异。而B组患者各时间点的MAP无明显变化。A组患者术后心血管不良事件发生率为23%,明显高于B组（10%,P<0.05）。A组患者感觉、运动阻滞起效时间［(1.3±0.9) min和(4.1±2.3) min］均短于B组［(7.9±2.4) min和(15.2±4.1) min,P<0.05］。但B组患者感觉阻滞维持时间［(418±103) min］明显长于A组［(182±99) min,P<0.05］,且运动阻滞维持时间［(282±68) min］明显短于A组［(305±76) min,P<0.05］。术后6 h B组患者的VAS评分［(1.1±0.2)分］明显低于A组［(5.2±1.7)分,P<0.05］。结论: 对于并发心血管疾患的老年高危患者施行下肢手术,采用后路腰丛联合坐骨神经阻滞麻醉,更有利于术中维持稳定的血流动力学,并减少术后心血管并发症的发生率,术后镇痛时间更长,有利于患者的术后恢复。     

老年妇科腹腔镜手术麻醉中静吸复合麻醉与全凭静脉麻醉的效果对比

目的探讨静吸复合麻醉与全凭静脉麻醉对老年妇科腹腔镜手术患者麻醉效果、血流动力学、应激反应及短期认知功能等的影响。方法 80例于全身麻醉下行妇科腹腔镜手术的患者按照麻醉方法分为静吸复合麻醉组与全凭静脉麻醉组各40例,对比两组患者麻醉效果,麻醉诱导前(T0)、诱导后(T1)、气管插管(T1)、手术结束时(T3)、收缩压(SBP)、舒张压(DBP)、心率(HR)等血流动力学指标,去甲肾上腺素、肾上腺素等应激反应指标及短期认知功能。结果静吸复合麻醉组麻醉起效时间、睁眼时间、拔管时间明显长于全凭静脉组(P<0.05),静吸复合麻醉组T1、T2时SBP、DBP较T0均明显降低,全凭静脉麻醉组T1较T0明显降低,静吸复合麻醉组T1、T2、T3时HR较T0均明显提高,且T1、T2时均明显高于全凭静脉麻醉组(P<0.05)。两组去甲肾上腺素T3较T0明显提高,静吸复合麻醉组肾上腺素T3较T0明显升高,且高于全凭静脉组T3,全凭静脉麻醉组T1~2较T0降低,T3较T0升高(P<0.05)。麻醉诱导后24 h静吸复合麻醉组简易精神状况(MMS)评分低于全凭静脉组(P<0.05),余未见明显差异。静吸复合麻醉组麻醉后6、12 h认知功能障碍发生率明显高于全凭静脉组(均P<0.05)。结论静吸复合麻醉与全凭静脉麻醉应用于老年妇科腹腔镜术中均可获得显著效果,患者的血流动力学及生理指标稳定,其中全凭静脉麻醉的效果更好,生命体征更加平稳,应激反应更小,短期认知功能影响更小。     

全身麻醉和硬膜外麻醉对糖尿病患者围手术期血糖的影响

目的探讨分析全身麻醉和硬膜外麻醉对糖尿病患者围手术期血糖的影响。方法选取该院2017年1—8月收治的88例糖尿病围术期患者作为研究对象,分为对照组和观察组,对照组给予全身麻醉,观察组给予硬膜外麻醉。对比分析两组患者术后血糖指标变化。结果术前,两组患者血糖水平相差异无统计学意义(P0.05),手术切皮充CO_2、手术结束时、术后3 h、术后24 h 4个时间段,观察组患者的血糖水平低于对照组,差异有统计学意义(P0.05);观察组患者胰岛素使用剂量低于对照组,差异有统计学意义(P0.05);手术前,两组患者的收缩压(SBP)、舒张压(DBP)和心率(HR)相差不大,差异无统计学意义(P0.05),手术30 min、手术完成后,观察组患者的SBP、DBP和HR均低于对照组,差异有统计学意义(P0.05)。结论对糖尿病患者围手术期患者实施硬膜外麻醉,可有效降低患者术中、术后的血糖水平,减少患者术中胰岛素的使用量,且患者的血流动力学指标相对稳定,具有较高的临床推广价值。     

腰丛复合坐骨神经阻滞麻醉对老年人股骨颈骨折患者术中血压和心率的影响

目的观察腰丛复合坐骨神经阻滞麻醉对老年股骨颈骨折手术患者术中血压和心率变化的影响。方法 96例老年股骨颈骨折患者,48例采用全髋关节置换术治疗（A组）,46例采用人工股骨头置换术治疗（B组）。记录两组患者麻醉前（T1）及阻滞完成后第5（T2）、10（T3）、20（T4）、30 min（T5）的动脉收缩压（SBP）、舒张压（DBP）、心率（HR）。结果阻滞完成后各时点A组患者SBP、DBP、HR和B组患者HR与T1相比P均〉0.05。B组患者T3、T4时SBP、DBP与T1、T2、T5相比P均〈0.05。结论采用全髋关节置换术治疗老年人股骨颈骨折时采用腰丛复合坐骨神经阻滞麻醉,术中麻醉诱导平稳,患者血压和心率稳定。采用人工股骨头置换术和治疗老年人股骨颈骨折时采用腰丛复合坐骨神经阻滞麻醉,术中麻醉诱导平稳,但患者血压和心率略有波动。     

硬膜外阻滞与全身麻醉下老年患者乳酸钠林格液液体动力学比较

目的探讨硬膜外阻滞与全身麻醉老年患者乳酸钠林格液液体动力学的差别。方法择期手术病人89例,美国麻醉师协会(ASAI)-Ⅱ级老年病人,根据病情及手术所需均可选择硬膜外阻滞与全身麻醉的麻醉方法,随机分为硬膜外阻滞组43例和全身麻醉组46例。通过检测血红蛋白水平采用Matlab 6.5软件包计算扩容后一级和二级容量动力参数,采用CHMT3002型血流动力学监测仪检测扩容前后的血流动力学指标。结果两组扩容前平均动脉血压(MAP)、心率(HR)、心排量(CO)和心脏指数(CI)无显著差异(P>0.05),扩容前后的MAP、HR、CO和CI无显著变化(P>0.05),与硬膜外阻滞组比,全身麻醉组扩容后MAP、HR、CO、CI和尿量均明显降低(均P<0.05)。一级容量动力学结果显示,与硬膜外阻滞组比,全身麻醉的靶容量(V)较低,清除率较低(均P<0.05),二级容量动力学结果显示,与硬膜外阻滞组比,全身麻醉的V1、V2、K1和Kt明显降低,尿量也较低(P<0.05)。结论与硬膜外阻滞麻醉比,全麻后血浆稀释度增加,组织中的液体保留率增大,有益于老年手术患者血容量替代扩充,辅助手术顺利进行。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.