氯胺酮复合氟烷麻醉在小儿短小手术中的临床应用

目的 比较氯胺酮复合氟烷与单独应用氯胺酮在小儿短小手术中的麻醉效果及安全性.方法 选择行短小手术患儿102例,随机分为氯胺酮复合氟烷麻醉组(F组)和氯胺酮麻醉组(R组),每组各51例,记录两组患儿心率(HR)、平均动脉压(MAP)、术后苏醒时间及不良反应发生情况并进行统计学分析.结果 F组患儿HR、MAP在诱导后(T2)、手术开始(T3)和术毕(T4)与人手术室安静后(T1)比较,差异无统计学意义(P＞0.05);R组患儿HR、MAP在T2、T3和T4时与T1比较,均有明显上升,差异有统计学意义(P＜0.05);F组术后苏醒时间为(15.08±4.97)min,较R组的(34.87±7.21) min明显缩短,差异有统计学意义(P＜0.05);F组不良反应发生情况明显少于R组,差异有统计学意义(P＜0.05).结论 小儿短小手术应用氯胺酮复合氟烷麻醉较单纯应用氯胺酮麻醉效果好,复苏更迅速,从药理经济学考虑,在缺乏更好的替代药物的情况下值得临床推广应用.     

剖宫产手术蛛网膜下腔小剂量罗哌卡因复合舒芬太尼的麻醉效果

目的 研究剖宫产手术蛛网膜下腔小剂量罗哌卡因复合舒芬太尼的麻醉效果.方法 将我院的100例剖宫产患者作为研究对象,随机分为实验组50例和对照组50例.实验组采用0.75％ 1.2 ml罗哌卡因复合0.2 μg舒芬太尼蛛网膜下腔联合麻醉,对照组使用0.75％ 1.2 ml罗哌卡因进行蛛网膜下腔麻醉.比较两组患者麻醉后的平均动脉压、药物起效时间、痛觉恢复时间、运动恢复时间、术后不良反应,并评定麻醉总体效果.结果 实验组麻醉后3 min和5min的MAP值比对照组高,差异有统计学意义(P＜0.05),其余时间点比较差异无统计学意义(P＞0.05);实验组与对照组药效起始时间、痛觉恢复时间、运动恢复时间以及术后的不良反应差异皆无统计学意义(P＞0.05);麻醉总体效果实验组极满意度为64.0％,与对照组极满意度(42.0％)比较差异有统计学意义(P＜0.05),不满意度分别为4.0％和18.0％,差异也有统计学意义(P＜0.05).结论 剖宫产手术蛛网膜下腔小剂量罗哌卡因复合舒芬太尼,麻醉效果好,循环稳定.     

芬太尼联合丙泊酚用于无痛人流术麻醉的临床观察

目的 对芬太尼联合丙泊酚在无痛人流术的麻醉效果和安全性进行观察.方法 选择2012年5月-2013年6月在海宁市妇幼保健院自愿要求行无痛人工流产术的112例孕妇,随机分为2组,每组56例,A组应用丙泊酚麻醉,B组应用芬太尼联合丙泊酚进行麻醉.观察并记录2组孕妇在麻醉诱导前、麻醉诱导后、手术5 min中及手术完成这些时间点的平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2);记录所有孕妇的术中疼痛反应、丙泊酚用量、起效时间、清醒时间及术中、术后不良反应.结果 2组患者在麻醉诱导前MAP、HR、SpO2的比较差异均无统计学意义(t值分别为1.374,1.267,1.047,P＞0.05);与诱导前比较,2组在麻醉诱导后的MAP、HR、SpO2均下降,且组间比较差异无统计学意义(P＞0.05);但手术开始5 min后A组的MAP、HR较B组明显升高(t值分别为2.413,2.558,P均＜0.05);而B组在各个时间点的MAP、HR、SpO2变化差异均无统计学意义(P＞0.05);虽然2组患者的麻醉起效时间差异无统计学意义(P＞0.05),但术后清醒时间及术中丙泊酚总用量B组均显著小于A组(P＜0.05);A组患者术中出现呼吸抑制、循环抑制、体动及术中疼痛均显著性高于B组(P＜0.05);术后常见的并发症如恶心呕吐等的发生率无明显差异.结论 丙泊酚联合芬太尼用于无痛人流,麻醉效果好,可减少丙泊酚用量,苏醒时间短,术中不良反应少,术后疼痛轻,值得临床推广.     

七氟醚复合骶管阻滞麻醉在小儿腹腔镜疝气手术麻醉中的临床应用

目的 探讨七氟醚复合骶管阻滞麻醉在小儿腹腔镜疝气手术中的可行性和安全性.方法 选择在腹腔镜下行单侧腹股沟斜疝修补术患儿60例,ASA Ⅰ～Ⅱ级,按随机方式分为A组(七氟醚复合骶管阻滞麻醉组)和B组(全麻插管组),每组30例,观察气腹效果、术后清醒时间,连续监测心率(HR)、平均动脉压(MAP)、呼气末二氧化碳分压(PetCO2)、血氧饱和度(SpO2).结果 两组患儿手术时间(min)差异无统计学意义(P＞0.05);两组患儿苏醒时间(min)A组短于B组,组间比较差异有统计学意义(P＜0.05).两组患儿气腹后HR、MAP、PetCO2比气腹前明显升高(P＜0.05),A组和B组间比较差异无统计学意义(P＞0.05).结论 七氟醚复合骶管阻滞麻醉用于小儿腹腔镜疝气手术是可行和安全有效的.     

静脉快通道麻醉联合硬膜外阻滞对老年患者血浆ET及TXB2的影响

目的 观察静脉快通道联合硬膜外麻醉对老年患者上腹部手术围术期血浆内皮素(ET)及血栓素A2(TXA2)的影响.方法 择期行胃癌根治术患者68例,ASA Ⅰ～Ⅱ级,随机分为单纯静脉快通道全麻组(A组)与静脉快通道联合硬膜外麻醉(B组).分别于麻醉前(T0)、插管后5min(T1)、切皮后5min(T2)、进腹探查(T3)时和术毕拔管后(T4)在非输液侧各采集静脉血6mL.采用放射免疫法测定血浆ET、TXB2含量,同时观察血流动力学变化.结果 两组患者麻醉效果均满意,总麻醉时间组间比较差异无统计学意义(P＞0.05);患者从静脉停止给药至睁眼时间、术毕至离开手术室时间及拔管时间B组明显短于A组(P＜0.01).Steward评分:术毕10min A组≥4分者(25例)少于B组≥4分者(34例),P＜0.01.A组T3时间点SBP高于T0时(P＜0.05)、T4时间点SBP及MAP显著高于T0时(P＜0.01);A、B两组在T1、T2时间点SBP、MAP、HR均低于T0时(P＜0.05),但两组间比较差异无统计学意义(P＞0.05);B组T3、T4时间点SBP、MAP及HR显著低于A组同时间点(P＜0.01).两组患者血浆ET水平T1 ～ T4时间点与T0点比较差异无统计学意义(P＞0.05),两组间相同时间点比较差异也无统计学意义(P＞0.05).A、B组患者在T1、T2、T3时血浆TXB2水平均低于T0时(P＜0.05);B组T2、T3、T4时血浆TXB2水平低于A组(P＜0.05).结论 静脉快通道联合硬膜外麻醉对老年上腹部手术患者血浆TXB2调控优于静脉全麻,能有效减轻患者围手术期的应激反应,有利于患者术后康复.     

七氟醚复合瑞芬太尼在门诊短小手术中的应用

目的 比较七氟醚与丙泊酚临床疗效的异同,探讨其在门诊短小手术麻醉中应用的临床效果.方法 将40例ASAⅠ或Ⅱ级门诊短小手术(手术时间<45 min)患者随机分成两组,Ⅰ组单纯静脉麻醉组,Ⅱ组静吸复合麻醉组.记录两组患者注药前、切皮前、术中、术毕时间四个点的MAP、HR、SpO2变化以及不良反应发生情况.结果 两组患者术前一般情况比较差异无统计学意义(P＞0.05);Ⅱ组诱导时间慢于Ⅰ组,Ⅱ组术毕清醒时间快于Ⅰ组,差异有统计学意义(P＜0.05);Ⅰ组呼吸抑制及术中体动反应发生率均明显高于Ⅱ组,差异有统计学意义(P＜0.05);清醒后疼痛程度轻,VAS 0～3分,两组差异无统计学意义(P＞0.05);两组术后均无术中知晓、恶心呕吐等不良反应.结论 咪唑安定与瑞芬太尼复合吸入七氟醚用于门诊短小手术的麻醉效果很好,与丙泊酚有着同等重要的临床价值.     

乳腺癌保乳术与改良根治术的临床对比研究

目的 通过早期乳腺癌保乳手术与改良根治术疗效的比较,探讨早期乳腺癌保乳手术的可行性.方法 回顾性分析乳腺癌患者547例,符合保乳手术标准的206例.其中行保乳手术(A组)43例.选出改良根治组(B组)患者86例.A组43例与B组86例进行临床对比研究.结果 A组与B组手术时间、术中出血量、术后引流总量、术后引流时间比较,差异有统计学意义(P＜0.05);2组清扫淋巴结个数的比较,差异无统计学意义(P＞0.05).A组与B组并发症的比较,2组患侧上肢水肿发生率比较差异无统计学意义(P＞0.05);切缘皮瓣缺血情况的比较差异有统计学意义(P＜0.05).A组与B组总生存率、总局部复发率、总远处转移率差异无统计学意义(P＞0.05).结论 保乳手术对于早期乳腺癌患者是一种较好术式.     

异丙酚复合不同剂量罗哌卡因在肛肠手术中的麻醉效果分析

目的:分析异丙酚符合不同剂量罗哌卡因在肛肠手术中的麻醉效果.方法:将84例肛肠手术患者随机平分为三组,A、B、C三组在20ml异丙酚中分别加入20m10.1％、0.2％、0.5％的罗哌卡因进行骶管阻滞麻醉,观察三组麻醉效果.结果:B、C组镇痛优良率均高于A组(P＜0.05),B、C组镇痛优良率比较差异不显著(P＞0.05);B组麻醉阻滞时间长于明显长于A组(P＜0.05),B、C组麻醉阻滞时间比较差异不显著(P＞0.05);三组运动阻滞程度评分差异不显著(P＞0.05);C组不良反应发生率高于A、B组(P＜0.05);A、B组不良反应发生率比较差异不显著(P＞0.05).结论:异丙酚复合0.2％罗哌卡因骶管阻滞麻醉在肛肠手术中可起到良好的镇痛作用,阻滞时间长,不良反应少,安全可靠.     

FloTrac/Vigileo系统联合被动抬腿试验在老年感染性休克患者液体复苏中的应用

目的:观察FloTrac/Vigileo系统联合被动抬腿试验(PLR)在指导老年感染性休克患者液体复苏中的应用效果.方法:54例老年感染性休克患者随机分为中心静脉压组(CVP组)、每搏量组(SV组)及PLR组,在接受常规感染性休克治疗基础上,分别监测CVP、SV及PLR时的SV值,观察3组患者液体复苏后6h及24 h的乳酸(Lac)、脑钠肽(BNP)、氧合指数(PO2/FiO2,P/F)和补液量,同时比较血管活性药物平均使用时间及28 d生存率.结果:液体复苏6h时,CVP组补液量和BNP值均明显高于SV组及PLR组(P＜0.05),Lac和P/F差异无统计学意义(P＞0.05),SV组与PLR组间Lac、BNP、P/F及补液量差异无统计学意义(P＞0.05);24 h补液量,CVP组＞SV组＞PLR组,组间比较差异有统计学意义(P＜0.05);P/F,CVP组＜SV组＜PLR组,组间比较差异有统计学意义(P＜0.05);PLR组BNP低于CVP组及SV组,差异有统计学意义(P＜0.05),CVP组与SV组间差异无统计学意义(P＞0.05);3组患者的Lac、使用血管活性药物平均时间及28 d生存率的差异无统计学意义(P＞0.05).结论:FloTrac/Vigileo系统联合被动抬腿试验在指导老年感染性休克液体复苏治疗中比传统CVP监测更精确.     

择期和急诊手术治疗寰枢椎节段椎管内占位性病变的疗效比较

目的 比较择期和急诊行寰枢椎节段椎管内占位性病变手术的疗效.方法 选取2010年5月至2015年4月在该院接受治疗的寰枢椎节段椎管内占位性病变患者32例,将患者分为急诊手术组(A组)14例和择期手术组(B组)18例.比较两组患者手术时间、术中出血量、JOA评分、ODI指数及VAS评分、术后影像学(MRI)改变情况和两组患者对疗效的满意度.结果 术后A组患者的JOA评分[(25.23±4.47)分]高于B组[(22.10±3.56)分],差异有统计学意义(P＜0.05).两组患者的ODI指数及VAS评分都有所下降,ODI指数A组(18.56±3.10)分,B组(21.56±4.37)分、VAS评分A组(1.89±0.53)分,B组(3.16±0.89)分,两组ODI指数比较差异有统计学意义(P＜0.05);两组VAS评分比较差异有统计学意义(P＜0.05).两组患者术前及术后1个月时脊髓功能分级(Frankel分级)比较,差异均无统计学意义(P＞0.05).A组手术时间[(120.23±9.02)min]与B组[(126.25±12.12)min]相比差异无统计学意义(P＞0.05);A组患者的术中出血量[(211.26±12.25) mL]与B组[(220.43±17.58)mL]相比差异无统计学意义(P＞0.05).治疗后1个月A组患者的满意度(92.56％)高于B组患者(72.22％),差异有统计学意义(P＜0.05).结论 急诊行寰枢椎节段椎管内占位性病变手术,能有效提高治疗效果,并且治疗后患者的满意度比较高,值得推广使用.     

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.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.