术前急性高容血液稀释对术中控制性降压血流动力学的影响

目的:探讨术前急性高容血液稀释对术中控制性降压血流动力学的影响.方法:将30例脊柱外科手术病人随机分为两组,术前急性高容血液稀释联合术中控制性降压组(联合组)和单纯的控制性降压组(降压组),以输入6%HES(费森尤斯公司生产,德国)20ml/kg和乳酸林格氏液20 ml/kg,速率50ml/min实施高容血液稀释,保持Hct＞20%.采用硝普钠微量泵输注实施控制性降压,输注速度为0.5～6μg·kg-1.min-1,控制平均压(MAP)在55～65mmHg.观察联合组插管后稀释前(T0)、稀释后降压前(T1)、降压后10 min(T2)、降压后20 min(T3)、降压后30min(T4)和停降压后30min(T5)六个时间点,降压组插管后降压前(T1)、降压后10 min(T2)、降压后20min(T3)降压后30 min(T4)和停降压后30 min(T5)五个时间点的HR,MAP,CVP,SV,CI和CO变化.结果:心率联合组T1较T0降低(P＜0.05);降压组T2,T3和T4明显高于T1(P＜0.01),T4明显高于T5(P＜0.05).CVP联合组T1较T0升高(P＜0.05);降压组T2,T3,T4和T5明显低于T1(P＜0.05).SV,CI和CO联合组T1,T2,T3和T4较T0升高(P＜0.05).结论:术前急性高容血液稀释可以增加术中控制性降压期间的心输出量,提高血流动力学的稳定性.     

高容血液稀释联合控制性降压对腰椎手术病人术中胃黏膜pH值的影响

目的:探讨术前急性高容血液稀释联合术中控制性降压对胃黏膜pH值的影响.方法:择期行腰椎骨折椎板减压、切复内固定病人30例,随机分为高容血液稀释联合控制性降压组(联合组)和单纯控制性降压组(对照组).观察比较联合组插管后稀释前(T0)、稀释后降压前(T1)、降压后30 min(T2)和停降压后30 min(T3)四个时间点,对照组插管后降压前(T1)、降压后30 min(T2)和停降压后30 min(T3)三个时间点的pHi,PgCO2,PgCO2-PaCO2和动脉血气的变化情况.结果:pH值联合组T1,T2,T3明显低于T0(P＜0.01);PaCO2对照组T3较T1明显升高(P＜0.05),且高于对照组(P＜0.05);PETCO2对照组T3明显高于T1(P＜0.05);PgCO2对照组T2较T1升高(P＜0.05),且高于对照组(P＜0.05);PgCO2-PaCO2对照组T2较T1升高(P＜0.01),pHi对照组T2较T1升高(P＜0.01).结论:硝普钠控制性降压可降低可引起一过性胃肠道微循环障碍,术前急性高容血液稀释可以改善术中控制性降压对胃肠道微循环的影响.     

急性高容量血液稀释联合控制性降压在胸椎手术中的应用

目的 观察术前急性高容量血液稀释联合术中控制性降压对血液的保护作用,评价其可行性.方法 选择择期全麻俯卧位下行胸椎减压内固定手术患者60例,随机分成3组,术前急性高容量血液稀释联合术中控制性降压(实验组)、单纯控制性降压组和急性高容量血液稀释组,每组20例.手术开始前输血浆代用品菲克雪浓(明胶注射液)20 mL/kg和复方林格氏液20 ml/kg,速率50 mL/min,术中采用微量泵输注硝普钠实施控制性降压,输注速率为0.5 μg/kg·min,控制平均动脉压(MAP)在55～65 mmHg.结果 实验组实际失血量明显低于单纯控制性降压组和急性高容量血液稀释组.结论 急性高容量血液稀释联合控制性降压,可减少术中出血量,提高节血效果和改善微循环,对机体的血液动力学、凝血功能、心功能及氧代谢均无明显影响.     

瑞芬太尼与硝普钠控制性降压对心率变异性影响的对比研究

目的观察瑞芬太尼与硝普钠控制性降压期间心率变异性(HRV)变化.方法42例行鼻内镜手术患者,随机分为瑞芬太尼组(R组)20例和硝普钠组(N组)22例.分别泵入瑞芬太尼或硝普钠,将收缩压降低基础值的30%左右.记录降压前、降压过程中及复压前后低频(LF)、高频(HF)、低高频比值(LF/HF)及收缩压(SBP)、心率(HR).结果①与降压前相比:降压期间两组LF、HF均下降;R组LF/HF下降,但N组LF/HF升高(P＜0.05,P＜0.01);复压后两组LF、HF均回升至降压前水平(P＞0.05),但R组LF/HF仍低于降压前水平(P＜0.01),N组LF/HF回升至降压前水平(P＞0.05).②降压期间R组HR较降压前减慢,N组HR明显增快(P＜0.01);复压后R组HR无明显变化,N组HR明显减慢(P＜0.01);R组HR与LF/HF呈正相关关系(P＜0.01),N组HR与LF、HF呈负相关关系,与LF/HF呈正相关关系(P＜0.01).结论R组降压时迷走神经张力下降的幅度小,HR较降压前减慢;N组降压时交感神经张力下降的幅度小,HR明显增快;复压后R组交感迷走神经张力均衡性未改变,HR无明显变化,N组迷走神经张力增高的幅度大,HR明显减慢.     

不同方法控制性降压对鼻内镜手术患者内脏灌注及术中出血量的影响

目的 研究不同方法控制性降压对内窥镜下鼻窦手术患者内脏灌注及术中出血量的影响.方法 择期内窥镜下鼻窦手术患者30例,随机分为A组(普通全麻组)、B组(硝普钠控制性降压)和C组(硝酸甘油控制性降压).每组10例.在静吸复合全麻下,桡动脉穿刺置管监测平均动脉血压(MAP),B、C组于麻醉后行急性高血容量血液稀释.然后于手术开始前15 min分别予硝普钠或硝酸甘油复合异氟醚吸入行控制性降压,使MAP降至50～55 mmHg,并维持至术毕A组不进行扩容和控制性降压.B、C组于麻醉后(T0)、降压开始时(T1)、降压30min(T2)、降压60min(T3)、停降压30min(T4)[A组未降压,在与降压组相对应的时间即麻醉后(T0)、手术开始前15min(T1)、手术开始后15min(T2)、手术开始后45 min(T3)、手术结束后30min(T4)]时分别记录HR、MAP,并采集动脉血行血气分析,记录PaCO2和pH值.胃二氧化碳张力仪测量PgCO2,根据血气值计算pHi.记录手术出血量和手术时间.结果 B、C组比A组出血量少,手术时间短,C组出血量比B组少.3组病人pHi、PgC02组内前后此较及组间比较均无统计学意义.结论 硝酸甘油或硝普钠控制性降压联合急性高血容量稀释时如采用合理的措施,MAP降至50～55 mmHg时并不一定会导致胃肠道循环低灌注和氧合障碍.内窥镜下鼻窦手术控制性降压可减少手术中出血量,且使用硝酸甘油降压比使用硝普钠降压减少出血效果更好.     

脑动脉瘤开颅术中瑞芬太尼和硝普钠控制性降压效果的比较

目的探讨在脑动脉瘤开颅术中采用瑞芬太尼和硝普钠控制性降压效果。方法择期行脑动脉瘤开颅切除术患者30例,ASA分级Ⅱ～Ⅲ级,随机分为瑞芬太尼(R组)和硝普钠组(N组),每组15例。两组于切皮前即刻开始降压,R组持续静脉输注瑞芬太尼0.3-0.7ug·kg-1·min-1,N组持续静脉输注硝普钠0.5-6.0ug·kg-1·min-1。使MAP降至术前基础值的70%左右(60-70mmHg)并维持至术毕,分别于控制性降压前(T0),控制性降压20min(T1)、40min(T2),术毕(T3)时记录MAP、HR,并于上述各时点抽取动脉血,进行血气分析,测定Hb、Hct、血乳酸(Lac)水平;记录开始降压至目标血压所需的时间,停降压药后MAP恢复的时间,以及术中的出血量,输血量。结果两组降压诱导时间,MAP恢复时间差异无统计学意义(P>0.05),与N组比较,R组T1,T2时HR降低(P<0.01),R组出血量减少(P<0.05)。N组有4例患者使用艾司洛尔。N组T3时有2例患者发生反跳性高血压,R组无一例发生。两组术后均未见并发症。结论脑动脉瘤开颅术中持续静脉输注瑞芬太尼0.3-0.7ug·kg-1·min-1,控制性降压可控性好,降压及恢复平稳,且血液保护作用好于硝普钠。     

急性高容量血液稀释联合控制性降压在脊柱手术中的应用

目的观察急性高容量血液稀释联合控制性降压用于脊柱手术对减少术中出血和异体输血及输血量的影响。方法选择ASAⅠ-Ⅱ级行胸、腰椎椎管减压内固定术的病人60例,随机分为对照组（Ⅰ组,n=30）和急性高容量血液稀释联合控制性降压组（Ⅱ组,n=30）。麻醉诱导后Ⅱ组于术前行急性高容量血液稀释,术中静脉泵输注硝普钠使（平均动脉压）MAP维持在65—70mmHg（1mmHg=0．133kPa）至术毕。术中连续监测循环变化,比较两组异体输血情况及输血量、尿量,观察有无反跳性高血压发生等。结果急性高容量血液稀释联合控制性降压组出血量、输血量和异体血输注比例明显低于对照组,且无反跳性高血压发生。结论急性高容量血液稀释联合控制性降压用于脊柱手术可减少术中出血和异体输血及输血量。     

艾司洛尔复合硝普钠控制性降压用于腹主动脉瘤腔内支架隔绝术

目的:观察艾司洛尔复合硝普钠控制性降压对腹主动脉瘤腔内支架隔绝术患者血流动力学的影响。方法:24例择期腹主动脉瘤腔内支架隔绝术病人随机分为2组,Ⅰ组采用单纯硝普钠控制性降压,Ⅱ组硝普钠联用艾司洛尔控制性降压。观察降压前、降压后5,10,15 min以及停止降压后5,15 min的SBP、HR、RPP、CI、SVR、PCWP及CVP值,记录2组从降压开始到降到目标血压所需的时间。结果:Ⅰ组与Ⅱ组从降压开始到达目标血压的时间分别为(5.3±1.5)min和(3.6±0.9)min(P<0.05)。Ⅱ组HR、RPP值在降压后5,10,15 min及停止降压后5 min时均低于Ⅰ组对应值(P<0.05)。结论:艾司洛尔复合硝普钠控制性降压可以降低腹主动脉瘤腔内支架隔绝术患者的HR与RPP、减少硝普钠的用量、降压迅速、复压平稳。     

丙泊酚复合硝普钠控制性降压对机体应激反应的影响

目的研究丙泊酚和硝普钠控制性降压对机体应激反应的影响.方法 ASAⅠ～Ⅱ级择期耳鼻喉显微外科手术病人30例,随机分两组,Ⅰ组为硝普钠组,Ⅱ组为丙泊酚复合硝普钠组.分别在控制性降压前(T1),降压后10 min(T2)、40 min(T3)及停降压后10 min(T4),记录降压期间血流动力学参数,采集颈内静脉血样测内皮素、血管紧张素Ⅱ和醛固酮浓度.记录硝普钠总用量和控制性降压时间,计算硝普钠输注速度;记录动脉血糖(BGa),颈内静脉球部血糖(BGjv), 计算动脉-颈内静脉球部血糖差(D(a-jv)BG)和脑葡萄糖摄取率(BGER).结果Ⅰ组降压期间心率增快(P<0.05),Ⅱ组无心率增快,T4时刻MAP显著低于Ⅰ组(P<0.05); 血管紧张素和内皮素在T3、T4时刻Ⅰ组均显著高于Ⅱ组(P<0.05或P<0.01).Ⅰ、Ⅱ组动、静脉血糖与降压前相比逐渐升高(P<0.05);Ⅰ组D(a-jv)BG和BGER降压后进一步下降(P<0.05).结论丙泊酚复合硝普钠控制性降压期间可减少硝普钠用量、降低快速耐药及反跳性高血压的发生,能有效抑制应激反应及与应激反应有关激素水平的增加,对降压期间糖代谢无明显影响.     

不同控制性降压方式在全髋手术中的临床应用

目的:探讨不同控制性降压方式在全髋手术中的临床应用.方法:行全髋手术印例随机分为控制性降压Ⅰ组和控制性降压Ⅱ组各30例,两组麻醉诱导相同.控制性降压的方式:Ⅰ组硝酸甘油0.3mg/kg稀释为50ml泵入,Ⅱ组硝普钠0.3mg/kg稀释为50ml泵入.维持MAP为50-70mmHg.分别记录两组的麻醉诱导后控制性降压前(T0)、控制性降压后10min(T1)、控制性降压后30min(T2)、手术结束后30min(13)的HR和MAP变化.结果:控制性降压30分钟后,两组的心率及MAP分别与T0、T1/T3比较,差异均有显著性(P<0.05或P<0.01).但Ⅰ组的降压效果较Ⅱ组弱,Ⅱ组的心率下降较Ⅰ组较弱.结论:硝普钠可控制性好,起效快,作用消失的也快,硝酸甘油对心脏有保护作用.对于全髋手术来说,控制性降压要根据患者的病情及手术方法来选择不同的控制性降压药物.     

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.