丙泊酚靶控输注麻醉与七氟醚吸入麻醉用于腹腔镜手术的比较

目的 比较丙泊酚靶控输注(TCI)麻醉与七氟醚吸入麻醉用于腹腔镜胆囊切除术对患者血流动力学及术后恢复的影响.方法 60例择期行腹腔镜胆囊切除术患者,ASAⅠ～Ⅱ级,随机分为丙泊酚TCI组(P组,n=30)和七氟醚吸入组(S组,n=30).术中麻醉,P组输注血浆靶浓度为3μg/ml丙泊酚,S组持续吸入2%七氟醚(氧流量2 L/min),两组按需追加芬太尼和维库溴铵.分别记录两组病人麻醉前(T1)、气管插管后即刻(T2)、手术开始即刻(T3)、气腹后10 min(T4)及手术结束即刻(T5)的平均动脉压(MAP)和心率(HR),记录停药后完全清醒时间、术后24h恶心呕吐(PONV)发生率.结果 与S组比较,P组T4时点的MAP较低,HR较慢(P＜0.05),其他时点的MAP、HR比较差异无统计学意义(P＞0.05).停药后完全清醒时间两组间比较差异无统计学意义(P＞0.05),但术后24 h PONV发生率P组明显低于S组(P＜0.05).结论 丙泊酚TCI麻醉和七氟醚吸入麻醉用于腹腔镜胆囊切除术均可产生良好的麻醉效应,维持术中血流动力学稳定,术后苏醒迅速完全,但丙泊酚TCI麻醉比七氟醚吸入麻醉术后恶心呕吐发生率低.     

丙泊酚靶控输注麻醉与七氟醚吸入麻醉用于腹腔镜手术的比较

目的:对比分析丙泊酚靶控输注( TCI)麻醉和七氟醚吸入麻醉应用于腹腔镜胆囊切除术对患者的血流动力学和术后恢复的影响. 方法:从2012年1月~2014年1月在我院择期行腹腔镜胆囊切除术的患者中随机选取60例作为本次研究的对象, ASAⅠ-Ⅱ级,将其随机列入丙泊酚TCI组( P组) 与七氟醚吸入组( S组) ,每组各为30例. 术中行麻醉, P组输注血浆靶浓度为3μg/ml的丙泊酚,S组则持续吸入2%的七氟醚,观察2组患者血流动力学的变化情况及术后的恢复情况. 结果:与S组相比,P组患者T4时点的MAP显著较低,而HR则较慢(P<0.05),其余时点的MAP和HR相比,比较差异不具备统计学的意义(P>0.05). 停药后2组患者完全清醒的时间相比,比较差异不具备统计学的意义(P>0.05),但是术后24小时PONV的发生率相比,P组要显著低于S组( P<0.05). 结论:与七氟醚吸入麻醉术相比,丙泊酚TCI麻醉下患者的效果显著,术后苏醒迅速、完全,值得临床推广应用.     

丙泊酚靶控输注麻醉预防腹腔镜胆囊切除术后恶心呕吐的效果

目的观察丙泊酚靶控输注麻醉对腹腔镜胆囊切除术(LC)后恶心呕吐的效果.方法60例择期行LC的慢性胆囊炎、胆囊结石患者,随机分为丙泊酚靶控输注组(TCI组)和异氟醚静吸复合麻醉组(对照组),每组各30例.术后随访,观察恶心呕吐情况.结果TCI组恶心呕吐发生率明显低于对照组(P＜0.01).结论丙泊酚靶控输注麻醉能明显降低LC术后恶心呕吐的发生率.     

瑞芬太尼复合丙泊酚靶控输注麻醉在腹腔镜胆囊切除术中的麻醉效果观察

目的观察瑞芬太尼复合丙泊酚靶控输注在腹腔镜胆囊切除术中的麻醉效果.方法将腹腔镜胆囊切除术患者280例随机分为瑞芬太尼复合丙泊酚靶控输注组（TCI组）和异氟烷复合丙泊酚组（对照组）各140例.比较两组各时间节点血流动力学参数的变化、术毕不同时间节点的苏醒情况和镇静评分.结果与对照组比较,TCI组T1时间节点的SBP、DBP、HR差异有统计学意义（P〈0.05）;TCI组麻醉恢复的自主呼吸恢复时间、苏醒时间、拔管时间,差异有统计学意义（P〈0.01）;TCI组的5 min、10 min OAAS评分差异有统计学意义（P〈0.01）,但30 min后,两组差异无统计学意义（P〉0.05）.结论瑞芬太尼复合丙泊酚靶控输注麻醉,在麻醉诱导插管时易导致血压下降、心率减慢、术中血流动力学平稳;术毕苏醒迅速、完全,麻醉安全性高、可控性强.     

丙泊酚TCI与异氟醚复合麻醉对腹腔镜术后恢复的影响

目的研究丙泊酚TCI全凭静脉麻醉与异氟醚静吸复合麻醉对腹腔镜胆囊切除术后苏醒速度及PONV的影响.方法 90例择期行腹腔镜胆囊切除术的患者,ASAⅠ-Ⅱ级,随机分成丙泊酚TCI组(Ⅰ组)和异氟醚静吸复合组(Ⅱ组),均以丙泊酚-芬太尼-阿曲库铵诱导,插管后Ⅰ组以丙泊酚TCI维持麻醉至缝皮前,靶浓度为3 μg/mL,Ⅱ组持续吸入2%异氟醚(氧流量为2 L/min)至缝皮前,关闭吸入麻醉后使用回路内麻醉气体吸附器促进苏醒.术中按需追加芬太尼与阿曲库铵.两组病人分别记录:术前,术中1、5、10 min及术后MAP和HR;麻醉停止至拔管的时间以及清醒、定向力恢复的时间;麻醉用药量及术后d1随访有无恶心呕吐(PONV).结果Ⅰ组各时段MAP及HR与Ⅱ组间无显著差异,同组各时段MAP及HR除术始后1 min有所下降(P<0.05)外,其余也无显著差异.Ⅰ组麻醉停止至拔管时间、清醒及定向力恢复时间明显短于Ⅱ组,术后PONV发生率也明显低于Ⅱ组(均P<0.05).结论丙泊酚TCI全凭静脉麻醉用于腹腔镜之短小手术,与异氟醚静吸复合麻醉相比有苏醒快和术后PONV发生率低的优点.     

丙泊酚TCI全凭静脉麻醉与静吸复合麻醉对麻醉恢复期综合评分的影响

目的研究Marsh药代动力学模型,效应室靶控输注（TCI）丙泊酚全凭静脉麻醉与恩氟烷（安氟醚）静吸复合麻醉对麻醉恢复期综合评分的影响.方法选择204例ASAⅠ～Ⅲ择期手术患者,随机分为静吸复合麻醉（C）组和丙泊酚TCI全凭静脉麻醉（T）组,观察麻醉效果和并发症.结果两组均无术中知晓.两组患者停止泵入丙泊酚和停止安氟醚吸入至OAA/S评分≥4分的时间、拔除气管导管后5分钟的麻醉后恢复计分（PAS）有显著性差异.结论Marsh药代动力学模型,效应室靶控输注丙泊酚麻醉与安氟醚静吸复合麻醉比较,麻醉诱导、维持、麻醉深度的控制与静吸复合麻醉一样容易.患者恢复期清醒质量高,恢复对时间、地点的定向力以及正常精神运动行为的时间过程更快.术后恶心、呕吐发生率低.     

靶控输注全凭静脉与吸入七氟醚麻醉用于妇科腹腔镜手术的比较

通过比较七氟醚吸入麻醉与瑞芬太尼、丙泊酚靶控输注全凭静脉麻醉(TCI),探索出合适的临床麻醉方式.方法 为选择50例妇科腹腔镜手术,随机分为T组和R组.T组以瑞芬太尼,丙泊酚,诱导插管,术中以组靶控输注异丙酚(效应室浓度3μg/kg)和瑞芬太尼(靶控浓度在2.6-7ng/ml).直至术毕;R组用七氟醚,诱导插管,以七氟醚(2.5%-3.5%)维持至术毕.通过观察得出结论:七氟醚或瑞芬太尼联合丙泊酚的TCI均能满足妇科腹腔镜的麻醉需要.从麻醉诱导时的呼吸抑制和诱导的血流动力学看,七氟醚的麻醉优干瑞芬太尼联合丙泊酚的TCI麻醉.从术后的恶心,呕吐率看,七氟醚的麻醉高于瑞芬太尼联合丙泊酚的TCI麻醉.     

七氟醚与丙泊酚用于全麻诱导的效果比较

目的:探讨七氟醚和丙泊酚用于全麻诱导,比较两者麻醉效果及对患者血流动力学、应激反应的影响。方法:选择40例腹腔镜胆囊切除手术患者,ASA级或级,年龄21～63岁,随机分为两组(n=20),七氟醚组(S组)吸入1MAC七氟醚麻醉诱导,丙泊酚TCI组(P组)靶控输注血浆靶浓度3ug/ml丙泊酚麻醉诱导。患者入室静卧5min后记录血压(BP)、心率(HR)作为基础值(T0)。记录插管前即刻(T1)、插管后1min(T2)、3min(T3)、5min(T4)的BP、HR、血糖和患者意识消失的时间。结果:两组数据均与基础值(T0)作比较,T1、T2时两组SBP均下降(P<0.05),S组HR减慢(P<0.05);T3时P组SBP下降(P<0.05);T4时P组SBP下降(P<0.05);组间比较,T3、T4时P组SBP较S组下降明显(P<0.05)。S组意识消失时间短于P组(P<0.01)。结论:七氟醚吸入麻醉比丙泊酚静脉麻醉应激反应小,血流动力学变化小,更适合于全麻诱导。     

丙泊酚TCI与异氟醚复合麻醉对腹腔镜术后恢复的影响

目的研究丙泊酚TCI全凭静脉麻醉与异氟醚静吸复合麻醉对腹腔镜胆囊切除术后苏醒速度及PONV的影响。方法90例择期行腹腔镜胆囊切除术的患者 ,ASAⅠ Ⅱ级 ,随机分成丙泊酚TCI组 (Ⅰ组 )和异氟醚静吸复合组 (Ⅱ组 ) ,均以丙泊酚 -芬太尼 -阿曲库铵诱导 ,插管后Ⅰ组以丙泊酚TCI维持麻醉至缝皮前 ,靶浓度为 3μg/mL ,Ⅱ组持续吸入 2 %异氟醚 (氧流量为2L/min)至缝皮前 ,关闭吸入麻醉后使用回路内麻醉气体吸附器促进苏醒。术中按需追加芬太尼与阿曲库铵。两组病人分别记录 :术前 ,术中 1、5、10min及术后MAP和HR ;麻醉停止至拔管的时间以及清醒、定向力恢复的时间 ;麻醉用药量及术后d1随访有无恶心呕吐 (PONV)。结果Ⅰ组各时段MAP及HR与Ⅱ组间无显著差异 ,同组各时段MAP及HR除术始后 1min有所下降 (P<0 .0 5 )外 ,其余也无显著差异。Ⅰ组麻醉停止至拔管时间、清醒及定向力恢复时间明显短于Ⅱ组 ,术后PONV发生率也明显低于Ⅱ组 (均P <0 .0 5 )。结论丙泊酚TCI全凭静脉麻醉用于腹腔镜之短小手术 ,与异氟醚静吸复合麻醉相比有苏醒快和术后PONV发生率低的优点     

瑞芬太尼联合丙泊酚双通道靶控在腹腔镜胆囊切除术中的应用

目的 比较瑞芬太尼联合丙泊酚双通道靶控输注全凭静脉麻醉和静吸复合全麻应用于腹腔镜胆囊切除术(LC)的血流动力学变化和不良反应.方法 择期手术患者40例,ASAⅠ～Ⅱ级,心肺功能正常,随机分成瑞芬太尼-丙泊酚靶控输注组(TCI组)和静吸复合全麻组(F组)各20例.记录基础值,插管后1 min,气腹前,气腹后5 min,气腹后10 min和拔管时的桡动脉有创动脉压[收缩压(SBP),舒张压(DBP)],心率(HR)和拔管时间,清醒程度及术后24 h的恶心、呕吐情况.结果 术中TCI组血流动力学比F组平稳,差异有显著性(P<0.05).术后苏醒TCI组也优胜于F组(P<0.05).而且术后发生恶心、呕吐的患者明显较F组减少(P<0.05).结论 与常规静吸复合全麻下行LC手术比较,瑞芬太尼联合靶控输注全凭静脉麻醉围术期血流动力学更平稳,术后恢复快,不良反应更少.是腹腔镜胆囊切除术的理想方法.     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.