OSAHS手术后并发症和围手术期的治疗

目的探讨阻塞性睡眠呼吸暂停低通气综合征（obstructive　sleep　apnea　hypopnea　syndrome，OSAKS）术后并发症和围手术期治疗的临床意义。方法169例OSAHS患者，其中行H—UPPP高位腭咽成形术150例，联合H—UPPP、硬腭截短术19例。结果50例（29．5％）术前2周CPAP（Continuous　positive　airway　pressure，持续气道正压通气）治疗，92例（54．4％）术后保留经鼻气管插管并转入ICU治疗，3例术后伤口出血经全麻插管后拆开缝线、用双极电凝止血后再缝合创面，3例术后出现呼吸道梗阻经吸氧、再次插管、激素等治疗后缓解，2例因插管困难行清醒状态下的纤维喉镜引导插管，1例术后发生肺栓塞在ICU抗凝、综合治疗。结论OSAHS患者注意围手术期治疗可以避免发生严重的并发症。     

持续正压通气治疗在阻塞性睡眠呼吸暂停综合征患者围手术期的应用

目的：探讨围手术期持续正压通气治疗(continue positive airway pressure，CPAP)在中、重度阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea synclrome，OSAS)患者围手术期应用的意义。方法：经多导睡眠监测确诊为中、重度OSAS 60例，行悬雍垂腭咽成形术(uvulapalatopharyngoplasty，UPPP)。Ⅰ组25例，术前未经任何治疗。Ⅱ组35例，术前予以智能型持续正压通气机(Auto—CPAP)治疗3～5d，比较两组患者围手术期并发症的发生率。结果：术前未接受CPAP治疗的25例，术中一过性呼吸困难3例，术后高血压危象5例，原发性出血1例。经CPAP治疗的35例，术前多种临床症状基本缓解，精神佳，睡眠质量明显改善，围手术期无严重并发症出现。结论：中、重度OSAS患者手术有极大的潜在危险，术前应用CPAP治疗能显著提高患者对手术及麻醉的耐受性，降低手术风险，减少并发症的发生。     

阻塞性睡眠呼吸暂停低通气综合征行腭咽成形术围手术期的临床研究

目的 :探讨腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)治疗中、重度阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrome ,OSAHS)围手术期的临床处理。方法 :对 5 4例中、重度OSAHS患者实施了腭咽成形术 ,围手术期的处理包括 (1)多道睡眠监测和心肺功能评估 ;(2 )术前 4 4例、术后 2 9例行正压通气治疗 ;(3)静脉诱导吸入全身麻醉 4 6例 ,局部浸润麻醉 8例 ;(4) 4 2例行保留悬雍垂的改良腭咽成形术。结果 :术前未接受CPAP治疗的局麻患者术中出现短暂呼吸困难 2例 ,术后高血压危象、心动过速各 1例 ,术后原发性出血 2例。CPAP治疗组在麻醉清醒期及术后无急性上气道阻塞发生。全身麻醉 5例插管困难 ,有高血压病史的 19例术中血液动力学波动大。经典腭咽成形术后 1周内腭咽关闭不全 4例 ,行保留悬雍垂的改良腭咽成形术后咽部有异物感 9例 ,但无其他并发症。结论 :充分认识UPPP手术存在的潜在风险 ,认真进行围手术期的正确治疗有助于减少手术并发症 ,提高手术和麻醉的安全性     

阻塞性睡眠呼吸暂停低通气综合征患者围手术期无创正压通气治疗的临床意义

目的研究无创正压通气（CPAP）治疗对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）围手术期的影响，探讨其对减少手术并发症的临床意义。方法对36例OSAHS患者行术前诊断性及CPAP治疗下的多道睡眠监测，分析CPAP治疗前后睡眠结构、呼吸、血氧饱和度及微觉醒等监测指标的变化。结果CPAP治疗后，各项指标较治疗前明显好转，患者睡眠结构趋于正常，1期浅睡眠减少，3+4期深睡眠及REM期睡眠明显增加；微觉醒、呼吸事件和血氧饱和度下降幅度明显减少；轻、中、重度OSAHS患者各项指标变化有一定差异。经CPAP治疗后张口呼吸减少，同时，通过术前咽腔局部药物雾化治疗，患者咽腔充血明显减轻，术中、术后出血量不多，无高血压危象等严重并发症出现。结论围手术期CPAP治疗可有效改善OSHAS患者的睡眠结构,并通过纠正呼吸紊乱和血氧饱和度下降，达到稳定血液动力学变化的目的，对提高手术和麻醉耐受性,降低围手术期风险具有重要的临床意义。     

阻塞性睡眠呼吸暂停综合征的围术期处理

目的：阻塞性睡眠呼吸暂停综合征（OSAS）的围术期麻醉管理及围术期并发症的处理。方法：OSAS患者34例均采用全身麻醉方法,术前评估患者的插管条件,采用不同的诱导方法、气管插管方法、术中及术后处理。结果：2例因鼻腔阻塞,面罩供氧诱导时放置口咽通气道,3例体重〉100kg插管困难外,其余患者诱导插管均较顺利,术后0．5小时内拔管22例,带气管导管回病房12例。结论：OSAS患者的麻醉,术前充分估计病情和气道困难程度及并发症的合理处理有助于围术期安全,防止并发症的发生。     

经鼻CPAP治疗对OSAHS合并慢性心力衰竭患者心功能影响的探讨

目的探讨经鼻持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并慢性心力衰竭患者心功能的影响。方法接受经鼻CPAP辅助治疗的72例OSAHS合并慢性心力衰竭患者为观察组,因经济条件或对CPAP不能耐受而未接受经鼻CPAP辅助治疗的74例OSAHS合并慢性心力衰竭患者为对照组,比较两组患者的心功能和动脉血气结果。结果观察组患者的LVESV缩小更明显(P<0.01),LVEF、Sv增加程度更大(P均<0.01),2h后PaO2即有显著上升(P<0.05)。结论应用CPAP治疗OSAHS可在提高动脉血氧值的同时改善心功能。     

CPAP治疗阻塞性睡眠暂停综合征远期疗效观察

目的 了解经鼻持续气道内正压通气（n－CPAP）治疗阻塞性睡眠呼吸暂停综合征（OSAS）长期应用的临床疗效和不良反应。方法 应用n－CPAP治疗OSAS患者24个月以上，并对治疗前后患者的临床症状及多导睡眠图（PSG）的各项指标进行观察。结果 OSAS患者的症状得到有效的控制，呼吸紊乱指数、最长呼吸暂停时间、最低氧饱和度等多项指标均有显著改善（均P＜0．01）。结论 经鼻持续气道内正压通气（n－CPAPO）治疗OSAS患者，长期应用临床疗效确切，不良反应少，患者依从性和安全性佳，是目前临床治疗OSAS的有效方法。     

阻塞性睡眠呼吸暂停低通气综合征的麻醉体会

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的治疗近年来多采用在全麻下行悬雍垂腭咽成形术（VPPP）。由于患者具有肥胖的外表和麻醉学判断的困难气道,在全身麻醉经鼻气管插管下行VPPP对麻醉的管理及术后处理具有一定的风险和并发症。我科2006年1月～2009年11月共实施53例VPPP手术,取得较好的效果,报告如下。     

睡眠呼吸暂停的无创气道正压通气治疗

无创通气是指在不需要建立有创人工气道的情况下，进行辅助通气，治疗各种原因所致的呼吸衰竭。无创通气有多种方式，其中经口鼻气道正压通气是临床上最为常用、发展最为迅速的一种，已经成为治疗睡眠呼吸暂停的重要方法。１历史１９８１年Sullivan等首次报道用经鼻或口鼻面罩持续气道正压通气治疗OSAS，取得满意疗效。１９８３年经鼻CPAP呼吸机正式成为商品在临床得到广泛应用，取得了消除OSAS患者症状，提高生活质量，降低并发症和死亡率的良好效果。该方法具有使用方便、疗效可靠，可携带回家长期治疗等优点。但由于CPAP呼吸机不…     

CAUP全身麻醉术后气管插管拔管时机选择

目的 探讨阻塞性睡眠呼吸低通气暂停综合征(abstructive sleep apnea and hyperpnoea syndrone,OSAHS)经低温等离子射频扁桃体、腺样体消融,软腭减容成形手术(CAUP)后发生急性呼吸道梗阻的原因及预防方法.方法 对48例OSAHS患者在经鼻气管插管全身麻醉下行CAUP手术治疗.观察两组不同拔管时间对患者的影响.结果 24例患者均在术后完全清醒状态下拔除气管导管,无1例出现急性呼吸道梗阻,效果明显优于对照组.结论 术后延长气管插管拔管时间对预防术后急性呼吸道梗阻有重要作用.     

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.     

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…     

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.     

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.