瑞芬太尼复合丙泊酚靶控输注在门诊隆乳术中的应用

目的探讨胸部美容手术行非气管插管全身麻醉中,不同浓度瑞芬太尼复合丙泊酚靶控输注的量效关系。方法选择ASAI-Ⅱ级行乳晕切口假体植入隆乳术女性患者,根据诱导期瑞芬太尼效应室靶浓度(0、1.0、1.5ng/mL)分为3组(n=20):C组(单纯丙泊酚组);REF1组(丙泊酚复合1.0ng/mL瑞芬太尼组);REF2组(丙泊酚复合1.5ng/mL瑞芬太尼组)。观察并记录患者不同时间点的血压、心率、脉搏氧饱和度及丙泊酚、瑞芬太尼的效应室浓度以及诱导期和维持期丙泊酚、瑞芬太尼用量和麻醉过程呼吸抑制、体动等不良反应,术后随访患者对麻醉的满意度。结果各组患者在不同时间点的血压、心率、脉搏氧饱和度、麻醉期间不良反应发生率的差异均无统计学意义(P>0.05),患者对麻醉满意率为100%;达到口头反应消失时,C组丙泊酚效应室浓度和诱导时间明显高于其余两组(P<0.05),且REF1和REF2组间比较无统计学意义(P>0.05)。结论小剂量(1.0～1.5ng/mL)瑞芬太尼复合丙泊酚靶控输注可满足胸部美容手术非气管插管全身麻醉需求,并且没有剂量依赖性效应。     

新型抗凝血透析液在高危出血肾衰患者血透中的抗凝效果

目的　研究新型枸橼酸盐浓缩抗凝血液透析液在高危出血肾衰患者血液透析临床应用的抗凝效果。方法　 3 8例患者按抗凝方式分为二组 :Ⅰ组无肝素血液透析 ;Ⅱ组枸橼酸盐透析液血液透析。透析期间观察患者出血、体外循环凝血、游离钙、ACT和静脉压变化 ,并用扫描电镜观察滤器中空纤维内膜纤维蛋白沉积和血细胞聚集情况。结果　Ⅰ组 18例中 12例静脉压升高 ,7例透析器及管路发生严重凝血 ,未完成 4h血液透析。Ⅱ组 2 0例静脉端ACT明显延长 ,游离钙明显下降 ,动脉端ACT和游离钙正常 ,透析器及管路无严重凝血 ,全部完成 4h透析。结论　新型枸橼酸盐浓缩抗凝血液透析液抗凝透析效果良好     

Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma

Objective To assess the effect of surgery combined with preoperative and postoperative radiotherapy ("sandwich" treatment) in rectal carcinoma. Methods From October 1990 to January 2002, 260 patients with stage Ⅱ (117 patients) and stage Ⅲ (143 patients) rectal carcinoma were randomly divided into three groups: "sandwich" group (92 patients, group A), postoperative radiotherapy group (98 patients, Group B) and operation group (70 patients, Group C). The preoperative accelerated hyperfractionation (15 Gy/6f/3d) was given for "sandwich" group which was followed by conventional postoperative fractionation (DT 35 - 40 Gy/3.5 - 4 weeks). Patients in Group B were given postoperative radiotherapy (Dr 50 Gy/5 weeks). Patients treated with surgery alone served as control. Results The local recurrence rates of Group A, B and C were 5.4% (5/92), 16.3% (16/98) and 64.3% (45/70), respectively (X2 =5.726, P=0.017); and the distant metastasis rates were 6.5% (6/92), 28. 6%(28/98) and 31.4%(22/70), respectively (X2 =15. 703, P= 0. 001). The 3-ycar survival rate was 86. 9%(80/92), 62.2%(61/98) and 51.4%(36/70), respectively (X2 =15. 141, P=0. 001). The 5-year survival rate was 68. 5%(63/92), 54.1%(54/98)and 41.4%(29/70), respectively (X2 =4. 218, P=0.04). The Ⅰ and Ⅱ grades of radiation entero-colitis in Group A and Group B were 7.6% (7/92) and 6.1% (6/98), respectively (X2 = 0. 164, P= 0. 685). Conclusion Surgery combined with preoperative and postoperative radiotherapy can improve the survival rate and reduce the local recurrence rate in rectal carcinoma patients with stage Duke's B (Ⅱ) and C (Ⅲ).     

PREDICATING THE “WITS” APPRAISAL FROM THE ANB ANGLE

Objective In order to explore the relationship between the “Wits" appraisal and the ANB angle, and to see how accurately one can predict the “Wits”. Methods Given the ANB, lateral cephalometric radiographs were taken on 50 boys and 50 girls between the ages of 11～13. Results Each subject had no treatment either a Class Ⅰ or Class Ⅱ malocclusion, a good growth pattern. Group Ⅰ , 13 subjects of 100 had ANB≤1.5°, and negative “Wits” appraisal; group Ⅱ , 61 subjects had 5.8°＞ANB＞1.5°, and “Wits” appraisal either positive or negative; group Ⅲ , 26 subjects had ANB angle≥5.8°, and positive “Wits” appraisal. Statistically analysis showed that there was no sig nificant difference in sex (P＞0.05); there was significant correlation between the ANB and “Wits” values in the group Ⅱ and group Ⅲ (P ＜0. 05); there was statistical significance in regression analysis in the group Ⅰ and group Ⅱ (P ＜0. 05). We could predict the “Wits” with 21％ accuracy in group Ⅱ. Conclusion The results indicate that these figures are statistically significant but clinically irrelevant.     

硒、蛋氨酸对饲克山病病区粮大鼠心、肝组织溶酶体膜的影响

利用差迷离心法分离提取大鼠心、肝组织富含溶酶体部分,并以溶酶体之标志酶酸性磷酸酶(ACP)及组织蛋白酶D(CD)的游离酶和总酶活性比值为观察溶酶体膜稳定性变化的指标。分别观察了低硒的克山病病区粮及病区粮加亚硒酸钠或蛋氨酸喂养的大鼠之心、肝溶酶体酶(ACD和CD)的活性变化。发现用低的病区粮喂养的大鼠心肝组织溶酶体膜的稳定性下降,而加硒或蛋氨酸后,其稳定性增加。考虑这种变化与大鼠心肝组织中的GSH-P_x活性变化有关。     

咪唑安定经静脉肌肉途经辅助硬膜外麻醉的效果观察

ASA ～ 级上腹部手术患者 5 0例 ,随机分为咪唑安定静注组 ( 组 )、肌注组 ( 组 )和氟哌啶组 ( 组 ) ,观察用药前后 5、1 5和 30 min MV、RF、SBP、DBP、HR和血气分析等指标的变化。结果 组 MV显著降低 ( P <0 .0 5 ) , 、 组 MV无显著降低。 组用药后 BP、HR显著降低 ( P <0 .0 5 )。三组血气指标无显著性变化 (P >0 .0 5 )。表明咪唑安定可用作硬膜外麻醉辅助用药 ,肌肉注射较安全 ,但应加强监测。     

单极、等离子双极宫腔镜黏膜下肌瘤电切术的临床对照研究

目的 比较单极宫腔镜电切术和等离子双极宫腔镜电切术的安全性及优越性.方法 收集行宫腔镜黏膜下肌瘤电切术患者60例.所有患者均于术前、术后即刻检测外周静脉血Na~+、Cl~-、K~+、Glu浓度,记录手术时间、灌流液吸收量、术中出血量等指标,应用SPSS10.0统计软件进行比较分析.结果 ①单极电切组术后Na~+、Cl~-、K~+浓度较术前明显下降(P<0.05),而Glu则明显升高(P<0.05);等离子双极电切组术前、术后Na~+、Cl~-、K~+、Glu浓度变化均无统计学意义(P>0.05).②术后比较,两组间Na~+、Cl~-、Glu的变化具有统计学意义(P<0.05),手术时间差异无统计学意义(P>0.05);单极电切组灌流液吸收量、术中出血量均较等离子双极电切组为多(P<0.05).③单极电切组中,Ⅱ型肌瘤患者的Na~+、Cl~-、Glu浓度、灌流液吸收量、手术时间、术中失血量均明显高于Ⅰ型肌瘤及0型肌瘤患者;等离子双极电切组中,Ⅱ型肌瘤患者的灌流液吸收量、手术时间、术中失血量亦均明显高于Ⅰ型肌瘤及0型肌瘤患者,(P<0.05),但Na~+、Cl~-、K~+、Glu浓度变化3型之间无明显差异.结论 相对于单极宫腔镜电切术而言,等离子双极电切术不引起血电解质及血糖的明显变化,术中出血量相对较少.肌瘤类型对灌流液吸收量、手术时间、术中出血量影响较大,Ⅱ型肌瘤的灌流液吸收量、手术时间、术中出血量明显较0型及Ⅰ型增多.     

同种瓣体内再内皮化的效果

目的　研究不同方法处理的心脏瓣膜组织在体内再内皮化的效果 ,试图确定最佳的再内皮化方法。方法　选用羊新鲜瓣叶 2 5个 ,分别用液氮冷冻 ,脱氧胆酸、戊二醛以及低 /高渗液、酶处理 ,比较各组瓣膜抗原性大小。将各组瓣叶分别植入羊股动脉内 ,3月后取出 ,扫描电镜观察再内皮化效果。结果　各种处理方法均可减弱瓣膜的抗原性。脱氧胆酸、戊二醛、低 /高渗液、酶处理组抗原性最低。体内再内皮化效果以脱氧胆酸、低 /高渗液、酶处理组最优。结论　经脱氧胆酸或低 /高渗液、酶处理的同种瓣抗原性低 ,受体内皮细胞易于再内皮化。     

不同镇痛方法对子宫切除术后患者血糖、胰岛素和皮质醇水平的影响

目的　评价4 种常见的不同镇痛方法对子宫切除术后应激反应的抑制程度,以选择较为合理的镇痛方法。方法　根据镇痛方法的不同,将48例行子宫切除术患者随机分为4组:罗哌卡因复合芬太尼硬膜外镇痛组(Ⅰ组);芬太尼静脉镇痛组(Ⅱ组);罗哌卡因复合曲马多硬膜外镇痛组(Ⅲ组);曲马多静脉镇痛组(Ⅵ组)。观察麻醉前、手术后2、24、48、72 h血糖、胰岛素和皮质醇水平的变化。结果　①4种镇痛方法均能提供良好的镇痛效果;②在抑制术后高血糖和术后应激方面Ⅰ组和Ⅲ组好于Ⅱ组和Ⅵ组,尤以Ⅲ组为优。结论　硬膜外镇痛可以更有效的降低术后高血糖反应,抑制术后应激反应,以罗哌卡因复合曲马多组为更优。     

非对称型漏斗胸微创手术的探讨

目的探讨非对称型漏斗胸的微创手术方法。方法2003年6月至2004年9月住院手术的6例非对称型漏斗胸患儿,按体表和3DCT形态学测量分为Ⅰ、Ⅱ、Ⅲ度,分别采用Nuss原法、斜板及不规则型支撑板方法手术,均采用双3点法固定。结果6例患儿全部在胸腔镜辅助下手术,手术时间65～105min,出血量极少,均不需输血。1例患儿术后轻度胸腔积气,第6天完全吸收。随访2～6个月支撑板的位置良好,胸廓饱满、左右对称,矫正效果满意。结论采用新分类和改良技术,非对称型漏斗胸微创手术矫正短期效果满意,长期效果有待观察。     

青年乳癌

本文报告青年乳癌(30岁以前)41例,占我科同期乳癌病人的5.46％(42/1749),报告了临床资料,讨论了青年乳癌与哺乳和生育的关系:多生育的青年妇女发病率高,占58.5％(24/41),作者认为;对已有腋淋巴结转移的病例,不论组织类型如何,只要能做到彻底根治,达到临床绝对治愈切除(R>N)即Halsted's术,术后再辅以放疗、化疗,还是能提高长期生存率的,讨论了青年乳癌的特点和误诊的原因。     

高氧液预处理对心脏瓣膜置换术患者血浆丙二醛和超氧化物歧化酶的影响

目的观察高氧液预处理对心脏瓣膜置换术患者血浆丙二醛(MDA)和超氧化物歧化酶(SOD)的影响。方法30例择期心脏瓣膜置换术患者随机分为试验组和对照组,在麻醉后切皮前(T0)至心肺转流(CPB)开始后10 min,对照组静滴复方氯化钠注射液10 mL/kg,试验组给予相等容量的高氧液。分别于麻醉后切皮前(T0)、CPB开始后1 h(T1)、主动脉开放后2 h(T2)、主动脉开放后24 h(T3)共4个时点,测定MDA和SOD。结果T0时点MDA质量浓度两组间无明显差异(P>0.05),T1时显著增高,T2时达高峰,T3仍显著高于术前(P<0.05)。两组间比较,T2时试验组明显低于对照组(P<0.01)。T0时点SOD活性两组间无明显差异(P>0.05),试验组各时点无明显变化(P>0.05)。对照组T1、T2时明显降低,与试验组相比有明显差异(P<0.05)。两组心脏自动复跳率、电除颤率、心律失常发生率、术中多巴胺用量相比均无明显差异(P>0.05),术后24 h多巴胺用量,试验组明显低于对照组(P<0.01)。结论高氧液预处理能使MDA质量浓度明显下降,SOD活性保持不变,减轻心肌缺血/再灌注损伤。     

贺斯行急性超容性血液稀释时对机体血液动力学及凝血功能的影响

目的　观察羟乙基淀粉 (6 %贺斯 2 0 0 0 .5 ,HES)行急性超容性血液稀释 (AHHD)时血液动力学、血气及凝血功能的变化。方法　选择ASAⅠ -Ⅱ级在硬外复合浅全麻下行食道癌根治及全髋置换手术患者 5 0例 ,麻醉前 30～4 0min内输入HES(15mL·kg- 1 ) ,使血容量增加 2 0 %。当Hb低于 90 g·L- 1 时输入同型异体血。术中连续监测HR、BP、SpO2 ,于HD前 (H0 )、HD后 15min(H1 )、输入同型异体血前 (H2 )以及术毕 (H3)各时点抽取动、静脉血行血气分析、血常规及凝血功能检测。结果　HR、BP在整个手术过程中无明显变化 (P >0 .0 5 ) ;Hb、Hct在HD后各时点均降低 (P <0 .0 5或P <0 .0 1)。PT在HD后H1 、H2 ,FIB在H2 时均明显降低 (P <0 .0 5或P <0 .0 1)。结论　采用HES行AHHD对心、肺、肝、肾及凝血功能正常患者行血液保护是安全有效的 ,可避免异体血不必要的输入     

EFFECT OF 1％ TETRACAINE HYDROCHLORIDE JELLY FOR PAIN CONTROL DURING TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY

Objective To study the effects of 1％ tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound (TRUS)-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided prostate biopsy were divided into two groups with 50 in each.In Group 1,patients received liquid paraffin,and in Group 2,patients were given 1％ tetracaine hydrochloride jelly before biopsy. Pain score was measured by horizontal visual analogue scales ( VAS ),and pain and discomfort were compared between the two groups. Results The average pain scores at the time of insertion of the ultrasound probe were 2.9 ± 1.7 and 1.4 ± 1.8 ( P =0.000) and the average pain scores at the time of performing biopsy were 5.2±1.5 and 3.1±1.7 (P=0.000) in Group 1 and Group 2,respectively.There were no significant differences between the two groups in terms of age,serum prostate specific antigen,digital rectal examination,TRUS,and biopsy core number ( P ＞ 0.05).There were no significant differences of complications after biopsy,such as hematuria,acute urinary retention,urinary tract infection,rectum bleeding,and fever ( P ＞ 0.05 ). Conclusion TRUS-guided prostate biopsy is safe.Use of 1 ％ tetracaine hydrochloride jelly in the rectum and anus before TRUS-guided prostate biopsy is an effective method for relieving TRUS guided prostate biopsy-induced pain during the procedure.     

低温、钾通道开放剂停搏对幼兔心肌的保护作用

目的探讨以钾通道开放剂(PCOs)取代传统的高钾用作停搏剂时对未成熟心肌的保护效果,以及低温与PCOs之间的关系。方法32颗未成年(14-28 d兔龄)兔心进行Langendoff模型缺血/再灌注研究:对照组(C组,n=8),改良St.Thomas液灌注心脏停跳,15℃保存;实验Ⅰ组(T1组,n=8),单纯低温心脏自然停跳,15℃保存;实验Ⅱ组(T2组,n=8),4℃Pinacidil(50μmol/L)液灌注停跳,15℃保存;实验Ⅲ组(T3组,n=8),37℃Pinacidil(50μmol/L)液灌注停跳,37℃常温保存。观察缺血前后心功能(左心室收缩峰压、舒张末压、最大压力变化速率)、冠状动脉流量、生化指标、心肌含水量、心肌超微结构等的改变。结果T2组左室功能和冠脉流量的恢复均优于另外3组(P<0.01),而在左室收缩功能的恢复方面,T1组优于C组(P<0.05),T1组与T3组间无明显差异(P>0.05);再灌注后心肌酶外漏及超微结构改变以T2组最为轻微,T3组最重;心肌含水量各组间无显著性差异(P>0.05)。结论PCOs超极化停搏液对未成熟心肌的保护效果明显优于高钾停搏液;单纯低温即能对未成熟心肌提供良好的保护作用;低温与超极化停搏之间的作用互相增强,但高钾去极化停搏削弱低温对未成熟心肌的保护作用。     

胎儿软骨细胞体外培养过程中生长及代谢的变化

目的探讨体外培养的软骨细胞形态及Ⅰ、Ⅱ型胶原和聚集蛋白聚糖的表达变化,为组织工程软骨种子细胞选择合适的回植时机。方法取体外培养的第1-5代胎儿软骨细胞,观察细胞形态和细胞增殖率;用爱茜蓝(alcianblue)法检测软骨细胞聚集蛋白聚糖中糖胺聚糖含量;分别用免疫细胞化学和逆转录聚合酶链反应检测Ⅰ、Ⅱ型胶原及聚集蛋白聚糖在蛋白和mRNA水平的表达。结果体外培养的胎儿软骨细胞从第3代起逐渐向成纤维样细胞转换;各代软骨细胞糖胺聚糖的含量随传代次数的增加而逐渐降低,第3代后处于较低水平;第2代以前Ⅱ型胶原表达较强,Ⅰ型胶原表达较弱,之后随传代Ⅱ型胶原表达减弱,Ⅰ型胶原表达逐渐增强;而聚集蛋白聚糖在第3代以前表达较高,从第4代后明显下降。结论人胎儿软骨细胞体外培养过程中,第2代软骨细胞从形态和功能上最接近体内状况,可作为软骨组织工程的种子细胞。     

腺苷、卡托普利联合用药对心肌缺血再灌注的保护作用

目的　观察腺苷、卡托普利联合用药对缺血再灌注心肌的保护作用。方法　 40只SD雄性大鼠 ,随机分成 4组 :空白组 (Ⅰ组 ) ,腺苷组 (Ⅱ组 ) ,卡托普利组 (Ⅲ组 ) ,联合用药组 (Ⅳ组 ) ,制成Langendorff离体心脏模型。测定冠脉回流液中LDH、CPK活性、心肌组织匀浆中MDA含量、SOD活性 ,观测心肌组织超微结构变化。结果　①各组心脏冠脉回流液中LDH、CPK活性随时相变化逐渐上升 ,复灌 2 0、3 0min时用药组明显低于对照组 ,Ⅳ组上升趋势最慢。Ⅱ、Ⅲ、Ⅳ组心肌MDA含量明显降低 ,SOD活性增强。②心肌组织超微结构观察示用药组心肌损伤轻于对照组 ,Ⅳ组损伤最轻。③Ⅱ、Ⅳ组出现心脏复跳延迟及心律失常。结论　①腺苷、卡托普利联合用药对心肌缺血再灌注的保护作用优于单一用药。②腺苷有延缓心脏复跳作用。     

乌饭树树叶及其提取物对视网膜光损伤的保护作用

目的研究乌饭树树叶及其提取物对视网膜免受光损伤的保护功能。方法将20只新西兰白兔分成4组:正常对照组和模型对照Ⅰ、Ⅱ、Ⅲ组。正常对照组动物自由摄取饲料,自由饮水;模型对照Ⅰ、Ⅱ、Ⅲ组动物除自由摄取饲料,自由饮水外,每天分别喂乌饭树新鲜树叶[50 g/(kg.d)]、乌饭树陈旧树叶[50 g/(kg.d)]和乌饭树树叶提取物[50mg/(kg.d)],连续4周。并且进行强光刺激,同时利用视网膜电图(ERG)进行视网膜分析,最后处死白兔测定视网膜中丙二醛(MDA)的含量和总超氧化物岐化酶(T-SOD)的活力。结果ERG测定结果发现,对照组B波的潜伏期时间延长而振幅降低,模型组白兔ERG的变化趋势正好相反。同时模型组视网膜中的MDA含量要低于对照组(P<0.01),而SOD含量则高于对照组(P<0.01)。结论服用乌饭树树叶及其提取物对眼睛视网膜具有明显的保护作用。     

FOLLICULO-STELLATE CELLS OFTHE RAT ANTERIOR PITUITARY RESPONDED TO ANGIOTENSIN Ⅱ BY INCREASING INTRACELLULAR CONCENTRATION

Objective The main purpose of this study was to investigate whether the folliculo-stellate cells (FSC) respond to angiotensin(Ang) Ⅱ by increasing intracellular free concentration ([]i) ,and where the o-rigin of mobilization is if that has occurred. Methods Pituitary cells in primary culture were prepared from male Wister rats(250g) by a conventional method and cultured in MEM supplemented with 4％ normal rat serum. Af-ter 2 days in culutre,cells were loaded with 1 μmol/L fura-PE3/AM for 1 h and subjected to a ment with Quanti Cell 700 system. Excitation wavelengths of 340 and 380 nm were selected by means of a computer-controlled filterwheel. Results The of FSC in the rat anterior pituitary was elevated by Ang Ⅱ. The eleva-tion of of FSC induced by 0. 1,1.0,10 and 100 nmol/L Ang Ⅱ was (56.33±6.18), (117.07± 36.07), (175.59 ± 40.01 ) and (216.02 ±11.52) nmol/L, respectively. The increase of of FSC induced by 100nmol/L Ang Ⅱ was not influenced by the medium without (0Ca),but significantly suppressed by thapsigargin (TG),an inhibitor of ATPase. The rate of responsive FSC to Ang Ⅱ (100 nmol/L) was 61.84％ which was obviously higher than that of pituitary endocrine cells (43.49％). Conclusion The present experiment demonstrates that the FSC in the rat anterior pituitary responds to Ang Ⅱ by increasing [which raises the possibility that Ang Ⅱ re-leased from either lactotrophs or gonadotrophs affects FSC through paracrine mechanism. The elevation of [induced by Ang Ⅱ presents a dosage-dependent relation, and is possibly because of the release of from an intra-cellular pool (s). Fashions of release are relative to the concentration of Ang Ⅱ. The results indicate that Ang Ⅱ functions as a paracrine factor among pituitary cells including FSC.     

老年胃癌患者全胃切除后早期肠内膳食纤维素营养液的作用

目的　探讨老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液肠内营养 (EN)的可行性。方法　 5 0例 6 0岁以上胃癌全胃切除患者 ,随机分为实验组 2 5例 ,用能全力 (TPF) 9d ;对照Ⅰ组 2 5例 ,用等氮、等热卡、等时间肠外营养 (PN)。另随机抽取同期 6 0岁以下同样患者 2 5例为对照Ⅱ组 ,支持方法和时间与实验组相同。结果　①营养指标。三组患者体重、三角肌皮折厚度、肌酐身高比、白蛋白 ,手术后第 9天都分别恢复到近于手术前 1d水平 (P >0 .0 5 ) ,仅谷氨酰胺对照Ⅰ组降低明显 (P <0 .0 5 )。术后第 4天至第 9天氮累积水平对照Ⅰ组也较低 (P<0 .0 5 )。②安全性。全部患者均无严重不良反应 ,都安全渡过术后恢复期。实验组比对照Ⅰ组肛门排气恢复显著提前 (P <0 .0 1)。结论　老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液EN ,安全适宜 ,效果良好 ,和较年轻患者近似 ,比同龄患者PN疗效高。