体外循环期间钙动态变化的研究

观察32例患者体外循环期间血浆及红细胞内钙的动态变化。目的在于揭示其变化规律，为更好的保护心肌提供新的措施和理论依据。结果：麻醉后体外循环前血浆钙较术前显著升高，体外循环开始显著下降；40min恢复至术前水平；停机时显著升高至停机8h。术前、中、后红细胞内钙无显著变化。体外循环期间钙变化与血液稀释、应激反应、预充液及心脏停跳液中含钙离子有关。高钙可导致心肌缺血及再灌注时大量钙进入心肌细胞，引起心肌细胞损伤。所以，体外循环期间，特别是复灌期适当降低钙浓度，对术中、后心肌功能恢复具有重要作用。     

A data model applied to the knowledge-based ICAS

Image-guided computer aided surgery system (ICAS) contributes to safeness and success of surgery operations by means of displaying anatomical structures and showing correlative information to surgeons in the process of operation. Based on analysis of requirements for ICAS, a new concept of clinical knowledge-based ICAS was proposed. Designing a reasonable data structure model is essential for realizing this new concept. The traditional data structure is limited in expressing and reusing the clinical knowledge such as locating an anatomical object, topological relations of anatomical objects and correlative clinical attributes. A data structure model called mixed adjacency lists by octree-path-chain (MALOC) was outlined, which can combine patient's images with clinical knowledge, as well as efficiently locate the instrument and search the objects' information. The efficiency of data structures was analyzed and experimental results were given in comparison to other traditional data structures. The result of the nasal surgery experiment proves that MALOC is a proper model for clinical knowledge-based ICAS that has advantages in not only locating the operative instrument precisely but also proving surgeons with real-time operation-correlative information. It is shown that the clinical knowledge-based ICAS with MALOC model has advantages in terms of safety and success of surgical operations, and help in accurately locating the operative instrument and providing operation-correlative knowledge and information to surgeons in the process of operations.     

基于入侵野草优化算法的粒子滤波算法

入侵野草优化(IWO)算法是近年来提出的一种简单、有效的基于种群的新颖数值优化算法,在许多领域得到成功运用。将IWO算法与粒子滤波(PF)算法相结合,提出一种基于IWO算法的粒子滤波算法(IWOPF)。该算法将IWO算法运用于粒子滤波的重采样中,以保证粒子的有效性和多样性。最后通过计算仿真验证该算法的有效性和优越性。     

恶性滋养细胞肿瘤致子宫穿孔26例临床分析

１９５７～１９８７年我院共收治恶性滋养细胞肿瘤３４２例，发生子宫穿孔２６例。其中绒毛膜癌１４７例，穿孔者１６例，占１０．９％；侵蚀性葡萄胎１９５例，穿孔１０例，占５．１％。其主要症状为阴道流血、阵发性腹痛或腹部剧痛，下腹部有压痛、反跳痛及移动性浊音。２１例行急诊手术，术后３天开始化疗。死亡３例，均系绒癌Ⅳ期患者。２３例经手术加化疗后治愈。     

肠梗阻死亡原因及手术时机问题

我室近20年手术治疗急性肠梗阻共437例,其中死亡40例(占9.19%),本文分析了40例中误诊的主要原因是过分强调腹部手术史,忽视了粘连性肠梗阻近半数合并肠扭转而致肠坏死,术前观察时间太长,多数超过72小时,丧失了手术机会。死亡原因除了13例合并腹腔脏器恶性肿瘤转移外,余均为肠穿孔致化脓性腹膜炎,中毒性休克及肠瘘等,结合40例死亡的教训,建议一旦有绞窄征象,应立即手术,文中提出了四种诊断绞窄的方法。     

布比卡因用于上腹部手术硬膜外阻滞(国产和进口药临床药理比较)

本文应用国产和进口两种布比卡因(浓度均为0.5%)进行上腹部手术硬膜外阻滞共76例,其中国产组43例,进口组33例。对两药显效时间、作用完全时间、一次剂量维持时间和镇痛持续时间进行比较,均无明显差别,加入1∶20万肾上腺素,上述各时间亦大多未见显著延长。两药在0.5%浓度时镇痛、肌松效果均颇满意,未见毒性反应,但麻醉后切皮前血压下降20%以上者比利多卡因增多,提示交感神经节前纤维更易受布比卡因阻滞。     

兔眼葡萄膜巩膜引流术后FITC-Dextran在眼组织中的分布

目的观察兔眼葡萄膜巩膜引流术后房水流出道的形态学改变。方法 20只中国白兔随机分为2组,一组行葡萄膜巩膜引流术,另一组行小梁切除术,均行右眼手术。术后2周术眼前房内灌注异硫氰酸荧光素标记的葡聚糖(FITC-Dextran),处死后取完整眼球做冰冻切片,在激光共聚焦显微镜下观察荧光素的分布。与手术部位处在眼环同一子午线上的同眼的对称部位未手术眼组织作为对照。结果在葡萄膜巩膜引流术组,荧光素的分布在前、中部巩膜最强,前葡萄膜次之;而在小梁切除术组,荧光素的分布在前葡萄膜最强,前、中部巩膜次之,两组的后葡萄膜和后巩膜均有部分中等亮度的显影,对照组的后葡萄膜和后巩膜则几乎无显影,且两组的前、中部巩膜荧光素强度均明显高于对照组。结论葡萄膜巩膜引流术和小梁切除术术后房水引流均是多途径的,既有外滤过,还增强了葡萄膜巩膜引流。与小梁切除术相比,葡萄膜巩膜引流术还明显增加了跨巩膜引流。     

体外循环期间钙动态变化的研究

观察32例患者体外循环期间血浆及红细胞内钙的动态变化。目的在于揭示其变化规律，为更好的保护心肌提供新的措施和理论依据。结果：麻醉后体外循环前血浆钙较术前显著升高，体外循环开始显著下降；40min恢复至术前水平；停机时显著升高至停机8h。术前、中、后红细胞内钙无显著变化。体外循环期间钙变化与血液稀释、应激反应、预充液及心脏停跳液中含钙离子有关。高钙可导致心肌缺血及再灌注时大量钙进入心肌细胞，引起心肌细胞损伤。所以，体外循环期间，特别是复灌期适当降低钙浓度，对术中、后心肌功能恢复具有重要作用。     

上皮型钙粘附蛋白和层粘连蛋白在妊娠滋养细胞疾病中的表达及意义

目的探讨上皮型钙粘附蛋白(E-cad)和层粘连蛋白(LN)在妊娠滋养细胞疾病(GTD)中的表达及意义。方法应用免疫组织化学(SP法)检测74例GTD中E-cad和LN的表达情况。结果在GTD中,E-cad的正常表达率和LN强表达率分别为37.8%(28/74)和64.86%(48/74),显著低于正常绒毛组织。在葡萄胎(HM)、侵蚀性葡萄胎(IM)及绒毛膜癌(CC)中E-cad的正常表达率分别为53.3%、31.25%和16.67%;LN的强表达率分别为80%、56.25%和50%。随着GTD恶性程度的增加,E-cad的正常表达率及LN的强表达率逐渐降低,且与正常绒毛组织有显著差异。结论E-cad及LN的表达与GTD的发生、恶变及侵袭有关系;对E-cad与LN表达的监测有助于预测GTD的发展趋势及提示治疗效果。     

THE STUDY ON THE CHANGES OF ZINC, COPPER, CALCIUM AND MAGNESIUM IN PLASMA AND ERYTHROCYTES DURING CARDIOPULMONARY BYPASS

Objective To study the changes and their influence factors involved of zinc, copper, calcium and magnesium in plasma and erythrocytes during cardiopulmonary hypass(CPB). Methods Zinc, copper, calcium and magnesium values in plasma and erythrocytes were measured by atomic absorption spectrophotometer during CPB. Results Zinc and copper levels in plasma were significantly elevated above preinduction level before perfusion, hut calcium and magnesium levels did not change significantly; zinc, copper and calcium levels in plasma were significantly below preoperation level during CPB, hut magnesium level in plasma was significantly increased above preoperation; zinc level in plasma was increased to preoperation level after CPB and began to decrease again at 8 hours after CPB,copper level in plasma was increased to preoperation level at 20 hours after CPB, calcium in plasma was increased significantly from beginning to 8 hours after CPB, magnesium level in plasma was decreased to preoperation level at 8 hours afterCPB. Concentration of zinc , copper, calcium and magnesium in erythrocytes did not change significantly. Conclusion During CPB, the changes of zinc, copper, calcium and magnesium had relation to hemodilution, operative wound, carrier protein, stress and component of priming Solution and cardioplegic solution, hut no relation to transferfrom plasma erythrocytes. The results indicate that it is beneficial to patient‘s recovery to supplement zinc, copper, calcium and magnesium properly by different ways during cardiac perioperation.