【摘要】 目的 觀察依托咪酯乳劑復合舒芬太尼用于全麻下喉罩置入的血流動力學變化。 方法 選擇2009年4月-2010年2月間，46例需全麻手術、適合使用喉罩，美國麻醉醫師協會（ASA）Ⅰ～Ⅱ級，年齡18～60歲的患者，隨機分為兩組:依托咪酯乳劑組（E組）23 例，靜脈推注咪達唑侖0.05 mg/kg，依托咪酯乳劑0.3 mg/kg；依托咪酯乳劑+舒芬太尼組（ES組）23 例，靜脈推注咪達唑侖0.05 mg/kg，依托咪酯乳劑0.15 mg/kg，加舒芬太尼0.5 mg/kg，誘導后置入喉罩，記錄患者誘導前、用藥后1 min、喉罩置入后1 min的心率（HR）、平均動脈壓（MAP）以及評估喉罩置入條件的6項指標（張口困難分級、置入喉罩困難分級、舌咽反射、干咳干嘔反射、肢動反應及喉痙攣分級），同時記錄呼吸暫停時間。 結果 ES組能提供更好的喉罩置入條件，且能減少舌咽反射和肢體反應， 更能保證喉罩置入時血流動力學的穩定。 結論 依托咪酯乳劑復合舒芬太尼能為全麻喉罩置入時提供更好的條件，且能保證更好的血流動力學穩定。【Abstract】 Objective To investigate the hemodynamics changes when etomidate combined with sufentanil was applied for laryngeal mask airway insertion under the general anaesthesia. Methods From April 2009 to February 2010, 46 patients requiring general anesthesia using laryngeal mask airway (LMA) (American Society of Anesthesiologists (ASA)Ⅰ-Ⅱ) aged 18-60 were randomly divided into two groups: 23 in etomidate emulsion group (group E) underwent the intravenous injection with midazolm (0.3 mg/kg) and etomidate (0.05 mg/kg); 23 in etomidate emulsion + sufentanil group (group ES) underwent the intravenous injection with etomidate (0.15 mg/kg), midazolm (0.05 mg/kg), and sufentanil 0.5 mg/kg. The patients were evaluated by six indexes of LMA insertion (mouth opening, swallowing reflex, cough reflex,vomiting reflex, body motion, and laryngospasm classification). After the anesthesia induction, LMA was inserted. The blood pressure (BP), heart rate (HR), and mean arterial pressure (MAP) were recorded before anesthesia induction one minute after the injection and one minute after LMA insertion. Meanwhile, the apnea time was recorded. Results Compared with group E, group ES offered better anesthesia for LMA insertion, less swallowing reflex and body motion, and more stable haemodynamics. Conclusion Etomidate combined with sufentanil provides good condition for LMA insertion under the general anaesthesia with steady haemodynamics.
Objective To establish an effective model of myocardial infarction in black goat so as to provide a safe, convenient and credible model of myocardial infarction for treatment and research. Methods Sixteen black goats were made chronic myocardial infarction by ligation of far end of left anterior descending coronary artery through incision below xiphoidprocess. Electrocardiogram(ECG) and serum myocardial enzymes were investigated before and after occlusion. Echocardiographic measurements were performed, and left coronary artery angiography was performed with digital subtraction angiography (DSA) before infarction and 6 weeks after infarction. The myocardial ultrastructure were observed. Results All goats survived more than 6 weeks. ECG showed ambulatory change, ST-segment elevated half an hour after occlusion and pathologic Q waves 6 weeks after infarction, CK-MB significantly increased. Echocardiographic indexes showed significant decrease of maximal peak A, percent wall thickening(WHT) and ejecting fraction (EF), increase ofend-systolic volume (ESV), end-diastolic volume (EDV), and dilation of left ventricle. DSA showed block or decrease of perfusion of far end of left anterior descending coronary artery. Conclusion It is safe, convenient and credible to establish model of myocardial infarction by ligation of far end of left anterior descending coronary artery through incision below xiphoidprocess in black goat.
【Abstract】ObjectiveTo explore selective criteria of sphincter preservation operation (SPO) for middle to low third rectal cancer, and analyze clinicopathologic parameters resulting in the selective criteria. MethodsTwo hundred and seventynine cases of middle to low third rectal cancer who accepted operative treatment from 1996 to 2004 were analyzed retrospectively. One hundred and eightyseven rectal tumours were located in 5-10 cm from anus, 92 rectal tumours in below 5 cm from anus. Among them 127 cases were treated by abdominalperineal resection (APR), and 152 cases were treated by SPO in which there were 130 Dixon operations, 12 Bacon operations, and 10 Parks operations. Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically. ResultsGender, age, size, tumor types, site of tumor, degree of differentiation, infiltrated circumference of intestine, and lymph node metastasis, depth of invasion and Dukes stages were not significantly different between APR and SPO groups. SPO performed rate was 54.48% in all. SPO was performed in 48 lower third rectal cancer cases (52.17%, 48/92). Regional recurrence rate was 6.81% （19/279）.Middle survival time was （65.00±6.87）months and 5year survival rate was 63.51% in SPO group. Middle survival time was （52.23±5.63） months and 5year survival rate was 52.50% in APR group. ChiSuqare was 18.14 by Logrank test (P=0.054 1). ConclusionThere is no statistically difference in survival rate between APR and SPO groups.
Objective To systematically review the clinical response and partial adverse effects of endostar plus chemotherapy for patients with unresected non small cell lung cancer. Methods The clinical trials of endostar plus chemotherapy for unresected non small cell lung cancers published before March 2, 2010 were searched in The Cochrane Library, Medline, EMbase, Pubmed, CBM, CNKI, VIP and so on. According to the Cochrane handbook for systematic reviews for interventions, the quality of clinical trials was evaluated by two reviewers independently, and the meta-analysis was conducted by using Revman 5.0 software. Results The endostar as an endostatin was developed by our country, so the relevant RCTs were not found in foreign databases. Fourteen studies involving 1 219 patients were included. All studies adopted random method but no blind method was mentioned in detail. The results of meta-analysis indicated that the rate of clinical response and clinical benefit of the endostar plus chemotherapy group was significantly higher than that of the chemotherapy alone group (RR=1.76, 95%CI 1.47 to 2.09; RR=1.43, 95%CI 1.10 to1.86; respectively). The incidence rate of thrombocytopenia was significantly lower of the endostar plus chemotherapy group than that of the chemotherapy alone group (RR=0.77, 95%CI 0.62 to 0.96). The incidence rates of hypoleukemia, anaemia, nausea and vomiting and hepatic and renal function damage were not significantly different between the two groups (RR=0.94, 95%CI 0.83 to 1.06; RR=0.94, 95%CI 0.79 to 1.13; RR=1.04, 95%CI 0.91 to 1.18; RR=0.63, 95%CI 0.25 to 1.60; respectively). Conclusion Endostar plus chemotherapy can improve the rate of clinical response and clinical benefit, and can relieve partial adverse effects of chemotherapy.
Objective To evaluate the clinical effect of the eyelid reconstruction using hard palate mucosa graft after resection of malignant tumor of eyelid. Methods From January 1998 to October2003, 18 cases of malignant tumor of eyelid underwent the eyelid reconstruction with local flap grafting and hard palate mucosa autotransplantation. Of 18 cases, there were 10 males and 8 females, aging from 35 to 67 years. The defect was caused by basal cell carcinoma of eyelid in 10 cases, by carcinoma of meibomian glands in 6 cases and by squamous cell carcinoma of eyelid in 2 cases, including 12 cases of complete eyelid defect and 6 cases of 2/3 eyelid defect. Results The appearance and function of the eyelid in all cases were almost normal after the eyelid reconstruction with hard palate mucosa autotransplantation in replacing posterior layer of eyelid. The complete eyelid closure and no entropion were observed in all cases. The infection and contracture of the graft, immunologic rejection were not observed in allcases during the followup period of 6 to 48 months. Conclusion The eyelid reconstruction using autotransplantation with hard palate mucosa in replacing posterior layer of eyelid was easy-to-operate and has satisfactory clinical effect. The hard palate mucosa as substitute of tarsus is superior to the traditional substitute.
Objective To summarize the effectiveness of F-shaped screw fixation technique in treatment of Pauwels type Ⅲ femoral neck fractures. Methods Between January 2013 and December 2016, 43 patients with Pauwels type Ⅲ femoral neck fractures were treated with F-shaped screw fixation technique. There were 32 males and 11 females with an average age of 38.9 years (range, 20-55 years). The fractures located on the left side in 21 patients and on the right side in 22 patients. The cause of injury included traffic accident in 19 patients and falling from height in 24 patients. There were 25 patients of Garden type Ⅲ and 18 of Garden type Ⅳ. The time from injury to operation was 2-3 days (mean, 2.2 days). These data were recorded, including operative time, fluoroscopy time, postoperative hospital stay, quality of reduction, postoperative complications (nonunion, varus deformity, femoral neck shortening, avascular necrosis of femoral head, screws back-out), and Harris scores. Results The operative time was 28-45 minutes (mean, 37.5 minutes). The fluoroscopy time was 13-20 seconds (mean, 14.7 seconds). The postoperative hospital stay was 2-3 days (mean, 2.7 days). All incisions healed by first intention. All patients were followed up 18–58 months with an average of 38.7 months. All patients have anatomical reduction of fractures. Fracture healing occurred in 42 patients; the union time was 3-5 months with an average of 3.6 months. Nonunion occurred in 1 patient who was treated with total hip arthroplasty. Of the 42 patients with fracture healing, 11 cases had a femoral neck shortening, 9 cases had varus deformity, 3 cases had avascular necrosis of femoral head, and 8 cases had screws back-out. There was no significant difference in complication incidences between Garden type Ⅲ fractures and Garden type Ⅳ fractures (P>0.05). Conclusion Treatment of femoral neck fractures by using the F-shaped screw fixation technique, can achieve satisfactory effectiveness with less postoperative complication.
Objective To evaluate the clinical efficiency of fresh amniotic membrane transplantation in treatment of stenosis of conjunctival sac. MethodsThirty cases (30 eyes) of stenosis of conjunctival sac were treated with fresh amniotic membrane transplantation. Amniotic membrane was obtained under sterile conditions after elective cesarean delivery. The woman’s serum was negative for HBsAg, syphilis, and human immunodeficiency virus. The placenta was first washedfree of blood clots with sterile saline. Under sterile conditions, the inner amniotic membrane was separated from the chorion by blunt dissection, and was cleaned of blood with the sterile saline again. The membrane was then flattened onto a surgidrape adhesive paper with the epithelium surface up. The paper with the adherent amniotic membrane was then cut into 5 cm×8 cm pieces, and then rinsed in solution containing 4×106 U/L of gentamycin and stored at 4℃. It could bestored for 12 hours after preparation. The-adhesiotomy was performed firstly. The separation between the conjunctiva and scar tissue should be complete and wide enough to reach to the orbital margin. The adhesiectomy was taken secondly. The scar tissues were removed completely. The fresh amniotic membrane was flattened onto the conjunctival defect with epithelium side up. The fresh amniotic membranewas 10 mm more than the conjunctival defect by trimming off the excess portion.This fashioned membrane was then secured to surrounding conjunctival edge with continuous 7-0 nylon sutures. The necessary mattress suture of inferior conjunctival fornix via skin next to the inferior orbital margin was performed simultaneously. The retrobular implantation of the an artificial globe made of hydroxyapatite was performed on some patients with sunken eye. Correction of traumatic ptosis was performed on a few patients.Results The operation ofreconstruction of partial conjunctival sac for 30 cases was successful. All amniotic membrane grafts were alive. The cosmetic result was complete favorable. The infection and contracture of the graft, immunologic rejection and amniotic lysis were not observedin all cases during the follow-up period of 13-18 months.Conclusion Fresh amniotic membrane transplantation can be used in reconstruction of the partial conjunctival sac effectively and can be popularized in thelocal hospital in China because the amniotic membrane can be obtained easily.
Objective To evaluate the effectiveness and safety of nedaplatin combined with chemotherapy versus cisplatin combined with chemotherapy for advanced non-small cell lung cancer (NSCLC). Methods The randomized controlled trials (RCTs) on nedaplatin combined with chemotherapy versus cisplatin combined with chemotherapy for advanced NSCLC were searched in The Cochrane Library, PubMed, EMbase, CBM, VIP and WanFang Data from the date of their establishment to January 2012. According to the inclusion and exclusion criteria, two reviewers independently screened the studies, extracted the data and assessed the quality. Then RevMan 5.0 software was used for meta-analysis. Results A total of 15 RCTs involving 1 076 patients were included. The results of meta-analysis showed that, compared with the cisplatin combined with chemotherapy, nedaplatin combined with chemotherapy could reduce the risks of nausea and vomiting (RR=0.56, 95%CI 0.48 to 0.65, Plt;0.000 01), decrease the risk of renal function impairment (RR=0.47, 95%CI 0.30 to 0.74, P=0.001), but increase the risk of thrombocytopenia (RR=1.59, 95%CI 1.20 to 2.11, P=0.001). There were no significant differences between the two groups in objective response rate (ORR) (RR=1.09, 95%CI 0.92 to 1.29, P=0.03), leukopenia (RR=1.05, 95%CI 0.92 to 1.19, P=0.50), and hemoglobin reduction (RR=0.92, 95%CI 0.80 to 1.07, P=0.30). Conclusion Compared with cisplatin combined with chemotherapy for advanced NSCLC patients, nedaplatin in combination with chemotherapy can significantly reduce the risks of nausea, vomiting and renal function impairment. Although the ORRs are similar in the two groups, nedaplatin combined with chemotherapy can cause a higher risk of thrombocytopenia. For the quality restriction and possible publication bias of the included studies, more high quality RCTs are required to further verify this conclusion.
Objective To evaluate the value of 18 F-fluorodeoxyglucose ( 18 F-FDG) metabolism imaging in evaluating the response of patients with non-small cell lung cancer ( NSCLC) in stable diseaseafter chemotherapy. Methods 28 patients with NSCLC in stable disease after chemotherapy admitted between September 2010 to September 2012 were retrospectively investigated. The reduction ratio of targetto-nontarget ratio ( T/N) before and after chemotherapy was calculated. The patients were followed up 3 to 12 months to measure progression-free survival ( PFS) . The correlation between the reduction ratio of T/N and PFS was analyzed. The patients were divided into a reduction group and a non-reduction group according to the difference of the reduction ratio of T/N and was compared the difference of the PFS.Results The reduction ratio of T/N had positive correlation with PFS( Pearson r = 0. 668, P lt; 0. 01) . The PFS of the reduction group was longer than that in the non-reduction group ( 8. 0 ±2. 5 months vs. 5. 3 ±1. 2 months,P lt;0. 05) . Conclusions The reduction ratio of T/N is positively correlated with PFS in NSCLC patients in stable disease after chemotherapy. It is possible to evaluate the efficacy of the treatment according to the reduction ratio of T/N.