目的 对比可视硬性喉镜与可视喉镜在减重手术患者气管插管中的应用价值.方法 对照组将2020年9月～2021年7月腹腔镜胃袖状切除术随机分为2组各30例,分别采用可视硬性喉镜(硬镜组)或普通可视喉镜(对照组)进行气管插管.2组性别、年龄、身高、体重、BMI、ASA分级、气道Mallampati分级以及合并症差异无统计学意义(P>0.05).比较2组插管时间、插管次数、插管相关并发症以及插管前后心率、平均动脉压的变化.结果 硬镜组和对照组均成功插管,首次插管成功率分别为93.3％(28例)和96.7％(29例),2组差异无统计学意义(P=1.000).硬镜组气管插管所需时间[(34.9±6.3)s]长于对照组[(31.7±5.2)s](t=2.139,P=0.037),但无临床意义.硬镜组气管黏膜损伤、声音嘶哑少于对照组(1例vs.7例、2例vs.6例),但无统计学差异(P>0.05).2组插管后HR和MAP均明显升高,对照组升高更明显(P<0.05).结论 与普通可视喉镜相比,采用可视硬性喉镜进行气管插管对血流动力学影响轻,插管相关并发症可能更少,安全有效.

目的 探讨含不同浓度罗哌卡因肿胀液在淋巴水肿吸脂减容术中的有效性及安全性.方法 选择2017年1月至2018年6月首都医科大学附属北京世纪坛医院择期行吸脂减容术患者60例,随机分4组,每组15例,分别用0.75％罗哌卡因20 ml(G1组)、30 ml(G2组)、40 ml(G3组)、50 ml(G4组)加入碳酸氢钠1.5 g、肾上腺素3 mg和生理盐水配成3 000 ml膨胀液.记录麻醉诱导前5 min(T0)、注射膨胀液后5 min(T1)、术毕即刻(T2)和拔除气管导管(T3)时的MAP、HR和SpO2.记录拔除气管导管后(T4)、术后1 h(T5)、术后6 h(T6)、术后24 h(T7)疼痛视觉模拟评分(visual analogue scale,VAS)和追加镇痛药例数.结果 G2、G3、G4组T4～T6的VAS评分均低于G1组,差异均有统计学意义(P＜0.05),而G2、G3、G43组间各时点比较,差异均无统计学意义(P＞0.05);G1、G2、G3组均无心血管及神经毒性等不良反应.但术后随访发现,G4组术后出现局部皮肤麻木、感知觉障碍等表现,提示浓度增加对局部皮肤仍存在麻醉遗留效果.结论 肿胀液中含0.75％罗哌卡因30 ml及40 ml能够为淋巴水肿吸脂提供了足够的镇痛,且比较安全.

目的 探讨右美托咪定联合帕瑞昔布超前镇痛在老年髋关节骨折手术患者中的镇痛效果及安全性.方法 60例择期行股骨切开复位内固定老年患者,随机分为两组,每组30例.实验组患者建立静脉通路后,予帕瑞昔布钠40 mg,然后右美托咪定0.5μg/(kg·h)持续泵注.对照组予同样体积的0.9％生理盐水.两组输注10 min后,实施椎管内麻醉,选择L2-3间隙进行腰硬联合麻醉.腰麻时注入0.75％罗哌卡因2 ml,后头端留置硬膜外导管3 cm,固定后恢复平卧位.记录患者一般资料,记录T1(患者从运送床搬至手术床时),T2(实施椎管内麻醉,摆放患者体位时)及T3(麻醉完成后恢复平卧位时)时的疼痛评分;记录T4(患者入手术室后),T5(搬送至手术床后),T6(椎管内麻醉摆放体位后)及T7(麻醉完成后恢复平卧位后)时的平均动脉压、心率及血氧饱和度,记录麻醉时间及OAA/S镇静评分,记录不良事件发生情况.结果 与对照组相比,在T1,T2,T3时点,实验组患者疼痛评分,OAA/S评分及麻醉时间均显著低于对照组,差异有统计学意义(P<0.05).在T5,T6,T7时点,实验组患者平均动脉压及心率均显著低于对照组,差异有统计学意义(P<0.05).两组患者血氧在任何时点均无统计学差异(P>0.05).另外,实验组有5例患者发生心动过缓,与对照组相比差异有统计学意义(P<0.05),予阿托品进行纠正.其余不良反应两组之间无统计学差异(P>0.05).结论 在椎管内麻醉前10 min,给予右美托咪定0.5μg/(kg·h)泵注联合帕瑞昔布钠40 mg干预,能有效抑制高龄患者搬动及麻醉体位改变造成的二次疼痛.同时不抑制患者循环和呼吸,是比较安全的.

Objective To screen and identify the acquired taxol ( TAX)-resistant related genes in human endometrial carcinoma cell line by applying gene chip technology.Methods We established the Ishikawa/taxol ( TAX)-resistant cell line by intermittent and repeated exposure to TAX of a high concentration on the human endometrial carcinoma cell line Ish-ikawa.The genes of Ishikawa/TAX and Ishikawa cells were examined by using Affymetrix Human Genome U133 Plus2.0 expression profile chip.The differentially expressed genes were classified by Gene Ontology ( GO) cluster analysis.Real-time quantitative PCR ( qRT-PCR) was performed to confirm part of the differentially expressed genes.Results Compared with Ishikawa cells, there were 110 significantly differential expression genes in Ishikawa/TAX cells (ratio>3), of which the up-regulated and down-regulated genes were 87 and 23, respectively.The classification of GO involved the cell signal transduction and regulation, cell adhesion molecule, cell metabolism and transcription regulation, etc.S100A12 was up-regulated significantly, followed by CYP1B1, FUBP1 and CEACAM6.TNFAIP3, CD44 and DKK1 were significantly down-regulated.The qRT-PCR showed that S100A12 and CYP1B1 was highly expressed in the drug-resistant cells, and TN-FAIP3 and CD44 was lowly expressed in the drug-resistant cells, which coincided well with the results of cDNA microarray. Conclusion Gene chip technology screens that the up-regulated genes of acquired TAX-resistant related genes in human endometrial carcinoma cell line are S100A12, CYP1B1, FUBP1 and CEACAM6, and the down-regulated genes are TN-FAIP3, CD44 and DKK1.

Objective To compare the results of cystectomy laparoscopicly and laparotomicly in the management of benign ovarian cysts,and to evaluate the value of combined laparoscopic operation with fibrin sealant.Methods 213 patients with benign ovarian cysts requiring operation from January,2003 to March,2010 were randomly divided into laparoscopy group(130 cases) and laparotomy group(83 cases).The characteristics of patients and results of laparoscopy and laparotomy in the cystectomyof ovarian cysts were compared.Results There were no differences in age,body weight,the size of cysts,previous laparotomy,the operation time and the hospitalization fee between two groups(P0.05).The amount of blood lost during the operation,postoperative morbidity,analgestic requirement,hospital stay and recovery period in laparoscopic group were significantly less than those in laparotomy(P 0.05).Conclusion The combined laparoscopic surgery with fibrin sealant is safe and effective and feasible in the cystectomy of benign ovarian cysts.

Platinum chemotherapy agents(cisplatin,carboplatin,oxaliplatin) have been approved in the first-line setting of numerous malignancies,such as ovarian,bladder,colorectal,and lung cancer,and are effective.However,hypersensitivity reactions often occurs in clinical applications,the main manifestations are rash,facial flushing,abdominal cramps,itchy palms and back pain,and can cause severe breathing difficulties,anaphylactic shock and even death. According to time of occurrence of hypersensitivity,cisplatin hypersensitivity is divided into two types of rapid onset and delayed.The former occurs in me process of cisplatin infusing,most of them have serious clinical symptoms,general with anaphylactic shock as the main performance,with or without skin symptoms,and are IgE-mediated typeⅠallergic reactions.The latter occurs in a few hours or several days after infusion,and are more moderate,with rash,local edema,itching and skin symptoms;T cells mediated typeⅣallergic reactions involved in it.This paper reported one case of severe anaphylactic shock occurs in recurrent ovarian cancer patients during chemotherapy with cisplatin and review the literature for nearly 10 years.