血栓性微血管病变（TMA）包括血栓性血小板减少性紫癜（TTP）、非典型溶血性尿毒症综合征（aHUS）和产毒大肠杆菌溶血性尿毒症综合征（STEC-HUS）等 [1] ,是一类罕见的、临床可表现出多种症状、可迅速致命的各种微血管病变 [2] ,可能导致肾脏、大脑、胃肠道和心脏的严重功能障碍 [3] 。目前国内外报道较少,行血液透析的TMA相关肾脏损害临床病理研究更少。本研究通过对我科行血液透析的TMA相关肾脏损害患者临床及病理进行回

Objective Explore the effect of wake quality and adverse reactions of using an anesthetic desflurane that is quickly eluded, on the basis of combined use of propofol combined fentanyl to quality in elderly patients.Methods 82 cases of elderly patients with total anesthesia were selected.Patients were randomized to two different group, 42 in the control group and 40 in the experimental group.In P group (control group), propofol and remifentanil were used to maintain anesthesia.D group (test group) target controlled infusion of propofol, remifentanil and combined inhaled difluoroether.Results In D group (experimental group), the dosage of propofol, time of wake up, extubation time and the time of Aldrete score is greater than or equal to 9 minutes are less than pure propofol combined fentanyl patients (control group), the difference was statistically significant (P＜0.05).In group D, there were 6 patients with a restlessness score of 3 and above, accounting for 15％ of group D, and 5 cases of group P 3 and above, accounting for 11.9％ of group P.There was no significant difference between the two groups (P＞0.05).There was no statistically significant difference in the incidence of tachycardia, nausea, vomiting and respiratory depression between the two groups detected in the wake period (P＞0.05).Conclusion The target controlled infusion of propofol, remifentanil and combined inhalation of desflurane can improve the resuscitation quality of the patients, and the ideal anesthetic effect can be achieved for the elderly.

副神经节瘤指位于肾上腺外的嗜铬细胞瘤，是一种罕见的副神经节组织的内分泌肿瘤。原发于肝脏的非功能性副神经节瘤极其罕见，目前国内外仅报道5例［1-3］。吉林大学第二医院2015年4月收治1例。现报道如下。

<正>1资料与方法1.1一般资料选择2009—2011年本院肺癌患者30例,均拟行肺叶切除术。排除长期使用皮质激素或内源性皮质激素增多者及凝血功能及血小板功能异常有出血倾向者及消化性溃疡患者。术前患者分级为ASAⅠ-Ⅱ级,年龄18～60岁,体质量50～70kg。随机分为氟比洛芬酯组和对照组,每组15例,2组患者均采用全凭静脉靶控麻醉;诱导:咪达唑仑-1-1-1-1

目的观察布托啡诺妇科手术后硬膜外镇痛效果。方法 ASAⅠ～Ⅱ级妇科手术患者40例,随机分为布托啡诺组(B组)和吗啡组(M组),B组用药为0.125%罗哌卡因+0.005%布托啡诺100ml,M组为0.125%罗哌卡因+0.005%吗啡100ml。两组PCEA设置均为背景流速2ml/h,自控剂量2ml/Bolus,锁定时间15min,术后1h、4h、12h、24h、48h双盲观察镇痛评分,采用视觉模拟评分(VAS),常规监测MAP、SpO2、HR、RR,并观察记录不良反应。结果 1)镇痛效应:各时间点VAS评分两组间比较无显著性差异(P>0.05);2)并发症:B组恶心呕吐及搔痒的发生率均低于M组(P<0.05)。结论布托啡诺用于妇科手术后硬膜外镇痛效果确切,恶心呕吐及搔痒的发生率低。

盐酸戊乙奎醚是一种新型的胆碱能受体阻断药,有研究表明盐酸戊乙奎醚对CPB过程中心、脑等重要器官具有保护作用,其机制可能与其扩张外周血管,改善微循环有关[1-2].TXA2和PGI2是影响血小板功能、调节外周血管阻力的重要物质[3].本研究拟通过观察盐酸戊乙奎醚对CPB下心脏瓣膜置换术患者血浆TXA2和PGI2的影响,探讨盐酸戊乙奎醚对CPB过程中器官保护作用的可能机制.

Objective:To explore the clinical effects of sufentanil on cellular immune function in patients with cervical cancer.Methods:Forty patients with cervical cancer were selected and divided into two groups,20 cases in each group. In experiment group,sufentanil was used;In contract group,fentanyl was used. Peripheral venous blood was extracted before anesthesia,1 h after anesthesia and l d,5 d after operation and the concentration of IL-2,IL-10 and T cell subgroup were measured.Results:The analgesia was good in both groups. Compared with that before anesthesia,CD3+,CD4+,CD4+/CD8+ and IL-2 in both groups decreased at T1 and T2,significantly in Group Ⅱ (P<0.05);CD3+,CD4+,CD4+/CD8+ and IL-2 in Group Ⅱ at l d after operation decreased significantly than that in Group Ⅰ (P<0.05).Conclusion:Sufentanil has little effect on cellular imunofunction and is more suitable to be used in patients with cervical cancer.

Objective To study the influence of laparoscopic cholecystectomy on Glucagon and C-peptide. Method 20 patients underwent elective cholecystectomy were randomly divided into laparoscopic cholecystectomy group(LC group, n=10) and open cholecystectomy group (OC group, n=10). Blood samples were obtained before operation, 10 min after pneumoperitoneum with carbon dioxide or laparotomy and 10 min after operation. The plasmic levels of C-peptide and Glucagon were measured with radio-immunoassay technique. Results Compared with preoperative values, significantly increased Glucagon were observed in both groups(P0.05), but the value of Glucagon after laparotomy in OC group were much higher than that in LC group after pneumoperitoneun(P0.05). The plasmic C-peptide levels after pneumoperitoneum and after operation were higher than those before operation in LC group and the level after operation significantly increased(P0.05). Compared with preoperation, C-peptide level reduced after laparotomy(P0.05) and increased after operation in OC group. The level of C-peptide in LC group after pneumoperitoneum has significant difference with that in OC group after laparotomy. Conclusion LC has a weaker impact on C-peptide and Glucagon compared with OC.