Left ventricular diastolic dyssynchrony (LVDD), a dyssynchronous relaxation pattern, has been known to develop after myocardial damage. We aimed to evaluate the dynamic changes in LVDD in the early stage of acute myocardial infarction (AMI) by phase analysis of 99mtechnetium methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) and explore its relationship with the progression of left ventricular remodeling (LVR). The left anterior descending coronary arteries of 16 Bama miniature swine were occluded with a balloon to build AMI models. Animals were imaged by SPECT GMPI before AMI and at 1 day, 1 week and 4 weeks after AMI, and quantitative analysis was performed to determine the extent of left ventricle (LV) perfusion defects, left ventricular systolic dyssynchrony (LVSD) and the LVDD parameters: phase histogram bandwidth (PBW) and phase standard deviation (PSD). Echocardiography was simultaneously applied to evaluate left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the LVDD parameters: Te-12-diff and Te-12-SD. Myocardial injury markers were measured, and 12-lead ECGs were performed. The degree of LVR progression was defined as ΔLVESV (%) = (LVESVAMI4weeks − LVESVAMI1day)/LVESVAMI1day. Thirteen swine completed the study. LVDD parameters changed dynamically at different time points after AMI. LVDD occurred as early as 1 day after AMI, peaked at 1 week, and trended toward a partial recovery at 4 weeks. Phase analysis on SPECT GMPI showed a significant correlation with tissue Doppler imaging for the assessment of LVDD during the longitudinal evaluation (r = 0.569 to 0.787, both P <0.05). During the univariate and multivariate regression analyses, the LVDD parameters PBW and PSD as of 1 day after AMI were significantly associated with the progression of LVR, respectively (PBW, β = 0.004, 95% CI 0.001 to 0.007, P = 0.024; PSD, β = 0.008, 95% CI 0.000 to 0.017, P = 0.049). Adjusted smooth curve fitting and threshold effect analysis indicated PBW and PSD break-point values of 142° and 60.4°, respectively, to predict the progression of LVR after AMI. Phase analysis of SPECT GMPI can accurately and reliably characterize LVDD. LVDD occurred on the first day after AMI, reached its peak at 1 week, and partially recovered at 4 weeks after AMI. LVDD as evaluated by phase analysis of SPECT GMPI early after AMI was significantly associated with the progression of LVR. The early assessment of LVDD after AMI may provide helpful information for predicting the progression of LVR in the future.

目的:探讨麻醉管理在老年糖尿病手术患者中的应用.方法:本次纳入2018年2月～2020年11月进行麻醉手术的老年糖尿病患者74例为对象,依据干预方法的不同,随机分为2组(各37例).对照组采用常规围手术期干预;观察组采用麻醉管理,分别于术前、手术开始时、手术开始15min、手术结束时、术后24h测定患者的血糖控制情况,同时比较两组的并发症情况.结果:对照组手术开始时、手术开始15min、手术结束时、术后24h血糖均高于观察组,有统计学意义(P<0.05).对照组的总并发症率37.84％高于观察组的16.22％,有统计学意义(P<0.05).结论:麻醉管理可以有效的调控老年糖尿病手术患者的血糖水平,降低术后并发症的发生.

Objective:To evaluate the left ventricular diastolic dyssynchrony (LVDD) and its influencing factors early after acute myocardial infarction (AMI) using phase analysis of SPECT gated myocardial perfusion imaging (GMPI).Methods:Bama miniature swines ( n=16) were subjected to establish AMI models. GMPI was performed before and 1 d after AMI to obtain the extent of myocardial perfusion defect (Extent, %) and left ventricular systolic dyssynchrony (LVSD)/LVDD parameters, namely the phase histogram bandwidth (PBW) and phase standard deviation (PSD). Meanwhile, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the ratio of early to late peak mitral diastolic flow (E/A) were obtained by echocardiography. Independent-sample t test, paired t test and Pearson correlation analysis were used to analyze the data. Results:Sixteen AMI swines were successfully created. Compared to baseline, Extent, LVEDV and LVESV significantly increased on 1 d after AMI ( t values: -11.14, -4.55, -6.12, all P<0.001), while LVEF and E/A significantly decreased ( t values: 10.16, 2.18, P<0.001, P=0.046). GMPI showed that the LVDD parameters PBW and PSD increased significantly on 1 d after AMI when compared to those at baseline((142.25±72.06)° vs (33.06±8.98)°, (56.15±26.71)° vs (12.51±5.13)°; t values: -6.11, -6.60, both P<0.001). There were significant differences between LVSD parameters and LVDD parameters (PBW: (109.06±62.40)° vs (142.25±72.06)°, PSD: (44.40±25.61)° vs (56.15±26.71)°; t values: -2.73, -2.20, P values: 0.016, 0.044). LVDD parameters PBW, PSD were negatively correlated with E/A after AMI ( r values: -0.569, -0.566, P values: 0.021, 0.022), and positively correlated with the Extent ( r values: 0.717, 0.634, P values: 0.002, 0.008). The phase analysis of SPECT GMPI to evaluate LVDD showed good intra-observer and inter-observe reproducibility (intraclass correlation coefficient (ICC): 0.953-0.984, all P<0.001). Conclusions:LVDD occurs early on 1 d after AMI, and can reflect left ventricular diastolic dysfunction. The Extent is correlated with LVDD significantly. Phase analysis of SPECT GMPI is an accurate method to evaluate LVDD and left ventricular diastolic function.

Whether the region of the latest electrical activation (LEA) corresponds with the segment of the latest mechanical contraction (LMC) in ischemic cardiomyopathy (ICM) is uncertain. We aimed to investigate the relationship between the left-ventricular (LV) viable segments with LEA and with LMC after myocardial infarction (MI) and analyze the acute hemodynamic responses (dP/dtmax) after cardiac resynchronization therapy (CRT) pacing at different LV sites. Bama suckling pigs (n = 6) were subjected to create MI models. Both gated myocardial perfusion imaging (GMPI) and electroanatomic mapping (EAM) were performed successfully before MI and 4 weeks after MI. LMC was assessed by phase analysis of GMPI, while LEA was evaluated by EAM. The dP/dtmax was measured before CRT and when the CRT LV electrode was implanted in viable segments of LMC, viable segments of lateral wall and scar, respectively. The viable segments of LEA were consistent with the sites of LMC for five in six cases. The dP/dtmax increased significantly compared with that before CRT when the CRT LV electrode was implanted in viable segments of LMC (1103.33 ± 195.76 vs 717.83 ± 80.74 mmHg·s−1, P = .001), which was also significantly higher than in viable segments of lateral wall (751.17 ± 105.62 mmHg·s−1, P = .000) and scar (679.50 ± 60.87 mmHg·s−1, P = .001). Non-invasive GMPI may be a better option than invasive EAM for guiding LV electrode implantation for CRT in ICM.

Background Left ventricular mechanical dyssynchrony (LVMD) is closely associated with left ventricular dysfunction and poor prognosis in patients with acute myocardial infarction (AMI). However, whether mechanical dyssynchrony is present in the noninfarcted areas remains controversial. This research aimed to quantitatively evaluate the global and regional mechanical dyssynchrony early after AMI by phase analysis of single-photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) and to further explore the related influencing factors. Materials and methods Of 11 Bama suckling pigs, eight animals were successfully subjected to left anterior descending artery occlusion by balloon to generate porcine AMI models and completed the study. SPECT GMPI was performed before AMI and at 1 day, 1 week, and 4 weeks after AMI. The global bandwidth (BW), SD, entropy, total perfusion deficit, summed rest score, regional BW, regional summed motion score, and regional summed thickening score were measured by SPECT GMPI. Results The global BW, SD, and entropy values significantly increased after AMI and showed no significant change among the three time points after AMI. The BW in the infarcted area (left anterior descending artery-dominated area) at 1 day, 1 week, and 4 weeks after AMI was significantly higher than that before AMI, as was the BW in the noninfarcted areas (left circumflex artery-dominated and right coronary artery-dominated areas), which revealed that there was less dyssynchrony in the noninfarcted areas than in the infarcted area at the three time points after AMI. The global BW was positively correlated with the scar burden measured by summed rest score (r=0.709–0.832, all P<0.05), whereas the regional BW in the noninfarcted areas after AMI showed moderate to good correlation with regional summed motion score (r=0.733–0.875, all P<0.05) and regional summed thickening score (r=0.713–0.889, all P<0.05). Conclusion LVMD occurs early on the first day after AMI, with no significant worsening over the next 4 weeks. Mechanical dyssynchrony was present in both the infarcted and noninfarcted areas. The global LVMD is mainly influenced by the scar burden, and the regional mechanical dyssynchrony in the noninfarcted areas is closely associated with the abnormal regional wall thickening and motion, which are indicative of reduced myocardial contractility.

Objective To assess left ventricular remodeling (LVRM) after acute myocardial in-farction (AMI) quantitatively by SPECT gated myocardial perfusion imaging (GMPI), and further explore its influencing factors. Methods Twelve Ba-Ma miniature swine were used to establish AMI model. GMPI was performed at the baseline (before AMI), 24 h, 1 and 4 weeks after AMI. Infarct expansion index, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction ( LVEF) and myocardial perfusion defect were measured. Meanwhile, creatine kinase isozyme MB (CK-MB) and hypersensitive cardiac troponin I (hs-cTn I) were detected. The changes of LVEDV and LVESV before and after AMI (ΔLVEDV and ΔLVESV) were calculated. Repeated measurement analy-sis of variance, the least significant difference t test and Pearson correlation analysis were performed. Re?sults Nine AMI swine were successfully created. LVRM was present 24 h after AMI. LVEDV and LVESV were significantly greater than those before AMI and aggravated within 1 week after AMI, then were down-wards at 4 weeks after AMI. Before AMI, 24 h, 1 and 4 weeks after AMI, the LVEDV was (34.44±7. 90), (47.56±22.66), (71.89±14.90) and (70.33±19.47) ml (F = 28.836, P<0.001), and the LVESV was (10.11±5.49), (25.33±11.62), (40.89±15.88) and (35.44±17.11) ml (F = 22.450, P<0. 001). In-farct expansion index increased progressively within 4 weeks after AMI (F= 16.054, P<0.001). LVEF was significantly lower after AMI than that before AMI (F = 18.267, P<0.001) and improved at 4 weeks after AMI compared to that at 1 week ((52.56±14.96)％ vs (45.11±15.80)％; t= 2.440, P<0. 05). There was a significant correlation between the change in perfusion defect and the ΔLVEDV or ΔLVESV (r values:0. 731 and 0.700, both P<0.05) at 1 week after AMI. In addition, hs-cTn I at 24 h was correlated withΔLVEDV at 24 h and 4 weeks after AMI, respectively (r values: 0.669 and 0.693, both P<0.05). Conclu?sions LVRM and cardiac dysfunction occur in the early period after AMI. LVRM and cardiac dysfunction are most severe at 1 week after AMI, and recover at 4 weeks after AMI, whereas infarct expansion is aggra-vated within 4 weeks. Infarct size and hs-cTn I are closely related to the degree of LVRM.

BACKGROUND The purpose of this study was to investigate the effects of sinomenine (SIN) on CFA-induced inflammatory pain in rats, and to explore the underlying molecular mechanisms. MATERIAL AND METHODS To determine the potential influences of SIN in the pathogenesis of inflammatory pain, an inflammatory pain (IP) mouse model was established and rats were treated with SIN (30 mg/kg). Behavioral tests were used to assess the MWT and TWL of the rats. ELISA assay was used to detect the level of inflammation cytokines. Western blotting and qRT-PCR were carried out to measure the related protein and mRNA expression level, respectively. RESULTS We found that the MWT and TWL of the CFA-treated rats were markedly lower than that of the control rats, and they were significantly increased by SIN administration. The results suggest that IP rats had higher levels of TNF-α, IL-1β and IL-6 compared with the control rats. SIN administration decreased the levels of TNF-α, IL-1β, and IL-6. In addition, we found that p-p65 and p-p38 expression notably decreased after SIN treatment in IP rats. Moreover, the results showed that SIN inhibited Cox-2 and PGE2 expression in IP rats. CONCLUSIONS The data indicate that SIN had a protective role in inflammatory pain through repressing inflammatory mediators via preventing the p38MAPK-NF-κB pathway.

Objective To evaluate the dynamic changes of left ventricular mechanical synchrony in the early period after acute myocardial infarction (AMI) by two-dimensional speckle tracking imaging (2D-STI) and real time three-dimensional echocardiography (RT-3DE),and analyze the correlation with phase analysis of single photo emission computed tomography gated myocardial perfusion imaging (SPECT GMPI) in porcine models,and further to investigate the clinical significance of left ventricular mechanical dyssynchrony in patients with AMI.Methods Bama minipigs(n =11) were subjected to left anterior descending (LAD) occlusion by balloon to introduce AMI porcine models.All animals underwent 2D-STI and RT-3DE at the baseline (before AMI),1 day,1 week and 4 weeks after LAD occlusion,respectively.In addition,SPECT GMPI was measured at baseline and 1 day after AMI.Data was analyzed and compared the dynamic changes of left ventricular mechanical synchrony before and after AMI.Then the correlation between echocardiography and SPECT GMPI in evaluating left ventricular mechanical synchrony before and after AMI were calculated.Results Eight pigs were successfully established as AMI models and complete the study.SPECT GMPI,2D-STI and RT-3DE showed that the left ventricular mechanical synchrony indexes were significantly higher at 1 day after AMI than those before AMI,which means the appearance of left ventricular mechanical dyssynchrony.Compared with those 1 day after AMI,GLS,Time SD,Tmsv16-SD％ and Tmsv16-Dif％ did not change significantly at 1 week after AMI,but they significantly increased at4 weeks after AMI (all P ＜0.05).At baseline and 1 day after AMI,the GLS measured by 2D-STI and the SPECT GMPI parameter phase bandwidth (BW) showed good correlation(r =0.708-0.719,P ＜0.05),Time SD was significantly correlated with the SPECT GMPI parameter phase standard deviation (SD)(r =0.717-0.830,P ＜0.05),while Tmsv16-Dif％ derived from RT-3DE had a better positive correlation with BW (r =0.713-0.857,P ＜0.05),as similar as Tmsv16-SD％ with SD(r =0.803-0.957,P ＜0.05).Conclusions Left ventricular mechanical dyssynchrony is present 1 day after AMI.Compared with that 1 day after AMI,left ventricular mechanical dyssynchrony doesn't change significantly at 1week after AMI,but further aggravates at 4 weeks after AMI.The parameters of 2D-STI and RT-3DE have good correlation with the mechanical synchrony parameters measured by SPECT GMPI.2D-STI and RT-3DE can be used as reliable methods to evaluate left ventricle mechanical dyssynchrony early after AMI.

In this study, we investigated the role of gated myocardial glucose metabolic imaging in assessing left ventricular (LV) systolic dyssynchrony after myocardial infarction (MI) and explored the influencing factors. Bama mini-pigs were divided into normal group and MI group and subjected to gated myocardial metabolic imaging (GMMI) and gated myocardial perfusion imaging (GMPI). The phase bandwidth (BW), standard deviation (SD) and the latest activation site of left ventricle were obtained using program Cedars QGS. The results showed that (1) BW and SD obtained in GMMI and GMPI showed significant correlation in pigs with MI, but not in the normal pigs, (2) BW and SD obtained in GMMI and GMPI had good consistency in both normal pigs and MI pigs, (3) GMMI and GMPI had a 66.7% identity in determining the latest activation site of left ventricle in the normal pigs and 77.8% identity in determining the latest activation site of left ventricle in pigs with MI. Multivariate stepwise regression analysis showed that total perfusion deficit and summed motion score were independent factors affecting BW and SD in GMMI. In conclusion, phase analysis of GMMI images could objectively reflect LV systolic dyssynchrony resulted from interactions of multiple factors.

目的 探讨射频消融联合臭氧治疗神经根型颈椎病的临床效果.方法 采用射频消融联合臭氧治疗颈椎病36例.射频消融:在C型臂X射线机辅助下定位穿刺,置入射频电极,测阻抗在150～250 Ω;分别用高频50Hz、0.5～2.0 mA低电流行感觉测试,低频2 Hz、0.5～2.5 mA高电流行运动测试;若无异常反应后,则行60℃、70℃和80℃各60 s,85℃治疗120 s.臭氧治疗:射频结束后,拔出电极,抽臭氧(60 mg/ml)共3～5 ml,缓慢推注.术后24 h、1周、1个月和6个月随访疗效.结果 术后24 h、1周、1个月和6个月的有效率分别为97.2％、94.4％、94.4％和94.4％,优良率分别为94.4％、88.8％、80.5％和86.1％.随访期未见并发症.结论 射频消融联合臭氧治疗神经根型颈椎病安全、有效.

目的探讨右美托咪定(Dexmedetomidine,DEX)联合丙泊酚和小剂量氯胺酮在单纯乳腺肿块切除术中的安全性和有效性。方法选择单纯乳腺局部良性病变切除手术的女性患者60例，随机分成P1、P2及D组，每组各20例。D组15 min内泵注DEX 1μg/kg，随后0.5μg/kg/h维持，P1、P2组泵注等量生理盐水。记录各组氯胺酮用量，各组基础(T0)、切皮前(T1)、切皮时(T2)、缝皮时(T3)时的血压、心率，以及苏醒时间、不良反应。结果 D组与P1组相比，氯胺酮用量减少26.8%(<0.05)，术中循环更稳定，术后精神症状减少(<0.05)。P2与P1组相比，呼吸抑制发生率增加(<0.05)。结论 DEX联合丙泊酚和小剂量氯胺酮用于单纯乳腺肿块切除术安全有效。

目的 比较超声引导下比较超声引导下两种颈神经丛阻滞(颈丛阻滞)方法即C4横突一点法和C2、C3、C4横突三点法的麻醉效果及并发症的发生情况.方法 择期拟行单侧甲状腺次全切除术患者60例,性别不限,ASA Ⅰ或Ⅱ级,随机分为2组(n=30):两组均作双侧颈浅丛阻滞及术侧颈深丛阻滞.颈浅丛阻滞均为在超声引导下将局麻药注射在胸锁乳突肌中点后缘下方.C4横突一点法组(A组)在超声引导下在C4横突处注射局麻药9ml;C2、C3、C4横突三点法组(B组)超声引导下于C2、C3、C4横突处各注射局麻药3ml.记录起效时间、麻醉优良率、阻滞前和阻滞后5、10、15、20、30min的生命体征,并观察并发症的发生情况.结果 超声引导C2、C3、C4横突三点法颈深丛阻滞和C4横突一点法颈深丛阻滞进行对比,三点法组的耳大神经分布区域起效时间短于一点法组,而锁骨上神经分布区域起效时间长于一点法组(P＜0.05).三点法组的深部麻醉优秀率较一点法更为完善(P＜0.05),两种方法成功率比较,差异无统计学意义.一点法A组出现1例Horner's综合征,两组均无膈神经阻滞、喉返神经阻滞、误入血管、局部麻醉药中毒.结论 超声可以作为颈深丛阻滞的定位方法并可进行实时引导颈丛神经阻滞.通过超声准确定位,进行C2、C3、C4横突三点法和C4横突一点法两种颈深丛阻滞方法的麻醉效果比较发现,三点法颈深丛阻滞比一点法更为完善,术中患者循环更为稳定,且并发症发生例数较少,但差异无统计学意义.

Objective To evaluate the effects of exogenous hydrogen sulfide on acute lung injury during hemorrhagic shock and resuscitation (HS/R) in rats.Methods Thirty-two SPF adult male rats,weighing 250-300 g,aged 6-8 weeks,were randomly divided into 4 groups (n =8 each) using a random number table:sham operation group (S group),sham operation + exogenous NaHS group (S + NaHS group),HS/R group and HS/R + NaHS group.HS/R was induced by withdrawing blood from the femoral artery for 10 min.The mean arterial pressure was maintained at 35-40 mmHg for 90 min.The animals were then resuscitated for 60 min with infusion of lactated Ringer's solution 3 times the volume of blood withdrawn and shed blood.NaHS 28μmol/kg was injected intraperitoneally before resuscitation in HS/R + NaHS and S + NaHS groups.At 3 h after the end of resuscitation,the lungs were harvested and bronchoalveolar lavage fluid (BALF) was prepared for determination of protein,IL-6 and TNF-α concentrations.Lungs were removed for examination of pathological changes which were scored and for determination of wet to dry lung weight (W/D) ratio,myeloperoxidase (MPO) activity,cell apoptosis,and expression of caspase-3,caspase-8,Bcl-2,Bax and BH3 interacting-domain death agonist (BID).Results Compared with S group,the protein,IL-6 and TNF-α concentrations in BALF,pathological score,W/D ratio,MPO activity,and the number of apoptotic cells were significantly increased,the expression of caspase-3,caspase-8,Bax and BID was up-regulated,and the expression of Bcl-2 was down-regulated in HS/R and HS/R + NaHS groups,and no significant changes were found in the parameters mentioned above in S + NaHS group.Compared with HS/R group,the protein,IL-6 and TNF-α concentrations in BALF,pathological score,W/D ratio,MPO activity,and the number of apoptotic cells were significantly decreased,the expression of caspase-3,caspase-8,Bax and BID was down-regulated,and the expression of Bcl-2 was up-regulated in HS/R + NaHS group.Conclusion Exogenous hydrogen sulfide can alleviate acute lung injury during HS/R in rats and inhibition of inflammatory responses and cell apoptosis is involved in the mechanism.

目的 比较下肢神经阻滞和硬膜外麻醉对高龄髋关节手术患者血流动力学的影响.方法 择期高龄行髋部手术的患者40例随机均分为腰丛-坐骨神经-椎旁神经阻滞(A组)和硬膜外麻醉(B组).记录麻醉前(T0)、麻醉给药后10 min(T1)、20 min(T2)、30 min(T3)和60 min(T4)的收缩压(SBP)、舒张压(DBP)、HR、心输出量(CO)和体循环阻力(SVR).结果 A组SBP、DBP、HR、CO和SVR各时间点均无统计学差异(P＞0.05).B组T2-T4的SBP和DBP低于T0(P＜0.05);B组T3时的CO为(3.52±0.78) L/min,低于T0时的(4.30±1.30) L/min和A组T3时的(4.28±0.89) L/min(P＜0.05).结论 下肢神经阻滞对高龄患者髋关节手术的血流动力学影响较硬膜外麻醉小.

目的：观察i-gel喉罩应用于腹腔镜胆囊切除手术全身麻醉气道管理的安全性及有效性。方法选择因慢性胆囊炎和/或胆囊结石而择期行腹腔镜胆囊切除术患者50例，随机分成两组：喉罩组和气管插管组。分别记录人工气道建立成功后气腹前(T1)、气腹后(T2)的平均气道压(Pmean)、气道峰压(Ppeak)、呼气末二氧化碳分压(PetCO2)。分别于患者入室时(T1')、人工气道建立成功时(T2')、建立后10 min(T3')、拔管(喉罩)前即刻(T4')、拔管(喉罩)后10 min(T5')记录平均动脉压(MAP)、心率(HR)。观察术中有无反流误吸情况，同时注意术后咽喉部有无声嘶或主诉咽痛以及胃胀等并发症。结果气腹建立后(T2)，两组平均气道压(Pmean)、气道峰压(Ppeak)、呼气末二氧化碳分压(PetCO2)均较气腹前(T1)增高(<0.05)；气管插管组在人工气道建立时(T2')及拔管前即刻(T4')MAP及HR较人工气道建立前(T1')显著升高(<0.05)，喉罩组仅在T4'心率较T1'升高(<0.05)。喉罩组不良反应少于气管插管组。结论 i-gel喉罩可安全有效的应用于腹腔镜胆囊切除手术全身麻醉气道管理。

目的 观察椎旁阻滞治疗神经根型颈椎病的疗效.方法 将120例神经根型颈椎病患者随机分为治疗组和对照组,治疗组采用椎旁神经阻滞,对照组采用口服药物加牵引热敷,治疗效果分为3级:痊愈、显效、无效.结果 治疗组的总有效率90％,对照组总有效率68.3％,两组间差异明显(P＜0.01).结论 椎旁神经阻滞治疗神经根型颈椎病疗效高.

Objective To evaluate the outcomes of paravertebral-lumbar plexus-sciatic(PVLPS) nerve block and epidural block in the elderly undergoing hip surgery.Methods Thirty patients aged from 69 to 102 years old scheduled for unilateral hip surgery were equally randomized into two groups of A(anesthetized with PVLPS nerve block) and B(anesthetized with epidural anesthesia).The onset time of blockade,anesthetic effect and the changes of blood pressure and heart rate were recorded and compared.Results Anesthesia effect was satisfactory in both groups.Compared to group B,group A had less changes of blood pressure and heart rate,earlier recovery of pain feeling,and less incidence of nausea,vomiting and indwelling time of urethral catheter(P0.05).Conclusion PVLPS nerve block can provide the aged patients undergoing hip surgery with satisfactory anesthesia without remarkable effect on physiological function.

目的 探讨射频消融联合臭氧治疗腰椎间盘突出症的临床效果.方法 采用射频消融联合臭氧治疗腰椎间盘突出症48例.射频消融:在C型臂X线机辅助下定位穿刺,置入射频电极,测阻抗在150-250Ω时,分别用高频(50Hz)低电流(0.5-2.0 mA)行感觉测试和低频(2 Hz)高电流(0.5-2.5 mA)行运动测试后行60℃、70℃、80℃分别治疗60 s,然后再用90℃治疗120 s.臭氧治疗:射频结束后拔出电极,置入穿刺针芯继续刺入椎间盘髓核内,抽臭氧5-10 ml,缓慢推注；退针至椎间盘外硬膜外前间隙,注入消炎镇痛液10 ml.术后1周、1个月、6个月和12个月随访4次,评估疗效.结果 术后1周、1个月、6个月和12个月的有效率分别为91.6％、79.2％、87.5％和89.6％,优良率分别为70.8％、60.4％、77.1％和75.o％.无不良反应.结论 射频消融联合臭氧治疗腰椎间盘突出症疗效稳定可靠,无不良反应.

屈指肌腱腱鞘炎,又称屈指肌腱狭窄性腱鞘炎,是手部软组织损伤的常见病症,好发于中老年,且以女性居多,常见于拇指、中指和环指.病变易发生于掌骨头相对应的屈指肌腱纤维鞘管的部位,在伸屈活动中常发生"咔嗒"弹响声和扳机样屈伸,故名"弹响指"、"扳机指".该疾病采用以局部注射为主的保守治疗常能取得较好的疗效,但复发率较高[1].开放手术可以治疗本病,但易引发感染、神经损伤、疤痕疼痛和关节挛缩等并发症,影响患者对手术的依从性[2-3].本研究采用针刀松解加局部注射的方法治疗狭窄性腱鞘炎,取得了良好效果,现报告如下.

Objective To compare the effects of sevoflurane inhalation and propofol intravenous anesthesia on hypoxic pulmonary vasoconstriction(HPV) and intrapulmonary shunt fraction(Qs/Qt )during one-lung ventilation(OLV).Methods Thirty six patients undergoing selective thoracic operation were randomly divided into two groups with 18 cases each.Sevoflurane 3%-5% was inhaled in group A and propofol in a target concentration of 2.0-3.0 μg/ml in group B was used intravenously.The arterial and mixed venous blood were taken for blood gas analysis before induction,at 15 main after two-lung ventilation(TLV), at 15 min and 30 main after OLV and at 15 min after recovering TLV.The Qs/Qt was calculated.Results Compared with those during TLV in two groups, PaO_2 decreased and Qs/Qt increased significantly during OLV(P<0.01).There was no significant difference in Qs/Qt during OLV between two groups.Conclusian There is a certain degree of decrease of PaO_2 and increase of Qs/Qt during DLV in patients under anesthesia with sevoflurane inhalation or intravenous propofol anesthesia.