目的 探讨连续硬膜外阻滞麻醉对子宫内膜癌患者凝血功能、D二聚体(D?D)水平及预后的影响.方法 以2019年3月?2021年3月我院收治的100例子宫内膜癌患者为对象,对照组50例给予全身麻醉,观察组50例给予连续硬膜外阻滞麻醉.观察两组的凝血功能指标、血浆D?D水平及生活质量评分与疼痛评分.结果 手术后观察组患者的凝血酶原时间(PT)、活化部分凝血酶时间(aPTT)显著低于对照组(P<0.05),纤维蛋白原(Fbg)显著高于对照组(P<0.05);观察组D?D水平在手术后24 h、72 h显著低于对照组(P<0.05);观察组的生活质量评分显著高于对照组、疼痛评分显著低于对照组(P<0.05).结论 连续硬膜外阻滞麻醉能够改善子宫内膜癌患者的凝血功能、抑制D?D水平升高,同时也能改善患者预后的状态.

目的 探讨七氟烷麻醉对乳腺癌患者凝血功能及免疫功能的影响.方法 选取2018年5月～2021年4月在我院治疗的80例乳腺癌患者为对象,按照随机数字法分为对照组和观察组,各40例.对照组予以异氟烷麻醉,观察组予以七氟烷麻醉.比较两组手术前后凝血功能[、部分凝血活酶时间(aPTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(Fbg)]、免疫功能[检测CD3+、CD4+、CD8+].结果 手术后,观察组aPTT、PT均长于手术前(P<0.05),Fbg低于手术前(P<0.05),对照组aPTT、PT、TT均长于手术前(P<0.05),Fbg水平低于手术前(P<0.05),且观察组TT水平短于对照组(P<0.05),两组在Fbg、aPTT、PT、比较(P>0.05);观察组CD3+、CD4+水平高于对照组(P<0.05),观察组CD8+水平低于对照组(P<0.05).结论 与异氟烷麻醉相比,七氟烷麻醉可降低对乳腺癌患者全血凝血功能影响,调节免疫平衡.

目的 比较羟考酮与舒芬太尼对宫颈癌根治全麻术后镇痛衔接的有效性和安全性.方法 采用随机双盲对照研究,选取宫颈癌根治全麻手术患者68例,随机分为S组(舒芬太尼镇痛衔接,n=35)和O组(羟考酮镇痛衔接,n=33).手术结束前30 min,S组给予舒芬太尼(腔镜手术0.1μg/kg或剖腹手术0.15μg/kg),O组给予羟考酮(腔镜手术0.1 mg/kg或剖腹手术0.15 mg/kg).记录术后意识恢复时间、拔管时间、RSS躁动评分、呛咳次数、Ramsay评分及拔管即刻(T0)与拔管后30 min(T1)、1 h(T2)、2 h(T3)、4 h(T4)和术后12 h(T5)、24 h(T6)的静态NRS评分及术后24 h内的不良并发症.结果 与S组比较,O组患者意识恢复时间短[(4.28±3.35 vs.5.53±2.25)min,P=0.027],拔管时间短[(5.92±3.67 vs.8.09±2.49)min,P=0.001],苏醒期RSS躁动评分低(0.38±0.49 vs.0.83±0.63,P<0.001),呛咳次数少(0.96±0.78 vs.1.34±0.93,P=0.026),Ramsay评分低(2.3±0.58 vs.2.63±0.85,P=0.017);O组患者T3和T4的静态NRS评分低于S组(2.64±0.63 vs.3.14±0.66;2.86±0.81 vs.3.69±0.75),差异均有统计学意义(P<0.001).O组患者恶心发生率和呕吐发生率低于S组(9.09％vs.20％;3.03％vs.11.43％).结论 羟考酮和舒芬太尼均能在宫颈癌根治全麻术后的镇痛衔接中提供满意的镇痛效果,羟考酮的镇痛时间长于舒芬太尼,且苏醒快,不良并发症少.

目的 探讨血清癌胚抗原(CEA)、癌抗原19-9(CA19-9)和癌抗原50(CA50)水平对胰腺癌手术可切除性的预测价值.方法 选取2015年1月—2017年5月我院收治的86例胰腺癌作为研究对象,根据手术方式的不同分为手术可切除组(根治术治疗)和手术不可切除组(姑息性治疗),回顾性分析两组临床及随访资料,分析胰腺癌患者不可手术切除的影响因素及CEA、CA19-9、CA50联合检测对胰腺癌手术可切除性的预测价值.结果 86例胰腺癌可切除34例,可切除率为39.53％.非条件多因素logistic回归分析显示,CA19-9、CEA、CA50升高及TNM分期Ⅲ～Ⅳ期为胰腺癌不可手术切除的影响因素;CEA、CA19-9、CA50联合检测预测胰腺癌手术可切除性的灵敏度和特异度均高于各指标单独检测(P<0.05).结论 CA19-9、CEA、CA50升高及TNM分期Ⅲ～Ⅳ期为胰腺癌不可手术切除的影响因素,可将CEA、CA19-9、CA50联合检测作为预测胰腺癌手术可切除性的有效方法.

Objective To prepare PTD4-Cu,Zn-SOD fusion protein.Methods The recombinant plasmid of pET 1 6b-Cu,Zn-SOD and pET16b-PTD4-Cu,Zn-SOD was transformed into Escherichia coli BL21 (DE3).Isopropyl β-D-1-thiogalactopyranoside was then added at a final concentration of 0.84 mmol/L,and the cells were incubated for 4 h to induce the expression of Cu,Zn-SOD and PTD4-Cu,Zn-SOD fusion protein.Lysozyme and ultrasound were used to lyse the bacteria,the supernatant was collected for 15％ SDS-PAGE to analyze the expression of the target protein.Ni-NTA His bind resin was used to purify Cu,Zn-SOD protein and PTD4-Cu,Zn-SOD fusion protein under natural conditions.Western blot was used to identify the target protein.Results The results of Western blot showed that the purity of the target protein was about 90％,and the Cu,Zn-SOD protein with a molecular weight about 19 kDa and the PTD4-Cu,Zn-SOD fusion protein with a molecular weight about 20 kDa were found.Conclusion PTD4-Cu,Zn-SOD fusion protein is prepared successfully.

Objective:The aim of this research was to study the effects on hydrogen-rich saline against the rat model of cerebral ischemia-reperfusion injury and elucidate the possible mechanisms.Methods:Sprague-Dawley rats weighing 250-300 g were distributed randomly into 3 groups (n=20):sham group,cerebral ischemia-reperfusion injury group (I/R group),and hydrogen-rich saline treated group (HS group).The model was induced by right middle cerebral artery occlusion (MCAO) via suture.Reperfusion was accomplished by withdrawing the suture after 90 min ofischemia.During the process of reperfusion,rats in I/R group were injected saline (10 mL/kg) intraperitoneally,and rats in HS group were injected hydrogen-rich saline (10 mL/kg) intraperitoneally.Neurological deficit scores were evaluated at 24 h after reperfusion.Then,the rats were decapitated,TTC tests were performed to detect the infarct volume of cortex (n=10).Ischemic penumbra was collected to analyze the involved indexes (n=10).We used HE staining to observe the morphology of cortical ischemic penumbra,and used SOD and MDA to evaluate the oxidative response in the region of cortical ischemic penumbra,and used TNF-α and IL-6 to evaluate the inflammatory response in cortical ischemic penumbra via Elisa test.Results:TTC staining test suggested that the model of right MCAO could induce focal ischemia of brain obviously (P＜0.05).Compared with I/R rats,rats in HS group had decreased infarct volume of cortex (P＜0.05) and lower neurological deficit scores (P＜0.05).Rats in HS group maintained cellular structural integrity superiorly and had higher concentration of SOD (P＜0.05),and lower concentration of MDA(P＜0.05),TNF-α and IL-6 (P＜0.05) when compared to rats in I/R group.Conclusions:Hydrogen-rich saline could treat cerebral ischemi.a-reperfusion injury effectively,and the possible mechanisms involved the selectively antioxidant stress damage and effects of anti-inflammation in the region of cortical ischemic penumbra.

目的：探讨丁苯酞与依达拉奉配伍治疗急性脑梗死的临床疗效。方法：将60例急性脑梗死患者随机分为治疗组（30例）和对照组（30例），两组患者入院后均予以相同的基础治疗，治疗组给予丁苯酞与依达拉奉治疗，对照组单独给予依达拉奉治疗，均治疗14d ，比较两组患者的临床疗效。结果：经过14d 的治疗后，治疗组总有效率为90．0％，对照组总有效率为56．7％；治疗组SSS 评分明显优于对照组（P＜0．05）。结论：丁苯酞与依达拉奉配伍治疗急性脑梗死可快速明显的改善神经功能，无明显不良反应。

目的 探讨并研究右美托咪定联合舒芬太尼在宫颈癌术后镇痛中的应用.方法 选取陕西省肿瘤医院2015年6月至2016年3月收治的80例行宫颈癌手术的患者,根据患者采用的术后镇痛方案分为对照组和试验组,各40例.对照组采用舒芬太尼进行术后镇痛,试验组采用舒芬太尼联合右美托咪定进行术后镇痛,比较两组患者的镇痛效果.结果 两组患者各时间点的镇痛评分、生命体征差异不显著(P>0.05),试验组各时间点的镇静评分低于对照组(P<0.05).试验组不良反应总发生率低于对照组(P<0.05).结论 右美托咪定联合舒芬太尼对宫颈癌患者术后具有良好的镇痛效果,血流动力学相对稳定,患者较为满意,临床应用安全有效.

Objective To study the effect of preemptive analgesia with dezocine on perioperative immune function and stress level in patients with breast cancer.Methods Totally 80 female patients with unilateral breast cancer who underwent modified radical mastectomy from February 2012 to October 2014 were randomly divided into dezocine group and control group (40 cases in each group).Patients in dezocine group were administered intravenously with 5 mg of dezocine for preemptive analgesia 15 min before induction;instead,patients in dezocine group were given 5 ml of 0.9％ saline instead was given in control group.The operation duration and intraoperative blood loss were recorded;the T-lymphocyte subsets (CD3+,CD4+ and CD8+) and natural killer cells (NK cells)CD+16 CD+56) were measured by flow cytometry before anesthesia,2 h after incision,24,48,120 h after operation,and the ratio of CD3+/CD4+ subset were calculated;the renin,angiotensin Ⅱ,aldosterone and cortisol in plasma were measured 30 min before anesthesia induction (T0),and 2 h (T1),12 h (T2),24 h (T3),48 h (T4) after operation were detected and compared between groups.Results The levels of CD3+,CD4+ and CD4+/CD8+lymphocyte subset in dezocine group were significantly higher than those in control group 24 h after operation [(52.25±4.75)％ vs (47.79 ±4.40)％,(27.38 ±2.52)％ vs (24.85 ±2.58)％,(1.12±0.18) vs (1.01 ±0.15)] (P ＜0.05).The level of NK cells in dezocine group was significantly higher than that in control group 2 h and 24 h after operation [(14.8 ±2.0)％ vs (13.8 ± 1.5)％,(14.4 ±2.2)％ vs (13.0 ± 1.8)％,P ＜0.05].The levels of plasma renin,angiotensin Ⅱ,aldosterone and cortisol in dezocine group were significantly lower than those in control group 12 and 24 h after operation [12 h:(0.59 ±0.16) μg/L vs (0.72 ±0.15) μg/L,(45 ± 11) μg/L vs (59 ± 12) μg/L,(236 ± 20) μg/L vs (259 ± 24) μg/L,(260 ± 31) μg/L vs (300 ±30) μg/L;24 h:(0.67±0.15) μg/L vs (0.89±0.16) μg/L,(43±10) μg/L vs (57±8) μg/L,(221 ±25) μg/L vs (267 ± 28) μg/L,(265 ± 30) μg/L vs (286 ± 30) μg/L] (P ＜ 0.05).Conclusion Preemptive analgesia with dezocine can protect the T lymphocyte subsets and natual killer cells,thus to promote the recovery of perioperative immune function and reduce the stress response to surgical trauma in patients with breast cancer.

目的:观察达克罗宁胶浆对喉罩全身麻醉行乳腺癌手术的患者喉罩置入时血流动力学及苏醒期咽喉舒适度的影响.方法:择期全身麻醉下行乳腺癌手术患者120例随机分成两组,每组60例.A组将石蜡油均匀涂抹至喉罩表面,快速诱导后置入.B组将盐酸达克罗宁胶浆均匀涂抹至喉罩表面,快速诱导后置人.两组均采用静吸复合全身麻醉,术中麻醉用药均相同.观察两组患者喉罩置人前后的心率、血压变化,麻醉苏醒期呛咳、呕吐发生率,以及术后24h咽痛发生率.结果:A组患者置入喉罩后心率、血压均高于置入喉罩前,差异有统计学意义(P＜0.05).B组患者置入喉罩后心率、血压与置入喉罩前比较差异无统计学意义(P＞0.05).B组麻醉苏醒期呛咳、呕吐发生率及术后24h咽痛发生率均低于A组(P＜0.05).结论:在喉罩全麻行乳腺癌手术中使用达克罗宁胶浆,可减轻喉罩置入时的血流动力学波动及术后咽喉部应激反应.

Objective:To observe the clinical effect of Propofol combined with oxycodone hydrochloride injection in painless endoscopes. Methods:Ninety six patients in ASA I and II,planned for painless endoscopes,were included in the study. Subjects were randomly divided into two groups:Propofol combined with oxycodone administrated intrave-nousl was group A,and propofol combined with fentanyl infusion was group B. All the subjects were monitored and re-corded MAP,HR,RR and SPO2 after enter into endoscope room(T1),before endoscopes putting(T2),during endo-scopes putting(T3)and after endoscopes taking out(T4). The waking time,respiratory depression occurrence,body movement,Ramsay scale,nausea and vomiting occurrence and dosage of propofol were recorded. Results:MAP de-creased significantly on T2,T3 and T4 compared with that of on T1(P < 0. 05). RR and SPO2 in group B had signifi-cant difference on T3 compared with that on T1,and also had significant difference compared with group A on T3 time point(P < 0. 05). The dose of propofol,waking time and respiratory depression in group A were decreased significantly campared with group B(P < 0. 05). The Ramay scale had no significant difference between the groups(P > 0. 05). There was no patient occurring nausea and vomiting in both groups. Conclusion:Propofol combined with oxycodone hydrochloride injection for painless endoscopes could decrease propofol dosage,avoid respiratory depression and de-curtate waking time.

ObjectiveObservation of oxycodone in gynecological tumor operation for postoperative analgesia in the tran-sition period of efficacy and safety.Methods 90 cases of gynecological tumor operation, American Society of Anesthesiologi sts(ASA)gradeⅠ~Ⅱ, Were randomly divided into 3groups: the F group(Fentanyl group), the D group(Dezocine group), the Q group(Oxycodone group).In 15min before the end of operation sev stop. F group was given fentanyl,D group was given dezocine,Q group was given oxycodone.Comparison of 3 groups were observed in patients with consciousness recovery time ,extubation time, the Ramsay score,the VAS score, postoperative nausea and vomiting, respiratory depression, lethargy and other adverse reactions after operation.Results Application of oxycodone group of patients in the recovery of consciousness recovery time ,ex-tubation time, the Ramsay score, the VAS score, postoperative nausea and vomiting, respiratory depression, lethargy and other adverse reactions were better than the control group(P<0.05). No significant difference in Ramsay scqre(P>0.05). There was no significant difference between the fentanyl group and dezocine group(P>0.05).Conclusion Oxycodone in gynecologic oncology postoperative analgesia effect of exact transition period, and conventional analgesics than ever.

目的：探讨纳美芬对老年妇科肿瘤患者术后呼吸抑制拮抗作用的有效性及安全性。方法：将行根治性手术的妇科肿瘤患者84例随机分为3组，A 组（空白对照组）在手术结束待自主呼吸恢复后给予生理盐水；B 组（纳洛酮组）给予纳洛酮；C 组（纳美芬组）给予纳美芬，待病人清醒后拔除喉罩。比较观察3组患者的血流动力学变化，以及意识恢复时间、拔管时间、定向力恢复时间，拔管后5min 意识状况评分，拔管30min 后镇痛评分等指标。结果：应用纳美芬拮抗组和纳洛酮拮抗组意识恢复时间、拔管时间及定向力恢复时间均明显短于对照组（P ＜0．05），纳美芬拮抗组和纳洛酮拮抗组之间无显著性差异（P＞0．05）。3组在用药时、用药后5min 、10min 、30min 等4个时间点的血流动力学均无显著性差异（P＞0．05）。 Ramsay 评分及 VAS 评分3组无显著性差异（P ＞0．05）。结论：纳美芬对老年妇科肿瘤患者术后呼吸抑制的拮抗作用效果确切，安全有效。

Objective:To observe the clinical effect of Sufentanil combined with ropivacaine on patient controlled extradural analgesia(PCEA).Methods:Ninty patients,ASA I-II,undergoing gynecological tumor operation were randomly divided into three groups.Group A:the composition of PCEA 0.2% Ropivacaine,sufentanil 0.5 μg/ml and 5mg Haloperidol added to 100ml with normal saline.Group B:sufentanil 0.75 μg/ml,and others were same as group A.Group C:sufentanil 1.0μg/ml,others same as group A.All the subjects were carried on VAS and RSS score on postoperative instantly and 6h,12h,24h after operation with PCEA(maintenance dose 2ml/h,PCA0.5ml,interval time 15min).Results:VAS and RSS score were lower in group B and C than group A,there was significant difference(P<0.05);and no significant difference between group B and C(P>0.05).The incidence of adverse reaction in group A and B was lower than that of in group C,there was significant difference between them(P<0.05),and no significant difference between group A and B(P>0.05).Conclusion:Sufentanil can be used for PCEA securely,and the dosage of sufentanill 0.75 μg/ml is better.

目的:观察罗哌卡因复合利多卡因用于颈丛阻滞麻醉的临床效果.方法:选择ASAⅠ～Ⅱ级,拟行甲状腺腺瘤切除术患者60例,随机分为2组(A组为罗哌卡因-利多卡因合剂组,B组为布比卡因-利多卡因合剂组),行双侧颈丛阻滞(患侧深浅丛,对侧浅丛).观察麻醉起效时间、镇痛持续时间及麻醉并发症,并评价麻醉效果.结果:麻醉起效时间A组与B组相似,差异无统计学意义(P＞0.05).麻醉并发症比较两组差异也无统计学意义(P＞0.05).结论:罗哌卡因复合利多卡因用于颈丛阻滞麻醉效果确切,安全有效.

Objective: To observe the clinic effect and adverse reaction of ketorolac tromethamine used for patient controlled intravenous analgesia(PCIA) in breast cancer.Methods: 60 patients for operation on breast,ASAⅠ-Ⅱ,aged between 36 and 61,were randomly divided into two groups(Group A and Group B) and the fentanyl was used for PCIA in group A,the ketorolac tromethamine in group B.VAS and RSS scores of all the subjects were kept at different time points of 2 h,4 h,8 h,12 h,24 h and 48 h after operation with PCIA(maintenance dose 2 mL/h,PCA 0.5mL,interval time 15 min).Results: there was no significant difference between the two groups in VAS and RSS score(P>0.05),and there was less adverse reaction in group B than in group A,but with no statistical difference(P>0.05).Conclusion: ketorolac tromethamine can be used for PCIA in breast cancer,safe and effective.

Objective:To observe the clinical effect of butorphanol and propofol using for Leep procedure on cervical intraepithelial neoplasia.Methods:Sixty patients treated with Leep for CINⅡ-Ⅲ were randomly divided into two groups:A group with a simple anesthesia propofol;group B,butorphanol and propofol anesthesia.The anesthetic effects and adverse reactions were observed and compared.monitoring MAP,HR,SpO2 and other indicators,record the amount of intraoperative propofol and recovery time of surgery,postoperative pain score.Results: The recovery time in group A was longer than that of in group B.MAP,HR,SpO2 and were significantly different in group B than that of in group A.Postoperative pain score was significantly lower in group B than that of in group A.Propofol dosage was significantly less in group B than that of in group A.Conclusion:Butorphanol and propofol combination anesthesia could be used for Leep procedure safely.

目的:观察持续靶控输注丙泊酚用于癫痫持续状态患者的临床效果.方法:伴有明显躁动的癫痫持续状态患者22例,使用巴比妥酸盐类和苯二氮(艹卓)类均不能终止发作.丙泊酚以首剂1 ～ 2 mg/kg,持续2 ～ 3 mg/(kg·h)给予.记录输注前、输注中、停药15 min后BP、HR、SpO2的变化及血气变化,采用Ramsay镇静分级法评分.结果:Ramsay镇静评分达到2分者2例,3分2例,4分5例,5分8例,6分5例.用药后BP和血液pH值、BE值下降,差异均有显著性,停药后各项体征与用药期间无明显变化.未见丙泊酚输注综合征、代谢性酸中毒、低血压、恶心、呕吐等不良反应.结论:对传统治疗无效的癫痫持续状态患者,丙泊酚靶控输注具有良好的治疗作用.

目的:观察布托啡诺复合丙泊酚用于门诊无痛胃镜的麻醉效果.方法: 门诊ASA 1-2级无痛胃镜检查的患者61例,随机分为3组,即单纯丙泊酚组(P)15例、丙泊酚复合芬太尼组(PF)23例和丙泊酚复合布托啡诺组(PB)23例,观察入室后 (t1)、置镜前 (t2)、置镜中 (t3)、出镜后 (t4) 各时点MAP、HR、RR、 SPO2及意识恢复时间、定向力恢复时间、Ramsay镇静评分、丙泊酚用量及不良反应.结果: P组麻醉效果有效率为86.7%,PF、PB组有效率100%.各组t1时点的MAP、HR、RR、SPO2与t2,t3及t4各时点相比均有显著变化(P<0.05),其中P组有4例出现低血压,3例出现低血氧症,PF组有2例出现低血氧,PB组无一例出现低血压及低血氧.意识恢复时间及定向力恢复时间 P组与PF、PB三组之间相比均有显著性差异(P<0.05),Ramsay评分无显著性差异,丙泊酚用量P组与PF、PS组相比显著增加(P<0.05).结论: 丙泊酚复合布托啡诺不仅可以减少丙泊酚用量,有效降低呼吸抑制不良反应,而且缩短苏醒时间,使整个检查过程更加平稳,周转加快.

目的:观察氯诺昔康和芬太尼用于乳腺癌手术后持续静脉镇痛的临床效果。方法:60例ASAⅠ-Ⅱ级择期行乳腺癌改良根治术患者,随机分为氯诺昔康组(L组,n=30)和芬太尼组(F组,n=30),术毕完全清醒后静脉注射负荷剂量再连接镇痛泵装置,术后4 h、8 h、12 h、24 h和48 h观察并记录疼痛评分和不良作用发生情况。结果:两组间疼痛评分无统计学意义(P>0.05)。恶心、呕吐和头晕不良作用发生率L组均低于F组,但差异无统计学意义。结论:氯诺昔康用于乳腺癌改良根治术后持续静脉镇痛可提供与芬太尼同样的效果。