Lung cancer (LC) is a malignant tumor that poses the greatest threat to human health and life. Most studies suggested that the occurrence of LC is associated with environmental and genetic factors. We aimed to explore the association between COL6A4P2 single nucleotide polymorphisms (SNPs) and CHD risk in the Chinese Southern Han population. Based on the 'case-control' experimental design (510 cases and 495 controls), we conducted an association study between five candidate COL6A4P2 SNPs and the corresponding LC risk. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated by logistic regression to analyze the LC susceptibility under different genetic models. The results showed that COL6A4P2 rs34445363 was significantly associated with LC risk under alleles model (OR = 1.26, 95%CI: 1.01-1.58, p = 0.038). In addition, rs34445363 was also significantly associated with LC risk under the log-additive model (OR = 1.26, 95%CI: 1.01-1.58, p = 0.041). The results of subgroup analysis showed that rs34445363 (OR = 1.42, 95%CI: 1.03-1.95, p = 0.033) and rs61733464 (OR = 0.72, 95%CI: 0.52-0.99, p = 0.048) were both significantly associated with LC risk in the log-additive model among participants who were ≤ 61 years old. We also found that the variation of rs34445363 (GA vs. GG, OR = 1.73, 95%CI: 1.04-2.86, p = 0.034) and rs77941834 (TA vs. TT, OR = 1.88, 95%CI: 1.06-3.34, p = 0.032) were associated with LC risk in the codominant model among female participants. Our study is the first to find that COL6A4P2 gene polymorphism is associated with LC risk in the Chinese Han population. Our study provides a basic reference for individualized LC prevention.

目的:探讨脑电双频指数(BIS)监测下丙泊酚闭环靶控输注用于腹腔镜下胃癌根治术的效果.方法:选取在本院接受腹腔镜下胃癌根治术治疗的原发性胃癌患者106例作为研究对象,根据麻醉方式不同分为对照组、观察组各53例.对照组接受BIS监测下手动调节丙泊酚靶控输注浓度,观察组接受BIS监测下丙泊酚闭环靶控输注.对比两组患者麻醉前(T0)、手术开始后30 min(T1)、手术结束前30 min(T2)的血流动力学指标水平、血清中炎症因子及应激激素含量的差异.结果:T0,两组血流动力学指标水平、血清中炎症因子及应激激素含量的差异无统计学意义.T1、T2,观察组血流动力学指标MAP、HR的水平低于对照组相应时间点;血清中炎症因子sICAM-1、IL-1β、IL-8、TNF-α的含量低于对照组相应时间点;血清中应激激素Cor、T4、glucagon的含量低于对照组相应时间点.结论:腹腔镜下胃癌根治术患者接受BIS监测下丙泊酚闭环靶控输注麻醉,可有效稳定患者术中血流动力学并抑制全身炎症应激反应.

目的 旨在探讨多层螺旋CT联合超声检查对结肠癌的诊断价值.方法 选取我院2017年5月-2018年5月收治的结肠癌患者62例,患者均进行了多层螺旋CT及超声检查,收集46例患者临床资料及影像学资料,以手术病理结果为金标准,计算不同检查方式对结肠癌T分期的诊断准确率.结果 超声检查对结肠癌T1-2、T3、T4分期的诊断正确率分别为75.00％(12/16)、70.58％(24/34)、66.66％ (8/12);CT检查对结肠癌T1-2、T3、T4分期的诊断正确率分别为93.75％(15/16)、88.23％(30/34)、83.33％(10/12),CT检查对结肠癌T分期的总诊断正确率明显高于超声检查(88.70％vs 70.96％) (x2=6.062,P＜0.05);CT联合超声检查对结肠癌T1-2、T3、T4分期的诊断正确率分别为100％(16/16)、97.05％(33/34)、100％(12/12),显著高于超声检查(P＜0.05);CT联合超声检查对结肠癌T分期总诊断正确率为98.38％(61/62),明显高于单一CT及超声检查(P＜0.05).结论 多层螺旋CT联合超声检查可有效提高对结肠癌T分期的诊断准确率.

目的 探讨普鲁卡因抑制脂多糖诱导结肠癌细胞肿瘤侵袭性行为的调控及其机制.方法 CCK-8细胞活性实验检测不同浓度的普鲁卡因对结肠癌细胞活性的影响,Western blotting分析普鲁卡因对脂多糖结合蛋白表达水平的影响,划痕愈合实验检测普鲁卡因对结肠癌细胞迁移能力的影响,Transwell侵袭实验检测普鲁卡因对结肠癌细胞侵袭能力的影响.结果 浓度为0.08 mg/mL的普鲁卡因对结肠癌细胞的活性影响情况最明显,差异有统计学意义(P<0.05);浓度为0.08 mg/mL的普鲁卡因对脂多糖结合蛋白的表达水平抑制最明显,差异有统计学意义(P<00.5);划痕愈合测定显示普鲁卡因可以直接抑制结肠癌细胞的运动能力;Transwell侵袭实验测定显示普鲁卡因可以直接抑制结肠癌细胞的侵袭能力,差异有统计学意义(P<0.05).结论 普鲁卡因可以通过影响脂多糖诱导结肠癌细胞的迁移和侵袭,可作为化疗辅助药物,为探索结肠癌诊疗的分子机制和新的潜在治疗策略提供相应理论帮助,为结肠癌的临床治疗方式提供有效支持.

目的:探讨在老年肿瘤患者麻醉中应用七氟烷复合瑞芬太尼靶控输注的临床效果.方法:选取2015年1月至2017年8月老年肿瘤行全麻手术患者98例,按照麻醉方案的不同将其分为观察组和对照组,对照组患者采用丙泊酚复合七氟烷靶控输注进行麻醉,观察组患者采用瑞芬太尼复合七氟烷靶控输注进行麻醉,对两组患者麻醉前后生命体征变化情况进行观察记录,并对其术后清醒时间、拔管时间进行对比分析.结果:观察组、对照组患者其收缩压、舒张压、MAP同各自T0时刻相比均有显著变化(P＜0.05),但在T0、T1、T2、T3时刻,观察组与对照组患者的收缩压、舒张压、心率、MAP水平均无明显差异(P＞0.05);观察组患者的清醒时间、拔管时间均明显短于对照组,差异具有显著性(P＜0.05).结论:在老年肿瘤患者手术中应用七氟烷复合瑞芬太尼靶控输注,在取得良好麻醉效果的同时可有效缩短患者术后苏醒时间,有利于后续治疗和护理的进行,建议在临床推广应用.

目的 探讨呼气末正压(PEEP)联合保护性肺通气(PV)对腹腔镜直肠癌根治术肥胖患者围术期肺功能的影响.方法 对2015年1月-2017年5月收治的在腹腔镜下行直肠癌根治术治疗的102例肥胖患者的临床资料进行回顾性分析,根据不同处理方式分为对照组48例和观察组54例.对照组在手术过程中予以PV处理,观察组在对照组基础上联合PEEP处理.治疗结束后比较2组不同时点肺功能相关指标情况,并记录2组术后并发症发生情况.结果 观察组T3～T6时点氧分压(PaO2)、T2～T4和T6时点氧合指数(PaO2/FiO2)、T2～T4时点气道峰压(Ppeak)及T2～T5时点Cdyn均高于对照组(P<0.05,P<0.01).2组并发症发生率比较差异无统计学意义(P<0.05),且经相应处理后均好转.结论 PEEP联合PV可明显改善经腹腔镜行直肠癌根治术治疗的肥胖患者的肺功能,且具有一定的安全性.

Objective:To compare the effects of penehyclidine hydrochloride and atropine on respiratory and circu-latory function in patients with thoracic surgery. Methods:Eighty pations with ASAI or II treated with thoracic surgery were randomly divided into two groups(group P and group A)with 40 patients in each groups. Group P received pene-hyclidine hydrochloride(group P 0. 01mg/ kg)group A was administered with atropine(group A 0. 01mg/ kg). Mean artery pressure and heart rate were recorded,the arterial blood samples were taken and Ppeak,Pplat,Compl,Paw were recorded at the time point of before operation(T1 ),30min(T2 ),60min(T3 )after one - lung ventilation,15 min after double lung ventilation(T4 ). Results:The Compl,Ppeak,Pplat,Compl and Paw in group P was significantly lower than in group A at T2 ,T3 ,T4(P ﹤ 0. 05),SaO2 in group P was significantly higher than in group A at T2 ,T3 ,T4(P ﹤0. 05). Heart rate was lower in group P than group A at T2 and T3(P ﹤ 0. 05). Conclusion:Compared with atropine, penehyclidine hydrochloride can effectively improve respiratory fuction,the hemodynamics is more stable and effect is longer,which is more suitable for patients ungergoing thoracic surgery.

Objective To investigate the effects of propofol on the changes in myocardial Toll-like receptor 4 (TLR-4)and TNF-αand NF-κb protein expressions in ischemia-reperfusion injury (I/R).Methods Thirty healthy male SD rats weighing 250-320 g were randomly divided into 3 groups (n=10 for each):Group A,sham operation;Group B,I/R;and Group C,propofol + I/R.In Groups B and C myocardial I/R was induced by occlusion of the left anterior descending artery (LAD)for 30 min,followed by 120 min reperfusion.In Group C propofol was given intravenously 1 0 min before myocardial ischemia,followed by continuous infusion of propofol at 5 mg/(kg·h)until the end of 120 min reperfusion.In Groups A and B normal saline instead of propofol was given. The myocardial tissues were taken at the end of 120 min;ultrastructural changes of myocardial cells were observed under X-ray electron microscope and the expressions of TLR-4 mRNA as well as TNF-αand NF-κb protein were determined.Results Ultrastructural observation under electron microscope showed significantly worsened damage in myocardial tissue structure and mitochondria in Groups B and C compared with Group A.The myocardial expressions of TLR-4 and TNF-αand NF-κb protein were significantly higher in Groups B and C than in control Group A.The myocardial expressions of TLR-4 and TNF-αand NF-κb protein were down-regulated in Group C compared with Group B.Conclusion Intravenous injection of propofol can protect against myocardial damage.Propofol can suppress the increase in myocardial TLR-4 and TNF-αand NF-κb protein expressions induced by I/R.

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:观察自控泵静注吗啡治疗晚期重度癌痛的效果。方法:选择晚期重度癌痛病人10例,行静脉吗啡PCA治疗并进行临床观察,按照WHO制定的VRS进行评定。结果:治疗后疼痛指数为1~3分,明显缓解7例,中度缓解3例,即显效7例,有效3例。结论:吗啡PCA治疗重度癌痛效果满意,适合于止痛效果不佳的晚期癌痛患者。

设计制作术后功能重建评估数据库系统,探讨大段异体骨移植在骨肿瘤保肢治疗中的临床疗效.应用计算机评估骨肿瘤大段异体骨移植术后功能重建资料.使用Object Pascal设计程序,开发工具为Delphi.本系统窗口界面友好,易学上手,操作分级管理,确保数据安全,使用SQL的检索查询功能强大,可完成准确检索和近似查询:报表统计功能灵活多样,形式即可固定,又可自定义,并提供统计数据和图形,预留字段空间,运行中维护辅助性表单,可进一步扩充开发.经临床应用,效果良好.应用本数据库系统可动态存储和查询评估资料,简化评估过程,提高评估效率,利于按国际标准多中心协作,分析术后功能重建状况,评价手术疗效,促进骨肿瘤保肢治疗广泛深入研究.

临床资料 5例患者中,男3例,女2例,年龄50～65岁,均经X线诊断为食管癌,术前肺功大致正常,麻醉方法均为气管内插管静吸复合麻醉.使用Drager I B全能麻醉机麻醉,Ohmeda 5250RGM气体监护仪,COLINBP306监护仪监测,入室脉搏血氧饱合度(SpO2)均高于93%,面罩吸入医用氧气后,SpO2均在99%以上,麻醉诱导顺利,间断正压通气(定容)控制呼吸,至开胸前均正常.2例术中低氧血症发生时,气道压(Paw)渐进性增高,潮气量(VT)减低,SpO2降低至90%～92%,(SpO2测量值较动脉血氧饱合度高3%左右,故将临界值提高3%,定为93%[1])呼气末二氧化碳分压(PErC02)无明显变化,血压无明显变化或略有升高,心率上升不超过20%,检查后发现手控呼吸阻力增大,但无自主呼吸,尝试调整气管导管气囊气量及导管位置后,问题解决,气道压和潮气量恢复如初,SpO2升至100%.