髂筋膜腔隙阻滞在老年股骨颈骨折患者腰硬联合麻醉前摆放体位时的应用研究

目的观察髂筋膜腔隙阻滞在老年股骨颈骨折患者腰硬联合麻醉前摆放体位时的镇痛作用。方法将50例老年患者按随机数字表法分成两组，其中观察组为髂筋膜腔隙阻滞（FIC）组25例，对照组为静脉镇痛（IVA）组25例。FIC组在腰硬联合麻醉20min前予0.375%盐酸罗哌卡因行髂筋膜腔隙阻滞，IVA组在腰硬联合麻醉2min前予以1滋g/kg枸橼酸芬太尼注射。观察两组患者入手术室后、摆放体位时、术后6、24、48h的VAS疼痛评分；腰硬联合麻醉操作时间；围术期芬太尼总耗量；患者对操作前干预手段的接受度和不良事件发生率等指标。结果 FIC组比IVA组在摆放体位时和术后6h的VAS疼痛评分降低，分别为2.4±0.9、4.1±1.1及2.2±0.5、3.5±0.8（均P＜0.01）；腰硬联合麻醉操作时间缩短，分别为8.1±2.9、12.9±5.1（P＜0.01）；术后恶心、呕吐发生率下降，分别为10％、23％（P＜0.01）；患者接受度提高，分别为23/25、11/25（P＜0.01）；芬太尼用量增加，分别为（460＋88）、（550＋126）滋g（P＜0.01）。结论相比静脉芬太尼镇痛，超声引导下髂筋膜腔隙阻滞提供了更好的镇痛和更少的麻醉并发症。     

氟比洛芬酯对子痫前期患者剖宫产术后静脉自控镇痛疗效观察

目的 观察氟比洛芬酯复合丁丙诺啡和单用丁丙诺啡对子痫前期患者剖宫产术后静脉自控镇痛（PCIA）的临床效果和 应用价值。方法 选择90例ASAⅠ～Ⅱ级在腰硬联合麻醉下行子痫前期剖宫产术患者,按随机数字表法分为A组（胎儿娩出后氟比洛芬酯+术后丁丙诺啡PCIA）、B 组（术后氟比洛芬酯+丁丙诺啡PCIA）和C 组（术后丁丙诺啡PCIA）,每组30例。观察并记录患者术后1、2、4、12、24h 视觉模拟评分（VAS）、Ramassay镇静评分,平均动脉压（MAP）、心率（HR）及术后恶心、呕吐、嗜睡、皮肤瘙痒等不良反应发生情况,分别于麻醉前、术后4、12 和24h抽取静脉血,检测血清肾上腺素、去甲肾上腺素、多巴胺、血浆儿茶酚胺和内皮素的水平。结果 A 组和B组患者术后各时点VAS 评分均明显低于C组（P＜0.05）,A 组和B 组各时点Ramsay 镇静评分均明显高于C组（P＜0.05）;A 组和B 组术后各时点MAP 和HR 均明显低于C 组（P＜0.05）;术后24h 内PCIA 按压次数A 组和B 组明显低于C组（P＜0.05）;A 组和B 组术后各时点血清肾上腺素、去甲肾上腺素、多巴胺和内皮素水平均明显低于C 组（均P＜0.05）;A 组术后4h 内皮素水平明显低于B 组（P＜0.05）;A 组和B 组头晕、嗜睡、恶心、呕吐发生率均低于C 组（均P＜0.05）。结论 氟比洛芬酯能有效抑制术后应激,镇痛效果好且不良反应少,在胎儿娩出后应用氟比洛芬酯并结合术后丁丙诺啡进行PCIA更适合用于子痫前期剖宫产术后患者术后镇痛。     

七氟烷对术前化疗患者心肌细胞的影响

目的评价七氟烷对术前化疗患者心肌细胞的影响。方法择期拟行乳腺癌根治术全麻患者30例,ASAⅠ或Ⅱ级,依据术前是否化疗,分为化疗组（S组）15例和未化疗组（C组）15例,于麻醉前（T0）、手术结束（T1）、术后24h（T2）、术后48h（T3）时抽取患者颈内静脉血检测并比较血清肌酸肌酶（CK- MB）、心肌肌钙蛋白I（cTnI）和N端B型脑钠肽（NT- proBNP）水平。结果两组患者各时点CK- MB水平差异无统计学意义（P＞0.05）,与C组比较,S组各时点cTnI、NT- proBNP水平升高（P＜0.05）。两组内比较,与T0时刻相比,T1、T2、T3时刻cTnI和NT- proBNP水平差异均无统计学意义（均P＞0.05）。结论术前化疗对于心肌细胞有损伤,而对于术前化疗患者,七氟烷未加重心肌细胞损伤,可安全用于术前化疗患者麻醉。     

麻醉前视频宣教对全麻患者麻醉信息获取、术前焦虑及麻醉满意度的影响

目的 观察在麻醉前访视时辅助视频宣教对全麻患者麻醉信息获取、术前焦虑及麻醉满意度的影响。方法 将105 例全麻患者采用随机数字表法分为视频组（V 组）53 例和常规组（N 组）52 例,麻醉前访视后,所有患者完成访视内容问卷、STAI状态焦虑评分量表（S-AI）及焦虑视觉类比试验（AVAT）评分,术后24h 填写麻醉满意度评分,记录入手术室后10min的心率和平均动脉压值。结果 V 组问卷分数（3.80±1.21）分,显著高于N 组患者（2.79±1.03）分（P＜0.01）,V 组患者S-AI 评分（43.11±8.72）分,高于N 组患者（38.37±10.72）分（P＜0.05）,V 组患者AVAT 评分为（3.15±0.82）分,N 组患者（2.94±0.75）分（P ＞0.05）,V 组患者满意度评分（95.90±5.49）分,高于N 组患者（92.20±5.95）分（P＜0.05）。结论 对全麻患者麻醉前访视时进行视频宣教和告知,能增加其对宣教和告知内容信息的获取量,提高患者的麻醉满意度;但难以判断其对于术前焦虑的影响。     

腰丛+坐骨神经阻滞麻醉对口服阿司匹林股骨转子间骨折老年患者的效果观察

目的 探讨腰丛+ 坐骨神经阻滞麻醉在口服阿司匹林股骨转子间骨折老年患者中的应用效果。方法 拟行手 术治疗的股骨转子间骨折老年患者60 例，分为实验组（术前口服阿司匹林）和对照组（术前无服用阿司匹林），每组各30 例。实验组患者采用腰丛+ 坐骨神经阻滞麻醉，对照组患者采用腰麻- 硬膜外联合麻醉。两组患者术后48h 内均给予帕瑞昔布钠针40mg 静脉注射和盐酸布桂嗪针0.1g 肌肉注射，1 次/12h。记录两组患者围麻醉期血压和心率的变化，及术后静息状态下视觉模拟疼痛评分和恶心、呕吐等麻醉不良反应的发生率。结果 实验组患者围麻醉期血压、心率较对照组更平稳，术后疼痛评分与对照组比较均无统计学差异（均P＞0.05）；实验组术后不良反应发生率较对照组明显降低（P＜0.05）。结论 腰丛+ 坐骨神经阻滞麻醉对口服阿司匹林股骨转子间骨折的老年患者安全、有效，联合术后定时镇痛，可改善患者术后疼痛并降低术后麻醉不良反应发生率。     

重度子痫前期产妇剖宫产布比卡因蛛网膜下腔阻滞麻醉适合剂量的临床研究

目的 探讨重度子痫前期产妇剖宫产重比重布比卡因蛛网膜下腔阻滞麻醉（腰麻）的适合剂量。方法 选取200例重度子痫前期产妇,ASAⅠ级或Ⅱ级,按随机数字表法分为4组,每组各50 例,相应各组鞘内注入布比卡因剂量分别为10、8、6 及4mg,并混合2.5μg 舒芬太尼。选择L3~4行腰硬联合穿刺,注药10min 后记录麻醉平面。根据结果进行Probit 回归分析,计算布比卡因腰麻的ED50和ED95。观察各组利多卡因及去氧肾上腺素的用量、肌松效果及患者麻醉满意度,观察各组术中并发症以及新生儿的Apgar 评分和脐动脉pH。结果 重度子痫前期患者腰麻剖宫产布比卡因ED50 和ED95分别为：6.51（95%CI：5.81～7.01）和8.68（95%CI：7.96～10.26）。4 组患者10min 后麻醉平面的差异均有统计学意义（均P＜0.05）。4mg 组利多卡因用量高于其他3组,差异有统计学意义（P＜0.05）。8mg 组、10mg 组去氧肾上腺素的用量高于其他两组,差异均有统计学意义（均P＜0.05）。低血压的发生率8mg 组、10mg 组高于其他两组,差异均有统计学意义（均P＜0.05）。４ 组间其他不良反应恶心、呕吐、寒战以及心动过缓发生率的差异无统计学意义（P＞0.05）。4 组胎儿娩出后1、5min Apgar 评分及脐动脉血气分析的结果差异均无统计学意义（均P＞0.05）。结论 重度子痫前期产妇剖宫产鞘内注入6mg 布比卡因混合2.5μg舒芬太尼,必要时辅以硬膜外麻醉,麻醉效果确切,血流动力学稳定,适合该类患者手术麻醉。     

N-乙酰半胱氨酸对老年患者碘海醇肾损害的保护作用

目的探讨N-乙酰半胱氨酸对老年患者碘海醇肾损害的保护作用。方法选取行增强CT检查（静脉注射碘造影剂碘海醇）的老年患者74例,其中A组26例（于造影前48h和造影后48h口服N-乙酰半胱氨酸600mg,2次/d）,B组25例（于造影前48h和造影后48h口服N-乙酰半胱氨酸600mg,1次/d）;对照组23例（于造影前48h和造影后48h口服安慰剂,1次/d）。造影前和造影后48h,检测3组患者血尿素氮（BUN）、SCr、内生肌酐清除率（CCr）,并记录对比剂肾病发生率,造影前和造影后48h以及5d时,检测24h尿蛋白（PRO）、24h尿β2-微球蛋白(β2- MG)、24h尿微量白蛋白（UmAlb）。结果 A组无CIN发生,B组发生CIN5例（20%）,C发生CIN6例（26.09%）,A组CIN发生率明显低于B、C组（均P＜0.05）。3组患者造影前各指标的差异均无统计学意义（P＞0.05）。与造影前比较,3组患者造影后48h BUN、SCr、Ccr均发生明显变化（P＜0.05）;与B组、对照组比较,A组造影后48h BUN、SCr、Ccr均发生明显变化（P＜0.05）。与造影前比较,3组患者造影后48h、5d时PRO、Umalb、和β2- MG均发生明显变化（P＜0.05）;与对照组比较,A组造影后48h及5d、B组造影后48h的PRO、Umalb、和β2- MG均发生明显变化（P＜0.05）。结论口服N-乙酰半胱氨酸600mg（2次/d）能有效预防老年患者碘海醇肾损害。     

连续臂丛神经阻滞镇痛对断指再植血流动力学影响的研究

目的研究连续臂丛神经阻滞镇痛对断指再植术后再植指血流动力学的影响，探讨其缓解血管痉挛、增加血流量的可行性。方法将60例急诊行断指再植术患者按随机数字表法分为术后连续臂丛神经阻滞镇痛组（CA组）和对照组（NA组），每组30例。观察两组患者再植指术后血管痉挛、血管栓塞和指体坏死发生例数并计算再植指成活率，记录两组术后即刻（T1）、术后24h（T2）再植指固有动脉血流动力学参数及动脉内径（AD）、远指端血氧饱和度（SpO2）和温度（Ts）变化。结果断指再植术后成活率CA组高于NA组，血管痉挛、血管栓塞和指体坏死发生率CA组均低于NA组，差异均有统计学意义（均P＜0.05）。在T2时CA组各项血流动力学参数、AD、SpO2、Ts均高于NA组，阻力指数（RI）低于NA组，差异均有统计学意义（均P＜0.05）。结论术后连续臂丛神经阻滞镇痛可以缓解再植指固有动脉痉挛，增加指体血流量，提高了断指再植的成功率。     

罗哌卡因用于剖宫产术蛛网膜下腔阻滞注药速度的研究

目的 探讨罗哌卡因用于剖宫产术蛛网膜下腔阻滞的合理注药速度。方法 选择行剖宫产术产妇90 例,按蛛网膜 下腔阻滞时罗哌卡因注药时间采用随机数字表法分为30s 组、60s 组、90s 组,每组各30例。观察并记录麻醉前（T0）、麻醉后1min（T1）、5min（T2）、10min（T3）、20min（T4）收缩压（SBP）、舒张压（DBP）、心率（HR）变化,术中恶心、呕吐、胸闷、麻黄碱、阿托品使用例数,麻醉最高平面情况。结果 与60s 组、90s 组相比,30s 组SBP、DBP、HR 下降更为显著,发生恶心、呕吐、胸闷等不良反应及使用麻黄碱例数显著增多（P＜0.05）。30s 组、60s 组、90s 组产妇麻醉平面达T6以上分别为29 例、29 例、28例,均能满足手术要求,最高阻 滞平面达T4、T2的例数30s 组显著多于60s 组、90s 组（P＜0.05）。结论 常规剂量罗哌卡因用于蛛网膜下腔阻滞下剖宫产术,其注药时间宜控制在60～90s,同样能满足手术需要,且可减少不良反应的发生,而不是传统方法的15～30s。     

去甲斑蝥素对人胰腺癌PANC-1 细胞凋亡作用的研究

目的 探讨去甲斑蝥素对人胰腺癌PANC-1细胞凋亡的作用及其机制。方法 将PANC-1 细胞株随机分为处理组 和对照组,处理组加入不同浓度的去甲斑蝥素培养24h后,CCK-8 法检测细胞增殖情况;流式细胞术分析细胞的凋亡情况;免疫印迹法检测细胞内质网应激和凋亡相关蛋白的表达;荧光定量PCR 技术检测细胞内质网应激和凋亡相关蛋白mRNA表达。结果 不同浓度去甲斑蝥素处理PANC-1细胞24h后,与对照组相比,能降低细胞的存活率并诱导其凋亡。与对照组相比,处理组中内质网应激和凋亡相关蛋白的表达水平均上调（均P＜0.05）,同时其mRNA 的表达水平亦均上调（均P＜0.05）。结论 去甲斑蝥素能明显抑制人胰腺癌PANC-1 细胞的生长并诱导其凋亡,并且具有浓度依赖性,这一作用可能是通过内质网应激介导的凋亡途径实现的。     

Efficiency of purchasing and selling agents in markets with quality uncertainty: The case of illicit drug transactions

Since Akerlof’s theory of lemons, economists have viewed quality uncertainty as an informational advantage for sellers. Drawing on frontier techniques, we propose in this paper a simple method for measuring inefficiency of both sellers and buyers in markets for goods with different levels of quality. We apply a non-parametric robust double-frontier framework to the case of illicit substance markets, which suffer from imperfect information about drug quality for purchasers and to a lesser extent for sellers. We use unique data on cannabis and cocaine transactions collected in France that include information about price, quantity exchanged and purity. We find that transactional inefficiency does not really benefit either dealers or purchasers. Furthermore, information influences the performance of agents during market transactions.     

A RIEMANN-TYPE DEFINITION OF N-TH CESARO-PERRON INTEGRALS

In this paper, We give a varlational-type definition of (CnP) integrals. It is equivalent to the original definition of Perron-type and to the definition of Riemann-type, in this way the problem on definition of(CnP)′s Riemann-type has been solved completely.     

A stochastic multiscale model for electricity generation capacity expansion

Long-term planning for electric power systems, or capacity expansion, has traditionally been modeled using simplified models or heuristics to approximate the short-term dynamics. However, current trends such as increasing penetration of intermittent renewable generation and increased demand response requires a coupling of both the long and short term dynamics. We present an efficient method for coupling multiple temporal scales using the framework of singular perturbation theory for the control of Markov processes in continuous time. We show that the uncertainties that exist in many energy planning problems, in particular load demand uncertainty and uncertainties in generation availability, can be captured with a multiscale model. We then use a dimensionality reduction technique, which is valid if the scale separation present in the model is large enough, to derive a computationally tractable model. We show that both wind data and electricity demand data do exhibit sufficient scale separation. A numerical example using real data and a finite difference approximation of the Hamilton–Jacobi–Bellman equation is used to illustrate the proposed method. We compare the results of our approximate model with those of the exact model. We also show that the proposed approximation outperforms a commonly used heuristic used in capacity expansion models.     

对于双波理论及其在原子辐射上的应用的讨论

双波理论又被其创立者称为“非统计量子力学” ,它用含有隐参数的两个波函数来描述系综中各单个粒子的形态 .然而 ,从双波理论的基本假设可以看出 ,这个理论基本上不能反映微观世界的量子规律 ,在该理论描述下微观粒子运动的波动性特征和能量量子性特征几乎都不存在了 ;这个理论的创立者应用它对原子辐射诸问题所作的讨论 ,不是在数学计算上不正确 ,就是与实验、与通常理论不一致     

A mathematical programming-based scheduling framework for multitasking environments

A new paradigm along with a mixed (binary) integer-linear programming model is developed for scheduling tasks in multitasking environments, for which the number of completed tasks is not a good measure. One special case falls into the realm of deteriorating jobs. Polynomial time optimal solution algorithms are presented for this and one other special case. As the complexity of the original problem is believed to be strongly NP-hard, an efficient solution algorithm, based on tabu search, is developed to solve the problem. Small, medium, and large size problems are solved, and the solution obtained from the algorithm is compared with that of the optimal solution or the upper bound found from using the Lagrangian relaxation. Where it was measurable, the search algorithm gave quantifiably good quality solutions, and in all cases it had a much better time efficiency than the branch-and-bound enumeration method. A detailed statistical experiment, based on the split-plot design, is developed to identify the characteristics of the tabu search algorithm, thus guaranteeing a solution that is significantly better in quality. A conjecturing technique is introduced for problems with very large planning horizons. This technique had remarkable time efficiency with no apparent loss of quality.     

广义Calderón-Zygmund算子交换子的有界性

讨论了广义Calderón-Zyginund算子与Lipschitz函数生成的交换子在Lebe-sgue空间及Hardy空间上的有界性,同时得到了其端点估计.     

A fractional version of the peano-sard theorem

Sard's classical generalization of the Peano kernel theorem provides an extremely useful method for expressing and calculating sharp bounds for approximation errors. The error is expressed in terms of a derivative of the underlying function. However, we can apply the theorem only if the approximation is exact on a certain set of polynomials.

In this paper, we extend the Peano-Sard theorem to the case that the approximation is exact for a class of generalized polynomials (with non-integer exponents). As a result, we obtain an expression for the remainder in terms of a fractional derivative of the function under consideration. This expression permits us to give sharp error bounds as in the classical situation. An application of our results to the classical functional (vanishing on polynomials) gives error bounds of a new type involving weighted Sobolev-type spaces. In this way, we may state estimates for functions with weaker smoothness properties than usual.

The standard version of the Peano-Sard theory is contained in our results as a special case.     

基于鞅空间M(ln~+M)~p,L(ln~+L)~p与K(ln~+K)~p的关系研究

旨在利用概率方法探讨鞅空间K2与M1之间的鞅空间包含变化关系.首先提出了新的鞅空间M(ln+M)p,L(ln+L)p以及K(ln+K)p(其中p 1)的定义,并证明了其空间包含关系.     

Criterions for detecting the existence of the exponential dichotomies in the asymptotic behavior of the solutions of variational equations

We prove that the admissibility of any pair of vector-valued Schäffer function spaces (satisfying a very general technical condition) implies the existence of a “no past” exponential dichotomy for an exponentially bounded, strongly continuous cocycle (over a semiflow). Roughly speaking the class of Schäffer function spaces consists in all function spaces which are invariant under the right-shift and therefore our approach addresses most of the possible pairs of admissible spaces. Complete characterizations for the exponential dichotomy of cocycles are also obtained. Moreover, we involve a concept of a “no past” exponential dichotomy for cocycles weaker than the classical concept defined by Sacker and Sell (1994) in [23]. Our definition of exponential dichotomy follows partially the definition given by Chow and Leiva (1996) in [4] in the sense that we allow the unstable subspace to have infinite dimension. The main difference is that we do not assume a priori that the cocycle is invertible on the unstable space (actually we do not even assume that the unstable space is invariant under the cocycle). Thus we generalize some known results due to O. Perron (1930) [14], J. Daleckij and M. Krein (1974) [7], J.L. Massera and J.J. Schäffer (1966) [11], N. van Minh, F. Räbiger and R. Schnaubelt (1998) [26].