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。     

罗哌卡因复合芬太尼硬膜外用药对分娩方式的影响

目的探讨硬膜外罗哌卡因复合芬太尼分娩镇痛对分娩方式的影响。方法回顾7136例具备顺产条件初产妇的最终分娩方式,按产妇意愿分为对照组（A组）4168例及分娩镇痛组（B组）2968例。A组产妇未接受分娩镇痛,B组产妇给予L2~3或L3~4硬膜外阻滞,头向置管后1%利多卡因5ml试验量确定阻滞平面后,予以6~15ml/h持续泵注0.15%罗哌卡因和2μg/ml芬太尼的复合液。记录汇总最终分娩方式及剖宫产原因,评定两组新生儿出生后1、5minApgar评分,评定产妇镇痛后的视觉模拟评分（VAS）及改良Bromage评分。结果B组产妇剖宫产率（20.28%）及产钳使用率（4.38%）明显高于A组（7.70%、2.33%,P＜0.01）;B组第一产程时间延长于A组(P＜0.01）;B组因第一产程延长而行剖宫产比例（64.62%）明显高于A组（42.81%,P＜0.01）;B组胎儿宫内窘迫的比例（12.29%）明显低于A组（31.25%,P＜0.01）;胎头下降停滞及羊水问题、胎位异常比例与A组比较差异均无统计学意义（均P＞0.05）。两组新生儿出生后1、5min的Apgar评分差异无统计学意义（P＞0.05）。B组产妇宫口6、10cm时的VAS评分明显低于A组（P＜0.01）,但两组产妇下肢改良Bromage评分差异无统计学意义（P＞0.05）。结论0.15%罗哌卡因复合2μg/ml芬太尼的硬膜外分娩镇痛可增加产妇剖宫产率、阴道器械助产率及延长第一产程,但对新生儿Apgar评分及产妇下肢肌力无影响。     

不同浓度罗哌卡因联合芬太尼行硬膜外分娩镇痛的量效观察

目的探讨罗哌卡因联合芬太尼行硬膜外分娩镇痛的最佳有效浓度。方法选择120例初产妇接受L2-3硬膜外穿刺置管拟行分娩镇痛．按随机数字表法分为0．15％罗哌卡因联合1ug／ml芬太尼（F1组）、0．12％罗哌卡因联合1ug／ml芬太尼（F2组）、0．10％罗哌卡因联合1ug／ml芬太尼（F3组）及0．08％罗哌卡因联合1ug／ml芬太尼（F4组）。监测镇痛过程中阻滞平面和运动阻滞发生情况、VAS、缩富素使用增加例数等。结果F1、F2组运动神经阻滞发生的例数多于F3、F4组（P〈0．05）。F1组缩宫素使用增加例数多于其它3组（P〈0．05）。不同罗哌卡因浓度比较,F4组起效时间最长,明显长于F1、F2、F3组（P〈0．05）。F4组给药后30、60、90min时的VAS明显高于F1、F2、F3组,停药时的VAS明显高于F1组（P〈0．05）。F4组镇痛后30min内第3次宫缩开始每次宫缩对应的VAS明显高于F1、F2、F3组（P〈0．05）。结论罗哌卡因联合1ug／ml芬太尼用于分娩镇痛时,010％是最佳有效浓度,镇痛效果好,运动阻滞轻,安全性高。     

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。     

二甲胺四环素在蛛网膜下腔出血中保护作用的研究

Objective To investigate the effect of minocycline on early brain injury (EBI) following subarachnoid hemorrhage(SAH) in rats. Methods SAH was induced by the filament perforation model in male Sprague Dawley rats. SD rats(n=77) were randomly assigned to sham (n=22), SAH+vehicle (n=28), and SAH+minocycline (n=27) groups. Minocycline (135mg/kg) or equal volume of vehicle was administered 1 h after SAH induction. Mortality, neurological scores, brain edema were evaluated 24 h after SAH. Cell apoptosis were examined by TUNEL staining, and the expression of caspase-3 and Bcl-2 was assayed by Western blot at the same time point. Results The mortality was 21.4% in SAH+vehicle group, 18.5% in the SAH+minocycline group, while no death was observed in sham-operated rats; there was no significant difference in mortality between SAH+vehicle and SAH+minocycline groups (P＞0.05), but the mortality in these two groups was much higher than that in shamgroup(P＜0.05). The water content of brain was significantly increased in the SAH+vehicle group (80.00±0.16)% compared with that in sham group [(79.13±0.08)%, P＜0.05]. Minocycline treatment markedly reduced brain water content (79.36±0.07)% compared with that in SAH+vehicle group (P＜0.05). Caspase-3 levels were markedly increased in SAH+vehicle group (1.53±0.24) compared with sham group (1.00±0.21). Minocycline treatment significantly reduced caspase-3 levels, compared to SAH+vehicle group (1.11±0.18, P＜0.05). A significant decrease in Bcl-2 expression was observed in SAH+vehicle group(0.65±0.03) compared with the sham group (1.00±0.12). The treatment of minocycline upregulated the expression of Bcl-2,compared to SAH+vehicle group (0.93±0.13, P＜0.05). TUNEL-positive cells were increased in the cortex of SAH+vehicle rats,compared to sham group [(31.50±3.70)%, P＜0.05]. Minocycline treatment significantly reduced the number of TUNEL positive cells, compared to SAH+vehicle group [(14.25±2.50)%, P＜0.05]. Conclusion Minocycline may reduce early brain injury after subarachnoid hemorrhage in rats by inhibiting cell apoptosis, which is associated with down-regulation of caspase-3 and up-regulation of Bcl-2.     

去氧肾上腺素和麻黄碱预防剖宫产蛛网膜下腔阻滞后低血压效果的对比观察

目的对比观察去氧肾上腺素和麻黄碱预防剖宫产蛛网膜下腔阻滞后低血压的临床效果及对新生儿的影响。方法选择ASAⅠ～Ⅱ级择期行剖宫产手术患者160例,按随机数字表法分为去氧肾上腺素组（A组）和麻黄碱组（B组）,各80例。在蛛网膜下腔阻滞成功后分别以去氧肾上腺素40滋g/min和麻黄碱3mg/min的速度泵注6min,观察并记录两组产妇麻醉前及术中血压（SBP）、心率（HR）及追加麻黄碱的总量。胎儿娩出后抽取脐动脉行血气分析,并在1、5 min行Apgar评分。结果两组新生儿脐动脉血气分析中pH、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、碳酸氢根离子（HCO3-）结果均在正常范围;与A组比较,B组PaO2、PaCO2的差异无统计学意义（P＞0.05）,而pH、HCO3-差异有统计学意义（P＜0.05）,两组新生儿1、5min Apgar评分比较差异无统计学意义（P＞0.05）。两组产妇术前血压的基础值、术中血压的最低值、最高值及追加麻黄碱的总量差异均无统计学意义（均P＞0.05）。两组产妇均无反应性高血压和心动过缓等不良反应。结论使用去氧肾上腺素或麻黄碱均能有效地预防剖宫产患者蛛网膜下腔阻滞后低血压的发生,但在维持胎儿酸碱平衡稳定方面,去氧肾上腺素则更有优势。     

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。     

碘伏术前消毒阴道、术中冲洗宫腔预防急诊剖宫产术后切口感染疗效观察

目的 探讨碘伏术前消毒阴道、术中冲洗宫腔对产妇急诊剖宫产术后腹部切口及子宫感染有无预防作用。方法 选取2010 年3 月至2014 年6 月行急诊剖宫产术的产妇218例,随机分为3组,均采用抗生素围术期用药（头孢唑啉钠针2.0g,术中断脐后及术后各1次,静脉滴注）。Ⅰ组（81 例）0.5%碘伏术前消毒阴道、术中冲洗宫腔;Ⅱ组（73 例）0.9%氯化钠溶液术中冲洗宫腔;Ⅲ组（64 例）不做上述处理,比较3 组产妇术后腹部切口及子宫感染发生率。结果 术后腹部切口感染：Ⅰ组3例,Ⅱ组2例,Ⅲ组4例;3组比较,差异无统计学意义（P＞0.05）;术后子宫感染：Ⅰ组2 例,Ⅱ组4 例,Ⅲ组7 例;Ⅰ组与Ⅲ组比较,差异有统计学意义（P＜0.05）;Ⅰ组与Ⅱ组、Ⅱ组与Ⅲ组比较,差异均无统计学意义（均P＞0.05）。结论 在合理预防性使用抗生素前提下,碘伏术前消毒阴道、术中冲洗宫腔可降低急诊剖宫产术后子宫感染发生率。     

两种不同麻醉和镇痛方法对糖耐量减低的老年高血压患者全膝置换术后糖代谢的影响

目的两种不同麻醉和镇痛方法对糖耐量减低的老年患者全膝置换术后糖代谢的影响。方法60例择期行全膝置换术的糖耐量减低患者随机分成腰硬联合麻醉联合术后硬膜外镇痛组（腰硬组）和全身麻醉联合术后静脉镇痛组（全麻组）各30例,分别测定入手术室后,术后30min、1、3、7d的空腹血糖和胰岛素浓度;术后10d空腹和口服糖耐量试验（OGTT）2h的血糖和胰岛素浓度,并计算相应胰岛素抵抗指数,以视觉模糊疼痛评分（VAS）评估术后1h、1、3、7d的疼痛评分,并记录围手术期相关不良事件发生率。结果腰硬组术后30min、1、3d的空腹血糖相比全麻组明显较低（均P＜0.05）;腰硬组在术后30min、1、3、7d的胰岛素浓度和胰岛素抵抗指数相比全麻组明显较低（均P＜0.05）。腰硬组在术后1d和3d的中餐后2h血糖浓度相比全麻组明显较低（均P＜0.05）。全麻组术后10d空腹、OGTT2h的胰岛素浓度和胰岛素抵抗指数相比术前均明显升高（均P＜0.05）,且相比腰硬组明显更高（均P＜0.05）。术后1h和术后1d腰硬组VAS评分明显小于全麻组（均P＜0.05）。结论腰硬联合麻醉和硬膜外镇痛能减轻糖耐量减低的老年高血压患者的全膝置换术后糖代谢紊乱。     

Separation of spectra for block triangles

Separation of the spectra of the diagonal elements of a block triangle corresponds to comparison with its fundamental projection.

     

Alternating-directional PMHSS iteration method for a class of two-by-two block linear systems

In Bai et al. (2013), a preconditioned modified HSS (PMHSS) method was proposed for a class of two-by-two block systems of linear equations. In this paper, the PMHSS method is modified by adding one more parameter in the iteration. Convergence of the modified PMHSS method is guaranteed. Theoretic analysis and numerical experiment show that the modification improves the PMHSS method.     

Stability analysis of block boundary value methods for neutral pantograph equation

This paper deals with the convergence and stability properties of block boundary value methods (BBVMs) for the neutral pantograph equation. Due to its unbounded time lags and limited computer memory, a change in the independent variable is used to transform a pantograph equation into a non-autonomous differential equation with a constant delay but variable coefficients. It is shown under the classical Lipschitz condition that a BBVM is convergent of order p if the underlying boundary value method is consistent with order p. Furthermore, it is proved under a certain condition that BBVMs can preserve the asymptotic stability of exact solutions for the neutral pantograph equation. Meanwhile, some numerical experiments are given to confirm the main conclusions.     

Structured preconditioners for nonsingular matrices of block two-by-two structures

For the large sparse block two-by-two real nonsingular matrices, we establish a general framework of practical and efficient structured preconditioners through matrix transformation and matrix approximations. For the specific versions such as modified block Jacobi-type, modified block Gauss-Seidel-type, and modified block unsymmetric (symmetric) Gauss-Seidel-type preconditioners, we precisely describe their concrete expressions and deliberately analyze eigenvalue distributions and positive definiteness of the preconditioned matrices. Also, we show that when these structured preconditioners are employed to precondition the Krylov subspace methods such as GMRES and restarted GMRES, fast and effective iteration solvers can be obtained for the large sparse systems of linear equations with block two-by-two coefficient matrices. In particular, these structured preconditioners can lead to efficient and high-quality preconditioning matrices for some typical matrices from the real-world applications.

     

On the plane section of an integral curve in positive characteristic

If is an integral curve and an algebraically closed field of characteristic 0, it is known that the points of the general plane section of are in uniform position. From this it follows easily that the general minimal curve containing is irreducible. If char, the points of may not be in uniform position. However, we prove that the general minimal curve containing is still irreducible.