不同检验方法对肺结核早期诊断的应用

目的通过不同的检验方法对肺结核患者进行检查,以确定不同检验方法在诊断上的应用意义。方法对患者进行痰、胸水、血清聚合酶链反应(Polyerase Chain ReactionPCR)和涂片结核菌检查及皮肤结核菌素纯蛋白衍化物(PPD)试验,并用18例非结核病患者作为对照组。结果患者痰、血清和胸水结核杆菌的检出阳性率明显高于涂片法和PPD皮试法,其中尤以胸水PCR检测阳性率最高为76.5%。与国内大多散文献报道的56%～87%结果相仿。结论PCR检测技术对临床上肺结核病的诊断和鉴别诊断有较高的应用价值。

时间分辨荧光免疫分析与酶联免疫吸附分析检测血清甲胎蛋白的比较

目的比较测定甲胎蛋白（AFP）的2种方法，即时间分辨荧光免疫分析（TrF）与酶联免疫吸附分析（ELISA）。方法分别进行线性、相关性、回收与重复性试验。结果线性范围、回收率、批内CV%、批间CV％TrF分别为0．721～1089ng／L、97．03％、3．21％与5．79％；ELISA分别为4．21～530ng／L、95．68％、4．05％与6．20％。TrF与ELISA两种方法差异无统计学意义（P〉0．05），相关性好，r=0．921。结论TrF定量测定AFP，在方法学上要优于ELISA。

不同罗哌卡因输注方式用于腰麻-硬膜外阻滞分娩镇痛的比较

目的：探讨不同罗哌卡因输注方式用于腰麻-硬膜外联合阻滞（CSEA）分娩镇痛的效果及对产程和母婴的影响。方法：50例ASAⅠ～Ⅱ级足月单胎初产妇随机分为R1组和R2组,每组25例,两组均在宫口开大至3～4 cm时行CSE操作,蛛网膜下腔注入0.2%罗哌卡因1.5 ml（3 mg）。40 min后：R1组行PCEA镇痛,注入0.1%罗哌卡因与芬太尼2μg/ml混合液,基础输注速率6 ml/h,单次PCA 3 ml,锁定时间10 min。宫口开全时停泵。R2组行硬膜外间断注药镇痛,首次注入0.1%罗哌卡因与芬太尼2μg/ml混合液8 ml,以后在产妇有明显痛感时注入上述药物5 ml,在宫口开大至9 cm时注入最后1次药物。用视觉模拟评分（VAS）和下肢运动神经阻滞评分（MBS）评估镇痛情况和下肢运动神经阻滞情况,观察并记录产妇生命体征、产程时间、生产方式及新生儿Apgar评分。结果：两组产妇生命体征平稳,均达到良好的镇痛效果。结论：两组产妇用药后10、30、609、0 min及第二产程、第三产程VAS均〈2分。

胸段硬膜外阻滞改善全麻病人心肌供血的研究进展

全麻复合胸段硬膜外阻滞(TEA),可以阻断有害刺激对心交感神经的兴奋作用,使心率下降、心肌收缩下降,降低心脏前后负荷,从而改善心肌氧供。尤其是防止原已存在狭窄的冠状动脉进一步收缩,使缺血的心肌氧供得到改善。

不含局麻药单用吗啡行术后硬膜外持续镇痛的可行性

Objective To evaluate the feasibility of morphine without local anesthetics for continuous epidural infusion of postoperative analgesia.Methods Nine-hundred and twenty-five ASA physical status ofⅠorⅡpatients undergoing abdominal or leg surgery were randomly divided into three groups : the morphine-ondansetron group(group MO,n=312),the morphine-bupivacaine-droperidol group(group MBD,n=307),and the morphine-bupivacaine-ondansetron group(group MBO,n=306).In all patients,epidural puncture were performed at L1-2 interspace and a catheter was advanced 3～4cm in the epidural space.Anesthesia was maintained with 1.73% lidocaine carbonate injection.Different loading dose was given via epidural catheter at the end of surgery : group MO,morphine 2mg(5ml);group MBD,morphine 2mg+bupivacaine 20 mg+ droperiodl 1mg(5ml);group MBO,morphine 2mg+bupivacaine 20 mg(5ml).Then different continuous dose in 2ml/h was given in the ward and maintained for 48h: group MO,morphine 4mg and ondansetron 8mg mixture diluted in 0.09% sodium chloride injection to 100ml;group MBD,morphine 4mg+bupivacaine 125mg+droperiodl 3mg mixture diluted in 0.09% sodium chloride injection 100ml;group MBO,morphine 4mg+bupivacaine 125mg+ondansetron 8mg mixture diluted in 0.09% sodium chloride injection to 100ml.MAP,HR,RR,VAS,Prine Henry Score(PHS),and Sedation Scale(SS) were recorded at 2,4,8,16,48h postoperatively.The side effects such as nausea and vomiting(PONV),itching,urinary retention were observed.Results There was no significant difference in MAP,HR,RR,VAS,and PHS among three groups.The SS was significantly higher in group MBD than in other two groups at the same time,(P<0.05).In group MBD,the SS was(2.5±0.5)scores,(2.6±1.3)scores,(2.7±1.4)scores at 2,4,8h postoperatively.The rate of side effects was significantly higher in group MBD than in other two groups.There were 37 cases(12.1%) of SS more than 3 scores in group MBD and no case of SS more than 3 scores in group MO(P<0.01).The rate of urinary retention was 3.8% in group MO and 8.4% in group MBD and 7.5% in group MBO(P<0.05).The rate of nausea and vomiting was 11.1%(37 cases) in group MBD.There was significant difference between group MBD and MO(P<0.01).Conclusion There are potentially dangerous of local anesthetics and droperidol during continuous epidural analgesia with morphine combined bupivacaine and/or droperidol.Morphine combined ondansetron is satisfactory and safe during continuous epidural analgesia.