阿托品预防胆心反射的系统评价

评价阿托品在胆囊及胆道手术中对胆心反射的预防作用;计算机检索中国期刊全文数据库（1994-2009）、中国生物医学文献数据库（1978-2009）、中文科技期刊数据库（1989-2009）、中国医学会数字化期刊库（1997-2009）、PubMed（1966-2009）、Cochrane Library（2009年第1期）,同时,手检相关期刊和会议论文集,纳入有关阿托品的随机对照试验,依据Cochrane评价手册5.0的质量评价标准对纳入文献的方法学质量进行评估,数据采取Rev-Man 5.0软件进行分析;共纳入6个研究,570例患者。术前肌注阿托品不能够减少手术过程中胆心反射的次数（P=0.65）,但是可以降低牵拉或者切割胆囊前后心率下降的幅度（P=0.002）;开腹时或者切皮时静脉滴注阿托品,既可以减少手术过程中胆心反射的次数（P〈0.00001）,又可以降低牵拉或者切割胆囊前后心率下降的幅度（P〈0.00001）;现有临床证据表明,术前肌注阿托品预防胆系手术中胆心反射的作用不清楚,开腹时或者切皮时静脉滴注阿托品可以预防手术过程中胆心反射。但鉴于纳入研究少、质量低,使论证强度受到一定限制,有必要进一步开展高质量、大样本随机临床对照试验评价其在预防腮系手术中胆心反射的疗效。     

喉罩通气道在上腹部手术硬膜外麻醉中的应用分析

目的：探讨喉罩在上腹部手术硬膜外麻醉中应用的麻醉效果及安全性。方法：将120例病人分为3组：硬膜外麻醉静脉内辅助芬氟复合剂组（A组）;硬膜外麻醉复合全麻气管插管（B组）;硬膜外麻醉复合全麻喉罩通气（C组）。比较三组间麻醉效果及术后并发症发生等情况。结果：三组病人硬膜外麻醉效果均好,无显著性差异（P〉0.05）;A组术中内脏牵拉反应较重（P〈0.05）;B组气管内插管时循环参数波动较大,术后并发症发生较C组多（P〈0.05）;C组麻醉效果好,术后并发症发生较少,病人较舒适（P〈0.05）。结论：喉罩在上腹部手术硬膜外麻醉中应用具有能抑制内脏牵拉反应,发挥硬膜外麻醉优点,有效的维持术中通气,术后并发症少,病人舒适等优点。     

小儿硬膜外阻滞辅用氯胺酮的临床观察

目的 探索小儿硬膜外麻醉辅用小剂量氯胺酮的麻醉效果。方法 择期手术病人70例，ASA为I或Ⅱ级。年龄5～12岁，随机分为2组（n=35）：氯胺酮加咪唑安定组（A组）；哌替啶加氟哌利多组（B组）。病人入室静卧5min测量血压、心率作为基础值。记录用药后每5rain测BP，HR，SPO2以及内脏牵拉、低血压、体动的比例。结果 与基础值比较，B组低血压内脏牵拉、体动等发生率高于A组（P〈0．05）。结论 氯胺酮对防治内脏牵拉、低血压、体动反应有明显的优越性。     

瑞芬太尼复合丙泊酚在婴幼儿先天性唇腭裂修复术中的应用

探讨了瑞芬太尼、丙泊酚全凭静脉麻醉与芬太尼、丙泊酚和异氟烷静吸复合麻醉在婴幼儿先天性唇腭裂修复术中应用的比较。30例ASAⅠ~Ⅱ级择期行先天性唇腭裂修复术患儿,年龄8个月~3岁,随机分为瑞芬太尼、丙泊酚全凭静脉麻醉组（Ⅰ组）与芬太尼、丙泊酚和异氟烷静吸复合麻醉组（Ⅱ组）。Ⅰ组麻醉诱导后持续输注瑞芬太尼和丙泊酚维持麻醉;Ⅱ组麻醉诱导单次注入芬太尼后持续输注丙泊酚、辅助吸入异氟烷维持麻醉。观察术中血流动力学变化情况,术后苏醒、拔管情况及术后躁动发生情况。插管、手术开始后5 min、拔管时Ⅱ组HR、MAP均高于Ⅰ组HR、MAP（P〈0.01）;两组患儿自主呼吸恢复时间、拔管时间、苏醒时间I组均少于Ⅱ组（P〈0.01）;而在术后躁动发生率中II组少于Ⅰ组（P〈0.05）。瑞芬太尼、丙泊酚全凭静脉麻醉用于婴幼儿先天性唇腭裂修复术手术较芬太尼、丙泊酚和异氟烷复合麻醉围术期血流动力学更为平稳,术后苏醒迅速,而术后躁动发生率较高,可能与术后疼痛相关。     

老年人胆囊切除术中硬膜外与硬膜加全麻对循环？…

目的：观察老年人硬膜外麻醉和硬膜外加全麻插管下胆囊切除秫中循环的稳定程度。方法：６２例胆囊切除术患随机分为两组。Ａ组（ｎ＝３２）硬膜外加全麻,Ｂ组（ｎ＝３０）硬膜外麻醉。观察术中心率、血压和血氧饱和度。记录因血压下降和心率减慢所用麻黄素和阿托品剂量。结果：两组病人术前患高血压和心脏病人无显差异（Ｐ〉０．２５）,手术中麻黄素剂量Ａ组明显低于Ｂ组（Ｐ〈０．０５）;阿托品剂量Ａ组与Ｂ组无显差异（Ｐ     

老年人胆囊切除术中硬膜外与硬膜加全麻对循环的影响

观察老年人硬膜外麻醉和硬膜外加全麻插管下胆囊切除术中循环的稳定程度。方法：６２例胆囊切除术患者随机分为两组。Ａ组（ｎ＝３２）硬膜外加全麻，Ｂ组（ｎ＝３０）硬膜外麻醉。观察术中心率、血压和血氧饱和度。记录因血压下降和心率减慢所用麻黄素和阿托品剂量。结果：两组病人术前患高血压和心脏病人无显著差异（Ｐ＞０２５），手术中麻黄素剂量Ａ组明显低于Ｂ组（Ｐ＜００５）；阿托品剂量Ａ组与Ｂ组无显著差异（Ｐ＞００５），两组均未使用抗高血压药物。结论：老年患者行胆囊切除术采用硬膜外加全麻是十分有益的     

基层医院全凭静脉麻醉和静吸复合麻醉在腹腔镜手术的麻醉费用比较

比较腹腔镜胆囊手术全凭静脉麻醉和静吸复合麻醉在腹腔镜手术的麻醉费用。本研究选择择期腹腔镜胆囊切除术患者100例，ASA分级Ⅰ到Ⅱ级，年龄20～60岁，性别不限，随机分为A组和B组，麻醉诱导均采用咪达唑仑0．05mg／kg，丙泊酚1．5mg／kg，在患者意识消失后，静脉注射芬太尼、维库溴铵后气管插管。麻醉维持：A组丙泊酚持续静脉75～200ug／kg／min泵注，切皮前静脉注射芬太尼0．1mg，芬太尼3ug/kg/h，根据血压调节丙泊酚泵注速度。B组采用吸入异氟醚维持麻醉。两组维持新鲜气流量1L／min，均根据需要间断注射芬太尼和维库溴铵维持麻醉。记录患者MAP、HR变化，麻醉诱导前（T1）、插管即刻（T2）、切皮时（T3）、手术开始30min（T4）、拔管后（T5）记录术中心动过缓，高血压，体动，呛咳，低血压不良反应的情况。记录麻醉时间（诱导开始至停止给麻醉药时间），手术时间，苏醒时间、（停药到呼唤睁眼的时间）、呼吸恢复时间（停药到自主呼吸恢复间）、拔出插管时间（自主呼吸恢复至符合临床拔管指针的时间）。计算麻醉药物的费用。A组麻醉苏醒时间、呼吸恢复时间、定向恢复力时间均短于B组。与B组比较A组的所有麻醉药物费用、异氟醚或丙泊酚费用和每小时所有麻醉费用均降低（P〈0．05）．腹腔镜胆囊手术中，丙泊酚一芬太尼全凭静脉麻醉，效果确切，术后患者恢复时间缩短、费用低廉、安全可靠是基层医院开展腹腔镜胆囊手术较为经济有效的麻醉方法。     

艾司洛尔对胃癌根治术麻醉及术后镇痛的影响

目的：观察手术期间使用艾司洛尔对麻醉及术后静脉芬太尼镇痛的影响。方法：选择择期行胃癌根治术患者160例．随机分为艾司洛尔组（E组）和对照组（C组）,每组80例。E组在诱导前5min内静脉推注艾司洛尔1mg／kg,以单次静脉输注芬太尼和维库溴铵并辅以七氟烷吸入进行麻醉维持。术中持续静脉输注艾司洛尔,C组除不使用艾司洛尔外其余麻醉处理同E组。术后均采用静脉镇痛。结果：E组术中芬太尼用量显著低于C组（P〈0．01）。与C组比,诱导前、拔管时E组MAP、HR差异无显著意义;插管、切皮时E组显著低C组fP〈0．05．P〈0．01）。术后4、8及24hE组VAS显著低于C组（P〈O．05）。E组术后恶心呕吐率低于C组（P〉0．05）,术后随访两组均无术中知晓。结论：手术期间使用艾司洛尔能减少术中芬太尼药量,较好维持血液动力学稳定,术后镇痛效果好。     

单纯颈浅丛阻滞复合氟芬合剂在甲状腺手术中的应用

目的探讨单纯颈浅丛阻滞复合氟芬合剂应用于甲状腺手术中的可行性。方法将拟在颈丛阻滞下行甲状腺手术患者随机分成2组：实验组：在单纯颈浅丛阻滞后静注复芬合剂,对照组：传统C4横突一点法双侧颈丛阻滞后静注氟芬合剂。观察两组患者的麻醉效果、生命体征（平均动脉压（MAP）、心率（HR）血氧饱和度SPO2）、术中并发症,术中配合程度。结果两组患者的麻醉效果无显著性差异,实验组患者的平均动脉压（MAP）,心率（HR）均低于对照组,实验组术中并发症明显低于对照组,实验组患者配合程度明显好于对照组。结论单纯颈浅丛阻滞复合氟芬合剂应用于甲状腺手术中,具有良好的麻醉效果,术中生命体征平稳,并发症少,患者安静配合手术等优点。     

全麻复合硬膜外阻滞对开胸手术苏醒期血流动力学变化的影响

为了观察全麻复合胸段硬膜外阻滞在胸部手术患者苏醒期血流动力学的变化,将30例ASA Ⅰ-Ⅱ级择期普胸手术病人,随机分为硬膜外阻滞复合全麻组（复合组）和单纯全麻组（对照组）,每组 15例.两组全麻诱导和维持方法相同,复合组在全麻诱导前先行胸段硬膜外穿刺置管,给局麻药控制麻醉平面在T4-T10水平,并在术中定时追加局麻药,分别记录麻醉前、气管拔管前、气管拔管即刻、气管拔管后1min、5min血液动力学指标.结果显示：对照组各项指标在气管拔管即刻达到高峰,与麻醉前比有显著性差异（P〈0.01）;拔管前、拔管后1min也高于复合组,拔管后5min也未完全恢复,有显著性差异（P〈0.05）.结果表明：全麻复合胸段硬膜外阻滞应用复合组苏醒期中循环功能相对稳定,可减轻应激反应,是一种安全可行的麻醉方法.     

Markedness and its Interpretation in Language Use

Language markedness is a common phenomenon in languages, and is reflected from hearing, vision and sense, i.e. the variation in the three aspects such as phonology, morphology and semantics. This paper focuses on the interpretation of markedness in language use following the three perspectives, i.e. pragmatic interpretation, psychological interpretation and cognitive interpretation, with an aim to define the function of markedness.     

Features of Women's language

Language is a means of verbal communication. People use language to communicate with each other. In the society, no two speakers are exactly alike in the way of speaking. Some differences are due to age, gender, statue and personality. Above all, gender is one of the obvious reasons. The writer of this paper tries to describe the features of women＇s language from these perspectives： pronunciation, intonation, diction, subjects, grammar and discourse. From the discussion of the features of women＇s language, more attention should be paid to language use in social context. What＇s more, the linguistic phenomena in a speaking community can be understood more thoroughly.     

低渗透非均质砂岩油藏启动压力梯度研究

理论推导与室内实验相结合,建立了低渗透非均质砂岩油藏启动压力梯度确定方法。首先借助油藏流场与电场相似的原理,推导了非均质砂岩油藏启动压力梯度计算公式。其次基于稳定流实验方法,建立了非均质砂岩油藏启动压力梯度测试方法。结果表明:低渗透非均质砂岩油藏的启动压力梯度确定遵循两个等效原则。平面非均质油藏的启动压力梯度等于各级渗透率段的启动压力梯度关于长度的加权平均;纵向非均质油藏的启动压力梯度等于各渗透率层的启动压力梯度关于渗透率与渗流面积乘积的加权平均。研究成果可用于有效指导低渗透非均质砂岩油藏的合理井距确定,促进该类油藏的高效开发。     

On Tragic Consciousness In The Works By Ernest Hemingway

As an American modern novelist who were famous in the literary world, Hemingway was not a person who always followed the trend but a sharp observer. At the same time, he was a tragedy maestro, he paid great attention on existence, fate and end-result. The dramatis personae's tragedy of his works was an extreme limit by all means tragedy on the meaning of fearless challenge that failed. The beauty of tragedy was not produced on the destruction of life, but now this kind of value was in the impact activity. They performed for the reader about the tragedy on challenging for the limit and the death.     

Achieving Unusual States of Matter Under High Pressure

正The periodicity of the elements and the non-reactivity of the inner-shell electrons are two related principles of chemistry,rooted in the atomic shell structure.Within compounds,Group I elements,for example,invariably assume the+1 oxidation state,and their chemical properties differ completely from those of the p-block elements.These general rules govern our understanding of chemical structures and reactions.Using first principles calcula-     

Exchange-Correlation and Electronic Excitation Energies from Pairing Matrix Fluctuations

We have developed an adiabatic connection to formulate the ground-state exchange-correlation energy in terms of pairing matrix linear fluctuations.This formulation of the exchange-correlation energy opens a new channel for density functional approximations based on the many-body perturbation theory.We illustrate the potential of such approaches with an approximation based on the particle-particle Random Phase Approximation(pp-RPA).This re-     

Density Functional Theory for the Response of Periodic Systems to Electric Fields Based on the Vector Potential Approach

正The electronic and nuclear(structural/vibrational)response of 1D-3D nanoscale systems to electric fields gives rise to a host of optical,mechanical,spectral,etc.properties that are of high theoretical and applied interest.Due to the computational difficulty of treating such large systems it is convenient to model them as infinite and periodic(at least,in first approximation).The fundamental theoretical/computational problem in doing so is that     

Call for Papers

<正>"The Journal of Shanghai Normal University:Mathematics"is published by Shanghai Normal University as regular issues of The Journal of Shanghai Normal University each year from 2014 in English.The editors-in-chief of the issues are professors Yuhao Cong and Maoan Han.The Journal of Shanghai Normal University was started in 1958 with     

Journal of Donghua University ( English Edition) Contents of Volume 31

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Brief Introduction to “Journal of Jilin University( Science Edition) ”

<正>"Journal of Jilin University(Science Edition)"is a comprehensive academic journal in the fields of science sponsored by Jilin University and administrated by the Ministry of Education of the Peoples Republic of China.The journal started publication in 1955.The original name at starting publication was"Journal of Natural Science of Northeast People University",which was changed into"Acta Scientiarum Naturalium Universitatis Jilinensis"in 1958 owing to the name change of the university.The present journal name has