不同剂量咪唑安定与异丙酚、芬太尼、维库溴铵联合麻醉诱导的效果比较

目的　探讨不同剂量咪唑安定与异丙酚、芬太尼、维库溴铵联合麻醉诱导的效果并确定咪唑安定的合理用量。方法　 80例全麻患者随机分为 4组 , 组咪唑安定 0 .0 5 mg/ kg、 组 0 .1mg/ kg、 组 0 .15 mg/ kg、 组生理盐水对照。按分组静注不同剂量的咪唑安定或生理盐水后依次给予异丙酚 1.5 mg/ kg、芬太尼 3μg/ kg、维库溴铵0 .1mg/ kg麻醉诱导 ,面罩加压供氧后气管插管。观察并记录诱导前、插管前、插管后 1、3、5分钟时的心率、血压指标、术后拔管时间及术后不良反应。结果　 组患者插管前血压心率较诱导前下降 , 组患者插管后 1分钟血压升高 (P<0 .0 5 )。 、 组拔管时间较 组延长 (P<0 .0 5 )。 组 1例发生躁动。 组患者插管前后血压、心率平稳 (P>0 .0 5 ) ,无拔管时间延长 (与 组比 ,P>0 .0 5 ) ,未发现不良反应。结论　 0 .0 5 m g/ kg咪唑安定与异丙酚、芬太尼、维库溴铵联合诱导效果最佳。     

I-gel喉罩辅助纤维支气管镜引导经口气管插管对全麻手术患者血流动力学的影响

目的观察I-gel喉罩辅助纤维支气管镜(FOB)引导经口气管插管对全麻手术患者血流动力学的影响。方法将40例择期全麻手术患者随机分为M组和O组各20例,常规麻醉诱导后,M组采用Macintosh直接喉镜经口气管插管,O组采用I-gel喉罩辅助FOB引导经口气管插管。观察麻醉插管不同时间点血压(BP)和心率(HR)、喉部暴露情况的Cormack/Lehane(C/L)分级、插管时间,并计算收缩压(SBP)与HR乘积(RPP)。结果 O组C/L分级为(1.30±0.47)级,低于M组的(1.80+0.62)级(P<0.01)。O组气管插管时间为(74.2±11.1)s,建立有效气道通气时间为(18.2±4.9)s,M组分别为(34.4±10.5)、(34.4±10.5)s,两组比较,P均<0.01。两组诱导后的BP、HR和RPP值均较诱导前的基础值下降(P均<0.05),插管即刻和气管插管后3 min内BP、HR和RPP较诱导后增高(P均<0.05),但O组插管即刻和气管插管后1 min的BP、HR和RPP比M组低(P均<0.05),且M组气管插管后4 min的BP、HR和RPP较诱导后仍较高(P均<0.05)。结论 I-gel喉罩辅助FOB引导经口气管插管对全麻手术患者血流动力学的影响轻于Macintosh直接喉镜气管插管。     

不同浓度罗库溴铵用于全麻诱导气管插管时机的探讨

240例全麻下择期手术患者,随机分为8组,各30例。Ⅰa、Ⅰb,Ⅰc组分别于0．6mg／kg罗库溴铵注药后印、90、120s行气管插管;Ⅰd组于0．6mg／kg罗库溴铵注药后四个成串刺激引起的第1个肌颤搐（T1）完全消失时行气管插管;Ⅱa、Ⅱb、Ⅱc组分别于0．9mg／kg罗库溴铵注药后60、90、120s行气管插管;Ⅱd组于0．9mg／kg的罗库溴铵注药后T1完全消失时行气管插管。观察并评价患者声门暴露程度及气管插管条件,记录罗库溴铵的起效时间（从注射肌松药毕至T1完全消失的时间）,同时观察心率、血压等心血管反应。结果Ⅰc,Ⅰd组声门暴露程度和插管条件均优于Ⅰa、Ⅰb组（P〈0．05）。Ⅱb,Ⅱc,Ⅱd组声门暴露程度和插管条件均优于Ⅱa组（P〈0．05）。起效时间Ⅰd组为（125±30）s,Ⅱd组为（90±17）s,两组比较,P〈0．05。Ⅰa、Ⅰb、Ⅱa组插管后血压升高、心率加快,其余各组插管前后血压心率变化不明显。推荐临床单次静脉注射0．6mg／kg罗库溴铵后120s、0．9mg／kg罗库溴铵注药后90s行气管插管。0．9ms／kg比0．6mg／kg罗库溴铵更适宜快速诱导插管。     

罗哌卡因硬膜外阻滞复合全麻与单纯全麻对血压和心率的影响

目的 :比较罗哌卡因胸段硬膜外阻滞复合全麻 （CGA ）和单纯全麻 （GA）用于全胃切除手术时的心血管效应。方法 :4 0例拟择期行全胃切除手术患者 ,ASA ～ 级 ,随机分为 GA组和 CGA组 ,每组 2 0例 ,分别接受气管插管全麻和罗哌卡因胸段硬膜外阻滞复合气管插管全麻。记录麻醉诱导期、手术期及苏醒期的血压、心率变化。结果 :1CGA组患者术中收缩压、心率的变化均较 GA组小 （12 3± 14 m m Hg vs132± 17m m Hg和 78± 10 / m in vs 85±10 / min,均 P<0 .0 1） ;2 CGA组患者诱导插管时及苏醒期的血压、心率变化均较 GA组小 （均 P<0 .0 5 ）。结论 :与GA相比 ,CGA用于全胃切除手术可维持更加稳定的血流动力学 ,且特别适用于有心肌缺血或存在心肌缺血倾向的手术患者     

老年高血压患者全麻气管拔管时血压升高的影响因素

目的 探讨老年高血压患者全麻气管拔管时血压升高的影响因素,及其与脑源性神经营养因子(BDNF)基因多态性的相关性。方法 选取2017年2月至2021年8月在杭州市萧山区第一人民医院进行全麻手术的老年高血压患者350例为受试者。全麻气管拔管时血压升高明显(气管拔管时血压升高超过基础值的20%)者为观察组(154例),全麻气管拔管时血压升高未超过基础值的20%者为对照组(196例)。比较两组不同时间节点下的收缩压、舒张压、心率和血氧饱和度、BDNF基因的多个位点(rs56164415、rs11030101、rs11030100、G712A与rs6265)的差异,并通过logistic回归模型分析老年高血压患者全麻气管拔管血压升高的影响因素。结果 观察组在拔出气管插管时(T4)和拔出气管插管后10 min(T5)时收缩压、舒张压、心率高于对照组,血氧饱和度低于对照组(均P<0.05)。观察组BDNF基因位点rs6265的A等位基因(57.8%)与AA基因型表达频率(41.6%)高于对照组(24.5%、40.6%;均P<0.05)。二元logistic回归分析发现,男性、手术时间≥...     

不同剂量舒芬太尼在老年LC患者全麻气管插管中的麻醉效果

目的 探讨不同剂量舒芬太尼在老年腹腔镜下胆囊切除术(LC)患者全麻气管插管中的麻醉效果。方法 回顾性研究LC患者80例作为研究对象，在麻醉诱导中，采用0.4μg/(kg·h)舒芬太尼的患者21例为A组；采用0.5μg/(kg·h)舒芬太尼的患者25例为B组；采用0.6μg/(kg·h)舒芬太尼的患者34例为C组，比较3组应激反应、血流动力学、麻醉后恢复情况及并发症差异。结果 麻醉诱导前，3组肾上腺素(AD)、去甲肾上腺素(NA)水平、心率、平均动脉压、脑电双频指数差异无统计学意义(P>0.05)。在气管插管后1 min及气管插管后3 min, A组AD及NA水平显著高于其他两组(P<0.05),C组心率、平均动脉压及脑电双频指数均显著低于麻醉诱导前及A组和B组(P<0.05),B组气管插管后1 min及气管插管后3 min心率、平均动脉压及脑电双频指数变化值显著低于A组(P<0.05),C组自主呼吸恢复时间、拔管时间及呼吸睁眼时间显著长于其他两组(P<0.05),C组躁动、恶心、呕吐发生率显著高于其他两组(P<0.05)。结论 在老年LC患者全麻气管...     

右美托咪定联合丙泊酚麻醉在气管插管中的临床应用

目的探讨右美托咪定联合丙泊酚麻醉在气管插管中的应用效果。方法 78例拟行气管插管麻醉方式手术治疗的患者随机分为两组,对照组(n=38例)仅给予丙泊酚麻醉;观察组(n=40例)给予右美托咪定复合丙泊酚麻醉。比较两组患者在不同时间点(诱导前、气管插管前、插管时、插管后5 min)的收缩压、舒张压和心率等指标变化情况。结果与诱导前和气管插管前比较,两组气管插管时的收缩压、舒张压和心率等指标均明显升高,而观察组升高幅度明显低于对照组(P<0.05);气管插管后5 min时两组患者收缩压、舒张压和心率等指标均明显下降,观察组下降幅度明显高于对照组(P<0.05)。结论右美托咪定复合丙泊酚麻醉应用于气管插管手术效果显著,无明显不良反应,血流动力学稳定,值得临床推广应用。     

小儿全麻中全凭吸入安氟醚的临床应用

目的 观察在小儿全麻中全凭吸入安氟醚麻醉的安全性和麻醉效果.方法 90例年龄为1～7岁需在全麻下实施手术的患儿随机分为3组,每组各30例.Ⅰ组、Ⅱ组为常规全麻方法,分别采用氯胺酮、咪达唑仑、阿曲库铵(Ⅰ组)和氯胺酮、丙泊酚、阿曲库铵(Ⅱ组)进行全麻诱导和全麻维持.Ⅲ组采用吸入安氟醚患儿入睡后,静脉注射司可林全麻插管,插管后全凭吸入安氟醚进行全麻维持.分别观察麻醉前(T0)、全麻插管后1 min(T1)、手术即刻(T2)、手术后30 min(T3)、术毕(T4)以及气管插管后10 min(T5)的MAP、HR、SpO2、PETCO2的变化;检查T1、T4、T5时点的动脉血气值,记录各组术毕至清醒和拔管的时间;术后恶心、呕吐及难以安抚的哭闹的发生率.结果 各组的HR和MAP值在T1、T2时点,组内比较明显高于其它时点(P<0.05,T1、T2时点比较除外),组间比较,也明显高于其它时点(P<0.05,T1、T2时点比较除外).SpO2值各时点组内、组间比较差异均无统计学意义(P>0.05).Ⅲ组的T4时点PETCO2明显高于组内或组间不同时点之值(P<0.05).各组pH值、PaO2同一时点的组内和组间比较差异均无统计学意义(P>0.05),Ⅲ组的T4时点的PaCO2值明显高于组内T1和T5时点之值(P<0.05),也高于其它T1、T5时点之值(P<0.05).Ⅲ组的拔管时间、患儿的清醒时间明显短于其它两组(P<0.05);Ⅱ组患儿拔管时间及清醒时间明显短于Ⅰ组(P<0.05).Ⅲ组麻醉费用明显低于其它两组(P<0.05),而患者哭闹的发生率明显高于其它两组(P<0.05).Ⅱ组和Ⅰ组麻醉费用及恶心、呕吐及哭闹的发生率的比较差异无统计学意义(P>0.05).结论 小儿全麻中全凭吸入安氟醚在除心血管手术以外的其他外科手术如神经外科手术、肝脏手术等的麻醉是安全可靠的,患儿苏醒快、气管导管拔除早、并发症发生率少、费用低.     

罗库溴铵和顺式阿曲库铵用于全麻诱导的起效时间和插管条件探讨

目的 评价两种不同剂量罗库溴铵和顺式阿曲库铵用于全麻诱导气管插管时的起效时间和插管条件.方法 90例择期行全麻手术患者(ASA分级Ⅰ或Ⅱ级)随机分为3组各30例:罗库溴铵0.9 mg/kg组(Ⅰ组),罗库溴铵0.6 mg/kg组(Ⅱ组)和顺式阿曲库铵0.15 mg/kg组(Ⅲ组).Ⅰ、Ⅱ、Ⅲ组均在5 s内分别静推罗库溴铵0.9mg/kg、罗库溴铵0.6 mg/kg和顺式阿曲库铵0.15 mg/kg,记录从推药后(T1)由100％到0的时间(起效时间),当T1为0％时气管插管,评估气管插管条件.结果 Ⅰ组、Ⅱ组和Ⅲ组的起效时间分别为(70±16)、(90 ±21)、(226±47)s,两两比较,P均＜0.0l;三组患者的声门暴露评级差异无统计学意义(P＞0.05),三组的气管插管条件差异无统计学意义(P＞0.05).结论 0.9 mg/kg剂量的罗库溴铵诱导起效时间快于0.6 mg/kg罗库溴铵和0.15 mg/kg的顺式阿曲库铵;当诱导后T1为0％时,三组的声门暴露评级和气管插管条件无明显差异.     

不同肌肉松弛药对于先心病患者麻醉诱导时血压和心率的影响

目的 :研究不同肌肉松弛药用于先心病患者麻醉诱导时对血压和心率的影响。方法 :48例择期先天性心脏病矫形手术患者 ,心功能 ～ 级 ,随机分为 6组 ,每组 8例。泮库溴铵、阿曲库铵和维库溴铵 （剂量均为 0 .1mg/ kg）分别合用安定 （0 .2 m g/ kg）和小剂量芬太尼 （5 μg/ kg）或大剂量芬太尼 （10 μg/ kg）。记录插管前、后的血压、心率变化。结果 :与小剂量芬太尼合用进行麻醉诱导时 ,泮库溴铵有增快心率作用 （P<0 .0 1） ,对血压影响不明显 ,阿曲库铵有明显减慢心率作用和降压作用 （P<0 .0 5或 P<0 .0 1） ,维库溴铵有轻度减慢心率作用 （P<0 .0 1） ,对血压影响不大 ;与大剂量芬太尼合用时 ,泮库溴铵对心率的影响不显著 ,并引起血压轻度下降 （P<0 .0 5 ） ,阿曲库铵仍表现明显有减慢心率作用 （P<0 .0 5 ） ,其降压作用的时间有所延长 （P<0 .0 5或 P<0 .0 1） ,维库溴铵减慢心率作用时间有所延长 （P<0 .0 1） ,并使血压显著下降 （P<0 .0 5或 P<0 .0 1）。结论 :先心病矫治术麻醉诱导时宜选择泮库溴铵和较小剂量芬太尼 （5μg/ kg）合用 ,可减少诱导时心动过缓的发生率。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.