乌司他丁对缺血性脑血管病介入治疗患者血清白细胞介素-1、白细胞介素-6含量及术后认知功能的影响

目的 观察乌司他丁(ulinastatin,UTI)对缺血性脑血管病介入治疗患者血清IL-1、IL-6含量及认知功能的影响,探讨UTI对脑缺血患者的脑保护作用. 方法 选择拟在全身麻醉下行介入治疗的缺血性脑血管病患者50例,年龄40～65岁,ASA分级Ⅰ、Ⅱ、Ⅲ级,BMI 20～28 kg/m2,采用随机数字表法分为两组(每组25例):UTI(U组)和对照组(C组).U组患者麻醉诱导前给予UTI 1万U/kg,术后第1、2、3天延用0.5万U/kg(均由生理盐水稀释至100 ml静脉滴注);C组患者在相同时间段静脉滴注100 ml生理盐水.手术前和术后第1、3天行外周静脉采血,ELISA法检测患者血清IL-1、IL-6含量;同时用简易精神状态检查量表(mini-mental state exam,MMSE)评价两组患者术前和术后第1、3天的认知功能. 结果 U组患者血清IL-1、IL-6含量在术后第1天[(279±140)、(17±6)μg/L]和第3天[(204±83)、(14±4) μg/L]均显著低于C组[第1天(373±142)、(22±8) μg/L;第3天(307±116)、(18±6) μg/L],差异有统计学意义(P＜0.05).U组患者MMSE评分在术后第1天[(28.5±1.0)分]显著高于C组[(27.9±1.2)分],差异有统计学意义(P＜0.05). 结论 UTI可降低缺血性脑血管病介入治疗患者血清IL-1、IL-6含量并改善患者早期术后认知功能.     

中药丹参、生脉治疗全身炎症反应综合征的实验研究

目的探讨丹参、生脉治疗全身炎症反应综合征(SIRS)的作用及其机理。方法建立大鼠SIRS动物模型。40只Wistar大鼠随机分为4组，每组10只。对照组：生理盐水(5ml／kg) 脂多糖(LPS，1mg／kg)；丹参组：复方丹参注射液(5ml／kg) LPS(1mg／kg)；生脉组：生脉注射液(5ml／kg) LPS(1mg／kg)；联合用药组：复方丹参注射液(2，5ml／kg) 生脉注射液(2．5ml／kg) LPS(1mg／kg)。行血常规、血清TNF-α和IL-6水平检测，并行肝、肺及肾脏组织的病理组织学检查。结果丹参注射液及生脉注射液均能明显降低LPS腹腔注射后的血清TNF-α和IL-6水平，下调过高的炎症反应，并减轻肝、肺、肾等器官的损害．使SIRS大鼠48h存活率明显提高。结论本实验为丹参、生脉的抗SIRS临床应用提供了理论基础。     

高渗盐水和6%HES溶液对犬术后细胞因子的影响

目的 观察高渗盐水(7.5%NaCl溶液)、6%HES溶液(羟乙基淀粉溶液)对腹部手术后犬血清细胞因子分泌的影响.方法 18只麻醉犬全麻下行腹部手术后随机分成3组,输注不同液体并同时予以控制血压至基础值的60%(MAP65mmHg):4ml/kg 7.5%NaCl溶液(HS组);输注15ml/kg 6%HES溶液(HES组);C组(对照组)单纯降压组.在麻醉开始前(B),手术开始2小时(T1),液体输注完2小时(T2),术后第1天(T3),第2天(T4)抽取颈外静脉血3ml,检测血清中IL-2,IL-6,IL-8,IL-10,TNF-α的浓度.结果 对照组:各前炎因子TNF-α、IL-2、IL-6、IL-8随时间逐渐上升,至T3达到高峰,T4明显下降,但仍显著高于正常值(P＜0.05).HS组和HES组TNF-α、IL-2、IL-6、IL-8在T3时均明显低于对照组,T4时由低到高依次为,HS组、HES组、对照组.HS组术后的IL-10水平升高,在T3达到最高值22.5 mmol/L,高于对照组(P＜0.05).结论 HS溶液与6%HES溶液均可抑制腹部手术后犬致炎因子IL-2、IL-6、IL-8、TNF-α的升高.HS溶液还可使抗炎因子IL-10分泌增加,减轻术后的炎症反应.     

氟比洛芬酯对喉癌喉裂开术患者围术期细胞因子及术后疼痛的影响

目的 观察氟比洛芬酯对喉癌喉裂开术患者术后疼痛及围术期细胞因子的影响.方法 择期行喉癌喉裂开术患者60例,随机均分为三组:术毕前10 min分别静脉注射氟比洛芬酯1.0mg/kg(F<,1>组)、氟比洛芬酯1.5 mg/kg(F<,2>组)、生理盐水5 ml(C组).VAS评分评定术后1、2、4、68、12、24 h的疼痛程度.监测术前、术毕和术后6、24 h血浆白细胞介素(11)-2、可溶性白细胞介素-2受体(SIL-2R)、IL-6、IL-10的浓度.结果 与术前比较,C组SIL-2R水平在术后6 h明显降低、术后24 h明显升高;F<,1>、F<,2>组SIL-2R水平明显降低;三组IL-6、IL-10水平明显升高和IL-2水平明显降低(P<0.05).与C组比较,术后1、2、4 h时F<,2>组VAS明显降低,术后4 h时F<,1>组VAS明显降低(P<0.05);术后6、24 h时F<,1>、F<,2>组的IL-10水平和术后24 h时的IL-2水平明显升高,且F<,2>组明显高于F<,1>组(P<0.05);F<,1>、F<,2>组在术后6 h时的IL-6水平和术后6、24 h时SIL-2R水平明显降低,且F<,2>组明显低于F<,1>组(P<0.05).结论 1.5 nag/kg氟比洛芬酯能有效地平衡细胞因子,缓解术后的免疫损伤,具有免疫保护作用.     

短疗程糖皮质激素对原发性胃癌病人术后并发症及炎性细胞因子的影响

目的分析短疗程糖皮质激素对原发性胃癌病人术后并发症及炎症细胞因子的影响。方法因胃癌行腹腔镜辅助下胃部分切除术病人96例,随机分为对照组和治疗组。对照组术前术后采用常规治疗方案,治疗组在常规治疗的基础上加用静滴糖皮质激素(甲泼尼龙)每天1mg/kg,连用3天,后减半量使用2天后停药。比较两组病人术后并发症及住院情况,术前及术后1天、3天、7天血清白细胞介素(IL-6)、肿瘤坏死因子(TNF-α)、超敏C反应蛋白(hs-CRP)含量变化。结果对照组和治疗组术后胃排空障碍发生率分别为12. 5%和2. 1%、肠梗阻分别为14. 6%和2. 1%、吻合口漏分别为8. 3%和0,住院时间分别为(15. 52±3. 00)天和(13. 27±1. 54)天;术后第1天血清中IL-6分别为(109. 40±14. 48) pg/ml和(81. 59±12. 61) pg/ml,TNF-α分别为(52. 92±11. 67) pg/ml和(39. 16±11. 67) pg/ml,hs-CRP分别为(29. 56±4. 12) mg/ml和(22. 27±4. 61) mg/ml;第3天血清中IL-6分别为(93. 34±14. 19) pg/ml和(70. 19±12. 00) pg/ml,TNF-α分别为(44. 95±1. 55) pg/ml和(29. 99±1. 29) pg/ml,hs-CRP分别为(25. 58±1. 04) mg/ml和(18. 11±0. 47) mg/ml;第7天血清中IL-6分别为(83. 52±13. 99) pg/ml和(55. 74±11. 80) pg/ml,TNF-α分别为(34. 65±5. 44) pg/ml和(21. 85±4. 15) pg/ml,hs-CRP分别为(21. 11±3. 84) mg/ml和(14. 81±3. 38) mg/ml,两组比较差异均有统计学意义(P 0. 05)。结论原发性胃癌病人术后给予短疗程糖皮质激素可缩短住院时间,减少手术相关并发症,其机制可能与减少了血液中IL-6、TNF-α等炎症细胞因子以及C反应蛋白的表达有关。     

两种不同晶体液预扩容对剖宫产术后炎性反应的影响

目的探讨两种不同晶体液预扩容对剖宫产术产妇术后炎性反应的影响。方法选择择期剖宫产产妇60例,随机双盲分为复方乳酸钠组(RL组)和复方醋酸钠组(RA组),每组30例。麻醉前10 ml/kg晶体液预扩容,输液速率15~20 ml·kg-1·h-1。取左侧卧位行腰-硬联合麻醉。术中持续输入相应晶体液。分别在开始输液时(T1)、手术结束时(T2)、手术后4 h(T3)、24 h(T4)抽取静脉血,检测产妇血清中IL-6、TNF-α和CRP水平。结果 T1、T4时两组产妇CRP、IL-6和TNF-α水平差异无统计学意义。T2、T3时RA组CRP、IL-6和TNF-α水平明显高于RL组(P0.05)。结论复方醋酸钠导致产妇术后炎性因子释放的作用明显强于复方乳酸钠。     

胃癌根治术中自体输血病人围术期血清新喋呤和白细胞介素-2浓度的变化

目的探讨自体输血胃癌根治术病人围术期血清新喋呤、白细胞介素-2(IL-2)浓度的变化。方法拟行胃癌根治术病人60例,随机分为2组:异体输血组(H组)术中输异体全血400 ml;自体输血组(A组)麻醉诱导后采集自体血400ml,同时输入琥珀酰明胶500ml,术中将采集的自体血进行回输。分别于麻醉诱导前(术前)、术毕拔管后(术毕)、术后第5天抽取静脉血,用ELISA法检测血清新喋呤和IL-2浓度。结果与术前比较,H组术毕和术后第5天时血清新喋呤、IL-2浓度降低,A 组术毕血清新喋呤浓度降低(P<0.05或0.01),术后第5天时恢复至术前水平,IL-2浓度无明显变化(P>0.05)。与H组比较,A组术毕和术后第5天时血清新喋呤浓度升高,IL-2浓度术后第5天时升高(P<0.01)。H组和A组新喋呤和IL-2浓度的相关系数分别为0.071和-0.29(P>0.05)。结论自体输血对胃癌根治术病人术后机体细胞免疫功能抑制较轻,与IL-2相比,血清新喋呤可更敏感的反映病人术后免疫功能。     

氯诺昔康伍用芬太尼对妇科手术后炎症反应的影响

目的观察氯诺昔康伍用芬太尼用于妇科手术后镇痛对炎症反应的影响。方法择期行妇科手术患者40例,随机分为氯诺昔康术后镇痛组(Ⅰ组)和芬太尼术后镇痛组(Ⅱ组),Ⅰ组于手术后以芬太尼10μg/kg、氯诺昔康0.8mg/kg加入生理盐水稀释至100ml,加入一次性镇痛泵行术后患者静脉自控镇痛(PCIA);Ⅱ组手术后以芬太尼15μg/kg加入生理盐水稀释至100ml,PCIA泵行术后镇痛。分别于术前(T0)、术后第1天(T1)、第3天(T2)测肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)浓度及WBC。结果两组术后疼痛视觉模拟评分(VAS)比较差异无统计学意义;Ⅰ组T2时白细胞数、中性细胞数、单核细胞数明显低于Ⅱ组(P<0.05);两组T1、T2时IL-6均较T0时显著升高(P<0.01),但Ⅰ组IL-6明显低于Ⅱ组(P<0.05);T1时两组IL-10明显升高(P<0.01),Ⅰ组明显高于Ⅱ组(P<0.05)。结论氯诺昔康伍用芬太尼用于妇科手术后镇痛可减轻术后机体的炎症反应。     

沐舒坦不同雾化剂量在气管切开早期气道管理中的实验研究

目的探讨沐舒坦不同雾化剂量在气管切开早期对气道的保护作用。方法以家兔气管切开为研究模型,将24只家兔随机均分成对照组(雾化吸入0.9%氯化钠注射液5ml/d)、实验1组(沐舒坦2mg/kg加入0.9%氯化钠注射液配制成5ml雾化液,雾化吸入5ml/d)、实验2组(沐舒坦5mg/kg加入0.9%氯化钠注射液配制成5ml雾化液,雾化吸入5ml/d),雾化流量2L/min,4次/d,雾化7d后检测痰液黏稠度、支气管肺泡灌洗液TNF-α和IL-8水平及黏膜损伤情况。结果三组家兔雾化后痰液黏稠度、TNF-α及IL-8水平、黏膜损伤面积比例比较,差异有统计学意义(均P0.01),实验2组显著低于其他两组(均P0.01)。结论气管切开早期采用5mg/(kg.d)沐舒坦雾化剂量,能发挥抑制炎性因子表达的特殊作用,有效抑制气管切开早期气道的黏膜高分泌和高炎症状态。     

肺保护性通气可减轻轻中度慢性阻塞性肺疾病老年患者围术期肺部感染

目的探讨肺保护性通气对全麻轻中度慢性阻塞性肺疾病(COPD)老年患者围术期肺部感染的影响。方法选择择期行全麻上腹部手术的轻中度COPD老年患者40例,男24例,女16例,年龄65~81岁,ASAⅠ~Ⅲ级,BMI 19~28kg/m~2,采用随机数字表分为肺保护性通气组(PV组)和常规通气组(CV组),每组20例。PV组行肺保护通气:IPPV,V_T 6ml/kg,PEEP 5~10cm H_2O,每隔30分钟进行手法肺复张;CV组行常规通气:IPPV,V_T 10 ml/kg,不使用PEEP及肺复张。于麻醉诱导前(T_1)、机械通气后2h(T_2)、术毕时(T_3)、术后6hT_4)和24h(T_5)采集静脉血检测IL-6和IL-8的浓度;记录麻醉前、术后第1、3、5、7天的临床肺部感染评分(CPIS)和术后肺部炎症发生情况。结果两组患者年龄、BMI、ASA分级、术中输液量、出血量、尿量、机械通气时间、手术方式、T_1~T_5时IL-6和IL-8浓度组间差异均无统计学意义。与T_1时比较,T_2~T_5时两组IL-6和IL-8浓度明显升高(P0.05)。与麻醉前比较,术后第1、3、5天CV组CPIS评分和术后肺部炎症发生率明显升高(P0.05);术后第1、3、5天PV组CPIS评分明显低于CV组(P0.05)。结论肺保护性通气不能降低开腹手术轻中度COPD老年患者围术期IL-6和IL-8浓度,但是可减少术后肺部炎症的发生,减轻术后5d内的肺部感染。     

丹参对低温保存小肠的保护作用

目的:观察丹参对低温保存小肠的保护作用。方法:23只杂种猪分成4组,Ⅰ组(6只),Euro-collins(EC)液保存供肠;Ⅱ组(5例),获取小肠前供体给予复方丹参注射液1.0ml/kg;Ⅲ组(6例),EC液 丹参注射液(20ml/L)保存供肠;Ⅳ组(6例),EC液保存供肠,血管再通时受体给予丹参注射液(1.0ml/kg),供肠保存24小时后自体移植。结果:Ⅱ、Ⅲ组移植小肠组织损伤轻,肠粘膜能量物质(ATP)含量、Na~ -K~ ATP酶和肠粘膜双糖酶活性高于Ⅰ、Ⅳ组小肠。结论:丹参具有减轻低温保存小肠组织损伤的作用。     

小儿和成年患者全麻时瑞芬太尼药代动力学的比较

目的 比较小儿和成年患者全麻时瑞芬太尼的药代动力学.方法 择期全麻患者,ASA分级Ⅰ或Ⅱ级,根据年龄不同分为2组(n=8):成年组(年龄19～60岁,体重45～81 kg)和小儿组(年龄10月～7岁,体重7.2～21.0 kg).麻醉诱导时静脉注射瑞芬太尼5 μg/kg,于注射后1、2、3、5、7、10、15、20、25、30、45、60 min时分别采集上肢动脉血样1.0 ml,采用液-液萃取毛细管气相色谱-质谱法测定瑞芬太尼的血药浓度,应用3P97药理学程序软件计算药代动力学参数.结果 与成年组比较,小儿组消除半衰期缩短,表观分布容积和清除率升高(P<0.05),其余药代动力学参数差异无统计学意义(P>0.05).结论 小儿和成年患者全麻时瑞芬太尼药代动力学存在差异,应用相同剂量后小儿较成年患者血药浓度偏低,应适当增加剂量.

Abstract：

Objective To compare the pharmacokinetics of remifentanil during general anesthesia in children and adults.Methods Eight children(4 male,4 female)and 8 adults(4 male,4 female),undergoing elective operation under general anesthesia,were randomly divided into 2 groups(n=8 each):group adults(aged 19-60 yr,weighing 45-81 kg)and group children(aged 10 months-7 yr,weighins 7.2-21.0 kg).Remifentanil 5μg/kg was injected intravenously during induction of anesthesia.Arterial blood samples 1.0 ml were taken at 1,2,3,5,7,10,15,20,25,30,45 and 60 min after injection for determination of the plasma concentrations of remifentanil.The pharmacokinetic parameters were calculated using software 3P97.Results Elimination half-life was significantly shorter and apparent volume of distribution and clearance were significantly greater in children than in adults(P<0.05),while no significant change was found in the other pharmacokinetic parameters between the two groups(P>0.05).Conclusion There is difference in the pharmacokineties of remifentanil during general anesthesia between children and adults.The plasma concentration of remifentanil is lower in children than in adults after using the same dose,and the dose should be increased appropriately.     

术前静脉输注6%羟乙基淀粉200/0.5溶液对患者术后免疫功能的影响

目的 探讨术前静脉输注6%羟乙基淀粉(HES)200/0.5溶液对患者术后免疫功能的影响.方法 择期胆囊切除术患者40例,年龄21～58岁,体重47～79 kg,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=20):6%HES 200/0.5组(H组)和复方醋酸钠组(A组).麻醉诱导前经15 min静脉输注6%HES 200/0.5溶液或复方醋酸钠溶液10 ml/kg.于术前、术后1 h、术后1和3 d时取静脉血样,测定血清IL-6、IL-8、TNF-α、IL-2和IL-10以及IgG、IgA和IgM的浓度.结果 与术前比较,两组患者术后血清IL-6、IL-8、TNF-α、IL-2和IL-10浓度均升高,A组术后血清IgA和IgG浓度降低(P＜0.05或0.01),IgM浓度差异无统计学意义,H组上述指标差异无统计学意义(P＞0.05);与A组比较,H组术后血清IL-6、IL-8和TNF-α浓度降低,IL-2、IL-10、IgA和IgG浓度升高(P＜0.05).结论 术前静脉输注6%HES 200/0.5溶液可改善患者术后的免疫功能.

Abstract：

Objective To investigate the effect of 6 % hydroxyethyl starch (HES) 200/0.5 infusion before operation on postoperative immne function in patients. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 21-58 yr weighing 47-79 kg were randomly divided into 2 groups ( n = 20 each): 6% HES 200/0.5 group (group H) and compound sodium acetate group (group A). 6% HES 200/0.5 10 ml/kg or compound sodium acetate solution was infused intravenously over 15 min before anesthesia induction. Anesthesia was induced with iv injection of propofol, fentanyl and vecuronium and maintained with target-controlled infusion of propofol and infusion of remifentanil. Venous blood samples were collected before operation and at 1 h, 1 day and 3 days after operation to detect the serum concentrations of IL-6, IL-8, TNF-α, IL-2, IL-10, IgG, IgA andIgM. Results Serum concentrations of IL-6, IL-8, TNF-α, II-2 and IL-10 were significantly higher after operation in the two groups, and serum concentrations of IgA and IgG were significantly lower after operation in group A than those before operation ( P ＜ 0.05 or 0.01 ). Serum concentrations of IL-6, IL-8 and TNF-α were significantly lower, while serum concentrations of IL-2, IL-10, IgA and IgG were significantly higher after operation in group H than in group A ( P ＜0.05). Conclusion Preoperative infusion with 6% HES 200/0.5 can improve the immune function after operation in patients.     

Injectable midazolam as oral premedicant in pediatric neurosurgery

In a randomized, double blind, placebo controlled study; the acceptability, efficacy and safety of injectable midazolam as oral premedicant in children was evaluated. One hundred children (ASA 1,2) aged 6 months to 6 years, undergoing elective neurosurgical operations, like meningomyelocele, meningo-encephalocele, ventriculo peritoneal and other shunts and craniotomies for tumour decompression etc., were included in the study. The patients were randomly assigned to one of four groups (A, B, C, D) receiving respectively saline or 0.50, 0.75 and 1.0 mg/kg midazolam in honey, 45 min before separation from parents. All received identical general anesthesia (GA). Age, sex, weight, heart rate, blood pressure, respiratory rate, saturation (SaO2), reaction to parent's separation, sedation score and duration of anesthesia, recovery conditions and side effects were noted.We found no difference in age, sex, weight, patient acceptability vomiting after ingestion and duration of anesthesia between groups. Even though many children resisted the placement of premedicant in the mouth, only three children spat it out and none vomited after swallowing. The reaction to separation from parents was better after midazolam premedication. However, on reaching the operating room, 24% children (placebo-60%) were found anxious after 0.50 mg/kg, but 12% were deeply sedated after a dose of 1.0 mg/kg. Recovery was similar in groups A, B and C except that more (48%) patients were anxious in group A. Recovery, however was delayed in 16% patients of group D. Though, fewer complications were reported during recovery after midazolam than placebo premedication, they were minimal in the 0.75 mg/kg group.We concluded that giving injectable midazolam orally as premedication in pediatric age group scheduled for neurosurgical operations is acceptable, effective and safe in 0.75 mg/kg dose. While 0.50 mg/kg is less effective, 1.0 mg/kg does not offer any additional benefit over 0.75 mg/kg but does delay recovery and may compromise safety.     

体外循环心内直视手术补钾用量及方法研究

目的为防治心内直视手术后低血钾室颤心脏骤停,寻求合理的补钾用量及方法。方法对３１６例体外循环手术患者采取３种不同补钾方法及用量：（１）２１例先心病人按＜０．５ｍｍｏｌ／ｋｇ,３０例风心瓣膜病人按０．５～１ｍｍｏｌ／ｋｇ预补钾总量１次加入预充液。（２）９０例按１～１．５ｍｍｏｌ／ｋｇ预补钾总量分２～３次加入预充液。第１次将预补量的６０％加入预充液,余量分次加入氧合器内。（３）１５４例按１．６～２．０ｍｍｏｌ／ｋｇ和２１例风心瓣膜病术前血清钾均＜３．８ｍｍｏｌ／Ｌ,按２．１ｍｍｏｌ／ｋｇ预补钾总量的２／３～４／５加入预充液,余量加入５％ＮａＨＣＯ３内,转流３０分钟后持续氧合器内点滴,视尿量多少调整点滴速度,当排尿＞１０００ｍｌ时,每排尿＞５００ｍｌ追加钾１ｇ。结果方法１组在主动脉开放时血清钾＞４．１ｍｍｏｌ／Ｌ者１９．４％,方法２组主动脉开放时血清钾＞４．１ｍｍｏｌ／Ｌ者为３７．７％者,方法３组主动脉开放时血清钾＞４．１ｍｍｏｌ／Ｌ者９４．９％。结论方法１、２组用量不足方法也不完善,方法３组用量合理,方法较完善     

Efficacy of an epidural test dose in children anesthetized with halothane

The effect of an intravenous (iv) injection of lidocaine with epinephrine was studied to determine if such a test dose would cause a reliably detectable increase in heart rate and systemic blood pressure in children anesthetized with halothane and nitrous oxide. The effect of the injection of atropine before the test dose on these parameters was also determined. Sixty-five children 1 month to 11 yr of age and weighing 3.9-35 kg were studied. The children were assigned to one of four groups, each of which was anesthetized with 1% halothane and 50% nitrous oxide. Group 1 (n = 20) received 10 micrograms/kg atropine followed 5 min later by an iv dose of 0.1 ml/kg 1% lidocaine with 1/200,000 epinephrine (0.5 micrograms/kg) to simulate an intravascularly administered epidural test dose. Group 2 (n = 21) was identical to group 1 but did not receive atropine prior to the simulated intravascular test dose. Groups 3 (n = 12) and 4 (n = 11) were identical to groups 1 and 2, but the simulated intravascular test dose did not contain epinephrine: group 3 received atropine prior to the test dose and group 4 did not. The simulated intravascular test dose increased heart rate in group 1 (with atropine) at each time period from 15 to 120 s, but only at 45 and 60 s in group 2 (without atropine). Following the iv test dose, 6 of 21 children in group 2 had an increase in heart rate of less than 10 beats/min, while only one child in group 1 had an increase in heart rate of less than 10 beats/min. Intravenous test doses that did not contain epinephrine (groups 3 and 4) had no effect on heart rate or blood pressure. Atropine, 10 micrograms/kg, improves the reliability of an epidural test dose in children anesthetized with halothane and nitrous oxide but does not ensure total reliability in detecting an intravascular injection.     

吗啡对小鼠血清IL-6和NK细胞活性的影响

目的 探讨不同剂量吗啡对小鼠血清IL－6、NK细胞活性的影响。方法 选择BABL／C小鼠,随要分组。第一部分为6组,其中4组分别注射不同剂量的吗啡,另2组为完全空白对照组,生理盐水对照组,第二部分将小鼠分为5组,1－4组先注射不同剂量纳洛酮,15min后每组半数小鼠注射纳洛酮（30mg/kg）,余下的半数小鼠注射生理盐水。第5组是小鼠先注射吗啡（30mg/kg),15min后注射纳洛酮（1mg/kg)。检测血清IL－6、NK细胞活性、脾细胞cAMP含量。结果 第一部分：与对照组相比：①腹腔注射吗啡100mg/kg使IL－6明显增加;②3mg/kg吗啡即可使小鼠的NK细胞活性明显降低;③腹腔注射吗啡30mg/kg、100mg/kg使小鼠cAMP明显降低。第二部分：①注射纳洛酮和吗啡与同浓度纳洛酮加生理盐水组相比,IL－6含量没有明显改变;②纳洛酮0．1mg/kg不能拮抗吗啡NK细胞活性的抑制;而纳洛酮1.0mg/kg,10mg/kg能增加NK细胞的活性,但与对照组相比没有明显差别;③纳洛酮1.0mg/kg,10mg/kg可拮抗吗啡对cAMP的抑制作用;④不同注射顺序吗啡和纳洛酮的对IL－6和cAMP无影响,但先注射吗啡,后注射纳洛酮对NK活性的抑制较轻。结论 吗啡对小鼠的免疫功能的调节作用,大剂量使IL－6含量明显增加,纳洛酮没有明显的拮抗作用;小剂量吗啡即可使NK细胞活性受到抑制,且呈剂量依赖性,但纳洛酮不能反转抑制;cMAP降低呈吗啡剂量依赖性,纳洛酮对此拮抗作用,也呈剂量依赖性。后注射纳洛酮对NK细胞活性抑制要明显低于先注射纳洛酮组。     

Effect of oral liquids and ranitidine on gastric fluid volume and pH in children undergoing outpatient surgery

Eighty-eight children (mean age 5.6 yr, range 1-14 yr) about to undergo elective outpatient surgery were randomly assigned to four groups. All children were given phenolsulfonphthalein (PSP) orally 2-3 h before the scheduled time of surgery as a marker dye to assess gastric emptying. Immediately after receiving PSP they were given: group A--liquids, up to 5 ml/kg + placebo (glucose water 0.2 ml/kg); group B--liquids, up to 5 ml/kg + ranitidine 2 mg/kg in glucose water 0.2 ml/kg; group C--placebo only; group D--ranitidine only. Gastric contents were aspirated after induction of anesthesia. Mean volume (range) in ml/kg of aspirated gastric fluid in each group was: group A--0.34 (0-1.0); group B--0.17 (0.07); group C--0.25 (0-1.1); group D--0.16 (0-0.6). The pH mean (range) value was: group A--1.83 (0.9-3.6); group B--4.76 (2.0-7.7); group C--2.10 (1.2-4.1); group D--3.97 (1.3-7.3). PSP could not be detected in the gastric samples from children in whom the ingestion-sampling interval was more than 2.25 h. In comparison with prolonged starvation, administration of oral liquids without ranitidine 2-3 h preoperatively did not produce a significant increase in mean volume of gastric aspirate, and there was no increase in the number of patients with gastric aspirate greater than 0.4 ml/kg. Administration of ranitidine with or without fluids resulted in a decrease in both volume and acidity of gastric contents.     

关节内注射复方倍他米松对兔佐剂性关节炎的效果

目的评价关节内注射复方倍他米松对兔佐剂性关节炎的效果。方法日本大耳白兔，雌雄各半，体重2～3kg，6～8月龄。采用皮内注射卵清蛋白＋非完全弗氏佐剂的方法制备佐剂性关节炎模型。佐剂性关节炎模型制备成功的48只免随机分为2组（n=24），C组双膝关节内各注射生理盐水1ml；D组注射复方倍他米松0．5mg／kg。每组各随机取6只兔，持续观察膝关节外观，分别于治疗前、治疗后2周测量髌骨上缘处双膝周径，并测定膝关节灌洗液中一氧化氮（NO）浓度，治疗后2周处死兔，打开膝关节，观察关节腔内改变，取髌上囊处滑膜，光镜下观察病理学改变。2组分别于治疗后1、2、3d各随机处死6只兔，取髌上囊滑膜，观察细胞凋亡情况。结果与c组比较，治疗后D组关节滑膜炎性反应较轻，NO浓度降低（P〈0．01）；治疗后2、3d滑膜细胞凋亡率升高（P〈0．05或0．01）。结论膝关节内注射复方倍他米松0．5mg／kg对免佐剂性关节炎有抗炎作用，可能与抑制NO的合成及促进滑膜细胞凋亡有关。     

Haemodynamic effects of propofol in children

The haemodynamic effects of induction of anaesthesia with propofol in children were studied. Two hundred and sixteen children (ASA 1) were randomly allocated to receive one of six different doses of propofol, from 1.6 mg/kg to 2.6 mg/kg, in 0.2 mg/kg increments. Noninvasive measurement of blood pressure showed that mean arterial pressure was reduced by approximately 15% after 1 minute, and by 30% after 5 minutes. The reduction in pulse rate over a 5-minute period was approximately 17%. These changes were similar in each group, regardless of the dose administered. The propofol was mixed with lignocaine, 0.5 mg/ml, and the incidence of pain on injection into a vein on the dorsum of the hand was 24%. We conclude that, within the dose range of our study, the haemodynamic disturbance after induction of anaesthesia with propofol in children is not dose related.