七氟醚低流量满刻度洗入紧闭麻醉法在小儿手术中的应用

目的 探讨七氟醚低流量满刻度洗入、低流量洗出紧闭麻醉法用于小儿手术的可行性.方法 选择耳鼻喉、口腔及眼科择期短小手术患儿90例,2～14岁,ASA Ⅰ或Ⅱ级,静脉快速诱导后气管内插管,随机均分为三组,分别以0.3 L/min(0.3组)、0.6 L/min(0.6组)和1.0 L/min(1.0组)的氧流量满刻度洗入,肺泡气七氟醚浓度(FAsev)达到1.3 MAC后蒸发器刻度改为3%～8%,0.2～0.3 L/min氧流量维持.在手术结束前12 min关闭蒸发器,以0.3 L/min的氧流量洗出;手术结束时以5 L/min的氧流量快速洗出.结果 各组麻醉期间的血流动力学稳定,术中术后各组均未见并发症.0.3组的维持期耗约量[(1.54±0.70)ml]明显少于1.0组[(2.14±1.10)ml](P＜0.05),0.3组的洗入时间[(10.23±4.22)min]明显长于0.6组[(4.17±1.02)min]和1.0组[(2.70±0.88)min](P<0.05).结论 七氟醚低流量满刻度洗入、低流量洗出紧闭麻醉法用于小儿手术安全、有效、可行,可更大程度的节约麻醉药、减少对环境的污染,并能解决低流量麻醉早期不能向环路释放足够麻醉药这一问题.     

地氟醚低流量洗入紧闭环路麻醉的摄取规律

目的 研究地氟醚高浓度、低流量洗入时的摄取规律。方法 择期全麻下行上腹部手术的ASA I-Ⅱ级患者80例,随机分为A、B两组,洗入期:A组新鲜气流量为:氧气0.7 L/min;B组新鲜气流量为:氧气0.4 L/min,氧化亚氮 0.3 L/min。两组Tec-6地氟醚蒸发器刻度均为18％。维持期:两组新鲜气流量均不变,蒸发器刻度均改为8％。结果 A组平均洗入时间为（4.56±0.68）min,B组平均洗入时间为（4.05±0.52）min,二者无统计学差异（P>0.05）。两组间各时点 FA/FI均无显著差异（P>0.05）。结论 低流量洗入地氟醚、氧化亚氮时,氧化亚氮并不影响地氟醚的体内摄取过程。地氟醚低流量洗入紧闭环路麻醉安全可行。     

七氟醚中、低流量紧闭麻醉与双频指数监测下低流量紧闭麻醉的比较

目的 比较七氟醚中流量、低流量及双频指数监测下低流量循环紧闭麻醉,以探讨七氟醚的应用方法。方法 96例ASA Ⅰ～Ⅱ级择期全麻手术病人,随机分为三组,A组:中流量循环紧闭麻醉,氧流量1000 ml/min;B组:低流量循环紧闭麻醉,氧流量500 ml/min;C组:双频指数监测下低流量循环紧闭麻醉,氧流量500ml/min。各组均以七氟醚环路内吸入维持麻醉。A、B两组根据临床麻醉体征和手术刺激情况调节七氟醚浓度,C组根据BIS值调节七氟醚浓度。结果 A组、B组和C组呼气末七氟醚维持浓度分别为(1.4±0.2)MAC、(1.1±0.2)MAC和(0.8±0.2)MAC水平;七氟醚总耗量分别为(13.3±1.6)m1/h、(9.6±1.5)ml/h和(7.5±1.8)ml/h,C组七氟醚总耗量最低(P<0.01);苏醒时间分别为(14.3±3.3)min、(10.5±2.8)min和(7.5±2.6)min;意识恢复时间分别为(24.5±6.1)min、(17.4±5.5)min和(12.7±4.8)min,c组苏醒时间和意识恢复时间最快;恶心呕吐发生率分别为14.5％±2.6％、10.1％±2.3％和7.5％±2.1％,c组恶心呕吐发生率最低。结论 双频指数监测下七氟醚低流量循环紧闭麻醉具有节约麻醉药,苏醒时间短和恶心呕吐发生率低的优点,是一种良好的麻醉方法。     

半紧闭麻醉时氧流量对异氟醚吸入和呼出浓度的影响

目的 研究半紧闭麻醉时不同氧流量对异氟醚吸入和呼出浓度的影响。方法 60例静吸复合麻醉腹部手术病人随机分为氧流量2L/min和3L/min两组,挥发器开启浓度均为2％,辅助用丙泊酚和芬太尼维持适当麻醉深度。用Datex AS/3监测仪监测异氟醚吸入浓度(FI)和呼气末浓度(FA)。结果 开始吸入异氟醚的2～5 min内,FI和FA均上升迅速,以后上升速度减慢,3L/min组FI和FA均高于2L/min组。两组FA/FD随时间变化趋势一致,但氧流量3L/min组明显高于2L/min组,而FA/FI两组无明显差异。氧流量2L/min和3L/min组达到FA)_(MAC)时间分别为6.5和6.2min,达到FI_(max)时间3L/min组显著短于2L/min组(P<0.01),而达到FA_(max)时间两组间无显著性差异。结论 半紧闭麻醉时,氧流量增加使异氟醚FI、FA及FA/FD增加,而对机体摄取异氟醚的速率无影响。     

紧闭法吸入麻醉的不同洗入流量对环境污染的影响

目的探讨使用紧闭法吸入麻醉的不同洗入流量的可行性；通过环路外气体采样分析，寻找泄漏值及对环境污染最小的洗入方法；探讨使用不同吸入麻醉药异氟醚（ISO）、七氟醚（SEV）不同洗入方法对环境的影响。方法选择60例病人，ASAⅠ～Ⅱ级，随机分为六组：ISO0．3、ISO1．0、ISO5．0组和SEV0．3、SEV1．0、SEV5．0组，每组10例。各组均洗入达到1．3MAC后停止洗入，进入维持阶段。ISO0．3组：在氧流量为0．3L／min的情况下以蒸发罐的最高刻度5洗入。ISO1．0组：在氧流量为1L／min、蒸发罐刻度为3时洗入。ISO5．0组：在氧流量为5L／min、蒸发罐刻度为1．5（1．3MAC）时洗入。SEV0．3组：在氧流量为0．3L/min的情况下以蒸发罐的最高刻度8洗入。SEV1．0组：在氧流量为1L／min、蒸发罐刻度为4时洗入。SEV5．0组：在氧流量为5L／min、蒸发罐刻度为2．2（1．3MAC）时洗入。术中均以全紧闭法（氧流量为0．25L／min～0．3L／min）维持。于麻醉前、洗入后、术中、术后、离开术间时分别采集废气口（A）、病人头部（B）、检测仪处（C）、病人足部（D）、检测仪对侧（E）环境中气体进行分析。结果采用1．0L／min洗入时，在各采样点及不同时间段异氟醚、七氟醚的泄漏值无显著差别。采用5．0L／min洗入时，于洗入后废气口处异氟醚、七氟醚的泄漏值分别为（1．470±0．940）ppm和（1．998±0．633）ppm，明显高于其他布点（P〈0．05）；采用1．0L／win洗入时，在各采样点及不同时间段异氟醚、七氟醚的泄漏值无显著差别。采用5．0L／min洗入时，于洗入后废气口处异氟醚、七氟醚的泄漏值分别为（1．470±0．940）ppm和（1．998±0．633）ppm，明显高于其他布点（P〈0．05）。结论采用高浓度低流量洗入法行异氟醚、七氟醚麻醉时，环境中吸入麻醉药浓度均小于2ppm，可安全应用于临床；0．3L／min氧流量高刻度洗入法对环境污染最小；以1．0L／min氧流量洗入时在不同时段、不同布点对环境污染程度无统计学差异；以5．0L／min氧流量洗入时在不同时段、不同布点对环境污染程度有统计学差异。     

脑电双频指数监测下18%地氟醚低流量洗入紧闭麻醉法的应用

目的脑电双频指数（BIS）监测下探讨18%地氟醚低流量洗入、低流量洗出紧闭麻醉法的可行性。方法选择ASAⅠ或Ⅱ级行腹腔镜下胆囊切除术患者120例,男47例,女73例,静脉快速诱导,5L/min氧流量充分吸氧去氮3min,气管插管,随机均分为三组,气管插管后分别以0.3L/min（A1组）、0.6L/min（A2组）和1.0L/min（A3组）氧流量,地氟醚蒸发器刻度为18%洗入到肺泡气地氟醚浓度(F_Ades)达到1MAC,将蒸发器刻度降至10%～12%维持,维持期氧流量为0.3L/min,在手术结束前约10min停止吸入地氟醚开始洗出,洗出期的氧流量根据手术速度、BIS、BP及HR情况调整,手术结束时改为5.0L/min氧流量洗出。结果所有患者从静脉诱导后到手术结束BIS均在30～60,三组麻醉期间的BP、HR变化均在基础值的±20%范围内,SpO₂始终维持在97%～100%,FiO₂均高于75%,术中术后均未出现并发症。A1组洗入时间明显长于A2组和A3组（P<0.05）。结论 18%地氟醚低流量洗入、低流量洗出紧闭麻醉法是一种安全、有效、可行、低污染的麻醉方法。     

Sodasorb(R)LF降解七氟醚生成化合物A的临床研究

目的 测定七氟醚与Sodasorb(R)LF反应生成的化合物A含量.方法 30例 ASA Ⅰ或Ⅱ级行七氟醚全身麻醉的掸期手术病人随机均分为三组,吸入氧气的流量分别为2 L/min(A组)、0.5 L/min(B组)和0.3 L/min(C组).七氟醚呼气末浓度均为1 MAC.分别在0(七氟醚呼气末浓度到达1 MAC时)、1和2 h从回路中抽取气体样本,以气相色谱法测定其中的化合物A含量,并同时测定吸收剂温度和含水量.结果 各组均未测出化合物A的含量.结论 气相色谱法检测不到七氟醚与 Sodasorb(R)LF反应牛成化合物A.     

Sodasorb~LF降解七氟醚生成化合物A的临床研究

目的测定七氟醚与SodasorbLF反应生成的化合物A含量。方法30例ASAⅠ或Ⅱ级行七氟醚全身麻醉的择期手术病人随机均分为三组,吸入氧气的流量分别为2L/min(A组)、0.5L/min(B组)和0.3L/min(C组)。七氟醚呼气末浓度均为1MAC。分别在0(七氟醚呼气末浓度到达1MAC时)、1和2h从回路中抽取气体样本,以气相色谱法测定其中的化合物A含量,并同时测定吸收剂温度和含水量。结果各组均未测出化合物A的含量。结论气相色谱法检测不到七氟醚与SodasorbLF反应生成化合物A。     

患者低流量吸入地氟醚或异氟醚的药代动力学

目的比较腹部手术患者低流量吸入地氟醚或异氟醚的药代动力学。方法腹部手术患者40例,ASAⅠ级或Ⅱ级,年龄18～64岁,BMI＜35kg/m^2。随机分为2组（n=20）：地氟醚组（D组）和异氟醚组（Ⅰ组）。麻醉诱导后调节纯氧流量3L/min,术中调整挥发罐刻度,维持肺泡浓度（FA）0．8 MAC,稳定5min后纯氧流量改为1L/min。调节瑞芬太尼静脉输注速率,维持HR和BP波动幅度不超过基础值20%。手术结束时,停止吸入地氟醚或异氟醚,同时吸入纯氧3L/min。记录设定的吸入麻醉药浓度（FD）、吸入麻醉药浓度（FI）、FA/FI=1/2时间、FA/FAO=1/2时间（FAO为关闭挥发罐即时的肺泡浓度）,并计算各时点FA/FI、FA/FD。结果D组FA/FI=1/2时间及FA/FAO=1/2时间均较Ⅰ组缩短（P＜0．05）。低流量麻醉下,D组FD稳定,Ⅰ组FD波动较大。D组FA/FI、FA/FD上升速率较Ⅰ组快,且同一时点各比值D组均高于Ⅰ组。结论与异氟醚比较,腹部手术患者低流量吸入地氟醚时达到预定的肺泡浓度更迅速,可控性好,停止吸入时排泄较快。     

预测控制加智能控制用于七氟醚闭合环路定量麻醉的可行性

目的探讨自制的伺服控制闭合麻醉系统、预测控制加智能控制用于七氟醚定量麻醉的可行性。方法143例ASAⅠ-Ⅲ级病人,静脉注射芬太尼2-3μg·kg-1、咪唑安定0.12mg·kg-1、维库溴铵0.1mg·kg-1诱导插管后,使用由IBM计算机、氧气质量流量控制器、电控七氟醚注射泵组成的伺服控制全麻系统向呼吸环路中送入氧气和七氟醚,氧气的新鲜气流量为[体重(kg)3/4×10 20]ml·min-1。用预测控制加智能控制法控制七氟醚呼气末浓度为1.3MAC。结果洗入时间(5.2±2.4)min,麻醉洗入和维持期间的新鲜气流量为(0.22±0.04)L·min-1。七氟醚的累积摄取量为:5.16ml(30min)、7.74ml(60min)、9.17ml(90min)、11.08ml(120min)、12.47ml(150min)、13.00ml(180min)、14.18ml(210min)、15.60ml(240min)、18.56ml(300min)和24.60ml(420min)。在420min中,七氟醚注入速率的三指数方程为(0.2673e-0.0598t 0.2269e-0.0597t 0.1150e-0.0021t)ml·min-1。结论预测控制加智能控制可控制多因素干扰下的设定的七氟醚呼气末浓度,是一种安全有效的方法。     

The quotient end-tidal/inspired concentration of sevoflurane in a low-flow system

STUDY OBJECTIVE: To investigate the effect of two different fresh gas flows on inspired and end-tidal sevoflurane concentration for a given vaporizer setting in a low-flow anesthesia system. DESIGN: Prospective clinical study. SETTING: Department of Anesthesiology of a university teaching hospital. PATIENTS: 56 ASA physical status I and II patients without systemic diseases, having elective surgery with an expected anesthesia time of at least 120 minutes. INTERVENTIONS: Patients were randomly assigned to receive either 1.0 or 2.0 L/min fresh gas flow with the vaporizer setting fixed at 2% sevoflurane. The inspired (In), end-tidal (Et), and Et/In ratio sevoflurane concentrations were estimated. MEASUREMENTS AND MAIN RESULTS: After 120 minutes of sevoflurane anesthesia the inspired and end-tidal sevoflurane concentration were 1.45 +/- 0.10% versus 1.28 +/- 0.12% (p < 0.001) in the 1.0 L/min group and 1.64 +/- 0.08% versus 1.46 +/- 0.11% (p < 0.001) in the 2.0 L/min group. The ratio end-tidal and inspired concentrations/vaporizer setting was 0.64 +/- 0.06 and 0.73 +/- 0.05 in the 1.0 L/min group versus 0.73 +/- 0.05 and 0.82 +/- 0.04 in the 2.0 L/min group. For the ratio inspired and end-tidal/vaporizer setting there were significant difference between the groups (p < 0.001). The estimated ratio end-tidal/inspired was 0.88 +/- 0.04 in the 1.0 L/min group versus 0.89 +/- 0.04 in the 2.0 L/min group (ns). CONCLUSION: After 120 minutes of sevoflurane anesthesia at a vaporizer setting of 2% there is a significant difference between fresh gas flow of 1.0 and 2.0 L/min for inspired and end-tidal concentrations, but not for the ratio end-tidal/inspired.     

Anesthetic uptake of sevoflurane and nitrous oxide during an inhaled induction in children

The uptake of sevoflurane and nitrous oxide (N(2)O) was characterized during the mask induction of anesthesia in healthy children. We assessed concentration and second gas effects by determining the influence of two different inspiratory N(2)O concentrations on the rate at which the estimated alveolar concentration (FA) increased to the inspired gas concentration (FI). Eighteen children aged 4-12 yr old were randomly assigned to receive a 6% sevoflurane mixture with either a large or a small N(2)O concentration with balance O(2). End-tidal and inspiratory concentrations of respiratory and anesthetic gases were continuously assessed during the induction. The FA/FI for the small N(2)O was 0.87 +/- 0.09 (mean +/- SD) and increased to 0.92 +/- 0.08 for the large N(2)O (P < 0.01). Both groups differed significantly at 3, 4, and 5 min. The FA/FI for sevoflurane increased but more slowly than for N(2)O. The mean only differed significantly at 3 min. Equilibration between FA and FI for N(2)O and sevoflurane was attained rapidly. Consistent with their respective blood/gas partition coefficients, the FA/FI for N(2)O increased more rapidly than that for sevoflurane. Increasing FI-N(2)O produced a leftward shift in gas equilibration curves. A concentration effect was confirmed with N(2)O and a brief second gas effect, probably explained by the higher solubility of sevoflurane.     

Low-flow anaesthesia with desflurane: kinetics during clinical procedures

BACKGROUND AND OBJECTIVE: Low-flow anaesthesia is economical and less polluting. The purpose of this study was to determine the inspired and end-tidal desflurane concentrations during anaesthesia with a vaporizer setting maintained at 5%, during low-flow anaesthesia after 120 min with fresh gas inflows of 1.0 and 2.0 L min-1. METHODS: The study was both prospective and randomized, including 56 patients (28 patients in each group) scheduled for elective surgery of an expected anaesthesia time of at least 120 min. Inspired and end-tidal concentrations of desflurane were measured during low-flow anaesthesia with fresh gas inflows of 1.0 and 2.0 L min-1. The vaporizer setting was fixed at 5% desflurane. RESULTS: The inspired and end-tidal concentrations of desflurane in the 1.0 L min-1 group after 120 min were 4.54% vs. 4.37% (P < 0.001). In the 2.0 L min-1 group, the inspired and end-tidal concentrations of desflurane were 4.76% vs. 4.58% (P < 0.001). The estimated end-tidal/inspired ratios at 120 min of anaesthesia were 0.96 in both groups. At a fresh gas flow of 1.0 L min-1, the end-tidal concentration was 0.87 of the vaporizer setting. Increasing the fresh gas flow to 2.0 L min-1 increased the end-tidal value by 0.05. CONCLUSION: There is a significant difference between the inspired and end-tidal concentrations of desflurane when fresh gas inflows were 1.0 and 2.0 L min-1, but not for the ratio of inspired/end-tidal.     

Recovery and Kinetic Characteristics of Desflurane and Sevoflurane in Volunteers after 8-h Exposure, including Kinetics of Degradation Products

Background: Desflurane and sevoflurane permit speedier changes in anesthetic partial pressures than do older halogenated anesthetics. The authors determined the kinetic characteristics of desflurane and sevoflurane and those of compound A [CH2 F-O-C(= CF2)(CF3)], a nephrotoxic degradation product of sevoflurane.

Methods: Volunteers received 1.25 minimum alveolar concentration of desflurane or sevoflurane, each administered for 8 h in a fresh gas inflow of 2 l/min. Inspired (FI) and end-tidal (FA) concentrations of anesthetic and compound A were measured during administration, and FA relative to FAO (the last end-tidal concentration during administration) during elimination. The indices of recovery were also measured.

Results: The ratio FI /FA rapidly approached 1.0, with values greater for sevoflurane (desflurane 1.06 +/- 0.01 vs. sevoflurane 1.11 +/- 0.02, mean +/- SD). The ratio FA /FI for compound A was approximately 0.8. The FA /FAO ratio decreased slightly more rapidly with desflurane than with sevoflurane, and objective measures indicated faster recovery with desflurane: The initial response to command (14 +/- 4 min vs. 28 +/- 8 min [means +/- SD]) and orientation (19 +/- 4 vs. 33 +/- 9 min) was quicker, and recovery was faster as defined by results of the Digit Symbol Substitution, P-deletion, and Trieger tests. Desflurane produced less vomiting (1 [0.5, 3]; median [quartiles] episodes) than did sevoflurane (5 [2.5, 7.5] episodes). The FA /FAO ratio for compound A decreased within 5 min to a constant value of 0.1.     

Comparison of kinetics of sevoflurane and isoflurane in humans

The low solubility of sevoflurane in blood suggests that this agent should enter and leave the body more rapidly than isoflurane. However, the closeness of sevoflurane and isoflurane tissue/blood partition coefficients suggests that the rates of equilibration with and elimination from tissues should be similar. We tested both predictions, comparing sevoflurane with isoflurane and nitrous oxide in seven volunteers. We measured the rate at which the alveolar (end-tidal) (FA) concentration of nitrous oxide increased toward an inspired (FI) concentration of 65%-70%, then measured the concurrent rise in FA and mixed expired concentrations (FM) of sevoflurane and isoflurane at respective FI values of 1.0% sevoflurane and 0.6% isoflurane for 30 min. Minute ventilation (VE) was measured concurrently with the measurements of anesthetic concentrations. For the potent agents, we also measured VE, FA, and FM for 6-7 days of elimination. FA/FI values at 30 min of administration were as follows: nitrous oxide, 0.986 +/- 0.003 (mean +/- SD); sevoflurane, 0.850 +/- 0.018; and isoflurane, 0.733 +/- 0.027. FA/FA0 (FA0 = the last FA during administration) values after 5 min of elimination were as follows: sevoflurane, 0.157 +/- 0.020; isoflurane, 0.223 +/- 0.024. Recovery (volume of anesthetic recovered during elimination/volume taken up) of sevoflurane (101% +/- 7%) equaled recovery of isoflurane (101% +/- 6%). Time constants for a five-compartment mammillary model for sevoflurane were smaller than those for isoflurane for the lungs but were not different from isoflurane for the other compartments.(ABSTRACT TRUNCATED AT 250 WORDS)     

门静脉动脉化对扩大肝-胆切除术后肝脏储备功能的影响

目的 观察慢性、梗阻性黄疸小型猪肝-胆切除术联合限流性部分门静脉动脉化(PPVA)术后肝脏储备功能的动态变化.方法 利用梗阻性黄疸小型猪模型,模拟进行联合半肝切除的肝门部胆管癌扩大根治性手术.实验分组:无黄疸对照组(A组,n=4)、门静脉动脉化组(B组,n=4)及非门静脉动脉化组(C组,n=4).对照观察根治术中应用限流性PPVA在术后30 d内的吲哚菁绿15 min滞留率(ICG15),从而判断肝脏储备功能的动态变化.结果 术前B、C组高于A组[(0.66±0.07)%、(0.64±0.09)%比(0.09±0.01)%,P＜0.01],术后第1天B组低于C高于A组[(0.59±0.11)%比(0.82±0.09)%、(0.18±0.04)%,P＜0.05、P＜0.01],术后第7天B组高于A组低于C组[(0.34±0.09)比(0.17±0.04)%、(0.69±0.11)%,P均＜0.05].术后第30天B组低于C组、与A组差异无统计学意义[(0.12±0.03)%比(0.22±0.03)%、(0.09±0.003)%,P＜0.01、P＞0.05].B组术后第7天低于术前[(0.34±0.09)%比(0.66±0.07)%,P＜0.01].结论 限流性PPVA可促进慢性梗阻性黄疸小型猪肝-胆切除术后残肝储备功能的恢复.

Abstract：

Objective To investigate the change of hepatic functional reserve (HFR) after flowcontrolled partial portal vein arterialization (PPVA) in hepato-biliary resection (HBR) in miniature pigs with obstructive jaundice. Methods Eight miniature-pig models with chronic gradually obstructive jaundice were divided into 2 groups with 4 pigs each: PPVA group (group B,n =4), non-PPVA group (group C, n = 4), and another 4 pigs without chronic gradually obstructive jaundice served as control group ( group A, n = 4). Approaches of EHBR with or without PPVA were done, then the effects of flow-controlled PPVA on HFR of remnant liver were studied by detecting indocyanine-green retention at 15 min ( ICG15 ) in 30 days post-operation. Results ICG15 in groups B and C was significantly higher than in group A pre-operation[(0.66±0.07)%, (0.64±0.09)% vs (0.09±0.01)%,P＜0.01]. ICG15 in group B was significantly lower than that in group C, and higher than in group A at the first day post-operation[(0. 59 ±0.11)% vs (0.82±0.09)%, (0.59±0.11)% vs (0. 18±0.04)%,P＜0. 05,P＜0. 01]. ICG15 in group B was significantly lower than in group C, and higher than in group A at 7th day post-operation [(0. 34±0.09)% vs (0.69 ±0. 11)%, (0.34±0.09)% vs (0. 17 ±0.04)% ,both P＜0.05]. ICG15 in group B was significantly lower than in group C, but showed no significant difference from group A at 30th day post-operation[(0.12 ±0.03)% vs (0.22 ±0.03)%, (0.12 ±0.03)% vs (0.09 ± 0. 003)% ,P ＜0. 01 ,P ＞ 0. 05]. ICG15 in group B on the 7th day post-operation was significantly lower than that pre-operation[(0. 34 ± 0. 09 ) % vs (0. 66 ± 0. 07 ) %, P ＜ 0. 01]. Conclusion Flow-controlled PPVA in HBR is beneficial to recovery of HFR on miniature pigs with obstructive jaundice.     

可溶性酪氨酸激酶2融合蛋白对尿毒症腹膜透析大鼠腹膜形态和功能的影响

目的 研究可溶性酪氨酸激酶2融合蛋白（sTie-2-Fc）对尿毒症腹膜透析大鼠腹膜血管新生、溶质转运和超滤功能的影响。 方法 32只雄性Wistar大鼠按数字随机法分为假手术组、尿毒症组、尿毒症腹透组和sTie-2-Fc干预组（均n=8）。尿毒症腹透组和sTie-2-Fc干预组大鼠经腹透管每天2次腹腔灌注4.25%葡萄糖透析液（3 ml/100 g体质量）共4周,sTie-2-Fc干预组大鼠每次灌注时在透析液中加入1 μg sTie-2-Fc。各组大鼠处死前行腹膜平衡试验,检测腹膜转运和超滤功能,取大网膜标本行抗CD31免疫组化染色并计血管数。 结果 与假手术组大鼠相比,尿毒症组大鼠的2 h腹透液和血肌酐比值（D/Pcr）增高（0.78±0.05比0.70±0.09,P = 0.028）,腹透液2 h与0 h葡萄糖比值（D/D0）降低（0.69±0.05比0.76±0.07,P = 0.033）,腹膜超滤量（UF,ml）减少（2.29±0.50比4.58±1.64,P = 0.005）,腹膜血管数量增加[（5.8±3.0）/HP比（1.6±0.5）/HP,P < 0.01]。尿毒症腹透组大鼠的溶质转运较尿毒症组大鼠进一步增高（D/Pcr: 0.89±0.05比0.78±0.05,P < 0.01;D/D0:0.47±0.09 比0.69±0.05, P < 0.01）,UF（ml）减少（0.40±0.59比2.29±0.50,P = 0.005）,腹膜血管数量增多[（16.7±1.2）/HP比（5.8±3.0）/HP,P < 0.01]。干预组大鼠使用sTie-2-Fc后,UF（ml）较尿毒症腹透组大鼠显著增加（1.56±0.48比0.40±0.59,P = 0.014）,腹膜血管数量显著减少[（9.2±1.2）/HP比（16.7±1.2）/HP,P ＜ 0.01],但两组大鼠的D/Pcr和D/D0差异均无统计学意义。 结论 sTie-2-Fc使尿毒症腹透大鼠腹膜血管新生减少,超滤增加,有利于保护腹膜结构和功能,可能是防治腹透后腹膜结构和功能改变的另一靶点。     

穴位电刺激对薄型子宫内膜的治疗效果初探

目的探讨穴位电刺激对薄型子宫内膜的治疗效果。方法收集南京医科大学第一附属医院2014年1月至2016年11月拟行冻胚移植的薄型子宫内膜患者96人为研究对象,共计145个周期。记录患者的年龄、体重指数(BMI)及不孕年限等情况。根据子宫内膜厚度将其分为3组,A组:子宫内膜厚度≤3mm,共12个周期;B组:3mm<子宫内膜厚度≤5mm,共60个周期;C组:5mm<子宫内膜厚度≤7mm,共73个周期。所有患者均于月经第5~7天应用PHENIX系列神经肌肉刺激治疗仪U8,予以阴道及"中极"、"关元"、"子宫"、"足三里"、"三阴交"、"太冲"及"肾俞"等部位低频脉电刺激治疗(交流电,频率:40 Hz,脉宽:250μs,每次30min),1次/d,5~8次为1周期。观察治疗前后子宫内膜厚度、子宫动脉血流阻力指数(RI)的变化情况。结果 3组患者年龄、BMI及不孕年限比较无显著性差异(P>0.05)。A组子宫内膜厚度治疗前后无显著性差异(P=0.09);治疗前后双侧子宫动脉RI亦无显著变化(P>0.05)。B组与C组治疗后内膜厚度均显著增加[B组:(3.91±0.07)mm vs.(6.32±0.15)mm,C组:(5.39±0.07)mm vs.(7.77±0.12)mm,P均<0.01],双侧子宫动脉RI则显著下降[左侧RI:B组(0.90±0.04)vs.(0.87±0.05),C组(0.88±0.04)vs.(0.84±0.05);右侧RI:B组(0.90±0.04)vs.(0.87±0.05),C组(0.88±0.05)vs.(0.84±0.05),P均<0.01]。结论低频穴位电刺激对内膜厚度为3~7mm薄型子宫内膜患者的治疗安全有效,值得临床推广,但其长期的临床治疗效果及相关机制还有待于进一步研究。     

灯盏细辛对大鼠肾冷缺血再灌注损伤中细胞凋亡的影响

目的 观察中药灯盏细辛对大鼠肾脏冷缺血再灌注损伤(IRI)中肾脏细胞凋亡及相关基因表达的影响.方法 封闭群SD大鼠36只,随机分为3组,每组12只.假手术组(A组),对照组(B组),实验组(C组).药物应用:C组术前15 min,灯盏细辛注射液按1.2 ml/100 g通过尾静脉注射,A、B组按相应剂量注射生理盐水.动物手术:A组,切除右肾.B、C组采用的是冷IRI模型,3组大鼠均在术后24h再次手术切除左肾进行检测.透射电镜检查肾组织形态学,免疫组织化学检测凋亡相关的基因bcl-2与bax的表达,原位末端标记法(TUNEL)检测细胞凋亡.结果 (1)超微结构检查(透射电镜):A组结构正常;B组细胞呈损伤形态:线粒体肿胀,微绒毛减少,胞质内空泡形成,部分细胞核可见凋亡迹象.C组病变较B组显著减轻.(2)免疫组织化学蛋白阳性染色指数(PI):缺血再灌注后B、C组的bcl-2表达分别为(21.21±1.18)％和(35.52±1.94)％,较A组(4.95±0.77)％均增多(P＜0.05),B组低于C组(P＜0.05).B、C组的bax表达分别为(58.55±2.90)％和(45.90±3.14)％,较A组(4.67±0.67)％增多(P＜0.05),而且B组高于C组(P＜0.05).A组的蛋白阳性染色指数的比值bcl-2/bax为(1.06±0.07)高于B组(0.35±0.03)和C组(0.78±0.07,P＜0.05),而且C组高于B组(P＜0.05).(3)细胞凋亡检测(TUNEL):细胞凋亡指数B组(28.57±3.58)％和C组(19.99±3.37)％均显著大于A组(2.33±0.42)％(P＜0.01),C 组小于B组(P＜0.01).结论 灯盏细辛减少大鼠肾脏冷IRI诱导的肾脏细胞的凋亡,与调节凋亡相关基因bcl-2与bax表达有关.     

Comparison of MAC and the rate of rise of alveolar concentration of sevoflurane with halothane and isoflurane in the dog

The anesthetic requirements for sevoflurane, isoflurane, and halothane were determined in mongrel dogs. The MACs (minimum alveolar concentration) of sevoflurane, isoflurane, and halothane were 2.36 +/- 0.46% (n = 18), 1.39 +/- 0.25% (n = 10), and 0.89 +/- 0.20% (n = 12), respectively (mean +/- SD). In agreement with sevoflurane's low blood/gas partition coefficient (0.6), the rate of rise of alveolar concentration toward that inspired (FA/FI) for sevoflurane was significantly faster than that for either halothane or isoflurane. Thirty seconds after breathing a constant inspired concentration FA/FI was 0.75 for sevoflurane, which was 2.96 times higher than that with halothane (0.25 +/- 0.02) and 1.29 times higher than that with isoflurane (0.6 +/- 0.05). Induction with sevoflurane was smooth, with no struggling nor excessive salivation.