氟比洛芬酯超前镇痛对瑞芬太尼麻醉术后痛觉过敏的影响

目的观察氟比洛芬酯超前镇痛对瑞芬太尼所致痛觉过敏的影响。方法选择ASAⅠ～Ⅱ级择期腹腔镜手术患者50例,随机分为2组。A组麻醉诱导前静脉注射氟比洛芬酯50mg＋咪达唑仑0.1mg/kg;B组麻醉诱导前静脉注射生理盐水5mL＋咪达唑仑0.1mg/kg。靶控输注丙泊酚、瑞芬太尼完成麻醉诱导及维持。记录并比较入室后（T0）、手术开始5min（T1）、手术结束（T2）、清醒后30min（T3）、清醒后1h（T4）的血压、心率变化,及清醒后30min（T3）、清醒后1h（T4）时点的VAS评分。结果在T3、T4时点B组患者SBP、DBP、HR明显高于A组（P〈0.05）,B组患者T3、T4时点VAS评分明显高于A组（P〈0.05）。结论氟比洛芬酯超前镇痛可有效减少瑞芬太尼所致痛觉过敏的发生。     

瑞芬太尼在神经外科手术麻醉中的应用

躁动和呛咳可诱发颅内灌注压及颅内压的急剧波动，是围手术期脑功能障碍的危险因素。如何减少围手术期躁动和呛咳成为神经外科麻醉处理的关键之一。瑞芬太尼是新合成的阿片扯受体激动剂，广泛应用于中小手术麻醉中。本研究拟在探讨瑞芬太尼应用于神经外科手术对患者苏醒期血流动力学、躁动和呛咳及清醒质量的影响，为临床神经外科麻醉提供参考。     

舒芬太尼与瑞芬太尼对神经外科手术麻醉苏醒期的影响

目的观察舒芬太尼与瑞芬太尼对神经外科手术麻醉苏醒期的影响。方法选取120例患者随机分成2组,对照组予以瑞芬太尼静脉复合麻醉,实验组予以舒芬太尼静脉复合麻醉,观察2组清醒时间、拔管时间、血液动力学指标变化、围拔管期不良反应、VAS疼痛评分及术后镇痛药物使用情况。结果实验组清醒时间、拔管时间明显高于对照组,但血流动力学指标显著优于对照组,围拔管期躁动、寒战明显低于对照组,拔管后5min、30min、1hVAS评分及术后24h使用镇痛药物比例均明显低于对照组(P0.05)。结论舒芬太尼在神经外科手术中的麻醉效果优于瑞芬太尼,值得临床推广。     

瑞芬太尼在神经外科手术麻醉中的应用

目的观察瑞芬太尼在神经外科麻醉中的效果。方法选择40例ASAⅠ~Ⅱ级择期行颅内肿瘤切除术的患者,随机分为A组(芬太尼)、B组(瑞芬太尼)各20例。A组以丙泊酚2 mg/kg,芬太尼3μg/kg,阿曲库铵0.5mg/kg诱导,术中间断给芬太尼0.1mg;B组以丙泊酚2 mg/kg,瑞芬太尼3μg/kg,阿曲库铵0.5mg/kg诱导,术中持续输注瑞芬太尼3~5μg/(kg.h);2组均持续泵注丙泊酚3~4mg/(kg.h),按需给阿曲库铵0.2~0.3mg/kg。结果A组插管及拔管期间呛咳发生率,各时点血流动力学变化及苏醒时间均有统计学意义(P<0.05)。结论神经外科手术应用瑞芬太尼可有效抑制应激反应,维持血流动力学稳定,缩短苏醒时间。     

丙泊酚复合瑞芬太尼靶控输注在神经外科手术中的应用

目的探讨丙泊酚复合瑞芬太尼靶控输注全静脉麻醉在神经外科手术中应用的临床意义。方法对66例神经外科择期手术病人采用丙泊酚复合瑞芬太尼靶控输注全静脉麻醉。丙泊酚、瑞芬太尼靶浓度分别为2￣4m g/L和2￣5μg/L,间断追加维库溴胺。记录围麻醉期血流动力学、麻醉药用量以及麻醉后恢复情况。结果麻醉诱导后病人收缩压、舒张压均显著性降低(P<0.05),心率减慢(P<0.05),气管插管、切皮前后无明显改变,手术结束后睁眼时心率明显增快(P<0.05),麻醉恢复时病人苏醒较快,自觉舒适,无呼吸再抑制现象。结论丙泊酚复合瑞芬太尼靶控输注,麻醉诱导迅速,维持平稳,停药后清醒快,对气管导管耐受性好,适用于神经外科手术。     

舒芬太尼与芬太尼用于神经外科手术麻醉效果观察

目的：探讨全麻药物舒芬太尼和芬太尼用于神经外科手术患者的麻醉恢复情况、拔管的时间、围手术期患者的血流动力学以及对机体应激反应的影响。方法选取我院2012-01-2012-12神经外科收治的实施择期行开颅手术患者36例,其中胶质瘤16例,脑膜瘤20例,随机分为对照组和实验组2组,每组18例。对照组使用芬太尼,实验组使用舒芬太尼。咪唑安定、复合异丙酚、维库溴胺进行麻醉诱导。详细观察并记录患者于麻醉前、麻醉诱导后、患者插管、拔管时血压、心率的变化,呼吸恢复情况、患者睁眼、拔管时间及拔管后半小时疼痛评分（VAS评分）。结果2组麻醉诱导后患者的心率（HR）、收缩压（SBP）、舒张压（DBP）较诱导前均有明显下降。对照组插管及拔管时,血流动力学变化均较实验组有明显上升。实验组麻醉苏醒期睁眼、呼吸恢复、拔管时间均较对照组明显缩短;拔管后半小时疼痛评分（V A S评分）实验组低于对照组。结论实验组患者在不同麻醉时期患者的血流动力学更趋于平稳,相同剂量的舒芬太尼用于神经外科手术患者麻醉诱导,在患者的麻醉恢复期,有利于术后呼吸道的管理以及术后镇痛作用强。拔管时间短,术后意识恢复快。可明显的减轻全麻诱导气管插管时的心血管系统的反应。术后无明显药物不良反应的发生。舒芬太尼在神经外科手术麻醉中安全且具有良好的临床应用价值,值得临床推广。     

舒芬太尼和芬太尼用于神经外科手术麻醉的比较研究

目的 观察全身麻醉药物舒芬太尼和芬太尼对中枢神经系统肿瘤切除术患者围手术期血流动力学、苏醒期恢复情况及机体应激反应的影响.方法 50例择期行中枢神经系统肿瘤切除术患者,随机接受舒芬太尼和芬太尼全身麻醉,观察并记录麻醉诱导后、插管后1 min、头架固定时、切开皮肤、切开硬脑膜、关闭硬脑膜、恢复呼吸即刻和拔管即刻等不同观察时间点平均动脉压、心率、脉搏血氧饱和度等项指标的变化,测定麻醉诱导前后血糖和肾上腺素水平.结果 与基础值相比,两组患者在切开硬脑膜、恢复呼吸即刻和拔管即刻心率增加(均P＜0.05),麻醉诱导后、切开硬脑膜、关闭硬脑膜时平均动脉压下降(均P＜0.05),但芬太尼组患者在切开皮肤和拔管即刻均出现平均动脉压升高现象(P＜0.05).手术过程中不同观察时间点,芬太尼组患者平均动脉压和心率均高于舒芬太尼组(P＜0.05或P＜0.01),舒芬太尼组患者自主呼吸恢复时间早、拔管时间短(均P＜0.05).两组患者手术前、切开皮肤30min、拔管即刻血糖和肾上腺素水平比较,差异无统计学意义(均P＞0.05).结论 与芬太尼组比较,舒芬太尼组患者在不同麻醉时期血流动力学更稳定,气管插管时心血管反应更小;舒芬太尼和芬太尼对患者围手术期血糖和肾上腺素均无明显影响.     

异丙酚联合瑞芬太尼麻醉对颅脑手术患者麻醉复苏的影响

目的 观察瑞芬太尼和异丙酚联合液在颅脑手术麻醉中的应用价值.方法 选择ASA II级,无严重心肝肾病,择期行颅脑手术患者143例,随机分为异氟醚组(A组)120例,瑞芬太尼+异丙酚组(B组)123例.患者性别、年龄、身高、体质量、手术类型及时间均无明显差异.2组患者麻醉诱导均采用咪达唑仑0.15mg/kg,异丙酚2mg/kg,维库溴铵0.1mg/kg,芬太尼0.2mg方案.麻醉维持A组采用1%～2%异氟醚按需给予复合50%N2O;B组采用A组同浓度的异丙酚、N2O,手术开始前全程泵入0.2μg/(kg·min)瑞芬太尼至手术结束,结束前5min静脉推注1mg/kg曲马多.观察停止麻醉药给予后至拔管期间患者的呛咳发生率(数)、血流动力学及SPO2变化、苏醒时间等指标.结果 与A组拔管期间呛咳发生率(55%)相比,B组为5%(P＜0.05);且B组拔管期间血流动力学各指标及SPO2的变化也均较A组显著减少.2组的苏醒时间相比无显著差异.结论 颅脑手术围麻醉期应用瑞芬太尼和异丙酚可有效减少拔管期间呛咳的发生率,缩短清醒时间及提高手术质量.     

Narcotrend监测下舒芬太尼或瑞芬太尼复合异丙酚在唤醒麻醉中的应用

目的比较Narcotrend监测下靶控输注舒芬太尼或瑞芬太尼复合异丙酚在脑功能区唤醒麻醉中的效果。方法选择脑功能区手术病人40例,随机分为舒芬太尼（sufentanil,SF）组和瑞芬太尼（remifentanil,RF）组,每组20例。两组分别使用异丙酚复合SF或RF靶控输注诱导,插入喉罩行机械通气,在切口浸润麻醉和硬脑膜表面麻醉下,减少药物浓度使病人在功能定位和切除肿瘤过程中保持清醒。比较两组病人的血流动力学变化、Narcotrend监测下唤醒时间、唤醒质量,通过镇静评分（OAA/S）和视觉模拟评分法（VAS）评价两组是否能够提供合适的镇静和镇痛。结果两组均能在较短时间内唤醒病人,差异无统计学意义（P〉0.05）。插喉罩时,SF组的平均动脉压（MAP）高于RF组（P〈0.05）。在唤醒时,RF组心率和MAP明显高于基础值（P〈0.05）,SF组心率高于基础值（P〈0.05）,MAP稍低于基础值。苏醒后,SF组血压低于RF组（P〈0.05）。两组唤醒后的OAA/S评分无统计学差异（P〉0.05）,SF组唤醒后5min、10min、30min的VAS评分明显小于RF组（P〈0.05）。结论SF或RF联合异丙酚均能很好地应用于脑功能区唤醒手术,SF在病人苏醒后能提供更好的镇痛作用,且不延长病人苏醒时间,在苏醒后血流动力学稳定性方面更具有优势。     

舒芬太尼联合瑞芬太尼在全凭静脉麻醉的临床应用效果

目的评价舒芬太尼联合瑞芬太尼在全凭静脉麻醉(total intravenous anesthesia,TIVA)的临床应用效果。方法以我院收治的84例择期手术患者为研究对象,按照入院顺序,采用随机队列插入法分为对照组、观察组各42例,均给予咪唑安定+舒芬太尼+丙泊酚+维库溴铵诱导麻醉,对照组给予丙泊酚+舒芬太尼维持麻醉,观察组以丙泊酚+瑞芬太尼维持麻醉,对比手术进程相关指标、围术期麻醉相关不良事件发生情况以及在停止输注后至拔管前AAI、OAA/S水平。结果 2组苏醒时间、拔管时间、麻醉维持时平均动脉压水平差异无统计学意义(P0.05);观察组苏醒时HRVI水平高于对照组,差异有统计学意义(P0.05);观察组围术期麻醉相关不良事件例次率低于对照组,差异有统计学意义(P0.05);术毕时,2组AAI、OAA/S水平高于停止输注时,观察组高于对照组,差异具有统计学意义(P0.05)。结论在TIVA中应用舒芬太尼诱导联合瑞芬太尼复合丙泊酚维持麻醉,相对于舒芬太尼诱导联合丙泊酚维持麻醉,虽对手术进程影响不明显,但有助于血流动力学稳定,提高苏醒质量,降低不良事件发生风险,适用于风险相对较高的患者。     

消化道护理干预对神经外科患者呼吸机相关性肺炎的影响

目的 探讨消化道护理干预对神经外科患者呼吸机相关性肺炎的影响.方法 神经外科ICU收治的机械通气患者80例,根据随机抽签方法分为治疗组与对照组各40例,对照组进行常规护理.治疗组根据呼吸机相关性肺炎护理流程进行针对性的消化道护理干预.结果 治疗组的呼吸机相关性肺炎发生率为2.5％,对照组为12.5％,治疗组明显少于对照组(P＜0.05).干预后2组BMI与TSF值都明显增加,与干预前对比差异明显(P＜0.05).但均未达到肥胖的标准,干预后BMI与TSF值组间对比差异有统计学意义(P＜0.05).干预后治疗组健康宣教、口腔护理、床头抬高护理与消化道管理的认知率均明显高于对照组,差异有统计学意义(P＜0.05).结论 消化道护理干预应用于神经外科ICU患者能提高护理认知,减少呼吸机相关性肺炎的发生,增强患者的体质,值得推广应用.     

The role of p38MAPK activation in spinal dorsal horn in remifentanil-induced postoperative hyperalgesia in rats

Objectives: Remifentanil may induce hyperalgesia. Recent studies implicate a close relationship between post-surgical hyperalgesia and phosphorylation and activation of p38 mitogen-activated protein kinase (p38MAPK) in the spinal microglia. This study aimed to investigate whether the combination of post-surgical and remifentanil-induced hyperalgesia worsens post-operative pain and whether phosphorylated p38MAPK (phospho-p38MAPK) in the spinal dorsal horn in rats is involved in remifentanil-induced postoperative hyperalgesia.

Methods: Sprague-Dawley rats were randomly divided into six groups: control, incision only, remifentanil only, remifentanil + incision, remifentanil + incision + SB203580, and remifentanil + incision + DMSO. The p38MAPK inhibitor SB203580 and DMSO were injected intrathecally. A right plantar surgical incision was performed in the incision groups, and remifentanil was infused for 60 min in the remifentanil groups. Mechanical paw withdrawal threshold (PWT) and thermal paw withdrawal latency (PWL) of the bilateral hind paws were measured and the number of phospho-p38MAPK-positive cells in rat spinal dorsal horn sections was counted.

Results: Intravenous remifentanil infusion decreased bilateral plantar PWL values from 1 h to 3 days after surgery, however there was no additive effect with incision-induced values. There was a significant increase in the number of dorsal horn phospho-p38MAPK-positive cells in the remifentanil + incision group compared to the incision group, but no increase in the number of these cells when remifentanil was given alone. Intrathecal pretreatment with SB203580 attenuated remifentanil + incision–induced postoperative hyperalgesia and significantly reduced activation of phospho-p38MAPK in spinal dorsal horn.

Conclusions: Incision-induced and remifentanil-induced increases in hyperalgesia were not additive when incision and remifentanil were used together. Data on phospho-38MAPK activation in remifenanil-induced hyperalgesia were contradictory and need further clarification.     

Serotonergic signaling inhibits hyperalgesia induced by spinal cord damage

Although dysesthesia is one of the most serious problems in patients with spinal cord injury, most of them being unresponsive to conventional treatments. In this study, we established a rat thoracic spinal cord mild-compression model that revealed thermal hyperalgesia in the hind limb. The thoracic spinal cord was compressed gently, using a 20 g weight for 20 min. The withdrawal latency of the thermal stimulation of the bilateral hind-limb was monitored using Hargreaves' Plantar test apparatus. In this model, thermal-hyperalgesia was observed for 1 week after the injury. The spinal cord injury-induced thermal-hyperalgesia was mimicked by the intrathecal application of metergoline, a non-selective 5-HT antagonist, 1-(2-methoxyphenyl)-4-[4-(2-phthalimido) butyl]-piperazine hydrobromide (NAN190), a selective 5-HT1 antagonist, and 3-tropanyl-3,5-dichlorobenzoate (MDL72222), a selective 5-HT3 antagonist. Intraperitoneal application of fluvoxamine maleate, a selective serotonin reuptake inhibitor, reduced the intensity of hyperalgesia induced by spinal cord injury. The inhibitory effect of fluvoxamine maleate on thermal hyperalgesia was prevented by the application of the aforementioned nonselective or selective 5-HT receptor antagonists. Intrathecal application of fluvoxamine maleate and selective 5-HT receptor agonists, i.e., 8-hydroxy-2-(di-n-proplyamino)-tetralin hydrobromide (8-OH-DPAT: 5HT-1 selective) and 2-methyl-5-hydroxytryptamine maleate (2-m-5-HT: 5HT-3 selective), inhibited the spinal cord injury-induced hyperalgesia. These results suggest that the change in the descending serotonergic signal plays an important role in hyperalgesia after the spinal cord injury, and that the application of selective serotonin reuptake inhibitors will be one of the candidates for new therapeutic methods against post-spinal cord injury dysesthesia.     

单次亚麻醉剂量氯胺酮对乳腺癌根治患者术后早期情绪及恢复质量的影响

目的探讨乳腺癌根治患者采用单次亚麻醉剂量氯胺酮对术后早期情绪及恢复质量的影响。方法纳入2018年9月~2019年9月期间我院接诊的120例乳腺癌患者作为本次研究对象,掷币法将其分为两组,两组患者均行乳腺癌根治术,均在同样的麻醉方法下进行手术,对照组60例患者术后镇痛予以单纯静脉镇痛泵,观察组60例患者术后镇痛予以单次亚麻醉剂量氯胺酮+静脉镇痛泵,比较两组患者术后早期焦虑、抑郁情绪评分、疼痛评分及恢复质量评分。结果术后第3天,观察组患者焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分均明显降低,且低于对照组,焦虑,抑郁情绪病例数也明显少于对照组(P<0.05);观察组身体舒适度、情绪状态、心理支持及疼痛评分及总分均高于对照组(P<0.05)。结论单次亚麻醉剂量氯胺酮能快速改善围术期乳腺癌患者术后早期的焦虑、抑郁情绪,提高患者术后恢复质量。     

Thymulin reduces hyperalgesia induced by peripheral endotoxin injection in rats and mice

In a new model of peripheral localized inflammation, induced by intraplantar endotoxin (1.25 μg) injection in the hind paw of rats and mice, thymulin, a hormone of the thymus gland involved in immunomodulation, reduced inflammatory pain. High doses of thymulin reduced significantly, and in a dose-dependent manner, mechanical hyperalgesia as assessed by the paw pressure test and thermal hyperalgesia as assessed by the hot plate test and tail immersion test.     

Intrathecal treatment with dextrorphan or ketamine potently reduces pain-related behaviors in a rat model of peripheral mononeuropathy

The therapeutic effects of dextrorphan and ketamine, two non-competitive N-methyl-d-aspartate (NMDA) receptor antagonists, on neuropathic pain-related behaviors were examined in rats with peripheral mononeuropathy induced by loose ligation of the common sciatic nerve (chronic constrictive injury, CCI). Four daily intrathecal treatments (beginning 1 h after nerve ligation) with dextrorphan or ketamine (12.5–100 nmol) reliably attenuated hyperalgesia to radiant heat and spontaneous pain-related behaviors in CCI rats. Thermal hyperalgesia also was reduced in CCI rats receiving a single intrathecal treatment with either dextrorphan or ketamine (50 and 100 nmol for each compound) on day 3 after nerve ligation when thermal hyperalgesia was well developed. Since both dextrorphan and ketamine are currently utilized in other clinical applications, the results suggest a new therapeutic utility of these ‘old’ compounds in treatment of neuropathic pain syndromes resulting from peripheral nerve injury.     

Inhibition of platelet aggregation by ketamine hydrochloride

Ketamine hydrochloride, 10 mg/kg by intramuscular injection, inhibited aggregation of platelets from three out of three baboons. Aggregation to ADP, arachidonic acid, epinephrine, and collagen was inhibited but aggregation to ristocetin was normal. Two baboons anaesthetised with the related drug phencyclidine, 1.0 mg/kg intramuscularly, had delayed aggregation. Ketamine inhibition of human platelets was irreversible in that aggregation could not be restored by either gel filtration of inhibited platelets and the re-addition of normal plasma, or by increasing the concentrations of agonists. Mixtures of human ketamine inhibited and aspirinised platelets failed to aggregated. Thromboxane B2 production was reduced to 3% of the amount produced by non inhibited platelets but the oxygen burst was not inhibited.     

A combination of ketamine and diazepam synergistically controls refractory status epilepticus induced by cholinergic stimulation

PURPOSE: New treatments are needed for status epilepticus (SE) that is refractory to drugs modulating GABA(A) receptors, and NMDA receptor antagonists are candidate drugs. METHODS: Clinically available NMDA receptor antagonist ketamine was tested for effectiveness in terminating prolonged SE induced by a combination of lithium and pilocarpine. Animals were treated 10 min after first grade 5 behavioral seizure (Racine scoring scale) by intraperitoneal administration of ketamine, diazepam, or saline. Seizure termination was determined by electroencephalogram (EEG) recordings from the hippocampus and the cortex. RESULTS: Animals treated with normal saline or either 20 mg/kg diazepam, or 50 mg/kg ketamine continued in SE for the next 300 min. However, combined treatment with diazepam and ketamine rapidly terminated prolonged cholinergic stimulation-induced SE. Detailed study of dose response relationships demonstrated that diazepam enhanced efficacy and potency of ketamine in terminating SE. DISCUSSION: This study demonstrated synergistic action of diazepam and ketamine in terminating SE. It suggests that a ketamine-diazepam combination might be a clinically useful therapeutic option for the treatment of refractory SE.     

Effects of melatonin on orphanin FQ/nociceptin-induced hyperalgesia in mice

The pain modulatory properties of melatonin (MT) are generally recognized but the detail of the interaction between melatonin and opioid system in pain regulation is not fully understood. The present study was undertaken to investigate the modulatory effect of melatonin (MT) on the hyperalgesic effect of Orphanin FQ/Nociceptin (OFQ/NC, NC), a member of opioid peptide family. Intracerebroventricular (i.c.v.) administration of NC (10 microg/mouse) induced significant hyperalgesic effect in tail-flick test in mice; i.c.v. (5, 10, 50 microg/mouse) or intraperitoneal (i.p.) (5, 10, 50 mg/kg) co-injection of melatonin dose-dependently reversed NC-induced hyperalgesia and showed a profound analgesic effect. The antihyperalgesia effect of MT could be significantly antagonized by i.c.v. co-injection of luzindole (10 microg/mouse) (an antagonist of MT receptor) or naloxone (10 microg/mouse) (antagonist of traditional opioid receptor). Taken together, all the results suggested that MT could produce a luzindole and naloxone sensitive reversing effect on NC-induced hyperalgesia at supraspinal and peripheral level in mice. The augmentation effect of MT on the traditional opioid system may be one of the mechanisms of this antihyperalgesia action induced by MT. The present work will help to elucidate the mechanism of the pain modulation effect of MT, and also will help to represent new interesting modulating therapeutic targets for the relief of pain.     

神经外科术中MRI时麻醉深度的调控

目的探讨神经外科术中MRI时麻醉深度的调控。方法25例颅内肿瘤患者在气管插管全身麻醉下行术中MRI及导航系统辅助开颅肿瘤切除术。术中维持呼气末七氟醚浓度0.95%～1.05%,并参照患者基础平均动脉压调整瑞芬太尼输注浓度来维持麻醉,使术中平均动脉压维持于不高于基础值10%及不低于基础值20%,维持心率100次/分以下。记录患者钻骨孔、去骨瓣后、剪开硬膜、颅内操作30min、颅内操作1h及MRI扫描前、扫描时、扫描结束时和扫描后重新开始手术的瑞芬太尼浓度、心率、血压、体温变化。结果患者在术中MRI过程中瑞芬太尼的输注浓度与颅内操作时浓度并无统计学差异(P0.05)。术中生命体征稳定,无麻醉并发症。结论神经外科手术中MRI过程中,虽无手术刺激,但受噪音刺激、手术创面等影响使麻醉深度的维持基本与颅内操作期相同。