舒芬太尼在肾母细胞瘤患儿术后镇痛中的应用效果及对患儿免疫功能的影响

目的探讨舒芬太尼在肾母细胞瘤患儿术后镇痛中的应用效果及对患儿免疫功能的影响。方法采用随机数字表法将42例肾母细胞瘤患儿分为低剂量、中剂量和高剂量组,每组14例,低剂量组、中剂量组、高剂量组患儿术后舒芬太尼镇痛剂量分别为1.0、2.5、4.0μg/kg。术后6、24、48 h,采用中文版儿童疼痛行为量表(FLACC)评估三组患儿的镇痛效果,以及不良反应发生情况;麻醉前和术后1、24、72 h,检测三组患儿免疫功能指标,包括免疫球蛋白(Ig)G、IgA、IgM。结果术后6、24、48 h,中剂量组、高剂量组患儿FLACC评分均低于低剂量组患儿,差异均有统计学意义(P﹤0.05)。术后1、24、72 h,低剂量组患儿IgG、IgA、IgM水平均低于本组麻醉前,差异均有统计学意义(P﹤0.05);术后1、24 h,中剂量组和高剂量组患儿IgG、IgA、IgM水平均低于本组麻醉前,差异均有统计学意义(P﹤0.05),但术后72 h,中剂量组和高剂量组患儿IgG、IgA、IgM水平与麻醉前比较,差异均无统计学意义(P﹥0.05)。低剂量组患儿未发生不良反应,中剂量组患儿发生恶心1例,高剂量组患儿发生恶心5例、呕吐3例。结论2.5μg/kg的舒芬太尼在肾母细胞瘤患儿术后镇痛中效果明显,且对患儿的免疫系统发挥一定的保护作用,可以减轻患儿术后免疫功能抑制。     

大鼠骶髂关节传入神经通路的实验研究

目的:通过逆行神经追踪法研究大鼠骶髂关节的传入神经通路。方法:30只雄性Sprague-Dawley大鼠随机分成非交感神经切除组(A组)和交感神经切除组(B组),每组15只,交感神经切除组切除左侧L1以下椎旁交感干。两组左侧骶髂关节注入30%的辣根过氧化物酶(HRP)20μl,72h后取出双侧的L1-S1背根神经节(DRG),TMB法染色后在光学显微镜下观察HRP阳性神经元细胞并计数。结果:两组左侧L1、L2背根神经节内HRP阳性神经元差异有显著性意义(P<0·05),B组HRP阳性神经元明显减少;左侧L3-S1背根神经节内HRP阳性神经元差异无显著性意义(P>0·05)。结论:L1-S1神经节含有支配同侧骶髂关节的传入神经元,同侧椎旁交感干可能是骶髂关节到L1-L2神经节重要的传入神经旁路,而不是到L3-L5神经节的传入旁路或重要的传入旁路。     

冠心病患者肱动脉血管内皮依赖性舒张功能的超声检测

目的 利用高频超声评价冠心病（CAD）患者肱动脉内皮依赖性舒张功能（EDD）及其临床意义。方法 对113例连续冠脉造影（CAG）受检者术前行高频超声检查肱动脉EDD，并对两种检查结果进行相关性分析。结果 冠脉狭窄组、急性心肌梗死（AMI）组肱动脉EDD明显低于对照组（P〈0．01）；AMI组EDD显著低于心肌缺血组（P〈0．01）。结论CAD患者的EDD明显降低。     

Hypotension preferentially induces c-fos immunoreactivity in supraoptic vasopressin neurons.

Immunoreactivity to Fos protein (Fos-IR) was detected in rat hypothalamic neurons within 1 h of onset of hemorrhage by withdrawing 4-5 ml of blood, which lowered the arterial blood pressure to 50-70 mm Hg. About 70% of vasopressin (AVP)-containing neurons in the supraoptic nucleus (SON) and 20% in the paraventricular nucleus (PVN) expressed Fos-IR. In contrast, 5% of oxytocin (OXY)-containing neurons in the SON and < 1% in PVN were Fos-IR. Intravenous infusion of the vasodilating agent, nitroprusside, which lowered the blood pressure to levels comparable to that attained by hemorrhage, induced Fos-IR in greater than 65% of AVP-containing neurons in the SON, while relatively few AVP neurons in the PVN were Fos positive. These results suggest that hemorrhage or hypotension preferentially induces c-fos expression in supraoptic AVP-containing neurons.     

颈丛阻滞下行颈动脉内膜剥脱术--附32例分析

目的观察颈丛阻滞下行颈动脉内膜剥脱术的效果.方法 28名ASAⅡ～Ⅲ级患者行32例颈动脉内膜剥脱术,采用深浅丛联合阻滞,观察围术期血液动力学指标变化,分流管放置率和并发症情况.结果 麻醉后血压和心率与麻醉前相比差异有显著性(P＜0.05),其它时点与麻醉前相比差异无显著性(P＞0.05).颈动脉夹闭前后收缩压和心率的波动性的差异无显著性(P＞0.05).围术期高血压的发生率为50.0%,低血压6.25%,心动过速28.1%,心动过缓6.25%,分流管放置率6.25%.患者满意率84.4%.无1例改用全麻,无严重围术期并发症.结论颈丛阻滞是颈动脉内膜剥脱术安全、有效的麻醉方法.     

联勤后我分部医院开展优质服务的做法

为探讨军队医院联勤后开展联勤优质服务工作的管理，本介绍了我分部所属医院开展优质服务的做法，即：端正服务态度，增强服务意识，狠抓内涵建设，提高服务质量，改善医疗设备，美化诊疗环境，完善制度措施，加强监督管理等落实联勤优质服务。     

脑瘤手术中吸入异氟醚或异丙酚麻醉对血流动力学及应激反应的影响

目的　研究两种麻醉方法对血流动力学和应激反应的影响。方法　行脑瘤手术的 38例病人随机分为两组 ,醚组和酚组 ,醚组 (2 0例 ,咪唑安定、芬太尼、万可松诱导 ;维持麻醉为吸入异氟醚 1MAC ,30min后 1.5MAC ,30min。间断静注芬太尼、万可松 ) ;酚组 (18例 ,诱导同醚组 ,维持麻醉为全凭异丙酚静脉泵入 6mg·kg 1 ·h 1 ,30min后 12mg·kg 1 ·h 1 ,30min。间断静注芬太尼、万可松 )。快速补液。两组分别于诱导前 (T1 )、插管后即刻 (T2 )、麻醉维持 30min(T3)和 6 0min(T4 ) 4个时动脉血测定血糖浓度。同时监测血流动力学。结果　 (1)血流动力学变化　醚组 :MAP值在T3、T4 时点非常显著降低 (P <0 .0 1) ,且显著低于酚组同时点值 (P<0 .0 5 )。HR值各时点无统计学差异 (P <0 .0 5 ) ;酚组 :MAP值在T4 时点显著降低 (P <0 .0 5 )。HR值在T3、T4 时点显著降低 (P<0 .0 5 ) ,并低于醚组同时点值 (P <0 .0 5 )。 (2 )动脉血血糖浓度的变化　异丙酚组各时点血糖无变化 ;异氟醚组血糖浓度在麻醉后 30及 6 0min显著升高 (P <0 .0 5 ,P <0 .0 1)。结论　酚组的麻醉方式可适当控制应激反应 ,术中平稳 ,更利于脑瘤手术     

Effects of verapamil on synaptic transmission in mammalian sympathetic ganglia

Effects of verapamil (Ver) on the synaptic transmission of isolated superior cervical ganglia (SCG) were investigated by means of intracellular recording techniques. In the neurons of SCG of rabbits and guinea pigs, Ver (100-400 mumol/L) depressed both the synaptic responses (f-EPSPs and/or evoked action potentials) elicited by orthodromic stimulation and the acetylcholine (ACh) potentials induced by pressure ejection of ACh. 4-Aminopyridine (4-AP, 100 mumol/L) and BaCl2 (5 mmol/L) facilitated the f-EPSPs inhibited by Ver, but had no notable effect on the ACh potentials depressed by Ver. Ver suppressed the ACh potentials enhanced by pyridostigmine (1 mumol/L). The potentiating effect of soman (1 mumol/L) on the ACh potentials was prevented by Ver. It is suggested that Ver can block the synaptic transmission of mammalian SCG by both the pre- and postganglionic mechanisms.     

Excitatory postsynaptic potentials evoked by ventral root stimulation in neonate rat motoneurons in vitro

1. Intracellular recordings were made from antidromically identified motoneurons in transverse (500 microns) lumbar spinal cord slices of neonatal (12-20 day) rats. 2. Electrical stimulation of ventral rootlets evoked, with or without an antidromic spike or initial segment potential, a depolarizing response (latency, 1-4.2 ms), a hyperpolarizing response (latency, 1.5-3.5 ms), or a combination of two preceding responses in 38, 6, and 8% of motoneurons investigated. 3. The hyperpolarizing response was reversibly eliminated by low Ca2+ (0.25 mM), d-tubocurarine (d-Tc; 10 microM) or strychnine (1 microM), suggesting that this response represents an inhibitory post-synaptic potential (IPSP) mediated by glycine or a related substance release from inhibitory interneurons subsequent to their activation by axon collaterals in a manner analogous to the Renshaw cell circuitry described for the cat motoneurons. 4. The depolarizing responses were excitatory postsynaptic potentials (EPSPs), because they could be graded by varying the stimulus intensity and were reversibly abolished in low Ca2+ solution. 5. Membrane hyperpolarization increased the amplitude of EPSPs, and the mean extrapolated reversal potential was -4 mV. 6. EPSPs were augmented, rather than diminished, by dihydro-beta-erythroidine (1 microM) or d-Tc, arguing against a role of recurrent motor axon collaterals in initiating the responses. 7. The conduction velocity of the fibers initiating the EPSPs ranged from 0.35 to 0.96 m/s, indicating that these fibers were unmyelinated. Furthermore, the EPSP exhibited a constant delay when the stimulus frequency was varied from 1 to 5 Hz, and the synaptic delay estimated by extrapolation was less than 1 ms, suggesting that it was a monosynaptic event. 8. After complete separation of the ventral and dorsal horns by a knife cut, stimulation of ventral rootlets could still evoke an EPSP in motoneurons. 9. Superfusion of the slices with the nonselective glutamate receptor antagonist kynurenic acid (0.2-1 mM) or the selective quisqualate/kainate receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX) (0.5-1 microM) reversibly diminished the EPSPs. 10. EPSPs evoked by stimulation of dorsal and ventral rootlets exhibited different latency and waveform in the same motoneurons. 11. The results provide evidence that activation of ventral root afferents evoked an EPSP mediated by glutamate or a related substance in a population of motoneurons. Furthermore, the afferent pathway mediating the EPSP appears to be monosynaptic and confined to the ventral horn.