联合应用缺血后处理、远隔缺血后处理和纳洛酮后处理对大鼠脑缺血-再灌注损伤的影响

Objective To assess the effects of ischemic postconditioning, remote ischemic postconditioning and naloxone postconditioning on focal cerebral ischemia-reperfusion injury in rats.Methods A total of 110 adult SD rats were randomly divided into 5 groups (n =22 each). The focal cerebral ischemia-reperfusion injury was induced by a 90-minute occlusion of right middle cerebral artery (MCA) and a 24-hour reperfusion sequentially. Group 1 was of ischemia-reperfusion control; Group 2 ischemic postconditioning induced by three 30-second cycles of MCA occlusion followed by a 30-second reperfusion; Group 3 remote ischemic postconditioning performed via a transient occlusion of right femoralartery at 5 min before the initiatlon of reperfusion:Group 4 naloxone posteonditioning with naloxone 10 mg/kg intraperitoneaUy injected at the initiation of reperfusion;Group 5 combined ischemic,remote ischernic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2,3 & 4.The neumlogie deftcit scores(NDS)were obtained at 2 h & 24 h post-reperfusion.At 24 h post-reperfusion.the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to asseSS the size ofcerebral infaret(n=10),detect the cerebral expression of microtubule-associated protein2(MAP2)(n=6),measure the plasma volume of cerebral tissues and quantify the diameter and segment artery at 5 min before the initiation of reperfusion; Group 4 naloxone postconditioning with naloxone 10 mg/kg intraperitoneally injected at the initiation of reperfusion; Group 5 combined ischemic, remote ischemic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2, 3 & 4. The neurologic deficit scores ( NDS) were obtained at 2 h & 24 h post-reperfusion. At 24 h post-reperfusion, the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to assess the size of cerebral infarct (n = 10), detect the cerebral expression of microtubule-associated protein2 ( MAP2) (n =6) , measure the plasma volume of cerebral tissues and quantify the diameter and segment length of cerebral microvessel (n = 6 ). Results There were no significant differences in the heart rate (HR) and mean arterial pressure (MAP) among the above five groups at all observed time points (P ＞ 0. 05). At 24 h post-reperfusion, the percentage of ischemic cerebral infarct size was 43% ±6% , 31% ±4% , 32% ±5% , 28% ±6% & 21% ±7% in ipsilateral hemisphere area (i. e. , cerebral infarct severity)in Groups 1-5 respectively. Compared with Group 1, the levels of NDS and cerebral infarct severity significantly decreased at ischemic side in Groups 2-5 ( P ＜ 0. 05 ). And the cerebral expression of MAP2,plasma volume of cerebral tissues, diameter and segment length of cerebral microvessel significantly increased at the ischemic side (all P＜0. 05). However, there were no significant differences in the abovementioned parameters at ischemic side among Groups 2, 3 and 4 (all P ＞0. 05). The parameters of NDS,cerebral infarct severity, cerebral expression of MAP2 and plasma volume of cerebral tissues in the ischemic side significantly increased in Group 5 compared with Groups 1,2,3 and 4 (all P ＜ 0. 05). The diameter and segment length of cerebral microvessel at ischemic side were not different among Groups 2,3,4 and 5 (all P＞0. 05). Conclusion In focal cerebral ischemia-reperfusion rats, ischemic, remote ischemic and naloxone postconditioning may produce significant neuroprotective effects of reduced cerebral infarct severity and improved neurologic dysfunctions. A combination of three postconditioning approaches enhances the above neuroprotective effects.     

瘙痒介质在AEW诱发的小鼠干皮症模型中的表达

目的采用丙酮-乙醚-水(acetone-ether-water, AEW)贯序涂抹法建立小鼠干皮症慢性瘙痒模型,检测皮肤和背根神经节(DRG)中MrgprA3和TRPA1 m RNA的表达,初步探讨MrgprA3和TRPA1在AEW诱发的干皮症慢性瘙痒模型中的作用。方法 9周龄C57BL/6雄鼠12只,随机平均分为模型组和对照组,模型组颈背部皮肤涂抹丙酮/乙醚(1:1)和水,连续7 d制造小鼠干皮症慢性瘙痒模型;对照组小鼠涂抹蒸馏水,时间频率与模型组相同。观察小鼠搔抓行为学,皮肤组织学(HE染色)、肥大细胞浸润情况(甲苯胺蓝染色),RT-qPCR分析MrgprA3和TRPA1在颈段背根神经节(DRG)和病损皮肤中m RNA表达水平变化。结果与对照组相比,模型组小鼠的抓挠次数显著多于对照组(P<0.01);模型组小鼠病损部位皮肤水分明显减少,皮肤干燥、脱屑,病理提示表皮增厚明显,真皮层肥大细胞浸润不明显;颈部病损皮肤和颈部脊神经节中MrgprA3和TRPA1m RNA表达均高于对照组(P<0.01)。结论利用丙酮-乙醚和水贯序涂抹法成功建立小鼠干皮症慢性瘙痒模型,MrgprA... 更多     

右美托咪定复合舒芬太尼麻醉对老年患者内镜下食管静脉曲张套扎术血流动力学及术后认知功能的影响

目的观察右美托咪定复合舒芬太尼麻醉对老年患者内镜下食管静脉曲张套扎术(EVL)血流动力学及术后认知功能的影响。方法选取2017年10月至2019年12月于首都医科大学附属北京友谊医院择期行EVL的老年患者(≥65岁) 90例行前瞻性研究,按照随机数字表法将患者分为3组:A组(n=30)患者给予舒芬太尼0. 2μg/kg,丙泊酚1～1. 5 mg/kg诱导; B组(n=30)患者给予右美托咪定0. 5μg/kg(输注10 min),舒芬太尼0. 15μg/kg,丙泊酚1～1. 5 mg/kg诱导; C组(n=30)患者给予丙泊酚2～2. 5 mg/kg诱导。三组诱导后均连接微量泵,丙泊酚4～6 mg·kg~(-1)·h~(-1)维持麻醉。记录三组患者的平均动脉压、心率和脉搏血氧饱和度的变化,以及内镜手术时间、苏醒时间和丙泊酚总用量,并于术前1 d和术后1 d采用成人简易精神状态评价量表(MMSE)评估患者的认知功能情况。结果与术前相比,三组患者的心率均明显下降,B组患者下降更明显(P 0. 05); C组在给药后5 min(T1)、10 min(T2)、15 min(T3)和30 min(T4) 4个时间点的MAP较其他两组明显降低(P 0. 05); C组患者苏醒时间最长,丙泊酚总用量最多; B组患者苏醒时间最短,丙泊酚总用量最少; MMSE结果提示A组患者中有2例发生术后认知功能障碍(POCD),B组发生1例,C组发生6例(P 0. 05)。结论右美托咪定复合舒芬太尼对老年患者内镜下EVL的临床麻醉效果较好,可降低POCD的发生率。     

困难气道管理流程的选择和分析

对于参与气道管理的临床医师来讲,由于建立通畅气道失败所致的潜在性严重后果,困难气道仍然是与其最密切和对其最具挑战性的临床情况之一[1]. 因此,目前已经制定出许多实践指南,以帮助临床医师进行困难气道管理;而且已经设计出几个操作流程将这些实践指南分成步骤式决策树,以便气道管理者面临这种临床情况时使用[2-11].但是,困难气道管理的特殊性质却不允许采用随机对照临床试验比较不同实践指南或管理流程的有效性和可行性,从而不清楚哪种实践指南或管理流程是最佳的可用实践方案[12].本文回顾几个不同困难气道管理指南和流程以及支持它们的证据.     

小血管吻合技术在整形外科困难病例中的应用(14年临床科研工作总结)

我们自1985年开始,应用显微外科小血管吻合技术进行游离皮瓣移植、修复组织缺损的临床研究,共行手术103例,其中包括体表多个部位的先天或后天原因造成的组织缺损16种以及12种类型的游离皮瓣,游离皮瓣移植的总成功率为95％。近六年来一直稳定在100％,取得了较好的临床效果。总结十四年的临床经验,我们的体会是:     

麻醉和手术期间的心跳骤停与复苏

本文报告了13例在麻醉和手术期间发生循环骤停的患者,其中8例由于及时发现全部复苏成功,其余虽复苏一段时间,但终因中抠神经不可逆性损伤而死亡。说明手术中麻醉医师及早发现甚为重要,术中一旦血压和脉博不能测出或手术野出血发暗及停止,应立即进行复苏。     

氯胺酮麻醉导致严重喉痉挛死亡一例

<正> 现将我院一九八二年九月所遇到的氯胺酮麻醉导致严重喉痉挛死亡一例报告如下:患儿,陈某某,男,七岁,体重十九公斤。因左颈深部脓肿、颈椎脱位。拟于氯胺酮麻醉下,行脓肿切开引流,颈椎牵引术。术前患儿上感未愈,咳嗽频繁,且左肺底有湿性罗音,心率96次/分,节律规则。麻醉前肌注阿托品0.4毫克,鲁米那50毫克。三十分钟后静滴氯胺酮40毫克。两分钟后,患儿突然出现屏气、牙关紧闭,呼吸明显费力、氧饥饿征明显、口唇发绀。速给予紧闭面罩加压供氧,胸廓人工呼吸,均未能使上述症状     

经食管监测主动脉血氧饱和度及其临床意义

目的探讨经食管监测主动脉血氧饱和度(SteO2)的敏感性与精确性。方法45例择期手术患者,全麻气管插管后放置自制SteO2装置入食管下段。SteO2和脉搏血氧饱和度(SpO2)停止机械通气和稳定后供氧,SteO2从100%降到90%后立即纯氧吸入,实时动脉血气监测,观察相同时点SteO2和SpO2的变化。结果(1)SteO2与动脉血氧饱和度(SaO2)有良好的相关性(r=0.9514);SteO2与SaO2比较,相对与绝对偏差分别是1.7%和1.2%。(2)SteO2下降变化早于SpO2,提前(109.8±19.3)s(P<0.01)。结论经食管连续监测SteO2具有可行性。在预警条件下,急性缺氧时SteO2较SpO2更早报警。SteO2可以作为无创连续SaO2另一监测手段。     

食管引流型喉罩通气道及其临床应用

食管引流型喉罩通气道是一种新型喉罩通气道,下面就其发明设想、结构特点操作方法和临床应用进行讨论,以供临床医师在应用时借鉴和参考。     

视频喉镜在气道管理中应用的进展

视频喉镜是能够提供上呼吸道间接视野的新型气管插管设备。在困难气道管理处理方面．与直接喉镜相比．视频喉镜能够改善声门显露的Cormack—Lehane分级,并能在较短时间内达到相同或更高的气管插管成功率。尽管视频喉镜可获得非常好的声门显露．但是应用视频喉镜时插入和推进气管导管有时可发生失败。到目前为止,尚无确切证据表明在正常或困难气道患者视频喉镜应取代直接喉镜。