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.     

机械通气在急性呼吸衰竭治疗中同步呼吸的临床研究

目的 探讨机械通气在急性呼吸衰竭治疗中患者与呼吸机同步呼吸的方式。方法 采用随机方法将30例急性呼吸衰竭机械通气患者分为三组,Ⅰ组同步间歇指令通气(SIMV)10例。Ⅱ组同步间歇指令(SIMV)/压力支持通气(PS)或SIMV/PS-CPAV 10例。Ⅲ组双水平正压通气(BIPAP)/SIMV-PS 10例。各组观察同步成功率,同步方式前后SPO_2、ET-CO_2、HR、MAP、f每日查血气。结果 Ⅰ组与Ⅱ、Ⅲ组间同步呼吸成功率有非常显著差异P<0.01。Ⅱ与Ⅲ组间同步呼吸成功率有显著差异P<0.05。Ⅱ、Ⅲ组间各观察项目,同步方式前后无显著差异P>0.05。Ⅰ组各观察项目同步方式前后有显著差异P<0.01。结论 BIPAP/SIMV-PS是三组同步呼吸模式中效果最好,而SIMV同步呼吸效果最次。     

纤维光导内窥镜在小儿困难气管插管中的应用

对于任何一位麻醉医师来讲,小儿困难气道的处理均是一种可怕和充满挑战的过程,应充分掌握和采用能提高气道处理水平的各种方法。纤维光导内窥镜(fiberoptic endoscope,FES)是处理困难气道的有用措施之一,其在成人的应用技术已趋成熟和肯定。尽管既往FES在小儿困难插管中很少被提及,但近年来其在小儿的应用愈来愈受到人们的重视,这主要与FES设计的改进和人们应用水平的提高有关,特别是超细纤维光导内窥镜(ultrathinfiberoptic endoscope)的使用,即使在只能插入2.5mm气管导管的新生儿,也能采用此项技术进行气道处理。本文就上述问题进行综述,介绍进展如下。     

雷米芬太尼对大鼠肝脏缺血再灌注损伤后期细胞凋亡因子的影响

目的:探讨雷米芬太尼对大鼠肝脏缺血再灌注损伤后期细胞凋亡因子Bax和bcl-2蛋白及其mRNA表达的影响.方法:将90只雄性Wistar大鼠分为I、R、NR、N和C组.采用70%肝脏缺血再灌注损伤模型.在大鼠肝脏缺血前分别给予生理盐水(Ⅰ组)、雷米芬太尼(R组和NR组)和纳络酮(NR组和N组).测定肝脏缺血再灌注1h和12h时的血浆丙氨酸氨基转氨酶(ALT)活性、血浆肿瘤坏死因子(TNF-α)水平以及再灌注12h时肝脏组织Bax和bcl-2蛋白及其mRNA的表达情况.结果:再灌注1h后R组的ALT活性和TNF-α水平以及再灌注12h后R组的Bax和bcl-2蛋白及其mRNA表达的比值均明显低于Ⅰ组和NR组(P<0.05).结论:雷米芬太尼可减少肝脏缺血再灌注后期阶段细胞凋亡因子Bax和bcl-2蛋白及其mRNA的表达比值.纳络酮仅能阻断部分雷米芬太尼的肝保护作用.     

七氟烷联合静脉麻醉对腹腔镜胃肠肿瘤切除术中罗库溴铵用量的影响

目的 观察腹腔镜胃肠肿瘤切除术中采用吸入七氟烷联合静脉麻醉对罗库溴铵用量的影响,探讨其在减少术后不良反应中的作用。方法 51例行腹腔镜胃肠肿瘤切除术患者随机分为七氟烷联合静脉麻醉组25例,静脉麻醉组26例。2组均采用静脉注射咪达唑仑0.05 mg/kg、舒芬太尼0.4μg/kg、丙泊酚2.5 mg/mL、罗库溴铵0.6 mg/kg进行麻醉诱导。气管插管后行深度肌松麻醉,静脉泵注丙泊酚3～5 mg/(kg·h)和瑞芬太尼0.1～0.3 mg/(kg·min),维持术中脑电双频指数值40～60;强直刺激后计数≥3时静脉泵注罗库溴铵,初始剂量为7.5μg/(kg·min),调整静脉泵注速率,维持术中肌松深度强直刺激后计数≤2。七氟烷联合静脉麻醉组气管插管后吸入七氟烷并维持最低肺泡有效浓度为1.0;静脉麻醉组不吸入七氟烷。2组均于预计手术结束前40 min停止泵注罗库溴铵,静脉泵注丙泊酚和瑞芬太尼至术毕;七氟烷联合静脉麻醉组在预计手术结束前30 min停止吸入七氟烷。记录2组瑞芬太尼、丙泊酚、罗库溴铵等用量,拔管时间,手术时间,PACU治疗时间,肌松起效时间,临床肌松时间,体内作用时间,恢复指...     

麻醉诱导期不能插管不能通气5例临床分析

目的 总结麻醉诱导期不能插管不能通气(CICV)患者的临床特征,探讨其处理方法。方法 2014年12月—2023年3月首都医科大学附属北京友谊医院麻醉诱导期发生CICV 5例。例1麻醉诱导后可视喉镜发现舌根淋巴滤泡明显增生,无法显露会厌和声门,顺序采用多种气管插管方法均未成功,随后发生面罩通气困难,立即插入喉上通气装置维持通气至自主呼吸和意识恢复。例2麻醉诱导后面罩通气可行,但直接喉镜显露声门困难和气管插管失败,面罩通气时气道阻力增加、脉搏血氧饱和度(SpO₂)降低,插入喉上通气装置后通气明显改善、SpO₂逐渐升高,随后经喉上通气装置完成气管插管。例3麻醉诱导后可视喉镜无法显露声门和气管插管失败,行面罩通气、可视喉镜联合可曲支气管镜气管插管均失败,行紧急气管切开术。例4麻醉诱导后面罩通气时气道阻力较大,潮气量低,气道峰压高,可视喉镜联合可曲支气管镜插管失败,双人三手理想面罩通气后应用可视硬管镜气管插管成功。例5麻醉诱导后喉上通气装置插入顺利,但术中气道峰压反复升高,拔除喉上通气装置后应用可曲支气管镜引导气管插管,喉水肿明显,无法显露声门和通过...     

手术体积描记指数及熵指数用于肥胖患者伤害性刺激监测的可行性分析

目的比较麻醉状态下肥胖患者手术体积描记指数(SPI)、熵指数[包括反应熵(SE)及状态熵(RE)]对伤害性刺激的反应能力。方法前瞻性选取首都医科大学附属北京友谊医院2019年5～12月40例肥胖患者择期行胃减容手术常规诱导下气管内插管全身麻醉,记录插管前1 min、插管即刻、插管后2 min,切皮前1 min、切皮即刻、切皮后2 min,拔管前1 min、拔管即刻、拔管后2 min各时间点所对应的SPI、RE、SE数值以及心率(HR)、平均动脉压(MAP)。结果气管插管、切皮、拔管即刻SPI、RE、SE、HR、MAP数值较刺激前均升高,SPI在插管前(37.4±12.00)与插管即刻(54.1±15.60)比较差异具有统计学意义(P 0.05)。SPI在切皮前(29.17±8.82)与切皮即刻(57.71±17.64)比较差异具有统计学意义(P 0.05)。HR在插管前(83.7±12.6 bpm)与插管即刻(94.7±15.0 bpm)比较差异具有统计学意义(P 0.05),在切皮前(69.27±7.64 bpm)与切皮即刻(70.16±10.76 bpm)比较差异具有统计学意义(P 0.05),拔管前(80.7±16.35 bpm)与拔管即刻(91.3±15.9 bpm)比较差异具有统计学意义(P 0.05)。结论 SPI和心率在肥胖患者对伤害性刺激强度有一定的预测作用,均能在一定程度上反映伤害性刺激,其中相比于RE、SE,SPI升高更明显、更快速,具有较好的临床指导作用。     

Children''s development effecting blood oxygen desaturation following apnea.

One hundred and fifty-six children aged from 4 months to 12 years undergoing elective plastic surgery were included in this study. All children were ASA physical status I, under normal development, ranging from 64 to 140 cm in body height and from 6.0 to 41.0 kg in body weight. Following 2-minute preoxygenation, the time when SpO2 dropped to 95% and 90% in apneic period had a close correlation with age, weight and height of children by means of linear and non-linear-regression analysis. The smaller the children's weight, the higher the incidence of severe arterial desaturation after reinstitution of manual ventilation with 100% oxygen at SpO2 of 90%. It is suggested that younger children are more susceptible to hypoxemia than older ones during apnea and provided no problem existing other than oxygen delivery, an SpO2 of 95% might be the safe limitation of apnea in pediatric anesthesia induction.