不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

异氟醚、七氟醚和地氟醚预处理对脑缺血再灌注损伤大鼠海马CBS/H2S、iNOS/NO和HO-1/CO的影响

目的 研究异氟醚、七氟醚和地氟醚预处理对脑缺血再灌注损伤大鼠海马CBS／H，S、iNOS／NO和HO-1／CO的影响，探讨吸入麻醉药脑保护作用的机制。方法30只Wistar大鼠随机分为5组（n=6）：对照组（C组）、脑缺血再灌注组（I／R组）、异氟醚组（I组）、七氟醚组（S组）和地氟醚组（D组）。采用四动脉阻断法建立大鼠全脑缺血再灌注模型。Ⅰ组、S组和D组夹闭两侧颈总动脉前分别吸入氧气＋0．65MAC的异氟醚、七氟醚和地氟醚30min，C组和I／R组吸入氧气。缺血20min，再灌注12h后处死大鼠，取海马，测定大鼠海马组织中HS、NO、CO、cAMP和cGMP含量和CBS，iNOS和HO活性以及CBS—mRNA、iNOS，mRNA和HO—1-mRNA的表达水平；电镜下观察海马线粒体的变化。结果与C组相比，I／R组海马组织CO、H2S、NO、cAMP、cGMP含量和HO、CBS、iNOS活性升高，CBS—mRNA、iNOS-mRNA和HO-1-mRNA表达升高，海马神经细胞线粒体变性率升高（P〈0．01）；与I／R组相比，Ⅰ组、D组和S组CO含量和HO活性升高，H2S、NO、cAMP含量和CBS、iNOS活性降低，CBS—mRNA和iNOS-mRNA表达降低而HO-1-mRNA表达升高，线粒体变性率降低（P〈0．05或0．01）。结论 异氟醚、七氟醚和地氟醚预处理可通过抑制CBS／142S、iNOS／NO，激活HO-1／CO，减轻了大鼠脑缺血再灌注损伤。     

rhBMP-2对内毒素致急性肺损伤大鼠肺动脉构型重建的影响

目的探讨重组人骨形态发生蛋白-2（rhBMP-2）对内毒紊致急性肺损伤大鼠肺动脉构型重建的影响及其机制。方法Wistar大鼠60只,随机分成3组（n=20）：对照组（C组）、LPS组（L组）和rhBMP-2组（R组）。C组：在1．5h内经股静脉输注生理盐水5ml；L组：在1h内经股静脉输注生理盐水3ml,然后在30min内再输注LPS 1mg/kg（溶于生理盐水2ml中）；R组：在1h内经股静脉输注rhBMP-2 10μg/kg（溶于3ml生理盐水中）,然后输注LPS（方法同上）,并且分别在输注LPS后24、48h时静脉注射rhBMP-24μg/kg。输注LPS或生理盐水后72h处死大鼠,取肺组织,光镜下进行病理学观察并测定肺小动脉中膜厚度,免疫组织化学荧光标记法测定肺小动脉Survivin、cyclinD1、p21的表达,增殖细胞核抗原测定肺动脉平滑肌细胞（PASMC）的增殖情况,TUNEL法测定PASMC的凋亡情况；取肺动脉,用RT-PCR法测定Survivin mRNA、p21 mRNA、cyelinD1 mRNA,用Western blot法测定Survivin、p21、cyclinD1蛋白表达及活化的caspase-3水平。结果与C组比较,L组肺小动脉中膜厚度百分比明显增加,Survivin mRNA、cyclinD1 mRNA、Survivin、eyclinD1水平增加,p21 mRNA、p21及活化的caspase-3水平降低,肺小动脉中膜PASMC增殖指数增加,凋亡指数降低（P＜0．01）；rhBMP-2可抑制上述改变。R组肺组织病理学损伤及肺动脉构型重建程度轻于L组。结论rhBMP-2通过抑制Survivin、cyclinD1的表达,上调p21蛋白表达与活化caspase-3,促进了PASMC的凋亡,抑制了内毒素致ALI大鼠肺动脉构型重建。     

颈丛神经阻滞后患者血浆内皮素、降钙素基因相关肽浓度的变化

颈丛神经阻滞在颈部手术中的应用十分普遍,但阻滞后部分患者常常出现血压升高、心率(HR)增快。本研究利用放免法测定患者血浆内皮素(ET)、降钙素基因相关肽(CGRP)的含量变化,并与相应时点的平均动脉压(MAP)和HR进行相关性分析,旨在探讨颈丛神经阻滞后患者血浆ET、CGRP的变化与血压升高、心率增快之间有关。     

七氟醚对内毒素诱导大鼠肺组织氧化应激反应的影响

目的 探讨七氟醚对内毒素（LPS）诱导大鼠肺组织氧化应激反应的影响。方法Wistar大鼠48只，体重200-290g，随机分为4组（n=12）：对照组（C组）、LPS组（L组）、1．0MAC七氟醚组（S1L组）和1．5MAC七氟醚组（S2L组）。各组大鼠腹腔注射异戊巴比妥钠100mg／kg，麻醉后机械通气。维持呼气末二氧化碳分压在35～45mmHg。L组股静脉注射LPS5mg／kg，C组给予生理盐水1．2ml，S1L组、S2L组注射LPS后分别吸入1．0MAC、1．5MAC七氟醚4h。吸入七氟醚后4h处死大鼠，测定肺组织超氧化物超歧化酶（SOD）、丙二醛（MDA）、一氧化氮（NO）、总一氧化氮合酶（tNOS）水平、诱导型一氧化氮合酶（iNOS）活性及iNOS mRNA、蛋白表达。结果 与C组比较，L组肺组织SOD活性下降，MDA、NO、tNOS水平、iNOS活性及iNOS mRNA及蛋白表达均升高（P〈0．01）；与L组比较，S1L组、S2L组肺组织SOD活性升高，MDA、NO、tNOS水平及iNOS mRNA及蛋白表达降低（P〈0．05）；S1L组与S2L组上述各项指标比较差异无统计学意义（P〉0．05）。结论 吸入1．0MAC和1．5MAC七氟醚4h可减轻LPS诱导肺组织氧化应激反应。     

罗哌卡因用于蛛网膜下腔阻滞的实验研究

目的：观察不同浓度不同剂量罗哌卡因注入犬的蛛网膜下腔后，脊髓，神经根早期超微结构及脊髓组织髓钙含量的变化。方法：杂种犬18只，雌雄兼有，体重10kg左右，随机分为三组，A组为对照组6只，生理盐水2ml，B组6只，0.5％罗哌卡因2ml(10mg)，C组6只，1％罗哌卡因2ml(20mg)，动物麻醉后对氯胺酮，芬太尼间断静脉注射射维持麻醉。于L3－4穿刺，注入生理盐水或罗哌卡因，于注药后3h，迅速处死动物后，取L1－2脊髓及神经根，每组随机取1mm3脊髓前角组织和神经根，固定于2．5％戊二醛磷酸缓冲液中行透射电镜观察脊髓及神经根超微结构的改变。并采用原子吸收分光光度法测脊髓组织钙含量。结果：（1）C组脊髓组织钙离子含量明显高于A，B两组。（2）A，B两组电镜标本正常，神经膜完整，脊髓标本显示线粒体，内质网完整。C组神经膜分层，部分断裂，脊髓组织线粒体肿胀，部分空泡变性，内质网肿胀。结论：1％浓度的罗哌卡因用于蛛网膜下腔可以造成脊髓缺血损伤，所以诮地蛛网膜下腔还需谨慎。     

星状神经节阻滞对缺血性视神经病疗效的评价

目的 比较星状神经节阻滞(SGB)及肾上腺皮质激素治疗缺血性视神经病(ION)的疗效。方法 诊断明确的ION病人70例82眼,随机分为激素组和SGB组。其中激素组34例38眼(地塞米松15mg静脉滴注,每日1次;5～10d后改用强的松20mg顿服,每日1次);SGB治疗组36例44眼(2％利多卡因2～3ml,患眼同侧行SGB,每日1次,10～15d为1疗程);以视力提高、眼底改变、视野变化以及视觉诱发电位(VEP)的改变作为疗效的指标。结果 激素组治疗后显效10眼,有效12眼,好转3眼,无效13眼,总有效率为65.8％。治疗前、后视力为0.26±0.21、0.35±0.26,差异有显著性(P<0.05)。SGB组治疗后显效15眼,有效14眼,好转5眼,无效10眼,总有效率为77.3％。治疗前、后视力为0.26±0.21、0.44±0.23,差异有显著性(P<0.01);与激素组治疗后视力比较,差异有显著性(P<0.05)。两组病人治疗后VEP P_(100)波的潜时明显缩短,振幅明显升高,与治疗前比较,P<0.05;SGB组治疗后振幅升高较激素组明显(P<0.05)。治疗后两组大部分病人眼底视盘水肿逐渐消退,视网膜颜色、血管逐渐恢复常态,视野基本恢复正常,受损的视神经功能得到恢复。结论 星状神经节阻滞是治疗缺血性视神经病变较安全、有效的方法。     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

七氟醚预处理对急性心肌缺血再灌注损伤大鼠认知功能的影响

目的 探讨七氟醚预处理对急性心肌缺血再灌注损伤大鼠认知功能的影响.方法 健康SD大鼠60只,雌雄各半,体重300～350 g,随机分为4组:正常对照组(C组,n=6),假手术组(S组,n=18)仅挂线不结扎左冠状动脉;急性心肌缺血再灌注组(IR组,n=18)结扎左冠状动脉30 min后恢复再灌注;七氟醚预处理组(SP组,n=18)吸入七氟醚1.0 MAC 60 min,停止吸入七氟醚后60 min结扎左冠状动脉,缺血30 min后恢复再灌注.分别于左冠状动脉结扎前(T1)、缺血30 min(T2)及再灌注120 min(T3)时抽取股动脉血1 ml,测定血浆丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活性.C组随机取3只大鼠,其余各组于再灌注1、3、7 d各随机取3只大鼠测定海马长时程增强(LTP),C组取另外3只大鼠,其余各组于上述时点随机取3只大鼠,测定海马肿瘤坏死因子α(TNF-α)、TNF-α mRNA、白细胞介素1β(IL-1β)、IL-1β mRNA、血红素氧合酶(HO)-1的表达水平.结果 与C组和S组比较,IR组和SP组LTP降低;与IR组比较,SP组LTP升高(P＜0.05).与C组比较,IR组和SP组HO-1、IL-1β mRNA、IL-1β、TNF-α mRNA表达上调;与S组比较,IR组和SP组IL-1β mRNA及IL-1β表达上调;与IR组比较,SP组TNF-α mRNA、HO-1、IL-1β mRNA及IL-1β表达下调,血浆MDA浓度降低,SOD活性升高(P＜0.05).结论 七氟醚预处理可改善急性心肌缺血再灌注损伤大鼠认知功能,其机制可能与下调TNF-α、IL-1β表达有关.     

F波分析法观察全麻诱导期间静脉麻醉药对脊髓运动神经元兴奋性的影响

对手术刺激无体动反应是全身麻醉的基本特征之一，Rampil等^[1,2]通过动物实验首先提出吸入麻醉药可能是通过作用于脊髓而产生无体动反应的假设。当给予运动神经刺激时，正向传导的电流引起其支配肌肉去极化产生复合动作电位，在肌电图表示为M波；而逆向传导的电流折回脊髓，使运动神经元兴奋，产生的动作电位又沿运动神经传导至其支配肌肉，再次去极化产生的复合动作电位即为F波。F波分析法是一种无创性肌电图检测方法，主要用于检查外周神经疾病，也可用于监测脊髓运动功能。