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.     

七氟醚对大鼠心肌缺血再灌注损伤的影响

心肌缺血再灌注期间,由于细胞内钙超载、大量氧自由基生成及ATP耗竭,可导致心肌组织不可逆的损害.研究表明,吸入麻醉药可减轻心肌缺血再灌注损伤[1].七氟醚是继氟烷、安氟醚和异氟醚之后开发出来的新型吸人麻醉药,对其研究尚少,因此本实验采用大鼠离体心脏Langendorff灌流模型,探讨七氟醚对大鼠心肌缺血冉灌注损伤的影响.     

miR-146a通过靶向调控TLR4减轻脊髓缺血再灌注大鼠损伤

目的 检测miR-146a在脊髓缺血再灌注(IR)大鼠脊髓组织的表达情况,探索miR-146a对IR大鼠炎症蛋白表达和神经功能影响的潜在机制.方法 SD大鼠通过主动脉弓夹闭14min建立IR模型,通过鞘内注射miR-146a的mimics质粒构建miR-146a过表达模型,随机分为Sham组(假手术组),IR组(缺血组)和mimic组(miR-146a过表达组).qRT-PCR评估损伤节段脊髓组织miR-146a表达水平;Western blot检测TLR4和IRAK1蛋白表达;Tarlov评分对大鼠进行下肢神经功能评估;对miR-146a和TLR4进行生物信息学预测.结果 与Sham组相比,IR组miR-146a表达降低,TLR4和IRAK1蛋白表达增高,Tarlov运动功能评分降低;和IR组相比,mimic组TLR4和IRAK1蛋白表达下调,Tarlov运动功能评分增高;生物信息学预测显示miR-146a和TLR4存在结合位点.结论 miR-146a可作为IR潜在的诊断标记物,miR-146a可能通过靶向TLR4蛋白减轻大鼠脊髓缺血再灌注的炎性损伤.     

术前睡眠紊乱对鼻内镜手术患者氟比洛芬酯术后镇痛效果的影响

目的 评价术前睡眠紊乱对鼻内镜手术患者氟比洛芬酯术后镇痛效果的影响.方法 择期行鼻内镜手术患者96例,年龄20～60岁,体重50～80 kg,性别不限,ASA分级Ⅰ或Ⅱ级.采用匹兹堡睡眠质量指数量表评价患者入院前的长期睡眠状况,采用阿森斯睡眠质量指数量表评价患者住院期间的短期睡眠状况.按照术前睡眠紊乱的程度,将患者分为4组(n=24):Ⅰ组无睡眠紊乱;Ⅱ组长期睡眠紊乱;Ⅲ组急性短期睡眠紊乱;Ⅳ组既存在长期睡眠紊乱又存在急性短期睡眠紊乱.静脉注射舒芬太尼、异丙酚和顺阿曲库铵麻醉诱导,气管插管后行机械通气,维持SpO2 98％～100％,PETCO230～35 mm Hg.静脉输注瑞芬太尼和异丙酚维持麻醉.术中静脉输注尼卡地平行控制性降压,维持MAP 50～70 mm Hg,HR 60～90次/min.手术结束前15 min静脉注射氟比洛芬酯50 mg行术后镇痛.术后6h内采用VAS评分评价疼痛程度,维持VAS评分≤3分.当VAS评分＞3分时,静脉注射氟比洛芬酯50 mg进行镇痛补救.记录术后6h内进行镇痛补救的情况.结果 与Ⅰ组比较,Ⅱ组、Ⅲ组和Ⅳ组术后6h内镇痛补救率均升高(P＜0.05);与Ⅱ组和Ⅲ组比较,Ⅳ组术后6h内镇痛补救率升高(P＜0.05);Ⅱ组和Ⅲ组术后6h内镇痛补救率差异无统计学意义(P＞0.05).结论 术前睡眠紊乱可影响鼻内镜手术患者氟比洛芬酯的术后镇痛效果.     

右美托咪定或地塞米松复合罗哌卡因对椎旁神经阻滞效果的影响

目的比较右美托咪定或地塞米松复合罗哌卡因对椎旁神经阻滞(PVB)效果的影响。方法择期行胸腔镜肺叶切除术患者128例,男43例,女85例,ASAⅠ或Ⅱ级,随机分为三组:对照组(C组)、右美托咪定组(D组)和地塞米松组(S组)。使用0.5%罗哌卡因共15 ml对C组患者行PVB,D组和S组分别使用0.5%罗哌卡因复合右美托咪定100μg共15 ml、0.5%罗哌卡因复合地塞米松10 mg共15 ml行PVB。记录阻滞后20 min的Ramsay镇静评分、口干评分以及术中阿片类药物用量、去氧肾上腺素用量、液体入量和尿量。测定PVB后0.5、1、2、3、24 h罗哌卡因血药浓度。记录术后24、48 h的VAS疼痛评分。记录术后首次镇痛泵按压时间。结果D组PVB阻滞后20 min的Ramsay镇静评分、口干评分明显高于C组,术中尿量明显多于C组(P<0.05)。C组、S组Ramsay镇静评分、口干评分以及术中尿量差异无统计学意义。三组术中舒芬太尼、去氧肾上腺素用量、液体入量差异无统计学意义。PVB后0.5、1、2、3、24 h三组罗哌卡因血药浓度差异无统计学意义。术后24、48 h三组不同状态下VAS疼痛评分差异无统计学意义。D组、S组术后首次镇痛泵按压时间明显长于C组(P<0.05),S组术后首次镇痛泵按压时间明显长于D组(P<0.05)。结论与0.5%罗哌卡因复合右美托咪定100μg比较,0.5%罗哌卡因复合地塞米松10 mg行PVB的镇痛时间更长,且患者无口干、镇静过深等不良反应。     

KTP激光喉显微外科手术麻醉的临床观察

我院自 1 997年 3月始在国内首先利用ＫＴＰ激光在支撑喉镜下开展喉显微外科手术 ,现将选用全麻病例的有关情况报告如下。资料与方法一般资料　本组 1 0 1例 ,其中男 70例 ,女 31例 ;平均年龄 50岁 (9～ 77岁 ) ;平均体重 64ｋｇ(2 2～ 1 0 4ｋｇ) ;ＡＳＡ分级为Ⅰ～Ⅲ级。手术