普伐他丁预处理对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effect of preoperative pravastatin preconditioning on myocardial ischemia-repedusion(I／R)injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ orⅢpatients of both sexes aged 18-64 yr undergoing cardiac valve replacement under CPB were randomly divided into 4 groups(n=15 each)：control group(group C)and 3 pravastatin groups receiving oral pravastatin 10，20 and 40 mg respectively every night for 7 days before operation(group P1-3).The number of patients receiving dopamine(≥5 μg·kg-1·min-1)and adrenaline was recorded from the termination of CPB to the end of operation，from the end of operation to 12 h after operation，during 12-24 h after operation and during 24-48 h after operation.Venous blood samples were taken from central venous line for measurement of plasme cTnI and CK-MB concentrations at 7 days before operation，before induction of anesthesia，at opening of the aorta and at 2，24 and 48 h after opening of aorta.Results The number of patients receiving dopamine and adrenaline was significantly less in group P3 than in group C(P<0.05).Plasma CK-MB and cTnI concentrations were significantly lower in group P3 than in group C(P<0.05).Conclusion Preconditioning with oral pravastatin(40mg／d for 7 consecutive days)can protect myocardium against I／R injury in patients undergoing cardiac valve replacement with CPB.     

脑阿片受体在侧脑室注射吗啡预处理减轻大鼠心肌缺血再灌注损伤中的作用

Objective To investigate the role of cerebral opioid receptors in the protective effects of intracerebro-ventricular (ICV) morphine preconditioning (MPC) against myocardial ischemia-reperfusion (I/R) injury in rats. Methods Male SD rats weighing 320-370 g were used in this study. A needle was inserted through a surgically created hole into the cerebro-ventricle using a stereotactic instrument and fixed. Sixty male SD rats in which ICV needle was successfully placed without complication were randomly divided into 10 groups of 6 animals each. In group I sham operation was performed (S). In group]] myocardial I/R was produced (I/R) . In group Ⅲ (ischemic preconditioning), the animals were subjected to 3 episodes of 5 min myocardial ischemia at 5 min intervals before ischemia (IPC) . In group IV morphine was given ICV in 3 repeated doses of 1 μg/kg at 5 min intervals before ischemia (MPC). Three types of opioid receptor antagonists -nor-binaltorphimine (nor-BNI) (κ receptor antagonist), D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2(CTOP) (μ receptor antagonist) and naltrindole (NTD) (S receptor antagonist) 15 nmol were given ICV in group V . VI and VIⅡI respectively at 10 min before MPC. In group VIII,IX and X , nor-BNI, CTOP and NTD 15 nmol were given ICV respectively at 40 min before ischemia. Myocardial I/R was produced by occlusion of left anterior descending branch of coronary artery for 30 min followed by 120 min reperfusion. At the end of 120 min, femoral venous blood samples were taken for determination of lactate dehydrogenase ( LDH) and creatine kinase (CK) activities and calcitonin gene-related peptide (CGRP) concentration. The animals were then killed and hearts removed for measurement of area at risk (AAR) and infarct area (IA) . IA/AAR ratio was calculated. Results The size of IA was smaller and IA/AAR ratio lower and significantly less LDH and CK and more CGRP were released in group IPC and MPC ( group Ⅲ and IV) than in group I/R (group II ) . The protective effects of MPC were abolished by pretreatment with nor-BNI, CTOP and NTD. Conclusion Cerebral μ, k and δ opioid receptors are involved in the protective effects of ICV morphine preconditioning against myocardial I/R injury through CGRP released from peptidergic nerve fibers of heart.     

中枢吗啡预处理对在体大鼠心肌缺血/再灌注损伤的保护作用

目的 观察从侧脑室以预处理的方式注射吗啡对在体大鼠心肌缺血/再灌注损伤的影响,探讨中枢吗啡预处理对缺血后心脏保护作用的可能机制.方法 先建立侧脑室注射动物模型,再建立心肌缺血/再灌注损伤动物模型,观察记录平均动脉压(MAP)、心率(HR),平均动脉压和心率乘积(RPP);心肌缺血危险区(AAR)、梗死区(IS)的体积、以及IS/AAR;S-P免疫组织化学法测定大鼠孤束核中c-fos表达情况;放射免疫法检测血清中降钙素基因相关肽(CGRP).结果 与对照组(CON)比较,缺血预处理组(IPC)、吗啡预处理组(MPC)(IS/ARR)均降低(P<0.05和P<0.01);IPC、MPC孤束核中c-fos表达明显低于CON组(P<0.01);IPC、MPC组CGRP水平明显高于CON组(P<0.01);吗啡预处理+纳洛酮(MN)组,IS体积和IS/AAR、c-fos和CGRP差异无显著性;各组各时点的HR、MAP及RPP,差异无显著性.结论 侧脑室注射吗啡预处理可以模拟缺血预处理,对在体大鼠心肌缺血/再灌注损伤具有保护作用.这种保护机制可能是通过中枢-外周神经调节完成的,c-fos、CGRP可能参与这种保护作用的机制.     

右美托咪定对颅脑手术拔管期血流动力学的影响

目的观察不同剂量右美托咪定在颅脑手术拔管期对血流动力学的影响。方法 48例患者随机均分为右美托咪定0.4、0.6、0.8μg/kg组(D1、D、D3组)和生理盐水组(C组)。手术结束前分别给予不同剂量右美托咪定和等容量生理盐水。记录给药前(T1)、给药后10min(T2)、15min(T3)、拔管前(T4)、拔管时(T5)和拔管后1min(T6)的MAP、HR、SpO2;记录苏醒期血管活性药使用情况。结果与C组比较,D1、D2和D3组在拔管期间血流动力学较平稳,但D3组血管活性药物使用较多。结论术毕前给予右美托咪定0.4μg/kg和0.6μg/kg可有效维持颅脑手术拔管时血流动力学的稳定,且不延长拔管时间。     

预处理对病理状态下心脏缺血/再灌注损伤的影响

背景 缺血性心脏病被认为是世界范围内人类发病和死亡的主要原因;预处理,包括缺血预处理(ischemic preconditioning,IP)和药物预处理在正常心肌中的保护作用已得到证实.目的 了解合并心血管相关危险因素等病理条件下预处理对心脏缺血/再灌注(ischemia/reperfusion,I/R)的影响.内容 就近年来在某些病理状态下(如高血脂、糖尿病、高血压、老龄化及肥胖等)预处理对心脏缺血/再灌注损伤(ischemia/reperfusion injury,I/RI)的作用及可能机制的研究简要作一综述.趋向 为进一步研究相关的心脏保护策略提供思路.     

舒芬太尼复合七氟醚或丙泊酚在全麻诱导中的应用

目的 观察舒芬太尼复合七氟醚或丙泊酚在全麻诱导中的应用.方法 择期ASA I或Ⅱ级上腹部手术患者30例,随机分为七氟醚组(A组)和丙泊酚组(B组),每组15例.麻醉诱导先静脉注射舒芬太尼0.5μg/kg,1 min后,A组以肺活量法吸入8%七氟醚和8 L/min氧气,入睡后推注罗库溴铵0.6 mg/kg,维持吸入七氟醚使其呼气末浓度达6%;B组以靶控输注丙泊酚3 mg/L行麻醉诱导,入睡后推注罗库溴铵0.6 mg/kg,BIS值达50并维持5 s后行气管插管.记录患者入睡时间、BIS值达到50的时间以及不良反应.观察两组患者诱导前(T0)、达到插管条件时(T1)、气管插管时(T2)、气管插管后1 min(T3)、3 min(T4)、5 min(T5)、10 min(T6)时SBP、DBP、HR和BIS值的变化,并在各时点抽动脉血用酶联免疫法测定血浆肾上腺素(E)和去甲肾上腺素(NE)浓度.结果 A组患者诱导入睡时间、BIS值下降至50的时间均短于B组(P＜0.05),两组插管期间均无不良记忆反应.与T0时比较,两组T1时SBP、DBP明显下降(P＜0.05),B组HR明显减慢(P＜0.05).与T1时比较,两组T2～T4时SBP、DBP明显升高(P＜0.05),B组HR明显增快(P＜0.05),T5、T6时SBP、DBP和HR基本恢复到插管前水平.B组T1时SBP、DBP和HR下降幅度较A组明显(P＜0.05).两组T1～T6时BIS均小于50,组间差异无统计学意义.与T0比较,B组T3～T5时血浆E和NE浓度升高(P＜0.05).结论 舒芬太尼复合吸入七氟醚麻醉可以达到良好抑制插管应激反应的效果和足够的麻醉深度,且比复合靶控输注丙白酚麻醉诱导更为平稳和快速.     

脑阿片受体在侧脑室注射吗啡预处理减轻大鼠心肌缺血再灌注损伤中的作用

Objective To investigate the role of cerebral opioid receptors in the protective effects of intracerebro-ventricular (ICV) morphine preconditioning (MPC) against myocardial ischemia-reperfusion (I/R) injury in rats. Methods Male SD rats weighing 320-370 g were used in this study. A needle was inserted through a surgically created hole into the cerebro-ventricle using a stereotactic instrument and fixed. Sixty male SD rats in which ICV needle was successfully placed without complication were randomly divided into 10 groups of 6 animals each. In group I sham operation was performed (S). In group]] myocardial I/R was produced (I/R) . In group Ⅲ (ischemic preconditioning), the animals were subjected to 3 episodes of 5 min myocardial ischemia at 5 min intervals before ischemia (IPC) . In group IV morphine was given ICV in 3 repeated doses of 1 μg/kg at 5 min intervals before ischemia (MPC). Three types of opioid receptor antagonists -nor-binaltorphimine (nor-BNI) (κ receptor antagonist), D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2(CTOP) (μ receptor antagonist) and naltrindole (NTD) (S receptor antagonist) 15 nmol were given ICV in group V . VI and VIⅡI respectively at 10 min before MPC. In group VIII,IX and X , nor-BNI, CTOP and NTD 15 nmol were given ICV respectively at 40 min before ischemia. Myocardial I/R was produced by occlusion of left anterior descending branch of coronary artery for 30 min followed by 120 min reperfusion. At the end of 120 min, femoral venous blood samples were taken for determination of lactate dehydrogenase ( LDH) and creatine kinase (CK) activities and calcitonin gene-related peptide (CGRP) concentration. The animals were then killed and hearts removed for measurement of area at risk (AAR) and infarct area (IA) . IA/AAR ratio was calculated. Results The size of IA was smaller and IA/AAR ratio lower and significantly less LDH and CK and more CGRP were released in group IPC and MPC ( group Ⅲ and IV) than in group I/R (group II ) . The protective effects of MPC were abolished by pretreatment with nor-BNI, CTOP and NTD. Conclusion Cerebral μ, k and δ opioid receptors are involved in the protective effects of ICV morphine preconditioning against myocardial I/R injury through CGRP released from peptidergic nerve fibers of heart.     

超声引导不同入路的臂丛神经阻滞联合脑电双频指数监测对肩关节镜下患者的麻醉效果分析

目的 探讨超声引导不同入路的臂丛神经阻滞联合脑电双频指数(BIS)监测对肩关节镜下患者的麻醉效果。方法 前瞻性选取2020年1月至2022年7月来亳州市人民医院行肩关节镜手术的患者90例,按照随机数字表法将患者分为对照组与观察组,每组各45例。对照组患者行BIS监测下锁骨上入路臂丛神经阻滞复合全身麻醉,观察组行BIS监测下腋路臂丛神经阻滞复合全身麻醉。比较两组患者手术室时(T0)、气管插管即刻(T1)、切皮时(T2)、拔管(T3)的心率、平均动脉压水平;比较两组患者术中的七氟烷及舒芬太尼用量;比较两组患者在麻醉后恢复室中、术后6 h、12 h的疼痛评分和肌力评分;观察两组患者麻醉后的不良反应发生情况。结果 两组在T0、T3点的心率、平均动脉压比较,差异无统计学意义(P>0.05);观察组在T1、T2点的心率为(78.10±10.23)、(71.34±8.78)次/min,平均动脉压为(100.09±8.78)、(95.23±7.89) mmHg,均明显较对照组[(82.78±9.89)、(78.99±10.23)次/min和(110.45±9.23)、(104.45±10.55)...