倾向性评分匹配法分析术中脑氧饱和度变异度对术后心肌损伤发生率的影响

目的 应用倾向性评分匹配法前瞻性分析脑氧饱和度平均真实变异度（average real variability, ARV）对高龄胃肠道肿瘤手术患者术后心肌损伤发生率的影响。方法 选取择期全麻下行腹腔镜胃肠道恶性肿瘤根治术老年患者104例，男73例，女31例，年龄65～80岁，ASAⅡ或Ⅲ级，BMI 18～30 kg/m²。根据术中脑氧饱和度ARV中位数分为两组：高ARV组（A组，n=53）和低ARV组（B组，n=51）。应用倾向性评分匹配以均衡组间协变量，比较两组术后心肌损伤及心电图发生缺血性改变的发生率。结果 两组间BMI、术中麻黄素使用率、术中rSO₂最大值、最小值以及差值的差异有统计学意义（P<0.05）。经倾向性评分匹配，选用最近邻匹配法，设置卡钳值为0.2,两组按照1∶1进行匹配，成功匹配各32例。A组心肌损伤发生率高于B组（18.75%vs. 3.125%,P<0.05）,A组心电图发生缺血性改变发生率与B组比较差异无统计学意义（9.375%vs. 3.125%,P>0.05）。结论 术中低脑氧饱和度变异度有助于...     

综合保温对妇科腹腔镜手术患者复苏期并发症的影响

目的 探讨综合保温法对妇科腹腔镜手术患者复苏期并发症的影响.方法 以安徽医科大学第二附属医院妇科2017年4月至2017年6月收治的145例行腹腔镜手术的患者为研究对象,按接受手术先后顺序结合随机数字表法将其分为干预组(72例)和对照组(73例).干预组给予综合保温措施,对照组给予常规保温措施,比较两组患者麻醉前(T0)、入复苏室即刻(T1)、入复苏室15分钟(T2)、入复苏室30分钟(T3)的鼻温数值、心率、平均动脉压和复苏期并发症.结果 两组患者在T0时的鼻温、心率和平均动脉压比较差异均无统计学意义(P>0.05);干预组患者在T1、T2、T3时点的鼻温值均高于对照组,差异有统计学意义(P<0.05);干预组患者在T1、T2时点的心率、平均动脉压均低于对照组,差异有统计学意义(P<0.05);除低血压外,干预组患者低体温、低氧血症、通气异常、高血压、苏醒延迟、寒颤、躁动的发生率均低于对照组,差异均有统计学意义(P<0.05);干预组苏醒时长(17.5±2.2)分,亦低于对照组的(45.3±3.5)分,差异有统计学意义(P<0.05).结论 妇科腹腔镜手术患者术中采取综合保温措施可有效降低复苏期并发症的发生率,提高复苏效果.     

远端缺血预处理对肝脏切除术后肝功能的影响

目的观察肢体远端缺血预处理( RIPC)对肝脏切除术患者术后肝功能的影响。方法20例行肝切除术患者随机分为RIPC组：患者右上肢绑止血带,切皮即刻予以充气至压力达到26.6 kPa,维持5 min后放气至0 kPa,维持5 min,循环3次;对照组：切皮即刻右上肢绑止血带不予充气放气,维持30 min。结果与术前相比,两组术后转氨酶升高及对照组中胆红素升高(P<0.05);术后第1天,RIPC组转氨酶与胆红素低于对照组( P<0.05);两组患者均未发生严重并发症,住院天数比较差异无统计学意义;RIPC组肝组织病理学损伤减轻。结论肢体RIPC可改善肝脏切除术患者术后短期肝功能的恢复,减少缺血再灌注损伤。     

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.     

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.     

不同剂量纳布啡复合舒芬太尼用于腹腔镜全子宫切除术后患者自控静脉镇痛的效果

目的观察不同剂量纳布啡复合舒芬太尼在腹腔镜全子宫切除术后PCIA中的效果。方法选择本院择期行腹腔镜全子宫手术的患者120例,年龄40~60岁,体重45~70 kg,ASAⅠ或Ⅱ级,采用随机数字表法随机分为四组,每组30例。术后均采用PCIA,S组给予舒芬太尼2.0μg/kg+格拉司琼2 mg+生理盐水至120 ml,SN1、SN2、SN3组分别给予0.2、0.4和0.8mg/kg纳布啡+舒芬太尼2.0μg/kg+格拉司琼2 mg+生理盐水至120 ml。记录患者术后1、4、8、12、24、48 h Ramsay镇静评分、PCIA有效按压次数及补救镇痛和术后48 h内不良反应的发生情况。结果术后8、12、24、48 h,与S组比较,SN2组和SN3组镇痛泵有效按压次数明显减少,Ramsay镇静评分明显升高(P<0.05);与SN1组比较,SN2组和SN3组镇痛泵有效按压次数明显减少,Ramsay镇静评分明显升高(P<0.05);与SN2组比较,SN3组Ramsay镇静评分明显升高(P<0.05)。S组和SN1组补救镇痛率明显高于SN2组和SN3组(P<0.05)。术后48 h内SN2组和SN3组恶心、呕吐发生率明显低于S组和SN1组,SN3组嗜睡发生率明显高于SN2组(P<0.05)。结论纳布啡0.4mg/kg复合舒芬太尼2.0μg/kg用于腹腔镜全子宫镇痛效果满意,不良反应发生率低。     

电阻抗成像法评价顺式阿曲库铵对老年膝关节置换术患者肺通气功能的影响

目的采用电阻抗成像法(EIT)评价顺式阿曲库铵在老年患者膝关节置换术中对肺通气功能的影响。方法选择择期行人工膝关节置换术的老年患者60例,男14例,女46例,年龄65～80岁,ASAⅡ或Ⅲ级,随机分两组:为使用顺式阿曲库铵组(C组)和不使用顺式阿曲库铵组(N组),每组30例。C组在全麻时使用顺式阿曲库铵0.15 mg/kg诱导,N组在全麻时不使用顺式阿曲库铵诱导。分别在麻醉诱导前(T_0)、喉罩置入后5 min(T_1)、喉罩置入后30 min(T_2)、喉罩置入后60 min(T_3)、拔除喉罩后5 min(T_4)实施EIT监测,记录中心通气区(CoV)面积百分比、依赖静止区(DSS)面积百分比、非依赖静止区(NSS)面积百分比及T_1—T_3时气道压力;术前、术后1、3、5 d进行肺功能检测和血气分析。记录术后3 d内不良反应发生情况。结果 T_0、T_3、T_4时两组NSS、CoV和DSS面积百分比差异无统计学意义。T_1、T_2时C组CoV面积百分比明显高于N组(P0.05)。T_1—T_3时C组气道压力明显低于N组(P0.05)。两组术前和术后1、3、5 d的第一秒用力呼气容积(FEV_1)、用力肺活量(FVC)、最大通气容积(MVV)、PaO_2、PaCO_2及氧合指数(PaO_2/FiO_2)差异无统计学意义。两组不良反应发生率差异无统计学意义。结论顺式阿曲库铵可改善膝关节置换术患者术中通气情况,对术后肺功能无明显影响。     

不同通气模式对腹腔镜下Trendelenburg体位患者肺通气的影响

目的 采用电阻抗断层成像(EIT)技术观察容量控制通气(VCV)和压力控制容量保证通气(PCV-VG)模式对腹腔镜下Trendelenburg体位患者全麻术中肺通气的影响。方法 择期全麻下行腹腔镜下Trendelenburg体位妇科手术患者60例,年龄40～65岁,BMI 18～30 kg/m²,ASA Ⅰ或Ⅱ级,采用随机数字表法将患者分为两组：VCV模式组（V组）和PCV-VG模式组（P组）,每组30例。V组术中采用VCV模式,P组采用PCV-VG模式。记录入室后(T0)、插管后5 min(T1)、更改体位（由平卧位更改为Trendelenburg体位）后即刻(T2)、更改体位后30 min(T3)、更改体位后60 min(T4)、更改体位后120 min(T5)、改平卧位(T6)时的MAP、HR、通气中心(CoV)、依赖静止区(DSS)、非依赖静止区(NSS)的面积百分比。记录T1、T3—T5时气道峰压（Ppeak）、pH、PaO₂、PaCO₂、氧合指数（OI）。记录术后7 d内肺部感染、呼吸衰竭等肺部并发症发生情况。结果 T0—T6时两组MAP、HR差异无统计学意义。与V组比较,T3—T6时CoV面积百分比明显升高,DSS面积百分比明显降低（P<0.05）,T3—T5时Ppeak明显降低（P<0.05）,T4、T5时PaO₂、OI明显升高（P<0.05）。两组术后7 d内均无肺部并发症。结论 PCV-VG通气模式可明显改善腹腔镜下Trendelenburg体位患者术中肺通气及肺氧合功能。     

综合保温对妇科腹腔镜手术患者复苏期并发症的影响

目的 探讨综合保温法对妇科腹腔镜手术患者复苏期并发症的影响。方法 以安徽医科大学第二附属医院妇科2017年4月至2017年6月收治的145例行腹腔镜手术的患者为研究对象,按接受手术先后顺序结合随机数字表法将其分为干预组（72例）和对照组（73例）。干预组给予综合保温措施,对照组给予常规保温措施,比较两组患者麻醉前（T₀）、入复苏室即刻（T₁）、入复苏室15分钟（T₂）、入复苏室30分钟（T₃）的鼻温数值、心率、平均动脉压和复苏期并发症。结果 两组患者在T₀时的鼻温、心率和平均动脉压比较差异均无统计学意义（P>0.05）;干预组患者在T₁、T₂、T₃时点的鼻温值均高于对照组,差异有统计学意义（P<0.05）;干预组患者在T₁、T₂时点的心率、平均动脉压均低于对照组,差异有统计学意义（P<0.05）;除低血压外,干预组患者低体温、低氧血症、通气异常、高血压、苏醒延迟、寒颤、躁动的发生率均低于对照组,差异均有统计学意义（P<0.05）;干预组苏醒时长（17.5±2.2）分,亦低于对照组的（45.3±3.5）分,差异有统计学意义（P<0.05）。结论 妇科腹腔镜手术患者术中采取综合保温措施可有效降低复苏期并发症的发生率,提高复苏效果。     

吗啡预处理对NGF诱导神经细胞TRPV1通道敏化及ERK蛋白活化的影响

目的探讨吗啡预处理(morphine preconditioning,MPC)对神经生长因子(nerve growth factor,NGF)诱导的神经细胞辣椒素受体(transient receptor potential vanilloid 1,TRPV1)敏化,以及细胞外信号调节激酶(extracellular regulated protein kinase,ERK)活化的调控作用。方法原代培养的10日龄SD大鼠T2-T8节段背根神经节(dorsal root ganglia,DRG)神经元及大鼠嗜铬瘤细胞(pheochromocytoma cell,PC12)神经细胞,分别随机分为对照组(C组)、NGF敏化组(NGF组)、吗啡预处理组(MPC 0.3、1.0、3.0μmol·L~(-1)组)。经抗神经元特异性烯醇化酶(neuronal specific enolase,NSE)抗体鉴定DRG神经元后,用吗啡、NGF及辣椒素对两种细胞进行处理,模拟在体MPC对经历心肌缺血/再灌注损伤(ischemia/reperfusion injury,IRI)的T2-T8节段DRG神经元的影响。即刻采用单细胞膜片钳技术检测辣椒素诱发的DRG神经元内向电流;Western blot法检测PC12细胞TRPV1、磷酸化TRPV1(phosphorylated TRPV1,p-TRPV1)及pERK相对表达水平。结果 DRG神经元细胞状态良好,神经元特异性标志物NSE染色阳性;与对照组比较,NGF组的辣椒素诱发内向电流幅度增大(P<0.05),而MPC可以抑制电流幅度增大(P<0.05);NGF孵育可使TRPV1、p-TRPV1及p-ERK蛋白相对表达量上调(P<0.05),而MPC对表达上调的TRPV1、p-TRPV1及p-ERK蛋白具有抑制作用(P<0.05)。结论 MPC可以抑制NGF敏化的神经细胞TRPV1通道电流,其机制可能与降低TRPV1蛋白表达量及TRPV1、ERK蛋白磷酸化水平有关。