异丙酚—异氟醚静吸复合全麻对脊柱手术机体耗氧量的影响

目前对危重病人机体耗氧量和心血管病人围手术期氧供需平衡问题研究较多,而对脊柱手术病人麻醉时机体耗氧量了解甚少。本文采用异丙酚———异氟醚静吸复合全麻用于脊柱手术,并与单纯异氟醚吸入全麻对机体氧耗的影响进行对比观察 ,探讨其临床意义。方法和结果一、一般资料选择ＡＳＡⅠ—Ⅱ级 ,无明显心肺肝肾疾患的择期胸腰椎骨的病人３２例 ,随机分为异丙酚———异氟醚组 (Ｐ组 )和异氟醚组 (Ⅰ组 )。两组病人年龄、体重、体表面积分别为３３．２±６．６岁和３２．９±７．４岁、６３．５±７．１ｋｇ和６３．２±５．８ｋｇ、１．７０…     

速度向量成像技术检测兔腹主动脉粥样硬化易损斑块的初步研究

目的 探讨速度向量成像(VVI)技术评价兔腹主动脉粥样硬化斑块生物力学参数的价值.方法 45只雄性新西兰大白兔,随机选择10只作为正常对照组,余35只制成动脉粥样硬化模型.分别对其行常规超声检查及VVI脱机分析,测量右肾动脉分支1 cm以下处腹主动脉内-中膜厚度(IMT)或斑块厚度,记录此处收缩期最大切向速度(Vmax)、应变(Smax)及应变率(SRmax).最后行病理及免疫组化检查.结果 根据病理分为4组:正常对照组(A组,10只)、病理性内膜增厚组(B组,9只)、厚帽纤维粥样斑块组(C组,15只)及薄帽纤维粥样斑块组(D组,11只).C、D组间斑块厚度差异无统计学意义(P>0.05),均大于A、B组IMT(P<0.05).各组间Vmax、Smax、SRmax差异有统计学意义(P<0.05).以Smax>0.37%检测易损斑块的灵敏度为 84.4%,特异度为 91.7%.结论 VVI技术有望成为临床早期发现易损斑块的可靠方法.

Abstract：

Objective To explore the value of biomechanics parameter of rabbit abdominal aortic atheroma using velocity vector imaging(VVI).Methods Ten of 45 male New Zealand rabbits were chosen as normal control group randomly,the rest experimental rabbits were made atheromatous plaque model.The rabbits were examined by two-dimensional ultrasound and VVI respectively.The intima-media thickness(IMT) or thickness of plaques of abdominal aorta 1 cm from right renal artery branch were recorded.Maximum tangential velocity,strain and strain rate of IMT or plaques were measured using VVI.Then the rabbits were killed for pathological and immuno-histochemical examination.Results Based on pathology,the rabbites were divided into 4 groups:control group(group A,n=10),group of pathological endometrial thickening(group B,n=9),group of thick fibrous cap atheromatous plaques (group C,n=15) and group of thin fibrous cap atheromatous plaques (group D,n=11).The difference of plaques thickness and biochemical indicators had no statistically significant between group B and C(P>0.05),both bigger than group A and B (P<0.05).The difference of Vmax,Smax and SRmax had statistically significant each group(P<0.05).With Vmax>0.46×10-2 cm/s,Smax>0.37%,SRmax>1.415×10-2 s-1 to find the vulnerable plaques,the sensitivity were 75.0%,84.4%,84.4% respectively,specificity were 70.8%,91.7%,83.3% respectively.Conclusions VVI can identify plaque biomechanics parameter of different progression periods,which is expected to be a reliable method to find vulnerable plaques earlier in clinic.     

参附注射液对全髋关节置换术老年患者术中血流动力学和E-选择素的影响

Objective To investigate the effects of Shenfu (SF) injection on hemodynamics and plasma E-selectin concentrations in elderly patients undergoing total hip replacement (THR). Methods A total of 24 ASA Ⅱ/Ⅲ patients aged 65 to 85 years old were divided equally into two groups (n = 12). In Group S, SF injection was administered by peripheral intravenous infusion at initially 0. 2 ml/kg and then patients received a post-operative regimen of patient-controlled epidural analgesia (PCEA). Blood samples were taken pre-operation ( T0), immediately post-operation (T3) and 24 hours post-operation (T4) so as to detect the levels of E-selectin at these time points.mean arterial pressure (MAP) , heart rate (HR) and central venous pressure (CVP) were continuously monitored and recorded at T0, 15 min post-anesthesia (T1 ), 30 min post-anesthesia (T2) and T3. Results The concentrations of E-selectin in Group N increased at T3 and T4 while those decreased in Group S [(119 ± 23 ) mg/L and(109 ± 23) mg/L vs (86 ±15)mg/L,(83 ±15)mg/L and (83 ±12)mg/L vs(92 ±37)mg/ L, all P＜0. 01]. As compared with Group S, they were significantly higher in Group N (P ＜ 0. 05 or 0. 01). There was no significant difference in CVP, HR and MAP between two groups. Conclusion The activation of vascular endothelial cells is manifested by an elevated plasma concentration of E-selectin in the elderly patients undergoing THR. SF injection can inhibit the activation and exert no significant effects on the hemodynamics.     

外周NMDA受体在慢性痛中的作用及机制研究

<正>疼痛是组织损伤或潜在的组织损伤所引起的不愉快的感觉或情感体验(IASP,1994)。在正常生理状况下,疼痛是警示躯体受到威胁的警报信号,是生命不可缺少的一种特殊保护功能。但是,在病理性条件下(如损伤或炎症),疼痛已经不再是一种警报信号,而是逐渐发生持续慢性化,表现出:     

姜黄素通过调控Notch通路促进大鼠脑缺血后神经干细胞增殖和迁移

 目的： 观察姜黄素对大鼠局灶性脑缺血后室管膜下区（SVZ）神经干细胞(NSCs)增殖和迁移的影响,及其与Notch信号通路的相关性。方法： 采用线栓法制备大鼠大脑中动脉缺血再灌注损伤模型,随机分成假手术组（sham）、缺血再灌注组（I/R）及姜黄素治疗组(I/R+curcumin)。动物在模型成功后1 h连续腹腔注射姜黄素7 d后处死。免疫荧光法检测各组梗死侧SVZ BrdU及BrdU/DCX标记NSCs的数目及迁移趋势。Western blotting方法检测各组Notch通路的中间产物Notch 细胞内域（NICD)的表达。结果： I/R+curcumin组的大鼠梗死侧SVZ BrdU及BrdU/DCX标记的NSC较I/R组显著增多（P＜0.05）,同时其较I/R组更广泛地分布在往病灶迁移的路径上。I/R+curcumin组较I/R组的NICD生成也增多（P＜0.05）。结论： 姜黄素能促进缺血性大鼠脑SVZ NSCs增殖和迁移,其机制可能是通过激活Notch信号通路产生的。     

自控臂丛神经阻滞用于小儿上肢术后镇痛的效果

静脉自控镇痛是小儿术后常用的镇痛方法,但存在诸多不良反应.臂丛神经阻滞镇痛是成人上肢术后镇痛的有效措施之一[1-3],而该技术用于小儿术后的镇痛效果尚有待进一步探讨.本研究拟评价自控臂丛神经阻滞用于小儿上肢术后镇痛的效果,为临床应用提供参考.     

硬膜外芬太尼超前镇痛对围手术期血浆β—内啡肽的影响

β-内啡肽（β-ｅｎｄｏｒｐｈｉｎ，β-ＥＰ）是具有镇痛活性的内源性阿片样神经肽 ,在应激反应中起重要作用，是应激反应的敏感指标之一 ［１］。本文通过观察硬膜外芬太尼超前镇痛对剖宫产手术围手术期血浆β-ＥＰ的变化 ,探讨超前镇痛对应激反应的影响。１资料和方法１．１一般资料选择ＡＳＡＩ级、足背妊娠急诊剖宫产病人３０例 ,无心、肺、肾等合并症及无妊娠并发症。年龄２２～３２岁 ,体重５５～８５ｋｇ,身高１５０～１７２ｃｍ。试验采用双盲法 ,随机分为两组 ,ＦＭ组 (芬太尼加利多卡因组 )１５例。术前不用任何药物。１．２麻醉…     

异丙酚靶控输注联合纤支镜辅助气管插管在颈髓减压术中的应用

我们近来对30例颈髓损伤病人在作颈髓减压手术时采用异丙酚靶控输注、纤维支气管镜(纤支镜)辅助下经鼻行气管插管，以消除病人的痛苦，使气管插管得以顺利进行，效果满意，报道如下.     

新生儿麻醉75例总结

新生儿手术患者75例,年龄最小几小时,最大30天。其中各种先天畸形53例(70％)急诊手术49例(65％)。全部病例麻醉均成功。包括静脉复合麻醉32例,气静23例,骶麻加基麻14例,连硬加基麻5例。文中分析了新生儿的特点及麻醉方法等体会。     

前列腺素E1联合米力农治疗先心病重度肺动脉高压10例

先天性心脏病(CHD)合并重度肺动脉高压(PH)围术期出现的肺动脉压持续升高，低心排是术后早期死亡的主要原因，有报道这类病人死亡率高达35％～45％，尤其在贫困地区，CHD患者年龄偏大，心功能差，正确地选择性控制肺血管阻力，降低右心后负荷，维护心功能是减少术后死亡率的关键，我们将前列腺素E1(PGE1)合用米力农以降低肺动脉压，减少低心排脱离体外循环，疗效良好，报道如下。