顺式阿曲库铵对手术患儿的肌松作用

顺式阿曲库铵是一种新型强效中时效非去极化药,其突出优点是无明显组胺释放及心血管不良反应,无蓄积作用,适用于肝、肾功能障碍和心血管手术病人。其在小儿患者中的应用目前国内尚无定论,本研究旨在观察幼儿手术患者顺式阿曲库铵的肌松作用。     

挥发性吸入麻醉药对肺的作用

挥发性吸入麻醉药对肺的作用目前尚未有定论，其中有较多争议之处。不同种类、不同吸入浓度以及不同生理条件下的吸入麻醉药对肺的作用不同，可以引起肺的损伤作用、导致肺内分流增加，也可以产生肺的缺血／再灌注损伤的保护作用，其机制尚未完全清楚。     

皮质酮复合异丙酚对大鼠海马 CA1区长时程抑制的影响

目的探讨皮质酮复合异丙酚对大鼠海马CA1区锥体神经元产生的长时程抑制(LTD)的影响。方法制备Wistar大鼠400μm厚度的海马脑片,随机分为5组:对照组、脂肪乳剂组、异丙酚组、皮质酮组、皮质酮 异丙酚组。对照组不加任何药物,脂肪乳剂组、异丙酚组、皮质酮组、皮质酮 异丙酚组分别以100μmol/L脂肪乳剂、100μmol／L异丙酚、10μmol／L皮质酮、10μmol／L皮质酮复合100μmol／L异丙酚预孵脑片60min,然后给予低频刺激(LFS),记录LTD的表达情况。结果各组海马CAI区锥体神经元给予LFS后,都产生LTD,与对照组相比,脂肪乳剂组给予LPS后10-40minEPSC值没有明显变化,异丙酚组、皮质酮组和皮质酮 异丙酚组给予LPS后10-40min的EPSC值明显降低(P<0.05),且皮质酮 异丙酚组给予LPS后10-40min兴奋性突触后电流与异丙酚组和皮质酮组相比,差异有统计学意义(P<0.05)。结论100μmol／L异丙酚或10μmol/L皮质酮都使大鼠海马CA1区锥体神经元LTD表达易化,二药复合应用时则进一步增强LTD的表达。     

氧化亚氮,安氟醚肺摄取,肺排出和表观分布容积的观察

氧化亚氮、安氟醚肺摄取、肺排出和表观分布容积的观察姜爱芬徐旭仲以往吸入麻醉药的研究集中在肺摄取的研究（１～４），而对机体药物分布和肺排出未做深入观察。本文通过数学公式计算的方法，对氧化亚氮和安氟醚的肺摄取量、分布容积和肺清除率进行研究。１材料、方法和...     

GOE面罩法吸入麻醉在小儿门诊手术的应用

门诊小儿短小手术,通常多采用基础麻醉和小剂量静脉麻醉,采用面罩法吸入麻醉报道较少。 本院自1988年以来,将GOE(笑气、氧气、安氟醚)面罩法吸入麻醉应用于小儿门诊手术,取得较好效果。现将108例的临床资料总结报道如下。     

脂氧素A4抑制内毒素诱导的人支气管上皮细胞环氧合酶2及前列腺素E2的表达

目的: 探讨脂氧素A₄对人支气管上皮细胞(HBECs)环氧合酶2(COX-2)表达的影响。方法: 应用不同浓度(0.1、1、10 mg/L)的内毒素(LPS)刺激HBECs 9 h,或者用1 mg/L LPS分别刺激HBECs不同时点(3 h、6 h、9 h)后,测定HBECs的COX-2 mRNA表达和细胞上清液前列腺素E₂(PGE₂)水平。应用不同浓度 (0、100、400 μmol/L) 的脂氧素A₄作用于经过LPS(1 mg/L)刺激培养9 h的HBECs,采用酶联免疫吸附法(ELISA)检测细胞上清液PGE₂的水平, 同时分别应用RT-PCR和Western blotting分别检测HBECs COX-2 mRNA及蛋白的表达。结果: LPS刺激培养条件下HBECs的COX-2 mRNA表达及其上清液PGE₂水平增加,并呈时间、剂量依赖性。脂氧素A₄能抑制LPS刺激培养HBECs COX-2蛋白和mRNA的表达及上清液PGE₂的水平,并呈剂量依赖性。结论: 脂氧素A₄能抑制LPS诱导的HBECs COX-2表达及上清液PGE₂的水平。     

孕激素与认知功能及阿尔茨海默病关系研究进展

背景 内源性孕激素黄体酮不但是性激素,也是神经类固醇激素的一种,对神经发育、修复及相关疾病[如阿尔茨海默病(alzheimer's diseage,AD)]有重要影响.而越来越多的合成孕激素对神经系统的影响也渐受到研究人员的关注.目的 综述近年来孕激素与AD及认知功能关系相关文献,并阐释其可能机制,为研究合成的孕激素提供思路.内容 大量文献数据提示,黄体酮对AD发生发展及认知功能有积极作用,而合成的孕激素乙酸甲氧基孕酮则不然.现从细胞、动物实验及临床研究3个层面,从分子水平和功能研究,从学习记忆基础和AD发病成因等方面阐述其可能机制.趋向 越来越多的合成孕激素应用于临床,它们对AD发病和认知功能的影响有待于进一步阐明.

Abstract：

Background Endogenous progestin, progesterone, is not only a gonadal hormone, but also one of the neurosteroids, which exerts profound effects on neurogenesis, repair and central nervous system related diseases, such as Alzheimer's disease (AD). As more and more synthetic progestins are being introduced into clinical application, their effects on nervous system are attracting researchers' concern. Purpose Recent literature on the relationship between progestins and Alzheimer's disease or cognitive function was reviewed to provide some mechanism-based ideas for further research on artificial progestins. Content A great amount of literature suggested that progesterone had beneficial effects on AD and cognitive function, while the synthetic progestin methoxyprogesterone acetate (MPA) had adverse effects. The possible mechanisms are elucidated in this review based upon the results of cell culture, animal experiment and clinic research, from different aspects of molecular mechanism, functional research, basis oflearning and memory and pathogenesis of AD. Trend More and more artificial progestins are being used in the clinic, however, their impacts on AD development and cognitive functions still need to be further expounded.     

复合髂腹下／髂腹股沟神经阻滞对小儿七氟烷麻醉后苏醒期的影响

目的观察髂腹下／髂腹股沟神经阻滞对门诊腹股沟区手术小儿七氟烷麻醉后苏醒期的影响。方法门诊拟行择期单侧腹股沟区手术的小儿60例,随机分为2组,组Ⅰ为全身麻醉组（n=30）,组Ⅱ为全身麻醉联合INB组（n=30）。两组患儿均吸入七氟烷、笑气麻醉诱导,插入喉罩并保持自主呼吸。组Ⅰ患儿静脉注射芬太尼2～4μg·kg^-1,组Ⅱ患儿未使用静脉镇痛药,由同一麻醉医生实施骼腹股沟／髂腹下神经联合阻滞。两组患儿术中均以七氟烷、笑气维持麻醉。观察并记录：麻醉时间;入PACU后10min时的疼痛评分;PACU的滞留时间;PACU内发生躁动的患儿例数;局部麻醉部位有无血肿等并发症。结果入PACU后10min时组Ⅱ患儿的疼痛评分2．4±1．8,较组Ⅰ患儿的4．3±2．2为低,差异具有统计学意义,P〈0．05。组Ⅰ有6例,组Ⅱ有2例患儿发生了的严重的疼痛。组间比较差异无统计学意义。P〉0．05。组Ⅱ有2例（6．7％）患儿发生了躁动,较组Ⅰ10例（33．3％）为少,差异具有统计学意义。组Ⅱ患儿PACU的滞留时间为25±4min较组Ⅰ的31±3min为短,组间比较差异具统计学意义,P〈0．05。结论全麻联合髂腹下／髂腹股沟神经阻滞可为门诊行腹股沟区手术的小儿提供良好的镇痛并可降低七氟烷麻醉后EA的发生率,有利于此类小儿的围术期安全。     

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

目的 探讨参附注射液对行全髋关节置换术的老年患者术中血流动力学和血浆E-选择素浓度的影响.方法 择期行全髋关节置换术老年患者24例,按随机数字表随机分为参附注射液组(S组)与生理盐水对照组(N组),每组12例.术前两组患者一般情况差异无统计学意义.S组:麻醉成功后予参附注射液0.2 ml/kg经外周静脉缓慢注射,继以0.8 ml·kg-1·h-1持续注入至手术结束;N组则以生理盐水替代.术后均予患者自控镇痛(PCEA).检测术前(T0)、手术结束即刻(T3)及术后24 h(T4)血浆E-选择素浓度.分别记录T0、术后15 min(T1)、术后30 min(T2)、T3各时间点心率、平均动脉压和中心静脉压.结果 两组患者手术时间、术中输液差异无统计学意义;两组血流动力学差异均无统计学意义(均P＞0.05);S组各时间点血浆E-选择素浓度差异均无统计学意义(均P＞0.05),N组在T3、T4时明显升高[(119±23)mg/L、(109±23)mg/L],与T0比较差异有统计学意义[(86±15)mg/L,P＜0.01],与S组比较明显高[T0、T3、T4分别为(92±37)、(83±15)、(83±12)mg/L,P＜0.05或0.01].结论 行全髋关节置换术的老年患者围术期血浆E-选择素浓度明显升高,参附注射液可以抑制其升高,抑制血管内皮细胞的活化,对血流动力学无明显的影响.

Abstract：

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.