反相高效液相色谱法同时检测人血浆利多卡因和罗哌卡因

目的：建立人血浆利多卡因和罗哌卡因的高效液相色谱分析方法。方法：高效液相色谱仪为Agilent 1100系列;血浆碱化后经乙酸乙酯萃取浓缩,以ZORBAX Eclipse XDB-C18（4.6 mm×150 mm,5μm,Agilent,USA）为色谱柱;以乙腈∶0.02 mol·L^-1 KH2PO4（16∶84,V/V）为流动相,流速为1.0 ml·min^-1;检测波长为210 nm;内标为布比卡因。结果：利多卡因和罗哌卡因浓度在0.05～10 mg·L^-1范围内线性关系良好（r=0.999）;最低检测限为0.05 mg·L^-1;两种药物高、中、低3个浓度的平均相对回收率分别为（99.79±2.94）%和（100.32±2.95）%;平均绝对回收率分别为（68.36±4.63）%和（70.87±4.88）%;日内精密度变异系数分别为（0.86±0.43）%和（1.36±0.77）%,日间精密度变异系数分别为（2.07±1.45）%和（1.43±0.23）%.结论：本方法快速、简便、灵敏、准确可靠,适用于血浆利多卡因和罗哌卡因的同时测定及其临床药代动力学研究。     

自发性高血压大鼠缺血再灌注后视网膜毛细血管细胞凋亡及p53基因表达

Objective To investigate the effect of apoptosis-related gene p53 on the apoptosis of retinal capillary cells in rats with spontaneously hypertensive (SHR) after ischemic reperfusion injury. Methods A total of 60 SHR rats were randomly divided into sham group (SHR-SH) and retinal ischemie reperfusion group (SHR-RIR), which were subdivided into 5 subgroups according to the time after RIR: 2, 6, 24, and 72 hours and 7 days, with 6 rats in each subgroup. Another 60 Wistar-Kyoto (WKY) rats were divided into the same groups as the SHR rats as the control. The RIR model was set up. The apoptosis of retinal capillary cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) methods and the expression of p53 was determined by streptavidin-perosidase (SP) immunohistochemistry. Results The apoptosis rate of retinal capillary cells in the 5 SHR-RIR groups was (8.64±0.56)%, (14.92±0.99)%, (24.72±2.98)%, (16.53±1.80)%, and (7.12±1.10)%,respectively. The expression of p53 in SHR-RIR groups increased at the 2nd hour after RIR, reached the peak at the 24th hour, kept the high level at the 72nd hour, and remained a little at the 7th day, which was significantly different from which in the SHR-SH groups (P<0. 01). The expression of p53 were higher in SHR-IR groups than that in the WKY-RIR groups (P<0. 01). Conclusions p53 may play a part in RIR injury by inducing or promoting apoptosis. The apoptosis of retinal capillary cells after RIR is more severe under the hypertension, and reaches the peak at the 24 hour after RIR.     

活体供肾取肾术的麻醉处理

活体供肾移植目前国内开展不多 ,活体供肾取肾术麻醉的关键是保证供肾的高质量。我院自 1999年以来完成了 6例活体肾移植术 ,现将其麻醉结果分析如下。资料与方法一般资料　 6例供者年龄 42～ 5 3岁 ,ＡＳＡⅠ～Ⅱ级 ,无高血压、糖尿病等慢性病史 ,体检及化验检查示各脏器功能正常 ,肾血管无畸型。供者均经公证自愿捐肾 ,与受者关系为母 子 2例 ,母 女 1例 ,父 子 1例 ,姐 妹 1例 ,夫妻间 1例。供、受者均为同血型 ,群体抗原 <10 % ,ＨＬＡ Ａ、Ｂ、ＤＲ、ＱＲ均有一个以上位点相配。麻醉方法　供者术前常规禁食 ,其中 3例术前静滴复方乳…     

妇科腹腔镜手术对血浆血管紧张素Ⅱ和β2微球蛋白浓度的影响

目的：观察不同麻醉下妇科腹腔镜手术病人CO2气腹及屈氏体位（T位）对肾素－血管紧张素系统（RAAS）和肾功能的影响，方法：测定全麻下（全麻组7例）或硬膜外麻醉下（连硬组14例）妇科腹腔镜手术病人气腹前10min，T位15度和所腹（IAP1．33－、．6kPa)后30min及解除气腹后10min三个时点肾素活性（PRA），血浆血管紧张素Ⅱ（AⅡ）—β2－微球蛋白浓度。结果，全麻组病人气腹时血浆PRA，AⅡ，β2-MG浓度均比气腹前增高，其中仅AⅡ气腹时与气腹前比有显著性差异（P＜0．05），连硬组病人气腹时血浆PRA，AⅡ，β2－MG浓度均比气腹前有轻微下降（P＞0．05），结论：硬膜外麻醉能够抑制妇科腹腔镜手术CO2气腹刺激所致的RAAS’反应，同时气腹对肾小球滤过功能没有明显影响，而全麻下妇科腹腔镜手术即使尽量降低腹内压（IAR1．33－1．59kPa)，亦会明显激活RAAS’和影响肾小球滤过功能。     

氟比洛芬复合舒芬太尼用于鼻内镜术后患者自控静脉镇痛的临床观察

目的 观察非甾体类抗炎药氟比洛芬与舒芬太尼合用于鼻内镜术后静脉自控镇痛的临床效果.方法 拟行鼻内镜术后自控静脉镇痛64例,随机分为两组,实验组:舒芬太尼50 μg,氟比洛芬300 mg,恩丹西酮8 mg,生理盐水稀释至100 ml;对照组:舒芬太尼100 μg,恩丹西酮8 mg,生理盐水稀释至100 ml.术毕使用患者自控静脉镇痛(patient controlled intravous analgesia,PCIA)负荷量5 ml,持续给药速度1 ml/小时,单次PCIA 0.5 ml,锁定时间15分钟.分别记录并比较术后各时间点患者疼痛视觉模拟(visual analog analgesia,VAS)评分、镇静评分及不良反应发生率.结果 两组术后镇痛效果均满意,48小时内各时间点VAS评分无显著性差异(P＜0.05).实验组术后4、8、20小时3个时间点镇静评分小于对照组(P＜0.05).实验组不良反应少于对照组,其中头晕例数与对照组相比有显著性差异(P＜0.05).结论 氟比洛芬复合舒芬太尼可有效用于鼻内镜术后静脉镇痛,明显减少舒芬太尼的剂量及不良反应,提高镇痛的安全性.     

喉癌手术采用不同麻醉诱导方法对血压和心率的影响

喉癌手术采用不同麻醉诱导方法对血压和心率的影响温州医学院附属第一医院麻醉科（３２５０００）胡明伦喉癌手术目前普遍采用气管切开插管全身麻醉。本文随机选择喉癌患者５０例，观察双侧颈丛阻滞麻醉下行气管切开插管对血压和心率的影响，结果与对照组比较，各项观察指...     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

心脏瓣膜置换术危险因素评分系统的应用和比较

目前，心血管外科高危病人的比例逐渐增加，临床治疗亟需一个量化的评估体系对病人围术期危险性进行评估。1989年，Parsonnet等首次建立了一个针对心血管手术危险因素的评分系统（Parsonnet），提供了一个可以量化而且较为客观的评测标准。此后，临床上又相继出现了多个评分系统，其中较为知名的是欧洲心血管手术危险因素评分系统（EuroSCORE）。本文现对Parsonnet及EuroSCORE模型的应用作一比较分析，以讨论其在我国心脏瓣膜置换术后死亡率预测中的价值，报道如下。     

自发性高血压大鼠缺血再灌注后视网膜毛细血管细胞凋亡及p53基因表达

Objective To investigate the effect of apoptosis-related gene p53 on the apoptosis of retinal capillary cells in rats with spontaneously hypertensive (SHR) after ischemic reperfusion injury. Methods A total of 60 SHR rats were randomly divided into sham group (SHR-SH) and retinal ischemie reperfusion group (SHR-RIR), which were subdivided into 5 subgroups according to the time after RIR: 2, 6, 24, and 72 hours and 7 days, with 6 rats in each subgroup. Another 60 Wistar-Kyoto (WKY) rats were divided into the same groups as the SHR rats as the control. The RIR model was set up. The apoptosis of retinal capillary cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) methods and the expression of p53 was determined by streptavidin-perosidase (SP) immunohistochemistry. Results The apoptosis rate of retinal capillary cells in the 5 SHR-RIR groups was (8.64±0.56)%, (14.92±0.99)%, (24.72±2.98)%, (16.53±1.80)%, and (7.12±1.10)%,respectively. The expression of p53 in SHR-RIR groups increased at the 2nd hour after RIR, reached the peak at the 24th hour, kept the high level at the 72nd hour, and remained a little at the 7th day, which was significantly different from which in the SHR-SH groups (P<0. 01). The expression of p53 were higher in SHR-IR groups than that in the WKY-RIR groups (P<0. 01). Conclusions p53 may play a part in RIR injury by inducing or promoting apoptosis. The apoptosis of retinal capillary cells after RIR is more severe under the hypertension, and reaches the peak at the 24 hour after RIR.