Effects of intravenously administered lidocaine on pulmonary vagal afferents and phrenic nerve activity in cats

The ability of lidocaine to suppress activity of single vagal afferent fiber and that of phrenic nerve was studied in 20 cats anesthetized with pentobarbital. Slowly adapting stretch receptors (SAR, n = 16) and rapidly adapting stretch receptors (RAR, n = 7) were identified by their discharge pattern to pulmonary inflation. Intravenous lidocaine (1mg·kg^–1 or 2mg·kg^–1) produced a suppression of SAR activity but not of RAR activity. Suppression of phrenic nerve activity lasted much longer than that of SAR. These findings indicate that iv lidocaine acts more dominantly on CNS than on peripherals. We conclude that iv lidocaine prevents cough and hemodynamic changes caused by airway manipulation mainly through its action on CNS and not on peripherals (peripheral nerves or their receptor).(Aoki M, Harada Y, Namiki A, et al.: Effects of intravenously administered lidocaine of pulmonary vagal afferents and phrenic nerve activity in cats. J Anesth 6: 395–400, 1992)     

Anesthetic management of a patient with Hallermann-Streiff syndrome

Key words  airway management - difficult intubation - Hallermann-Streiff syndrome     

Vascular compression of the airway: Indications for and results of surgical management

Vascular compression of the airway is a significant cause of respiratory compromise in children. While the indications for surgical repair are sometimes life threatening, they can also be subtle. This retrospective study examines 45 surgical cases of tracheobronchial compromise secondary to vascular compression at a large children's hospital between July 1983 and February 1996. A total of 34 were diagnosed with innominate artery compression, ten with a double aortic arch and one with an anomalous right subclavian artery. The 45 patients, 25 male and 20 female, ranged in age from 12 days to 11 years at surgery (average 13 months). A total of 21 (47%) presented with proven or suspected episodes of cyanosis or apnea. All 45 patients had evidence of vascular compression during microlaryngoscopy and bronchoscopy. The diagnosis was confirmed by magnetic resonance imaging (MRI) in 23/45 (51%), barium swallow in 22/45 (49%) and aortogram in 3/45 (7%). There was one death. One patient had a tracheotomy before surgery and continues to require it after surgery. Complete resolution of symptoms was achieved in 39/45 (87%) with five requiring more than one operation before their symptoms resolved completely. A total of four patients experienced a recurrence of symptoms within a variable length of time after surgery. Surgical indications and treatment alternatives will be discussed.     

Laryngotracheal stenosis in children

The diagnosis of laryngotracheal stenosis should be suspected in children with stridor, feeding difficulties, or atypical croup. Only half of the children with congenital laryngotracheal stenosis require tracheotomy, and many of these children can be decannulated following uncomplicated surgical therapy. In contrast, tracheotomy-dependent patients with acquired laryngotracheal stenosis require more extensive surgical intervention, which should be carried out as early as possible to provide the best opportunity for developing normal oral communication. Received: 8 March 1977 / Accepted: 31 July 1997     

树舌多糖对胃黏膜损伤大鼠胃黏膜PGE2含量及血流量和黏液分泌的影响

目的:研究树舌多糖对大鼠胃黏膜损伤的保护作用及其机制。方法:采用醋酸法和幽门结扎法复制大鼠胃溃疡模型,分别测定胃黏膜PGE₂含量和胃黏膜血流量及胃黏液分泌。结果:与模型对照组比较,多次灌服树舌多糖250～1000mg·kg^-1可明显增加大鼠胃黏膜PGE₂含量和胃黏膜血流量,对大鼠胃内游离黏液和胃壁黏液的分泌也具有显著的增加作用,且有明显量效关系。结论:树舌多糖通过提高胃黏膜PGE₂含量和胃黏膜血流量及胃黏液分泌来加强胃黏膜屏障,这是其保护胃粘膜损伤的作用机制之一。     

诱导痰在慢性阻塞性肺病气道炎症监测中的应用

目的　观察COPD患者诱导痰细胞学和痰上清液IL -8浓度的变化 ,探讨诱导痰在COPD气道炎症监测中的作用。方法　以 2 6例临床确诊的稳定期COPD患者为研究对象 ,分离诱导痰细胞 ,同时检测痰上清液IL -8浓度和肺功能。并以 15例健康志愿者作为对照组。结果　COPD稳定期组与正常对照组诱导痰细胞总数、巨噬细胞数及中性粒细胞数比较 ,差异有显著性 (P <0 0 1) ;COPD稳定期组中性粒细胞百分率高于正常组 ,(P <0 0 1)。稳定期组诱导痰上清液IL -8浓度与正常组比较差异有显著性(P <0 0 1)。诱导痰上清液IL -8的浓度与FEV1占预计值 %呈负相关关系 (r=-0 5 3 9,P <0 0 1) ;诱导痰PMN数与FEV1占预计值 %呈负相关关系 (r =-0 73 3 ,P <0 0 1) ;AM数与FEV1占预计值 %无相关关系 (r =-0 2 2 3 ,P =0 161)。结论　诱导痰技术无创、简便 ,是监测COPD气道炎症的较理想指标。     

吸入皮质激素等对哮喘急性发作患儿诱导痰液中炎性细胞及炎性介质的影响

目的了解布地奈德联合沙丁胺醇雾化吸入治疗儿童哮喘急性发作前后其气道炎性细胞、白细胞介素 6(IL 6)、IL 8、肿瘤坏死因子 α(TNF α)的变化，探讨其影响机制。 方法对上海市第五人民医院2002 09—2003 12收治的急性哮喘发作患儿采用上述联合治疗1周，共对34例急性发作期、24例缓解期患儿和15名正常儿童的诱导痰液进行炎性细胞计数和分类，测定其中IL 6、IL 8、TNF α水平。 结果急性期哮喘患儿的总细胞数、嗜酸性细胞、中性粒细胞和单核细胞比例及IL 8、IL 6、TNF α水平均高于正常对照组。缓解期哮喘患儿除嗜酸细胞及淋巴细胞比例明显高于正常对照组外，其余上述炎性细胞比例及细胞因子水平均降至正常。 结论布地奈德联合沙丁胺醇雾化吸入可显著降低急性哮喘发作患儿气道分泌物内嗜酸性细胞、中性粒细胞和单核细胞数量及IL 8、IL 6、TNF α水平。     

胃甘胶囊对实验性胃溃疡的保护作用

目的:研究胃甘胶囊对实验性胃溃疡的作用.方法:采用水浸应激性、利血平型、幽门结扎型及乙酸型胃溃疡模型研究胃甘胶囊抗胃溃疡作用;以幽门结扎收集胃液观察对胃液分泌的影响.结果:胃甘胶囊对小鼠水浸应激性、利血平型及大鼠幽门结扎型胃溃疡均有明显的保护作用;对大鼠乙酸型胃溃疡有明显的促进愈合作用;能抑制大鼠胃酸的分泌并促进胃粘液分泌.结论:胃甘胶囊有抑制实验性胃溃疡的作用,该作用可能与其抑制胃酸分泌、促进胃粘液分泌有关.     

气道局部治疗对气道黏液高分泌干预作用的对比研究

目的探讨常用局部治疗性药物对慢性气道黏液高分泌作用的机制和特点。方法用超声雾化吸入中性粒细胞弹性蛋白酶(NE)复制慢性支气管炎动物模型,分别吸入糖皮质激素布地奈德(budesonide)、胆碱M受体阻断剂异丙托溴铵以及两者配伍联用进行干预,用酶联免疫吸附试验(ELISA)及斑点印迹法分别检测大鼠支气管肺泡灌洗液(BALF)中黏蛋白(MUC)的含量和MUC5ACmRNA表达水平。结果NE能显著增加气道MUC和MUC5ACmRNA的表达(P<0.01);普米克令舒和异丙托溴铵均可降低MUC和MUC5ACmRNA的表达(P<0.05),两者联用可增强抑制黏蛋白的效应(P<0.01)。结论NE是慢性气道黏液高分泌发生的重要因素;布地奈德和异丙托溴铵可抑制MUC基因及转录水平的表达,且两者联用有协同效应。     

病毒感染对慢性阻塞性肺疾病患者气道炎症的作用

目的探讨病毒感染与慢性阻塞性肺疾病(COPD)的关系及其对气道炎症的作用. 方法收集COPD急性加重期患者84例及23例健康人血清,应用ELISA方法检测患者呼吸道合胞病毒(RSV)、单纯疱疹病毒Ⅰ型(HSV-1)、副流感病毒(PIV)、巨细胞病毒(CMV)、腺病毒(ADV)的特异性IgM、IgG抗体;根据病毒检测结果及临床表现分成2组:病毒感染组(A组)及细菌感染组(B组);用ELISA法检测A、B两组患者治疗前后诱导痰液中白介素8(IL-8)和肿瘤坏死因子α(TNF-α)的水平. 结果 84例COPD急性加重患者81例检测到病毒抗体,IgM阳性者28例(33.3%),其中RSVIgM比例最高(53.5%),其次为PIV(26.7%);IgM阳性与感冒样症状、无脓痰等有关;经治疗后A、B两组痰液IL-8和TNF-α水平显著降低(P<0.05),A组治疗后IL-8下降更明显(P<0.05),TNF-α水平的变化两组间差异无显著性. 结论病毒感染是COPD急性加重的重要因素,并且可引起气道炎症加重.