四逆汤预处理对大鼠心缺血再灌注后心功能的延迟保护作用

目的:探讨四逆汤诱导的心肌延迟预适应对心缺血再灌注(MI/R)后心功能的影响及其可能机制。方法:缺血再灌注采用经典大鼠冠脉结扎,缺血1h,再灌1h。四逆汤预处理灌胃(5g/kg·d)连续3天,末次灌药24小时后缺血1h,再灌1h。以大鼠左心功能为评价指标,通过RTPCR检测热休克蛋白70(HSP70)mRNA的表达情况,利用免疫组织化学染色法检测大鼠心肌HSP70的表达。结果:四逆汤预处理组与缺血再灌注组相比可以显著改善心功能,上调HSP70基因的表达及蛋白合成。结论:四逆汤预处理对MI/R后心功能的损害具有延迟保护效应,其机制与四逆汤诱导HSP70的表达密切相关。     

腹腔镜下卵巢子宫内膜异位囊肿剥离术中两点注射垂体后叶素的临床观察

目的探讨两点注射垂体后叶素在腹腔镜下卵巢子宫内膜异位囊肿剥离术中的安全性和可行性。方法将86例行腹腔镜下卵巢子宫内膜异位囊肿剥离术患者分为研究组（术中在患侧宫角和输卵管系膜无血管区注射垂体后叶素）42例和对照组（未使用垂体后叶素）44例，比较两组患者的手术时间、术中出血量、术后最高体温、术后住院天数及复发率等。结果研究组和对照组的手术时间分别为（51．24±22．58）min和（67．02±25．14）min，术中出血量分别为（42．16±26．10）ml和（68．23±28．21）ml，差异均有统计学意义（P〈0．01）；研究组和对照组的复发率分别为4．76％和11．36％，但差异无统计学意义（P〉0．05）。两组术后最高体温和术后住院天数比较差异均无统计学意义（P〉0．05）。结论腹腔镜下卵巢子宫内膜异位囊肿剥离术中应用垂体后叶素在患侧宫角及输卵管系膜无血管区注射，能减少术中出血量，缩短手术时间，并有降低复发率的可能，是一种安全、可靠、价廉、方便的方法，值得推广。     

缺血预处理-后处理对大鼠肠缺血再灌注损伤的影响

Objective To evaluate the effects of ischemic preconditioning-postconditioning on the intestinal ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD weighing 225-275 g were randomly assigned into 5 groups ( n = 8 each): group I sham operation (group S) ; group II intestinal IR (group IIR); group Ⅲ ischemic preconditioning (group Ipr); group IV ischemic postconditioning (group Ipo); group V Ipr+ Ipo. The rats were anesthetized with intraperitonel 20% urethane 5 ml/kg. Superior mesenteric artery (SMA) was occluded for 60 min followed by 60 min reperfusion. In group S, SMA was isolated but not occluded. In group Ipr, SMA was occluded for 10 min followed by 10 min reperfusion, and the rest procedures were performed using the method described in group IIR. In group Ipo, 60 min ischemia was followed by three 30 s episodes of ischemia at 30 s intervals for reperfusion. In group Ipr+ Ipo, Ipr was performed followed by Ipo and the procedures were performed using the methods described in group Ipr and Ipo. The animals were killed at 60 min of reperfusion. The intestinal tissues were immediately removed for determination of MDA content, SOD and MPO activities and the degree of damage to intestinal mucous membrane was scored according to Chiu score. Arterial blood samples were taken for determination of plasma concentrations of TNF-α and 1L-6. Results Compared with group S, Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly increased, whereas SOD activity decreased in the other 4 groups ( P < 0.05). Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly decreased, whereas SOD activity increased in group Ipr, Ipo and Ipr + Ipo as compared with group IIR ( P < 0.05). Chiu score and MDA content were significantly lower, whereas SOD activity higher in group Ipr + Ipo than in group Ipr and Ipo ( P < 0.05). No significant differences were detected in the indices between group Ipr and group Ipo ( P > 0.05). Conclusion Ischemic preconditioning-postconditioning can attenuate the intestinal IR injury in rats, and the efficacy is better than that of either Ipr or Ipo alone.     

原位肝移植术中血流动力学、内稳态变化及麻醉处理

目的: 探讨原位肝移植(orthotopic liver transplan tation,OLT)围手术期的血流动力学、内稳态变化和麻醉处理。方法: 终末期肝病患者14例,采用气管内静吸复合全麻。右心置入Swan-Ganz导管监测不同时期血流动力学变化,同时监测内环境各项指标的变化。结果: 血流动力学变化显示,在无肝期肺小动脉楔压(pulmonary arterial wedge pressure,PAWP)、平均动脉压(MAP)、中心静脉压(central venous pressure,CVP)较术前明显下降(P<0.01);在腔静脉开放时CVP较术前明显升高(P<0.01)、PAWP升高(P<0.05)、MAP下降(P<0.01);术毕继续维持较高水平平均肺动脉压(MPAP)(P<0.01);心输出量在腔静脉阻断及开放时较术前降低(P<0.05)。结论: 血流动力学主要发生于无肝期和新肝早期,此期间加强监测、及时处理,可得到基本纠正。     

麻醉后监护与治疗病房建设及运营的现状和展望

2018年国家七部委发布的《关于印发加强和完善麻醉医疗服务意见的通知》(国卫医发〔2018〕21号)中鼓励有条件的医疗机构可设置麻醉后监护与治疗病房(anesthesia intensive care unit, AICU), 首次以官方文件的形式正式提出AICU的概念。随后国卫办医函〔2019〕884号文件中也提出建设AICU的规范要求。AICU的建立既有助于加速患者术后康复, 也是急危重症等患者术后救治的良好补充, 促进了麻醉学向围术期医学转变[1,2]。