七氟醚预处理对大鼠肾缺血再灌注损伤的影响

目的 评价七氟醚预处理对大鼠肾缺血再灌注损伤的影响.方法 雄性SD大鼠24只,体重250～300 g,采用随机数字表法,将大鼠随机分为3组(n=8):假手术组(S组)、肾缺血再灌注组(I/R组)和七氟醚预处理组(SP组).I/R组和SP组采用切除右肾然后夹闭左侧肾动脉45 min再开放的方法 制备肾缺血再灌注模型.SP组吸入2.2%七氟醚1 h,停止吸入后10 min时进行肾缺血.于再灌注2 h时采集静脉血样,测定血清肌酐(Cr)、尿素氮(BUN)和胱抑素C(Cys C)的浓度,取肾组织,光镜下及透射电镜下观察病理学结果,并根据肾小管病变程度进行Paller评分.结果 与S组比较,I/R组血清Cr和BUN浓度差异无统计学意义(P＞0.05),血清Cys C浓度和Paller评分明显升高(P＜0.05);与I/R组比较,SP组血清Cys C浓度和Paller评分明显降低(P＜0.05).SP组肾组织损伤程度轻于I/R组.结论 七氟醚预处理可减轻大鼠肾缺血再灌注损伤.

Abstract：

Objective To investigate the effects of sevoflurane preconditioning on renal ischemia-reperfusion(I/R)injury in rats.Methods Twenty-four adult male SD rats weighing 250-300 g were randomly divided into 3 groups(n=8 each):sham operation group (group S);I/R group; sevoflurane preconditioning group (group SP). After the rats underwent right nephrectomy, renal I/R was produced by occlusion of left renal artery for 45 min followed by reperfusion in I/R and SP groups.In group SP, the rats inhaled 2.2% sevoflurane for 1 h, then the inhalation was stopped and renal ischemia was performed 10 min later. Venous blood samples were collected at 2 h of reperfusion to determine the concentrations of serum creatinine(Cr), urea nitrogen (BUN), cystatin C (Cys C) . The renal tissues were obtained for microscopic examination, and Paller's score was recorded. Results Compared with group S, there was no significant difference in the serum Cr and BUN concentrations (P＞0.05), while the serum Cys C concentration and Paller's score for acute renal tubular injury were significantly increased in group I/R(P＜0.05). The serum Cys C concentration and Paller's score were significantly lower in group SP than in group I/R(P＜0.05).I/R-induced renal injury was significantly reduced in group SP compared with group I/R. Conclusion Preconditioning with sevoflurane can provide significant protection against renal I/R injury.     

不同程度急性等容量血液稀释对家兔血清S-100B蛋白浓度和脑氧代谢的影响

Objective To investigate the effects of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 20010.5 on serum S-100B protein concentration and cerebral oxygen metabolism at 37℃ in rabbits.Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups (n = 8each) : Ⅰ control group underwent no ANH and Ⅱ , Ⅲ , Ⅳ ANH group underwent ANH with hematocrit (Hct)reduced to 24%, 18% and 12% respectively. The animals were anesthetized with iv 20% urethane 5 ml/kg,tracheostomized and mechanically ventilated (VT = 15 ml/kg, RR = 30 bpm). The body temperature was maintained at 37℃. Left carotid artery and jugular vein were cannulated for BP monitoring, blood gas analysis and blood sampling. Right jugular vein was cannulated for CVP monitoring. Left femoral artery and vein were cannulated for hemodilution. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Hemodynamics parameters, were recorded and blood gases were analyzed and serum S-100B protein concentration and cerebral O2 metabolic rate (CERO2) were determined before (baseline) and at 2, 4 and 8 h after ANH. Brain water content was measured by wet/dry brain weight ratio. Results There were no significant differences in serum S-100B protein concentration, CERO2 and pH value between group Ⅰ and group Ⅱ (Hct 24%). Serum S-100B protein concentration and CERO2 were significantly increased at 8 h after ANH as compared with the baseline before ANH in group Ⅰ (Her 18%). Serun S-100B protein concentration and CERO2 were significantly increased at 2, 4 and 8 h after ANH as compared with the baseline before ANH in group Ⅳ (Hct 12%). There was no significant difference in brain water content among the 4 groups. Conclusion ANH does not affect cerebral O2 metabolic when Hct is reduced to 24%. CERO2 can not be sustained and ischemic cerebral injury may occur when Hct is reduced to≤18%.     

全麻诱导期不同预给药方式对丙泊酚注射痛的效果比较

目的比较全麻诱导期不同预处理方式对丙泊酚注射痛的效果。方法收集择期全麻下行外科手术患者100例,男性57例,女性43例,年龄(34.06±5.92)岁(25～45岁)。ASAⅠ～Ⅱ级,随机数字表法分为4组(n=25),即对照组(C):预注射生理盐水5mL;芬太尼组(F):预注射芬太尼0.004mg/kg;利多卡因1组(L1):预注射利多卡因1mg/kg;利多卡因2组(L2):左肘关节上1寸捆扎止血带,预注射利多卡因1mg/kg,并于静注丙泊酚时松开。所有药物均于静注丙泊酚前30s,按1mL/3s速度静脉推注。当丙泊酚推注量达到5mL(50mg)时,采用VAS评估丙泊酚注射痛情况。记录注射丙泊酚前后平均动脉压(MAP)、心率(HR),率压积(RPP)和心电图,肘静脉抽取静脉血测定血清皮质醇含量。结果各预处理组与C组比较,丙泊酚注射痛发生率显著降低(χ2=8.694,P<0.05),MAP、HR、RPP、注射痛严重程度明显降低(P<0.05),而血清皮质醇含量差别无统计学意义(P>0.05)。F、L1和L2组间比较,注射丙泊酚前后MAP、HR、RPP、血清皮质醇含量、注射痛严重程度差别无统计学意义(P>0.05),注射痛的特点各异。结论应用利多卡因、芬太尼全麻诱导期预处理均可减轻丙泊酚注射痛。     

葡甲胺环腺苷酸用于危重心脏直视手术围术期的临床研究

目的：研究危重心脏直视手术围术期应用葡甲胺环腺苷酸（心先安）的临床效果。方法：40例危重心脏直视手术患者，随机分为2组，I组用心先安3mg.kg^-1，于主动脉开放即刻静注1／3量后，微注泵持续静注至术毕；Ⅱ组作对照组。记录不同时间点心排血量（CO），心脏指数（CI），每搏量（SV），每搏指数（SVI），体循环阻力（SVR），肺循环阻力（PVR），左室搏功指数（LVSWI），右室搏功指数（RVSWI），平均动脉压（MAP），中心静脉压（CVP），肺动脉压（PAP），肺毛细血管嵌压（PCWP），心自动复跳率，电除颤率，窦性心律恢复率，心律失常发生率，围术期及术后2d腺苷酸（cAMP)依赖性正性肌力药应用情况。结果：Ⅰ组心自动复跳率高于Ⅱ组，电除颤率和心律失常发生率低于Ⅱ组（P＜0．05）。Ⅰ组窦性心律恢复率高于Ⅱ组（P＜0．01），各时段Ⅰ组所需cAMP依赖性正性肌力药物种类，剂量和维持时间均少于Ⅱ组，2组CO，CI，SV均明显高于术前，Ⅰ组变化较Ⅱ组更显著，PAP，PWCWP，PVR，SVR均低于术前（P＜0．05），Ⅰ组与Ⅱ组相比，SVR值差异显著（P＜0．01），而心率，MAP，CVP与诱导麻醉后和转流5min时比较均无明显变化（P＞0．05），结论：重症心脏直视应用心先安具有明显的正性肌力，改善心输出量，改善心肌氧供，降低肺和外周循环阻力及抗心律失常作用。     

急性等容性血液稀释对脑氧代谢的影响

急性等容性血液稀释作为一种血液保护措施已经地广泛应用于临床。它不可避免地降低动脉血氧含量,但血液稀释本身可以通过增加脑血流及提高组织氧摄取率等代偿机制以维持组织氧代谢平衡。由于这些因素的交互作用,对脑组织最合适的血液稀释程度还有待进一步的研究证实。     

二氧化碳气腹对肠脂肪酸结合蛋白的影响

随着腹腔镜手术日益增多,气腹对患者的影响已引起人们的关注,但是相关研究主要集中于CO2气腹对循环、呼吸等的影响,而其对胃肠道系统影响鲜有文献报道.本文观察CO2气腹对肠脂肪酸结合蛋白(I-FABP)的影响,为临床提供参考. 资料与方法 一般资料择期妇科手术患者40例,其中子宫肌瘤剔除术12例,卵巢囊肿剥除术8例,单侧附件切除术12例,腹腔粘连分离术8例.ASAⅠ或Ⅱ级,年龄24～38岁,体重40～75 kg.所有患者术前ECG、呼吸功能、血清电解质及生化检查均在正常范围内,心、肺、肝肾功能良好,既往无消化道疾病病史,排除不合作者.患者随机均分为两组,分别采用腹腔镜手术(P组)和剖腹手术(N组).     

法洛综合征矫治术后死因与术中麻醉关系

法洛综合征矫治术后死因与术中麻醉关系张小霓＊李晖陈秋荣福建省心血管病研究所麻醉科（福州３５０００１）＊：现在福建医科大学附属第一医院麻醉科（福州３５０００５）关键词法洛综合征矫治术死因麻醉法洛综合征矫治术后死亡率高，死亡原因多。本文旨在探讨其术后近期...     

4∶1液与微量晶体心停跳液在心内直视术中心肌保护的比较

９０例接受４∶１血液心停跳液和微量晶体心停跳液心肌保护心内直视手术病人，按设计的项目进行比较。阻断主动脉期间，两组病人冠状循环均连续灌注（顺灌或逆灌）从氧合器中引出并降温达８～１０℃的血液（红细胞压积０．２５左右）心停跳液，灌注量与速度相似。Ａ组（头２５例）用４∶１血液心停跳液连续灌注保护心肌；Ｂ组（后６５例）以高浓度晶体血液心停跳液连续灌注保护心肌。结果见两组病人术中心肌电机械活动抑制、心脏复苏、复苏后血液动力学稳定性、开放主动脉前冠状静脉血气分析、术后１、３、５天乳酸脱氢酶Ａ（ＬＤＨ－Ａ）检查均无明显差异。Ｂ组所用晶体停跳液量为Ａ组的５％（Ｐ＜０．０００１）；术中红细胞容积稳定，灌注装置简单，容量负荷低，停跳液用药少，是一种更理想的心肌保护法。     

B型主动脉弓离断畸形综合征纠治1例报告

主动脉弓离断畸形是罕见而复杂的先天性心脏病(先心病),以复合畸形综合征存在,发病率约占复杂先心病的1%,未手术治疗患儿75%在出生后1个月内死亡,90%在1岁以内死亡[1,2]。笔者于1999年7～8月收治1例,除主动脉弓离断约5cm外,还有2cm×3cm主-肺动脉窗和1.5cm内径动脉导管未闭并重度肺高压,报道如下。1　病例介绍患儿,男性,10岁。自幼发现心脏杂音伴轻度紫绀,活动时加剧,平素易感冒。体检:发育一般,体重21kg,轻度紫绀,杵状指,四肢无明显差异。右上肢脉搏正常,血压110/80mmHg(1mmHg=0.133kPa),末梢血氧饱和度93%;左上肢与双下肢脉搏微弱,血压8…     

丙泊酚对体外循环中脑氧代谢的影响

目的:研究丙泊酚对体外循环(CPB)中脑氧代谢的影响.方法:40例风湿性心脏病行瓣膜置换术病例,随机分4组.A组不加丙泊酚,B,C,D组在CPB期间分别给予丙泊酚2,4,6mg·kg-1·h-1.在麻醉诱导后(T1)、CPB开始后5min(T2)、CPB低温稳定期(26～28℃)(T3)、复温至34℃(T4)及停CPB后5min(T5)共5个时段取颈内静脉血测定颈内静脉血氧饱和度(SjO2),测定动脉血气,计算脑氧摄取率(CEO2).结果:T3期SjO2值D组与A组相比差异有显著意义(P<0.05),其他各时段组间比较差异无显著意义(P＞0.05).4组患者CEO2各时段组间比较差异无显著意义(P>0.05).结论:丙泊酚不能改善CPB中脑氧供需失衡.