阿片受体在异氟醚延迟预处理减轻兔心肌缺血再灌注损伤中的作用

Objective To investigate the role of opioid receptors in the protective effects of isoflurane-induced delayed preconditioning against myocardial ischemia-reperfusion (I/R) injury in rabbits. Methods Forty male New Zealand white rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups ( n = 10 each) : group I sham operation (S); group II I/R; group Ⅲ isoflurane + I/R (Iso) and group IV Iso + naloxone + I/R (Nal). Myocardial I/R was induced by 40 min occlusion of left anterior descending branch (LAD) of coronary artery followed by 120 min reperfusion. In group Ⅲ (Iso) 2% isoflurane in 100% O2 was inhaled for 2 h and I/R was produced 24 h later. In group IV (Nal) naloxone 6 mg/kg was given iv 10 min before 2 h of 2% isoflurane inhalation and I/R was produced 24 h later. At the end of 120 min reperfusion, infarct size (IS) and area at risk (AAR) were determined by Evan's blue and TTC staining. Myocardial ultrastructure was examined by electron microscopy. The phosphorylated p38MAPK protein expression in myocardium was determined by Western blot. Results The IS was significantly smaller in group Iso ( Ⅲ ) ( 19.7% ± 2.8%) than in I/R group ( II ) (37.8% ±1.7%) (P<0.05). The phosphorylated p38MAPK protein expression in myocardium was significantly lower in group Iso than in group I/R. Microscopic examination showed less myocardial damage in Iso group than in group I/R. The protective effects of delayed preconditioning by isoflurane was prevented by naloxone pretreatment. ConclusionOpioid receptors may be involved in the protective effects of delayed preconditioning by isoflurane against myocardial I/R injury.     

产后抑郁与去甲肾上腺素代谢酶基因多态性的关联及危险因素分析

目的探究剖宫产产后抑郁发病与去甲肾上腺素代谢酶基因多态性的关联以及其相关危险因素。方法招募591例行择 期剖宫产的中国产妇,以爱丁堡产后抑郁评分（EPDS）9/10分为产后抑郁评估截点;并对所有无产前抑郁产妇的儿茶酚氧甲基 转移酶基因5个位点（rs2020917, rs737865等）和单胺氧化酶A基因1个位点（rs6323)进行基因型检测。采用SPSS18.0 分析各 单核苷酸多态性与剖宫产产后抑郁的相关性,分析所有单核苷酸多态性、连锁不平衡、单倍型等在产后抑郁发病中的作用,并对 所有相关危险因素行logistic 回归分析以及基因与环境的交互作用分析。结果产后抑郁发生率为18.1%;单因素分析显示 COMT 多态性rs2020917 基因、COMT 多态性rs737865 基因与产后抑郁发病率相关（P<0.05）;COMT基因型rs2020917 和 rs737865具有共线性,logistic分析显示COMT基因多态性rs2020917TT基因型和rs737865GG基因型、孕期压力大、家庭暴力 是产后抑郁的危险因素（P<0.05）,以上两种基因多态性与环境因素不存在显著的交互作用。结论携带COMT 多态性 rs2020917TT基因型、COMT多态性rs737865GG基因型,孕期压力大、家庭暴力是产后抑郁的危险因素。     

氯诺昔康联合小剂量芬太尼术后镇痛的效果及对应激反应的影响

目的评价氯诺昔康联合小剂量芬太尼用于上腹部手术后患者自控镇痛(PCA)的效果、不良反应及对术后应激反应的影响。方法将择期上腹部手术患者36例随机分为芬太尼镇痛组(A组)、氯诺昔康+芬太尼镇痛组(B组)和未镇痛组(C组)。观察患者术后6 h、24 h和48 h疼痛视觉模拟评分(VAS)和镇静程度评分;检测麻醉前和术后24 h血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)浓度。结果各时点VAS评分,A、B组比较无显著性差异(P>0.05);各时点镇静评分B组均优于A组(P<0.05);术后24 h,A组、B组血清CRP和IL-6水平均明显低于C组(P<0.05),且B组低于A组(P<0.05);3组患者术后镇痛相关恶心、呕吐、眩晕等不良反应发生率无明显差异。结论氯诺昔康与小剂量芬太尼联合用于PCA,既可显著减少阿片类药物的用量,又可达到满意的镇痛效果,可有效缓解术后疼痛引起的过度应激反应。     

体感诱发电位与数量化脑电图监测地氟醚全身麻醉深度的临床研究

目的探讨地氟醚吸入全身麻醉时上肢短潜伏期体感诱发电位(short latency somatosensory evokedpotentials,SL-SEP)、数量化脑电图(quantitative electroencephalography,QEEG)的变化。方法选择全麻患者30例,麻醉诱导后吸入地氟醚,依次维持呼末地氟醚浓度在0.4MAC、0.7MAC、1.0MAC、1.3MAC;分别记录麻醉过程中平均动脉压(MAP)、心率(HR)、QEEG(BIS、95%SEF、MF)和SL-SEP(LP15、LN20、LN11、AMPP15-N20、AMPN11、CCT)。结果患者HR、MAP以及皮层下电位N11的变化与吸入地氟醚浓度无明显量效关系(P>0.05);而QEEG值随吸入地氟醚的呼末浓度增高而降低(P<0.05);LP15、LN20和CCT随地氟醚呼气末浓度的增加而逐渐延长(P<0.05)。结论LP15、LN20、CCT以及QEEG各参数是监测地氟醚麻醉深度的较好指标。     

住培医生实施纤支镜引导经鼻气管内插管的影响因素分析

目的观察麻醉科轮训医生在实施纤支镜引导下经鼻腔气管内插管成功率的影响因素。方法选择住培医师120人,经过不少于60分钟的集中培训后分别对120例患者进行纤支镜引导下鼻腔气管内插管,评估其气管内插管的成功率及影响因素。结果在纤支镜引导下鼻腔气管内插管中,住培医生的一次成功率为26.2%,两次成功率为60.2%,失败率为39.8%。Logistic因素分析结果显示曾经使用过纤维支气管镜、博士学历、患者接受全身麻醉是住培医生实施纤支镜引导下经鼻腔气管内插管成功的有利因素。结论背景知识的熟练掌握与技能培训相结合仍是提高是住培医生气道管理技能的重要手段。     

曲马多复合芬太尼应用于清醒气管内插管的探索

[目的]探讨曲马多复合芬太尼用于清醒气管内插管的可行性及其合适的剂量.[方法]采用up-and-down序贯设计方法分别探讨20～49岁组、50～69岁组和70岁以上组患者曲马多复合芬太尼用于纤维支气管镜引导下经鼻腔清醒气管内插管的可行性及其合适的剂量并进行验证.[结果]20～49岁组患者应用2.2 μg/kg芬太尼+2.0 mg/kg曲马多、50～69岁组患者应用1.6ug/kg芬太尼+1.9 mg/kg曲马多、70岁以上组患者应用1.0 ug/kg芬太尼+1.8 mg/kg曲马多后患者神志清楚,没有明显呼吸抑制;同时在该剂量下患者容易接受环甲膜穿刺气道表面麻醉和经鼻纤维支气管镜引导的气管内插管,术后随访大多数患者对插管过程有记忆但无明显不适,未发现清醒气管内插管相关后遗效应.[结论]曲马多复合芬太尼可以安全用于纤维支气管镜引导的经鼻腔清醒气管内插管,但具体用药剂量在不同年龄组患者稍有差异.     

异氟醚麻醉对大鼠海马蛋白质组的影响

目的 研究异氟醚麻醉后大鼠海马蛋白质组的变化.方法 将10只8月龄SD大鼠随机均分为异氟醚组(I组)和对照组(C组).1组大鼠以1.2%异氟醚吸入麻醉2 h,C组吸氧对照.于麻醉处理或吸氧对照结束后24 h取海马组织行双向凝胶电泳和质谱分析以鉴定差异蛋白点.结果 双向凝胶电泳结果显示I和C组差异蛋白质点共有17(4/13)个,MAL DI-TOF-MS分析后鉴定出12种蛋白质.结论 异氟醚麻醉可以引起大鼠海马蛋白质组变化,这些蛋白质变化可能具有一定的神经元保护作用.     

选择素P与心肺转流术后肺损伤

心肺转流中P-selectin的过度表达可以导致或加重肺损伤,特异性阻断P-selectin的表达可以在一定程度上使之得到缓解。现就P-selectin的结构、作用及针对P-selectin的肺损伤治疗和研究现状进行综述。     

阿片受体在异氟醚延迟预处理减轻兔心肌缺血再灌注损伤中的作用

Objective To investigate the role of opioid receptors in the protective effects of isoflurane-induced delayed preconditioning against myocardial ischemia-reperfusion (I/R) injury in rabbits. Methods Forty male New Zealand white rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups ( n = 10 each) : group I sham operation (S); group II I/R; group Ⅲ isoflurane + I/R (Iso) and group IV Iso + naloxone + I/R (Nal). Myocardial I/R was induced by 40 min occlusion of left anterior descending branch (LAD) of coronary artery followed by 120 min reperfusion. In group Ⅲ (Iso) 2% isoflurane in 100% O2 was inhaled for 2 h and I/R was produced 24 h later. In group IV (Nal) naloxone 6 mg/kg was given iv 10 min before 2 h of 2% isoflurane inhalation and I/R was produced 24 h later. At the end of 120 min reperfusion, infarct size (IS) and area at risk (AAR) were determined by Evan's blue and TTC staining. Myocardial ultrastructure was examined by electron microscopy. The phosphorylated p38MAPK protein expression in myocardium was determined by Western blot. Results The IS was significantly smaller in group Iso ( Ⅲ ) ( 19.7% ± 2.8%) than in I/R group ( II ) (37.8% ±1.7%) (P<0.05). The phosphorylated p38MAPK protein expression in myocardium was significantly lower in group Iso than in group I/R. Microscopic examination showed less myocardial damage in Iso group than in group I/R. The protective effects of delayed preconditioning by isoflurane was prevented by naloxone pretreatment. ConclusionOpioid receptors may be involved in the protective effects of delayed preconditioning by isoflurane against myocardial I/R injury.     

体感诱发电位、数量化脑电图与异氟醚吸入浓度的关系

目的 探讨短潜伏期体感诱发电位和数量化脑电图监测异氟醚吸入麻醉深度的可行性.方法 选择全麻患者30例,麻醉诱导后吸入异氟醚,依次增加呼气末异氟醚浓度为0.4、0.7、1.0、1.3和1.6 MAC,记录麻醉过程中MAP、HR、数量化脑电图(BIS、95%SEF和MF)和体感诱发电位(LP15、LN20、LN11和CCT),计算各监测指标与异氟醚吸入浓度的相关性.结果 患者HR、LN11与呼气末异氟醚浓度变化无直线相关关系;MAP、BIS、95%SEF和MF与呼气末异氟醚浓度变化呈负相关关系(P＜0.05),而LP15、LN20和CCT与呼气末异氟醚浓度变化呈正相关关系(P＜0.05).结论 BIS、95%SEF、MF、LN20和CCT是监测异氟醚吸入麻醉深度的较好指标.