骨科手术中自体血液回收对红细胞流变性的影响

目的:观察骨科手术中自体血液回收对红细胞流变性的影响.方法:将50例骨科手术患者随机分为两组(对照组和实验组),观察不同时间点红细胞流变学特征以及术前和手术结束时红细胞压积和钾离子浓度变化.结果:实验组洗涤前红细胞聚集性增加,变形性下降,经过洗涤处理后恢复至术前水平;与洗涤前相比,实验组洗涤后红细胞压积明显升高,而钾离子浓度明显降低.结论:骨科手术中,输入洗涤后的自体血液对机体整体血液流变学特性不会产生明显的负面影响.     

非抑郁脑梗死患者卒中后疲劳的现状及影响因素分析

目的 探讨非抑郁脑梗死患者卒中后疲劳(PSF)发生现状及影响因素。方法 纳入2021年4月-2022年6月我院神经内科、老年医学科的199例非抑郁脑梗死患者,采用一般资料调查表、疲劳严重度量表(FFS)、汉密尔顿抑郁量表(HAMD)等进行调查。将非抑郁脑梗死患者分为PSF组和非PSF组,比较2组患者的人口学因素、疾病病史、实验室检查、临床因素等。结果 纳入的199例非抑郁脑梗死患者中,PSF组71例(35.68%),非PSF组128例(64.32%)。Logistic回归分析发现,额叶病变(OR=5.026, 95%CI:1.926～13.115;P=0.001)、肌少症(OR=9.031,95%CI:3.586～22.743;P<0.001)、睡眠质量(OR=1.245,95%CI:1.111～1.395;P<0.001)是PSF的独立影响因素。结论 额叶病变、肌少症、睡眠质量是影响PSF的主要危险因素。这提示对于非抑郁脑梗死患者,需要注重额叶梗死、肌少症及睡眠质量的评估,以便予针对性预防措施,降低PSF发生率。     

含不同浓度乳化异氟醚的停跳液对大鼠离体心脏缺血再灌注损伤的影响

Objective To investigate the effects of cardioplegic solution containing different concentrations of emulsified isoflurane on myocardial ischemia-reperfusion injury in isolated rat hearts. Methods Fifty-six male SD rats, weighing 180-250 g, were anesthetized with intraperitoneal 20% urethane 1 g/kg and heparin 1 000 U/kg. Their hearts were excised and perfused in a Langendorff apparatus. Fifty-six isolated hearts were randomly divided into 7 groups ( n = 8 each) : St. Thomas cardioplegic solution group (group C) and St. Thomas cardioplegic solution containing 6 different concentrations of emulsified isoflurane groups (group E1-6 ). After 20 min equilibration, cardiac arrest was induced with St. Thomas cardioplegic solution 20 ml and St. Thomas cardioplegic solution containing 0.28, 0.56, 1.12, 1.68, 2.24 and 2.80 mmol/L emulsified isoflurane 20 ml at 4℃for 45 min followed by 60 min reperfusion in group C and E1-6 respectively. HR, left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP) and + dp/dtmax were recorded at the end of 20 min equilibration, 20, 40 and 60 min of reperfusion. Coronary effluent 1.5 ml was collected for determination of LDH and SOD activity and the concentration of cTnI. At the end of 60 min reperfusion, the area of myocardial infarction was calculated. Results Compared with group C, HR, LVDP, + dp/dtmax and SOD activity were significantly higher, LVEDP, LDH activity and cTnI concentration lower, and the area of myocardial infarction lower in group E4, and HR, LVDP, + dp/dtmax and SOD activity were significantly lower, LVEDP, LDH activity and cTnI concentration higher, and the area of myocardial infarction higher in group E6 and E6 ( P < 0.05) , but there was no significant difference in the above indices between group E1-3 and group C ( P > 0.05) . HR, LVDP, + dp/dtmax and SOD activity were significantly lower, LVEDP, LDH activity and cTnI concentration higher, and the area of myocardial infarction higher in group E1-3-5-6 than in group E4 (P < 0.05 ). Conclusion St. Thomas cardioplegic solution containing 1.68 mmol/L emulsified isoflurane can attenuate myocardial ischemia-reperfusion injury in isolatede rat hearts.     

含不同浓度乳化异氟醚的停跳液对大鼠离体心脏缺血再灌注损伤的影响

Objective To investigate the effects of cardioplegic solution containing different concentrations of emulsified isoflurane on myocardial ischemia-reperfusion injury in isolated rat hearts. Methods Fifty-six male SD rats, weighing 180-250 g, were anesthetized with intraperitoneal 20% urethane 1 g/kg and heparin 1 000 U/kg. Their hearts were excised and perfused in a Langendorff apparatus. Fifty-six isolated hearts were randomly divided into 7 groups ( n = 8 each) : St. Thomas cardioplegic solution group (group C) and St. Thomas cardioplegic solution containing 6 different concentrations of emulsified isoflurane groups (group E1-6 ). After 20 min equilibration, cardiac arrest was induced with St. Thomas cardioplegic solution 20 ml and St. Thomas cardioplegic solution containing 0.28, 0.56, 1.12, 1.68, 2.24 and 2.80 mmol/L emulsified isoflurane 20 ml at 4℃for 45 min followed by 60 min reperfusion in group C and E1-6 respectively. HR, left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP) and + dp/dtmax were recorded at the end of 20 min equilibration, 20, 40 and 60 min of reperfusion. Coronary effluent 1.5 ml was collected for determination of LDH and SOD activity and the concentration of cTnI. At the end of 60 min reperfusion, the area of myocardial infarction was calculated. Results Compared with group C, HR, LVDP, + dp/dtmax and SOD activity were significantly higher, LVEDP, LDH activity and cTnI concentration lower, and the area of myocardial infarction lower in group E4, and HR, LVDP, + dp/dtmax and SOD activity were significantly lower, LVEDP, LDH activity and cTnI concentration higher, and the area of myocardial infarction higher in group E6 and E6 ( P < 0.05) , but there was no significant difference in the above indices between group E1-3 and group C ( P > 0.05) . HR, LVDP, + dp/dtmax and SOD activity were significantly lower, LVEDP, LDH activity and cTnI concentration higher, and the area of myocardial infarction higher in group E1-3-5-6 than in group E4 (P < 0.05 ). Conclusion St. Thomas cardioplegic solution containing 1.68 mmol/L emulsified isoflurane can attenuate myocardial ischemia-reperfusion injury in isolatede rat hearts.     

罗比卡因用于高强度聚焦超声治疗下肢骨肿瘤的临床观察

高强度聚焦超声(HIFU)是一种新的非侵入性体外肿瘤治疗手段,在临床作为肢体骨肿瘤保肢治疗方法之一,已被成功地证明是一种安全、有效的肿瘤局部治疗技术。既往在HIFU过程中通常应用利多卡因等药物作为持续硬膜外腔用药,从2002年12月我们尝试罗比卡因替代利多卡因,现报告如下。 资料与方法 一般资料 20例 ASAⅠ～Ⅱ级下肢骨肿瘤行HIFU治疗的病人,男14例,女6例,年龄8～40岁,中位年龄18岁,体重24～72kg。其中原发性骨肉瘤18例,软骨肉瘤2例,肿瘤位于股骨下段16例,胫骨上段4例,HIFU治疗范围包     

尼可地尔后处理对大鼠心肌缺血再灌注损伤的影响

目的 探讨尼可地尔后处理和缺血后处理对大鼠心肌缺血再灌注损伤的影响。方法 健康成年SD大鼠24只,建立Langendorff模型灌注离体心脏,随机分为3组,每组8只,对照组（IR组）：全心缺血40min,再灌注Krebs-Henseleit缓冲液（K-H液）60min;缺血后处理组（IPC组）：全心缺血40min,再灌注10s、缺血10s,反复6次后,再灌注K-H液58min;尼可地尔后处理组（NPC组）：全心缺血40min,灌注含20μmol/L尼可地尔的K-H液10min,然后再灌注K-H液50min。测定缺血前5min、再灌注30min及结束时冠脉流出液中碱性磷酸激酶同工酶（CK-MB）活性,再灌注结束即刻取左心室组织,测定超氧化物歧化酶（SOD）活性、丙二醛（MDA）含量、ATP含量,电镜观察心肌超微结构。结果 与IR组比较,IPC组和NPC组再灌注期CK-MB活性及MDA含量降低,SOD活性和ATP含量增高（P＜0．05）,IPC组和NPC组上述指标比较差异无统计学意义（P＞0．05）。IPC组和NPC组的心肌超微结构损伤程度轻。结论 尼可地尔后处理和缺血后处理均可以减轻大鼠心肌缺血再灌注损伤,其机制可能与减少氧自由基的生成、增强心肌抗氧化能力和减少细胞能量消耗有关。     

含不同浓度乳化异氟醚的停跳液对大鼠离体心脏缺血再灌注损伤的影响

Objective To investigate the effects of cardioplegic solution containing different concentrations of emulsified isoflurane on myocardial ischemia-reperfusion injury in isolated rat hearts. Methods Fifty-six male SD rats, weighing 180-250 g, were anesthetized with intraperitoneal 20% urethane 1 g/kg and heparin 1 000 U/kg. Their hearts were excised and perfused in a Langendorff apparatus. Fifty-six isolated hearts were randomly divided into 7 groups ( n = 8 each) : St. Thomas cardioplegic solution group (group C) and St. Thomas cardioplegic solution containing 6 different concentrations of emulsified isoflurane groups (group E1-6 ). After 20 min equilibration, cardiac arrest was induced with St. Thomas cardioplegic solution 20 ml and St. Thomas cardioplegic solution containing 0.28, 0.56, 1.12, 1.68, 2.24 and 2.80 mmol/L emulsified isoflurane 20 ml at 4℃for 45 min followed by 60 min reperfusion in group C and E1-6 respectively. HR, left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP) and + dp/dtmax were recorded at the end of 20 min equilibration, 20, 40 and 60 min of reperfusion. Coronary effluent 1.5 ml was collected for determination of LDH and SOD activity and the concentration of cTnI. At the end of 60 min reperfusion, the area of myocardial infarction was calculated. Results Compared with group C, HR, LVDP, + dp/dtmax and SOD activity were significantly higher, LVEDP, LDH activity and cTnI concentration lower, and the area of myocardial infarction lower in group E4, and HR, LVDP, + dp/dtmax and SOD activity were significantly lower, LVEDP, LDH activity and cTnI concentration higher, and the area of myocardial infarction higher in group E6 and E6 ( P < 0.05) , but there was no significant difference in the above indices between group E1-3 and group C ( P > 0.05) . HR, LVDP, + dp/dtmax and SOD activity were significantly lower, LVEDP, LDH activity and cTnI concentration higher, and the area of myocardial infarction higher in group E1-3-5-6 than in group E4 (P < 0.05 ). Conclusion St. Thomas cardioplegic solution containing 1.68 mmol/L emulsified isoflurane can attenuate myocardial ischemia-reperfusion injury in isolatede rat hearts.     

右美托嘧啶联合地佐辛清醒镇静镇痛在骨科微创手术中的应用前景

清醒镇静镇痛是近年来国内外学者提出的新概念,其既可以产生良好镇静镇痛,又可保证患者能很好地和术者进行交流。微创脊柱外科手术是近年来研究较热门的手术方式,但术中神经损伤的并发症十分高,而应用清醒镇静镇痛麻醉,可以降低该并发症的发生率。右美托嘧啶具有剂量依赖性镇静、适当镇痛、轻微的呼吸抑制等特点,地佐辛具有强效镇痛、呼吸抑制弱于阿片类药物等特点。右美托嘧啶复合地佐辛能提供良好的镇静镇痛,该麻醉方式在微创脊柱外科手术中具有广阔的应用前景。     

猪原位肝移植麻醉及围术期麻醉管理的探讨

目的:为临床肝移植的麻醉和围术期的麻醉及管理作技术性准备.方法:对实验猪行经口气管内插管 全凭静脉复合麻醉,观察其各时点血流动力学、动脉血气、血生化的改变.结果:猪的气管插管术与人体相比有其自身特点;实验猪对麻醉药有较大的耐受量,无肝期麻醉药用量明显减少;无肝期和新肝期血流动力学变化剧烈并伴有代谢性酸中毒,血清K 在新肝期有一过性升高.结论:对实验猪实施经口气管内插管可行;无肝期不需要深麻醉状态;血流动力学改变的处理应以预防为主;随时纠正酸碱平衡紊乱,在新肝期前5min可预防性给予碳酸氢钠1mmol/kg以预防高K 和代谢性酸中毒加重.     

瑞芬太尼在无痛胃镜检查中的应用

目的:比较瑞芬太尼复合异丙酚与芬太尼复合异丙酚用于无痛胃镜的效果.方法:选60例要求行无痛胃镜检查的患者随机分成两组,A组(瑞芬太尼组)30例,B组(芬太尼组)30例,两组静注异丙酚1.5～2.0mg/kg后A组静注瑞芬太尼0.5μg/kg,B组静注芬太尼0.05mg,术中根据患者情况适当追加异丙酚,观察SpO2、HR、SBP的变化,病人的异丙酚用量、检查时间、苏醒时间、可行走时间.结果:苏醒时间和可行走时间A组显著短于B组,具有显著性差异.异丙酚的用量B组稍高于A组,但无显著性差异.结论:瑞芬太尼较芬太尼复合异丙酚用于无痛胃镜检查具有苏醒快,可行走时间短,镇痛效果满意等优点,而且安全.