无静脉转流肝移植术中患者门静脉和下腔静脉血酸碱及电解质的变化

原位肝移植术创伤大并且机体内环境干扰明显，术中常出现严重的全身电解质和酸碱紊乱，但门静脉和下腔静脉血的酸碱及电解质变化尚无定论。本研究拟观察无静脉转流经典式原位肝移植术患者新肝血流开放前后门静脉和下腔静脉血酸碱及电解质变化，以了解新肝开放时，门静脉和下腔静脉血再灌注对全身酸碱及电解质的影响，并为术中放血量的估计提供理论依据。     

氟烷、安氟醚、七氟醚肝毒性与TXB_2、6－keto－PGF（1α）含量变化（氟烷性肝炎的研究Ⅲ）

雄性ＳＤ大鼠饮用含苯巴比妥钠（１ｍｇ／ｍｌ）的饮水１周后，随机分为四组，每组８例，分别吸入：Ｃ，１４％Ｏ＿２／８６％Ｎ＿２；Ｅ，１４％Ｏ＿２／８６％Ｎ＿２／１．２ＭＡＣ安氟醚；Ｓ，１４％Ｏ＿２／８６％Ｎ＿２／１．２ＭＡＣ七氟醚；Ｈ，１４％Ｏ＿２／８６％Ｎ＿２／１．２ＭＡＣ氟烷１ｈ。２４ｈ后发现Ｈ组血浆ＡＬＴ活性显著高于其它各组，并有明显的小叶中心性肝细胞坏死及汇管区炎细胞浸润，血窦重度充血。Ｅ组可见部分肝小叶内有小叶中心性坏死及空泡变性。Ｈ组肝匀浆及血浆中ＴＸＢ＿２含量显著高于其它各组。６－ｋｅｔｏ－ＰＧＦ１ａ各组间均无显著差异。提示氟烷性肝炎与ＴＸＡ＿２／ＰＧＩ＿２平衡失调有一定的关系。     

异丙酚对鼠肝线粒体氧化磷酸化的影响

异丙酚对鼠肝线粒体氧化磷酸化的影响隋波俞卫锋缪明永马永德刘树孝作者单位：２５００３１济南军区总医院麻醉科（隋波、马永德）；第二军医大学长海医院（俞卫锋、刘树孝），本大学生化教研室（缪明永）探讨异丙酚对离体鼠肝线粒体能量转化功能的影响，对了解其肝细胞毒...     

氟烷、七氟醚肝毒性与肝细胞钙平衡

研究了3种配体（ConA、WGA、ZymosanA）引起的巨噬细胞溶酶体pH值动态变化情况。结果显示，在配体加入后溶酶体pH很快上升，5min左右达到峰值．提示受体介导内吞引起的溶酶体pH的上升，不是由于溶酶体体积增加引起的，而是由于内吞体酸化引起细胞内外离子变化所致。     

6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.     

曲马多对小鼠镇痛作用的药物代谢动力学研究

目的　探讨曲马多在小鼠体内的药物代谢动力学。方法　采用药效—药代统一模型 ,以小鼠腹腔注射醋酸后扭体反应次数为镇痛效应指标 ,测定时—效、量—效关系 ,进一步求时间—体存生物相当药量曲线及相应药代动力学参数。结果　曲马多在小鼠的镇痛作用呈显著的时—效、量—效关系 ,其镇痛作用效量半衰期(T1 /2 ,ED)为 4 68min ,消除速率常数K为 0 1 4 8。结论　曲马多母核药物与多种代谢产物均有镇痛作用 ,此法比单纯测定曲马多的血药浓度更能科学地反映药物在作用部位的药效变化规律     

白介素-10在脓毒症中的作用

白介素-10(IL-10)是一种极具应用前景的抗炎及免疫调节细胞因子。它能够抑制局部组织及全身过度释放致炎细胞因子及趋化因子,抑制抗原特异性T细胞反应,同时还能上调部分抗炎细胞因子的表达,极有可能在炎症治疗中发挥重要作用。本文就其分子生物学特性、生物学活性及其在脓毒症中的作用作一综述。     

吸入麻醉药全麻敏感基因的研究现状

利用分子遗传学研究手段,在生物整体水平探索影响吸入麻醉药全麻敏感性的相关基因及其表达产物,是近年来开展的全麻机制研究的新方法和新策略.目前已在酵母类、线虫类、果蝇类、哺乳类等生物模型中筛选到许多吸入麻醉药的全麻敏感基因,并进行了初步的定位、克隆和功能鉴定,为进一步阐明特异性的全麻分子靶位作出了有益的探索.     

布比卡因和芬太尼浓度与容量匹配对肝脏术后硬膜外镇痛效应的影响

目的:研究布比卡因和芬太尼联合用药的浓度与容量匹配对肝脏术后硬膜外镇痛效应的影响.方法:对125例肝脏手术患者(ASA Ⅰ～Ⅱ)采用布比卡因(3.75 mg/h)和芬太尼(12 μg/h)联合用药行术后硬膜外镇痛,将该两药等剂量的浓度与容量的匹配关系随机分成5组(n=25),G1组为0.375％布比卡因和12 μg/ml芬太尼混合液以1 ml/h速率持续硬膜外输注;G2组为0.187 5％布比卡因和6 μg/ml芬太尼(2 ml/h);G3组为0.125％布比卡因和4 μg/ml芬太尼(3 ml/h);G4组为0.093 75％布比卡因和3 μg/ml芬太尼(4 ml/h);G5组为0.075％布比卡因和2.4 μg/ml芬太尼(5 ml/h).选择负荷量+持续输注量+PCA给药模式,计算术后48 h的用药总量,观察镇痛效果及相应的不良反应.结果:(1)药物用量:术后48 h各组的布比卡因和芬太尼用药总量、按压总数/按压实进数比值(D/D值)均无明显差异(P>0.05);但G4组的按压实进数明显低于G1和G5组(P<0.05).(2)镇痛效果:各组的有效镇痛率依次为G4>G3>G2>G5>G1.组间比较G3和G4组的静息痛视觉模拟评分(VAS)明显低于G1和G5组(P<0.05),但G3和G4组的咳嗽痛VAS评分仅低于G1组(P<0.05).(3)不良反应:G1组的恶心、呕吐和瘙痒发生率最高,分别为24％和32％,但组间比较未见明显差异.结论:肝脏术后联合应用等剂量布比卡因和芬太尼行硬膜外镇痛,其浓度与容量的匹配关系对镇痛效应有明显的影响.     

6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.