ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

目的 比较ProSeal喉罩和气管导管在全身麻醉(全麻)苏醒期对老年乳腺癌根治术患者的影响.方法 美国麻醉医师学会(ASA)分级Ⅰ-Ⅱ级、择期在全麻下行乳腺癌根治术的老年女性患者30例,随机分为2组,ProSeal喉罩组(喉罩组,15例)与气管导管组(导管组,15例).全麻后喉罩组放置ProSeal喉罩,导管组为气管插管.记录两组患者入室后5min(T0)、手术结束(T1)、呼唤睁眼(T2)、拔除导管或喉罩后即刻(T3)、拔除导管或喉罩后3min(T4)时的心率、收缩压、舒张压;记录全麻苏醒期使用降压药的例数,呛咳、烦躁及拔除导管或喉罩后咽痛、恶心、呕吐发生率.结果 喉罩组在T2点血压、心率[(140.2±8.7)mm Hg、(77.1±7.4)次/min]仅轻度增高,与T0[(134.8±12.6)mm Hg、(71.5±8.8)次/min]比较差异无统计学意义(P＞0.05);但在T3点血压、心率[(143.3±8.5)mm Hg、(81.7±6.8)次/min]升高与T0比较差异有统计学意义(P＜0.05).导管组在T2和T3时点,血压、心率[(146.5±13.5)mm Hg、(85.7±6.6)次/min和(151.4±11.7)mm Hg、(95.3±6.8)次/min]较T0[(132.1±12.1)mm Hg、(70.3±8.0)次/min]均明显增加(P＜0.05),在T3点达最高峰.在T2、T3时点,喉罩组的血压、心率增加程度明显小于导管组(P＜0.05).喉罩组患者苏醒时使用降压药、呛咳、咽痛的例数明显少于导管组(P＜0.05);而拔管后烦躁、恶心、呕吐等并发症发生率,两组差异无统计学意义(P＞0.05).结论 老年乳腺癌根治术患者使用ProSeal喉罩,明显减少麻醉苏醒期并发症的发生,有利于老年患者的麻醉安全.     

ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

Objective To explore the effect of ProSeal laryngeal mask airway and endotracheal tube on analepsia stage of general anesthesia in geriatric patients undergoing radical mastectomy.Methods Thirty geriatric females with breast cancer of American Standards Association (ASA)Ⅰ-Ⅱscheduled for selective radical mastectomy under general anesthesia were randomly allocated to two groups: ProSeal laryngeal mask airway group(PLMA group, n=15) and endotracheal tube group (ET group, n=15). The patients were put on PLMA or were intubated with ET under general anesthesia in the two groups, respectively. The heart rate (HR), systolic blood pressure(SBP)and diastolic blood pressure (DBP) were recorded at the time points of 5 min after entering operation room (T0), end of surgery (T1), opening eyes (T2), after extubation (PLMA) immediately (T3) and 3 min after extubation (PLMA) (T4). The numbers of patients who were given antihypertensive agent,showed bucking, agitation or sore throat, nausea and vomiting after extubation were recorded during the analepsia stage of general anesthesia. Results The blood pressure (BP) and HR were mildly.increased in PLMA group at T2, and there was no significant difference compared with T0(P＞0.05). But the BP and HR were significantly higher at T3 than at T0 (P＜0.05). In ET group, the BP and HR were both significantly elevated at T2 and T3 than at T0 (P＜0.05), and reached the peak at T3. The increased levels of BP and HR were significantly lower in PLMA group than in ET group at T2 and T3 (P＜0.05). The quantities of patients who were given antihypertensive agent, showed bucking and sore throat were less in PLMA group than in ET group(P＜0.05). No differences in incidence rate of agitation, nausea and vomiting after extubation between the two groups were observed(P＞0.05). Conclusions PLMA can obviously reduce the occurrence of complications in analepsia stage of general anesthesia in geriatric patients scheduled for selective radical mastectomy,and is beneficial to provide much safer anesthesia.     

膝胸卧位改善无痛胃肠镜联合检查术后腹痛腹胀的效果观察

目的 比较膝胸卧位与常规肛管排气对改善无痛胃肠镜联合检查术后腹痛腹胀的效果，以减轻检查者痛苦、减少并发症。方法 采用目的抽样法，选取2021年1-12月于空军军医大学第一附属医院消化内镜中心接受无痛胃肠镜联合检查术后腹痛腹胀评分≥4分的受检者100例作为研究对象，采用随机数字表法将其分为观察组和对照组，每组各50例。观察组采用膝胸卧位排气，对照组采用一次性肛管排气，比较两组受检者首次排气时间、干预时长、排气前后腹痛腹胀评分变化及受检者对干预措施的满意度。结果 两组受检者干预前腹痛腹胀评分差异无统计学意义，干预后观察组腹痛腹胀评分低于对照组，差异有统计学意义（P<0.05）；观察组首次排气时间早于对照组，干预时长短于对照组，对干预措施的满意度高于对照组，差异均有统计学意义（P<0.05）。结论 膝胸卧位能显著改善无痛胃肠镜联合检查术后受检者的腹痛腹胀症状，效果优于肛管排气，且受检者的满意度高，值得临床推广。     

帕瑞昔布钠预防上腹部手术术后躁动临床观察

目的 观察帕瑞昔布钠预防上腹部手术苏醒期躁动的效果及安全性. 方法 美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级择期行上腹部手术患者120例按随机数字表法分为4组,每组30例.所有患者采用七氟醚、瑞芬太尼复合全麻,术中监测并维持脑电双频指数（bispectral index,BIS）值在40～50,A组于麻醉诱导前静脉注射帕瑞昔布钠0.8 mg/kg,B组于关腹前静脉注射帕瑞昔布钠0.8 mg/kg,C组于关腹前静脉注射静脉给予舒芬太尼0.08 μg/kg,D组于麻醉诱导前静脉注射生理盐水2ml.分别于麻醉诱导前（T1）、拔除气管导管前（停药10 min,T2）、拔管时（T3）、拔管后10 min （T4）,观察两组平均动脉压（meanarterial pressure,MAP）、心率（heart rate,HR）、脉搏血氧饱和度（oxygen saturation,SpO2）及T4时躁动评分（restlessness score,RS）、视觉模拟评分法（visual analogue scales,VAS）、Ramsay镇静评分（ramsay sedation score,RSS）、瑞芬太尼用量、术后30 min恶心呕吐发生率. 结果 苏醒时间,A组、B组、D组分别为（7±3）、（8±4）、（7±3） min显著短于C组（10±4）min（P＜0.05）;瑞芬太尼用量,A组为（0.8±0.3） mg,较D组（1.3±0.5）mg明显减少（P＜0.05）,差异有统计学意义.D组在T3时间点MAP、HR分别为（126±25） mmHg（1 mmHg=0.133 kPa）,（106±28）次/min,较A组[（106±25） mmHg,（96±25）次/min]、B组[（113±27） mmHg,（99±27）次/min]和C组[（111±27） mmHg,（86±19）次/min]升高,差异有统计学意义（P＜0.05）,T4时间点也有相似变化.与对照组D组比较,A、B、C组患者术后躁动总发生率分别为6.7％,13.2％,10.0％,均低于对照组术后躁动总发生率33.3％,其中A组躁动总发生率低于B组（P＜0.05）.A、B、C组患者VAS评分中位数分别为2、3、2均低于对照组评分5（P＜0.05）;A、B、C组患者RSS评分中位数分别为3、3、3均显著低于C组4分（P＜0.05）.与C组比较,A、B、D组副作用     

硝酸甘油减轻对乙酰氨基酚肝毒性的作用与机制

目的:研究硝酸甘油(GTN)对对乙酰氨基酚(AP)肝毒性的影响与机制.方法:小鼠ip GTN 0.1～1.6 mg/kg.15 min后ip AP 300 mg/kg,6 h后测定血清谷丙转氨酶(ALT)和谷草转氨酶(AST);GTN(1.6 mg/kg)预处理小鼠,测定AP半数致死量(LD50);荧光法测定肝蛋白S-亚硝基化水平;分光光度法测定肝谷氨酸脱氢酶(GDH)活性;S-亚硝基谷胱甘肽(GSNO)处理GDH纯酶,Saville-Griess法测定其S-亚硝基化水平,并观察对N-乙酰-P-苯醌亚胺(NAPQI)灭活GDH效应的影响.结果:GTN降低AP导致的ALT,AST升高,使AP对小鼠LD50由321 mg/kg上升至762 mg/kg;GTN引起肝蛋白S-亚硝基化水平升高,使AP对肝GDH的抑制作用完全消失;GSNO诱发GDH纯酶发生S-亚硝基化,且不影响酶活性,但修饰后的GDH不被NAPQI灭活.结论:GTN可减轻AP肝毒性,其机制与诱发肝蛋白巯基S-亚硝基化,减少NAPQI与蛋白(如GDH)巯基的共价结合有关.     

右美托咪啶与咪达唑仑对重症监护患者镇静作用的对比研究

目的比较右美托咪(Dex)和咪达唑仑(MDZ)对重症监护室(ICU)患者的镇静作用。方法收集247例在ICU治疗的患者,随机纳入D组和M组分别泵入Dex和MDZ,采用镇静-躁动评分(RASS)维持RASS评分(-2～+1)。记录各组出现躁动患者的百分比,目标镇静的维持时间,机械通气持续时间,ICU治疗总时间和不良反应。结果D组躁动百分比为46.3%,M组为77.9%,两组比较差异有显著性(P<0.05);两组目标镇静维持时间和ICU治疗总时间差异无显著性;机械通气时间D组小于M组(P<0.05)。D组易出现心动过缓,但其它不良反应较M组减少。结论Dex和MD对ICU患者目标镇静维持时间和ICU治疗时间无显著差异。但Dex显著缩短了患者机械通气时间,并在治疗中较少出现不良反应。     

PKC在缺氧预处理和去甲肾上腺素预处理减轻乳鼠心肌细胞缺氧复氧损伤中的作用

目的 评价蛋白激酶C(PKC)在缺氧预处理和去甲肾上腺素预处理减轻乳鼠心肌细胞缺氧复氧损伤中的作用.方法 原代培养乳鼠心肌细胞,随机分为6组(n=25):对照组(Ⅰ组)常规培养;缺氧复氧组(Ⅱ组)细胞缺氧3 h,复氧1 h;缺氧预处理组(Ⅲ组)缺氧20 min,复氧20 min后制备缺氧复氧模型;去甲肾上腺素预处理组(Ⅳ组)细胞经终浓度为10-7 mol/L去甲肾上腺素孵育30 min后,去除去甲肾上腺素,再行缺氧复氧;H7+缺氧预处理组(Ⅴ组)细胞经终浓度为5×10-5 mol/L的H7孵育10 min后,去除H7,其余操作同Ⅲ组;H7+去甲肾上腺素预处理组(Ⅵ组)细胞经终浓度为5×10-5 mol/L的H7(PKC活性抑制剂)孵育10 min后,去除H7,其余操作同Ⅳ组.复氧结束后,测定心肌细胞存活率、培养液乳酸脱氢酶(LDH)、肌酸激酶(CK)活性和心肌细胞MDA含量和SOD活性.结果 与Ⅰ组比较,Ⅱ组细胞存活率和SOD活性降低,LDH、CK的活性及MDA含量升高(P＜0.01).与Ⅱ组比较,Ⅲ组和Ⅳ组细胞存活率和SOD活性升高,LDH、CK活性及MDA含量降低(P＜0.01).与Ⅲ组比较,Ⅴ组细胞存活率和SOD活性降低,LDH、CK活性及MDA含量升高(P＜0.01).与Ⅳ组比较,Ⅵ组细胞存活率和SOD活性降低,LDH、CK活性及MDA含量升高(P＜0.05).结论 PKC激活参与了缺氧预处理与去甲肾上腺素预处理减轻乳鼠心肌细胞缺氧复氧损伤.     

ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

Objective To explore the effect of ProSeal laryngeal mask airway and endotracheal tube on analepsia stage of general anesthesia in geriatric patients undergoing radical mastectomy.Methods Thirty geriatric females with breast cancer of American Standards Association (ASA)Ⅰ-Ⅱscheduled for selective radical mastectomy under general anesthesia were randomly allocated to two groups: ProSeal laryngeal mask airway group(PLMA group, n=15) and endotracheal tube group (ET group, n=15). The patients were put on PLMA or were intubated with ET under general anesthesia in the two groups, respectively. The heart rate (HR), systolic blood pressure(SBP)and diastolic blood pressure (DBP) were recorded at the time points of 5 min after entering operation room (T0), end of surgery (T1), opening eyes (T2), after extubation (PLMA) immediately (T3) and 3 min after extubation (PLMA) (T4). The numbers of patients who were given antihypertensive agent,showed bucking, agitation or sore throat, nausea and vomiting after extubation were recorded during the analepsia stage of general anesthesia. Results The blood pressure (BP) and HR were mildly.increased in PLMA group at T2, and there was no significant difference compared with T0(P＞0.05). But the BP and HR were significantly higher at T3 than at T0 (P＜0.05). In ET group, the BP and HR were both significantly elevated at T2 and T3 than at T0 (P＜0.05), and reached the peak at T3. The increased levels of BP and HR were significantly lower in PLMA group than in ET group at T2 and T3 (P＜0.05). The quantities of patients who were given antihypertensive agent, showed bucking and sore throat were less in PLMA group than in ET group(P＜0.05). No differences in incidence rate of agitation, nausea and vomiting after extubation between the two groups were observed(P＞0.05). Conclusions PLMA can obviously reduce the occurrence of complications in analepsia stage of general anesthesia in geriatric patients scheduled for selective radical mastectomy,and is beneficial to provide much safer anesthesia.     

过氧亚硝基阴离子调控谷氨酸脱氢酶的催化功能

目的:观察过氧亚硝基阴离子(ONOO-)对谷氨酸脱氢酶(GDH)的硝基化修饰及功能调控.方法: GDH与ONOO-体外反应,测定酶活性及别构调节效应.Western Blot检测GDH硝基化修饰;制备含"去硝基化酶"的脾脏蛋白,观察能否逆转ONOO-作用.结果: 4～12 μmol/L ONOO-不影响GDH活性和二磷酸腺苷(ADP)别构激活作用,但使三磷酸鸟苷(GTP,10 μmol/L)别构抑制作用由(49±4)%降低至(69±7)%和(75±3)%;36～108 μmol/L ONOO-使GDH活性由(0.81±0.05)kat/kg降低至(0.55±0.06)和(0.29±0.07)kat/kg,使GTP(10 μmol/L)别构抑制作用降低至(83±4)%和(95±7)%;324 μmol/L ONOO-使GDH完全失活. Western Blot检测到ONOO-使GDH发生硝基化修饰.脾脏蛋白可部分逆转上述作用.结论: ONOO-可通过硝基化修饰调控GDH催化功能.     

重比重与等比重布比卡因在临床腰麻应用中的研究

目的探讨研究不同比重的布比卡因的临床效果与安全性。方法选择ASAⅠ-Ⅱ级的下腹部及下肢手术病例80例,随机分为重比重蛛网膜下腔阻滞麻醉组（A组,40例）和等比重蛛网膜下腔阻滞麻醉组（B组,40例）,比较两组患者麻醉起效时间及消退时间,及围术期血流动力学变化和不良反应。结果两组均取得良好的麻醉效果。与A组（重比重蛛网膜下腔阻滞麻醉组）相比,B组（等比重蛛网膜下腔阻滞麻醉组）在感觉阻滞起效时间,平面固定时间,镇痛持续时间和运动阻滞的持续时间显著增加（P〈0．05）,两组在感觉阻滞最高平面、Browage分级、血流动力学和不良反应差异无统计学意义（P〉0．05）。结论与重比重布比卡因腰麻相比,等比重布比卡因蛛网膜下腔阻滞麻醉持续时间长,不良反应无明显增加。在临床上应用不同比重的布比卡因在蛛网膜下腔阻滞麻醉均是安全有效。