利多卡因对缺氧/复氧后肝细胞Bcl-2、Caspase-3蛋白表达及细胞凋亡的影响

目的探讨利多卡因预处理对肝细胞缺氧/复氧后Bcl-2、Caspase-3蛋白表达及细胞凋亡的影响。方法将体外培养的肝细胞分为三组:缺氧/复氧组(Ⅰ组)、利多卡因预处理组(Ⅱ组)和正常对照组(Ⅲ组),每组10份。检测肝细胞缺氧/复氧培养后细胞培养液中谷丙转氨酶(ALT)、谷草转氨酶(AST)浓度,肝细胞Bcl-2、Caspase-3蛋白表达、肝细胞凋亡率及超微结构变化。结果Ⅰ、Ⅱ组细胞培养液中ALT、AST浓度、肝细胞Caspase-3蛋白表达和肝细胞凋亡率较Ⅲ组均升高(P<0.05),透射电镜示肝细胞损伤,可见凋亡细胞;Ⅱ组细胞复氧后培养液中ALT、AST浓度、肝细胞Caspase-3蛋白表达和细胞凋亡率均低于Ⅰ组(P<0.05),而肝细胞Bcl-2蛋白表达较Ⅰ组升高(P<0.05),透射电镜观察也显示Ⅱ组肝细胞比Ⅰ组损伤轻微。结论利多卡因预处理可以在一定程度上减轻缺氧/复氧后肝细胞损伤,降低细胞凋亡率,保护机制可能与Bcl-2、Caspase-3蛋白表达有关。     

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.     

自体血液回输在腹腔镜下宫外孕失血性休克治疗中的应用研究

目的 研究自体血液回输在腹腔镜下宫外孕失血性休克治疗中的安全性和效果。方法 选择42例宫外孕或黄体破裂，失血性休克患者行腹腔镜探查，血肿清除并止血术，随机分成两组：一组腹腔镜下直接清除血肿（A组）；另外一组在腹腔镜下清除血肿时，应用Autolog^TM Autotransfusion System（USA—made）（AA组），收集手术野和体腔内的出血、积血，处理后回输给患者。结果 AA组和A组比较，患者术中生命体征没有明显差异（P〉0．05）；但AA组较A组输血液成分、胶体，明显减少（P〈0．01）。结论 研究可以认为：自体血液回输在腹腔镜下宫外孕失血性休克治疗中的应用可节约血源且安全有效，临床上值得推广应用：     

静脉全麻复合骶管阻滞在婴幼儿先天性心脏病介人封堵治疗的研究

目的比较静脉全麻复合单次骶管阻滞麻醉与单纯静脉全麻用于婴幼儿先天性心脏病介入封堵治疗的效果。方法616例婴幼儿先天性心脏病介入封堵治疗患者随机分成两组:骶管阻滞加静脉全麻(I组);另一组用全凭静脉麻醉(II组)。结果全麻药的用量,II组比I组明显增多(P<0.05);I组苏醒时间短,分泌物少,手术后呕吐发生率少(P<0.05)。结论静脉全麻复合小儿单次骶管阻滞麻醉比全凭静脉麻醉用于婴幼儿先天性心脏病介入封堵治疗麻醉费用少,生命体征平稳,麻醉并发症少,值得推广。     

羟基磷灰石纳米颗粒/NR2B-siRNA复合物减轻小鼠福尔马林炎性痛

目的:观察羟基磷灰石纳米颗粒(hydroxyapatite nanoparticles,HA)/N-甲基-D-天门冬氨酸受体2B亚基(N-Methyl-D-aspartic Acid receptor 2B,NR2B)siRNA复合物(HA/NR2B-siRNA)鞘内转染对小鼠福尔马林炎性痛的影响及脊髓背角NR2B表达的变化,初步探讨HA作为NR2B-siRNA体内转染载体的可行性。方法:制备HA/NR2B-siRNA,检测HA对NR2B-siRNA的结合能力和稳定性。选18²0 g昆明小鼠48只,随机分六组(n=8):HANR组,PEINR组,HAGFP组,HA组,NS组,SO组。术后第7天,各组行福尔马林检测后,取腰段脊髓行NR2B免疫组化检测。结果:HA/NR2B-siRNA的最佳质量比为35:1,在生理盐水重悬液中不解离。HN组和PN组的Ⅱ相痛行为显著减少(P<0.05)。HN组和PN组脊髓背角NR2B阳性细胞数明显减少(P<0.05)。结论:1 HA能与NR2B-siRNA形成稳定的转染复合物;2鞘内注射HA/NR2B-siRNA能减少福尔马林致痛小鼠Ⅱ相痛行为并有效抑制脊髓背角NR2B的表达。     

控制性低中心静脉压对脊柱手术患者血管外肺水和失血量的影响

目的观察术中行控制性低中心静脉压(controlled low central venous pressure,CLCVP)对脊柱手术患者血管外肺水(extravascular lung water,EVLW)和失血量的影响。方法 36例择期行腰椎后路椎管减压植骨融合术的患者随机分为CLCVP组(L组)和对照组(C组),每组18例。L组于手术开始后通过限制输液联合静脉输注硝酸甘油使CVP维持在2~4cm H2O,植骨融合完成后迅速扩容使CVP恢复正常。C组常规补液,维持CVP在6~12cm H2O。分别于麻醉诱导后仰卧位(T0)、降压前俯卧位(T1)、CLCVP后30min(T2)、60min(T3)、90min(T4)和手术结束时(T5)记录血流动力学和EVLWI的变化;记录术毕总失血量和总输血量,单独记录CLCVP期间失血量与CVP和MAP相关性。结果与T0时比较,T1时两组CVP、T2时L组SVRI明显升高(P0.05)。与T1时比较,T4时两组HR明显增快、CI明显升高(P0.05),T2~T4时L组MAP、CVP、ITBVI和T4时C组MAP、CVP明显降低(P0.05)。与C组比较,L组T2~T4时MAP、CVP,T3、T4时SI明显降低(P0.05),而SVRI明显升高(P0.05),术中L组总失血量、总输血量和总输液量、尿量均明显减少(P0.05)。结论脊柱外科手术中应用CLCVP在减少术中失血量和输血量的同时,对患者的血流动力学和EVLW无不良影响。     

活体肾移植供体应用乌司他丁对受体肾功能影响的研究

目的研究乌司他丁应用于活体肾移植供体对受体术后移植肾功能的影响。方法选择行活体肾移植的供体和受体40对,按其供体是否应用乌司他丁分为乌司他丁组和对照组,每组20对。患者均签署知情同意书,符合医学伦理学规定。乌司他丁组供体在麻醉前即以乌司他丁5kU／kg静脉泵入。比较两组受者的一般资料;比较两组受者麻醉前、麻醉后、受体血管开放时和手术结束时的平均动脉压和心率;采用酶联免疫吸附试验（ELISA）法检测两组受者麻醉前、手术结束时和手术结束后24h血浆胱抑素C和α1-微球蛋白（α1-microglobulin,α1-MG）水平。结果两组受体的年龄、性别、体重指数、手术时问、术中输液量、术后24h尿量、冷缺血时间和热缺血时间比较差异无统计学意义（均为P〉0．05）。两组受体的平均动脉压和心率在各个时间点比较差异无统计学意义（均为P〉0．05）。受体手术结束时、手术结束后24h两个时间点的血浆胱抑素C和α1-MG水平较麻醉前时间点明显下降,两组在同时间点比较差异亦无统计学意义（均为P〉0．05）。结论本研究供体所应用乌司他丁的剂量和方法对移植后肾功能的改善效果不显著。     

舒芬太尼复合氟比洛芬酯用于结核性脓胸患者开胸术后镇痛的观察

目的比较不同剂量舒芬太尼及复合氟比洛芬酯用于结核性脓胸患者开胸术后自控镇痛（PCIA）的效果。方法将60例行胸膜纤维板剥除术的结核性脓胸患者随机分为三组,各20例。A组PCIA配方为舒芬太尼2.5μg/kg、氟比洛芬酯2 mg/kg、格雷司琼3 mg,加0.9%氯化钠溶液至100 mL;B组分别于手术切皮前15 min和手术结束前15 min静脉滴注氟比洛芬酯1 mg/kg,PCIA配方为舒芬太尼2.5μg/kg、氟比洛芬酯2 mg/kg、格雷司琼3 mg,加0.9%氯化钠溶液至100 mL;C组PCIA配方为舒芬太尼3.0μg/kg、格雷司琼3 mg,加0.9%氯化钠溶液至100 mL。评估记录术后2、4、12、24、48 h的视觉模拟评分（VAS）、视觉模拟疲劳评分法（VAFS）、镇静评分等,并在PCIA结束时记录VAS分值、PCIA有效按压次数和实际按压次数、不良反应发生情况等。结果 （1）A、C组患者术后各时间点VAS和VAFS分值比较,差异均无统计学意义（P〉0.05）。B组患者术后2、4 h VAS和VAFS分值明显低于A、C组,差异均有统计学意义（P〈0.05）。C组患者术后2、4、12 h镇静评分明显高于A、B组,差异均有统计学意义（P〈0.05）。（2）B组患者PCIA有效及实际按压次数明显小于A、C组,满意度评分明显高于A、C两组,差异均有统计学意义（P〈0.05）。A组患者满意度明显高于C组,差异有统计学意义（P〈0.05）。（3）C组患者中发生不良反应例数明显多于A、B两组,差异均有统计学意义（P〈0.05）。结论 3种不同剂量舒芬太尼及复合氟比洛芬酯均能安全、有效地用于结核性脓胸患者开胸术后镇痛,B组镇痛效果最佳,不良反应少,满意度最高。     

MRI测定海马体积预测老年患者发生术后认知功能障碍的准确性

Objective To assess the accuracy of MRI measurement of hippocampal formation in predicting postoperative cognitive dysfunction (POCD) in elderly patients.Methods Forty-one ASA Ⅱor Ⅲ patients aged≥65 yr undergoing gastrointestinal tract surgery were enrolled in this study.MRI was performed to measure the volume of hippocampal formation before surgery and the results were standardized according to the individual intracranial volume.All patients underwent a battery of neuropsychological tests including sensitive tests on the Wechsler adult memory scale and Wechsler adult intelligence scale,trail making test and the grooved pegboard test.We used the Z score to identify POCD as recommended by Moiler.All patients were then divided into POCD group and non-POCD group according to the results of the neuropsychological tests.The results of the tests were correlated with the volume of hippocampal formation measured by MRI.The value of MPI measurement of hippocampal volume in predicting POCD was analyzed.Results Thirty-six patients completed the whole battery of neuropsychological tests after surgery.Thirteen of the 36 patients were found to have COPD (36%) on the 4th postoperative day.The hippocampal volume was significandy smaller in POCD group (4.75±0.23) than in non-POCD group(5.06±0.31).Hippocampal volume was found to be effective in predicting POCD.The overall accuracy of prediction was 77.8%(28/36 patients) with 92.3% sensitivity (12/13 patients),70.0% specificity (16/23 patients) and 0.623 Youden index.Conclusion The MRI measurement of hippocampal volume is valuable as a predictor of POCD in the elderly.