PET在全麻机制研究中的应用

正电子发射计算机断层扫描(PET)是一种功能性影像诊断新技术，能够在体反映机体内的物质代谢、局部血流量、受体密度等理化特性的变化。近年来PET技术已开始应用于全麻机制的研究，并在全麻药物的中枢区域定位、相关受体的功能分析等方面显示出独特的应用价值。     

高渗氯化钠羟乙基淀粉40注射液高容量血液稀释对大鼠肝脏缺血再灌注损伤的影响

Objective To investigate the effects of hypervolemic hemodilution (HH) with hypertonic saline plus hetastarch solution 40 injectio on hepatic ischemia-reperfusion (I/R) injury in rats. Methods Thirty male Wistar rats weighing 300-350 g were randomly divided into 3 groups ( n = 10 each): group I sham operation (group S); group II I/R and group Ⅲ HH. Partial liver ischemia was produced by clamping hepatic portal vein and left arteria hepatica for 30 min with atraumatic mini-clamp, followed by 2 h of reperfusion in I/R group and HH group. In HH group the animals were infused hypertonic saline plus hetastarch solution 40 injectio 10 ml/kg through vena caudalis over 30 min and then hepatic I/R was performed IS min after the infusion.The animals were killed at 2 h of reperfusion. The left liver was removed and blood sample was taken from inferior caval vein for determination of (1) serum alanine amino transferase (ALT) and aspartate amino transferase (AST) activities; (2) superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content in the liver; ( 3 ) microscopic examination. Results The serum ALT and AST activities and MDA content in the liver were significantly higher, SOD activity in the liver significantly lower after hepatic I/R and pathological changes in the liver severer in group I/R and HH than in group S. The serum ALT and AST activities and MDA content in the liver were significantly lower, SOD activity in the liver significantly higher after hepatic I/R and pathological changes in the liver milder in group HH than in group I/R. Conclusion Hypervolemic hemodilution with hypertonic saline plus hetastarch solution 40 injectio can ameliorate hepatic I/R injury by decreasing oxygen free radical production in rats.     

全麻复合硬膜外阻滞与单纯全麻的比较

比较全麻复合硬膜外阻滞和单纯全麻在围术期对机体应激、炎性、免疫等方面的影响。使用全麻加硬膜外麻醉能有效地抑制手术引起的应激反应，稳定循环状态，减少并发症，使病人在术中更为安全平稳，麻醉效果更为可靠，术毕清醒快，术后镇痛有利于术后病人咳嗽咯痰，并且能减轻围手术期对T细胞亚群的影响。     

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.     

小儿肝移植无肝期丙泊酚的药代动力学特点

目的：研究小儿肝移植无肝期丙泊酚的药代动力学特征。方法：5例同种异体原位肝移植患,分别于麻醉诱导及无肝期开始时静脉注射丙泊酚2mg/kg,采用反相高效液相色谱法测定血浆中丙泊酚浓度,对比两之间的药代动力学差异。结果：丙泊酚的药-时曲线符合开放性三室模型,具有分布广,清除率高等特性。结论：无肝期与诱导期丙泊酚代谢无明显差异,推测该药可能存在明显的肝外代谢。     

器官保护与肿瘤治疗

恶性肿瘤是导致死亡的首要原因之一,手术切除、化疗及放疗是目前各种恶性肿瘤最主要的治疗方法.手术创伤,放疗、化疗药的毒副作用,肿瘤坏死等,这些损伤性因素不但会导致肿瘤部位器官损伤,还能诱发全身炎症反应综合征(SIRS),而导致其他器官的损伤.SIRS可诱发器官功能障碍综合征(MODS),因此部分患者在肿瘤治疗期间会使用器官功能保护措施,减少器官损伤和MODS的发生.而这些器官功能保护措施都是非特异性的,在保护患者体内正常的组织器官的同时可能也会保护患者体内的肿瘤细胞,导致患者术后肿瘤复发,或疗效下降,而术后肿瘤复发是肿瘤患者治疗后最主要的死亡原因,因此不能不考虑器官保护措施对肿瘤患者的远期治疗效果的影响.本文拟阐述围术期器官保护措施对患者肿瘤远期治疗效果的影响.     

浅谈临床型麻醉学研究生临床能力的培养

医学研究生的培养以综合能力培养为中心,包括临床工作能力和科研工作能力。而临床型研究生对临床工作能力的培养相对要求比较高。通过对研究生来源、学制等问题进行探讨,以期培养高素质的临床型麻醉学研究生,满足麻醉临床工作的需要。     

麻醉系实习生临床带教模式探讨

本文探讨在麻醉临床实习教学过程中不同带教模式的利弊，以期选择一种较为理想的教学模式，优化麻醉临床实习质量，培养合格的麻醉专业毕业生。     

核因子kB活性抑制对再灌注早期供肝损伤的保护作用

目的 :研究 NF-κB活性抑制对再灌注早期供肝损伤的保护作用。方法 :改良 Kam ada法建立同种大鼠原位肝脏移植模型 ,实验分对照组和二硫代氨基甲酸吡咯烷 (PDTC)组 ,对照组供肝于 4℃乳酸林格液中保存 6 h,PDTC组供肝于乳酸林格冷保存液中加入 0 .1mol/L PDTC,于再灌注早期分析测定供肝组织中 NF-κB的结合活性 (EMSA法 )、TNF-α和 ICAM- 1的 m R-NA转录水平 (RT- PCR)以及 AL T和 L DH的活性变化。结果 :供肝组织的 NF-κB在移植后再灌注早期明显激活 ;再灌注 1h,PDTC组的 NF-κB活性较对照组显著降低 ,但 6 h后两组 NF-κB活性未见明显差异。再灌注早期 TNF-α和 ICAM- 1m RNA转录水平上调以及 AL T和 L DH活性升高 ,但 PDTC组明显低于对照组 (P<0 .0 5 )。结论 :供肝组织中 NF- κB的活性抑制可显著降低再灌注早期供肝组织中炎症介质的转录表达 ,并有效改善供肝的再灌注损伤。针对 NF- κB的靶向治疗可能是供肝保护的一条新途径。     

表达大鼠caspase-3 siRNA腺病毒的构建及其对神经元凋亡的影响

目的 构建表达大鼠caspase-3 siRNA腺病毒,体外观察其抑制内毒素诱导神经元凋亡的效果.方法 合成正、反义寡核苷酸并克隆入pShuttleH1载体,与含caspase-3及绿色荧光增强蛋白序列的质粒pEGFPC1-Cas3共转染293细胞,流式细胞仪分析荧光强度;pShuttleH1-siCas3线性化后转化到含pAdEasy-1的BJ5183感受态细菌中获取重组质粒,脂质体转染293细胞获取重组腺病毒Ad-siCas3;TCIDs.法测定病毒滴度;感染海马神经元,观察内毒素诱导神经元caspase-3 mRNA的表达及凋亡情况.结果 目的基因序列正确,pShuttleH1-siCas3可明显减弱pEGFPC1-Cas3绿色荧光,Ad-siCas3滴度为1.06×1010 pfu/ml.转染病毒的海马神经元内毒素诱导的凋亡效应及caspase-3 RNA的表达明显减弱.结论 成功地构建了表达大鼠caspase-3 siRNA腺病毒,具有良好的抑制神经元凋亡作用.