低位硬膜外麻醉致腰痛的临床观察

目的探讨硬膜外麻醉后腰痛的原因及预防。方法将低位硬膜外麻醉的患者随机分为三组：Ⅰ组采用直入穿刺法；Ⅱ组采用侧入穿刺法；Ⅲ组采用侧入穿刺＋地塞米松法。结果腰痛发生率Ⅲ组与Ⅰ组、Ⅱ组比较差异均有统计学意义（P均〈0．05）。腰痛持续时间Ⅱ组、Ⅲ组与Ⅰ组比较差异均有统计学意义（P均〈0.01）。结论低位硬膜外麻醉采用侧入穿刺法与地塞米松局部注射相结合，明显降低腰痛发生率和持续时间，减轻疼痛程度，可有效地防止硬膜外麻醉后腰痛的发生。     

低位硬膜外麻醉致腰痛的临床观察

目的探讨硬膜外麻醉后腰痛的原因及预防。方法将低位硬膜外麻醉的患者随机分为三组:Ⅰ组采用直入穿刺法;Ⅱ组采用侧入穿刺法;Ⅲ组采用侧入穿刺+地塞米松法。结果腰痛发生率Ⅲ组与Ⅰ组、Ⅱ组比较差异均有统计学意义(P均<0.05)。腰痛持续时间Ⅱ组、Ⅲ组与Ⅰ组比较差异均有统计学意义(P均<0.01)。结论低位硬膜外麻醉采用侧入穿刺法与地塞米松局部注射相结合,明显降低腰痛发生率和持续时间,减轻疼痛程度,可有效地防止硬膜外麻醉后腰痛的发生。     

呼气末正压对单肺通气患者围手术期肺功能的影响

目的 探讨呼气末正压(PEEP)对单肺通气患者术中动脉氧合和肺内分流及术后肺功能的影响.方法 40例肺功能正常、ASA分级I～Ⅱ级、择期行肺叶切除术患者按随机数字表法分为对照组和PEEP组,每组20例.所有患者经静脉麻醉快速诱导后行双腔气管导管插管并双肺通气,潮气量10ml/kg,呼吸频率12次/min.开胸后改为健侧肺单肺通气,潮气量6ml/kg,呼吸频率16～18次/min.对照组无PEEP,PEEP组加用5 cm H2O(1 cm H2O=0.098 kPa)PEEP.连续监测血流动力学和呼吸力学参数,并测定术前和术后72 h肺功能.结果 与单肺通气前比较,两组单肺通气30min动脉血氧分压、脉搏血氧饱和度、氧合指数均显著下降,肺内分流率(Qs/Qt)显著增加(P<0.01或<0.05),且对照组变化更显著(P<0.05).两组术后72 h第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、用力肺活量(FVC)占预计值百分比(FVC%)、FEV1/FVC均较术前显著降低[对照组术前:(121.8±25.1)%、(117 2±24.3)%、(87.6±15.7)%,术后72 h:(84.9±21.6)%、(77.2±18.3)%、(70.5±12.5)%;PEEP组术前:(116 9±24.5)%、(112.1±23.6)%、(85.3±13.8)%,术后72h:(96.3±20.4)%、(881±19 8)%、(78.4±10.2)%](P<0.01或<005),且对照组变化更显著(P(0.05).结论 单肺通气期间加用适当的PEEP可增加动脉氧合、降低肺内分流、改善肺功能,从而降低围手术期患者低氧血症的发生和减轻单肺通气所致的肺损伤.

Abstract：

Objective To explore the effect of positive end expiratory pressure (PEEP) on arterial oxygenation and intrapulmonary shunt during one-lung ventilation (OLV) and pulmonary function during perioperation. Methods Forty patients with normal pulmonary function,ASA I - II :scheduled for pulmonary lobectomy, were divided into control group and PEEP group by random digits table with 20 cases each. Patients were induced by double-lumen tubes under intravenous anesthesia and were received 10 ml/kg tidal volume, 12 frequents/min breathing rate during the two-lung ventilation (TLV), secondary reduced to 6 ml/kg tidal volume, 16-18 frequents/min breathing rate without PEEP (control group) or with 5 cm H2O cm H2O =0.098 kPa) PEEP (PEEP group) during OLV.Hemodynamics and respiratory mechanical parameters were continuously monitored, lung function before operation and at 72 h after operation was detected. Results Compared to before OLV,arterial oxygen tension (PaO2), arterial oxygen saturation (SpO2), oxygenation index (OI) were decreased and intrapulmonary shunt ratio (Qs/Qt) was increased in control group and PEEP group at 30 min after OLV (P < 0.01 or < 0.05). However,PaO2 and SpO2 and OI were higher and Qs/Qt was lower in PEEP group than that in control group at the same time point (P<0.05). In addition, FEV1%, FVC% and FEV1/FVC were (121.8 ± 25.0% ,(117.2 ± 24.3)% , (87.6 ± 15.7)%before operation and (84.9 ± 21.6)%, (77.2 ± 18.3)% , (70.5 ± 12.5)% at 72 h after operation respectively in control group, (116.9 ±24.5)% , (112.1 ±23.6)% , (85.3 ± 13.8)% before operation and (96.3 ± 20.4)%, (88.1 ± 19.8)% , (78.4 ± 10.2)% at 72 h after operation respectively in PEEP group. Although decreased in control group and PEEP group at 72 h after operation comparing with preoperation (P< 0.01 or < 0.05 ), FEV1%, FVC% and FEV1/FVC were higher in PEEP group than those in control group at 72 h after operation (P<0.05). Conclusion Appropriate PEEP increases arterial oxygenation,reduces Qs/Qt and improves pulmonary function during OLV,reduces the risk of hypoxernia and lung injury induced by OLV during perioperation.     

黄芪多糖对肝叶部分切除小鼠术后认知功能及p38MAPK磷酸化的影响

目的探讨黄芪多糖对肝叶部分切除小鼠术后认知功能及p38MAPK磷酸化的影响。方法老年雄性昆明小鼠随机分为假手术组(S组)、手术组(O组)和黄芪多糖+手术组(A组)。术后1、3、7d,采用Morris水迷宫检测小鼠学习认知功能;采用Western blot技术检测小鼠海马区p38MAPK磷酸化水平。结果术后3d和7d,与S组比较,O组潜伏期明显延长(P0.01),穿台次数明显减少(P0.01或P0.05),在目标象限停留时间明显缩短(P0.01);与O组比较,A组潜伏期明显缩短,穿台次数明显增加,在目标象限停留时间明显延长(P0.05)。术后1、3、7d,O组p38MAPK磷酸化水平明显升高(P0.05);与O组比较,A组p38MAPK磷酸化水平明显下降(P0.05或P0.01)。术后1、3、7d各组p38MAPK蛋白表达总水平差异无统计学意义。结论黄芪多糖能够明显改善肝叶部分切除小鼠术后认知功能障碍,其机制可能与其抑制p38MAPK蛋白异常磷酸化有关。     

短期禁食诱导自噬对大鼠脑缺血损伤的保护作用

目的探讨短期禁食对大鼠脑局灶性缺血再灌注损伤的保护作用及机制。方法 57只成年雄性SD大鼠随机分为五组。假手术组(S组)、缺血再灌注组(I/R组)、短期禁食组(Fasting组)、自噬抑制剂3-甲基腺嘌呤组(3-MA组)和溶剂对照组(vehicle组)。I/R组采用右侧大脑中动脉阻闭120 min后再灌注72 h。Fasting组大鼠禁食但不禁水48 h后给予脑缺血再灌注损伤。3-MA组将3-MA 30μg溶于生理盐水10μl,于短期禁食前30 min行侧脑室注射给药,24 h后第二次侧脑室注射给药,共两次。脑缺血损伤检测指标为神经行为学评分和脑梗死容积。自噬的检测采用Westernblot测定微管相关蛋白1轻链3-II(LC3-II)的表达。结果再灌注后72 h,与I/R组比较,Fasting组可改善神经行为学评分,缩小脑梗死容积。Fasting组LC3-II的蛋白表达显著高于I/R组和S组。与Fasting组比较,3-MA组神经行为学评分降低,脑梗死容积扩大,脑损伤程度3-MA组与I/R组差异无统计学意义,表明抑制短期禁食所诱导的自噬,短期禁食的脑保护作用消失。结论短期禁食通过诱导自噬的形成减轻其后发生的大鼠局灶性脑缺血再灌注损伤。     

中西医结合治疗外阴溃疡60例

中西医结合治疗外阴溃疡60例(治疗组),设单纯西药治疗50例(对照组),进行对比观察。对照组用西药、理疗等治疗。治疗组在对照组治疗基础上加服中药甘露饮或龙胆泻肝汤,外用麝杏散。结果:治疗组总有效率90%,对照组总有效率68%,经统计学处理,差异有显著性意义(χ2=15.46,P<0.05)。提示:中西医结合方法治疗外阴溃疡疗效显著。