创伤性脑损伤病人术中低血压的危险因素分析

创伤性脑损伤(traumaticbraininjury,TBI)如脑挫伤、硬脑膜外血肿和硬脑膜下血肿的病人,在开颅血肿清除和去骨瓣减压手术过程中可能发生术中低血压(intraoperativehypotension,IHT)。低血压可加重脑缺血性损伤,并能使颅内压(ICP)进一步的升高乃至死亡。而低血压发生以后,采取容     

鞘内注射吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A催化亚单位表达的影响

Objective To observe the effect of intrathecal clonidine plus morphine on expression of protein kinase A (PKA) catalytic subunit in the spinal dorsal horn in a rat model of incisional pain. Methods Eighty male Sprague-Dawley rats were divided randomly into five groups: sham group, control group, pre-incisional morphine 2.5 μg group, pro-incisional clonidine 5 μg group and preincisional morphine 2.5 μg plus clonidine 5 lag group (n=16). lntrathecal catheter and the model of incisional pain were pro-duced according to Yaksh and Brennan's described method respectively. Changes of pain behavior were assessed by mechanical with-drawal threshold (MWT) and thermal withdrawal latency(TWL). The expressions of PKA catalytic subunit in the spinal dorsal horn were assessed by immunohistochemical method and western blotting analysis. Results Compared with sham group, MWT and TWL in control group were decreased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were increased significantly in control group (P<0.01). Compared with control group, MWT and TWL in pre-incision morphine 2 μg plus clonidine 5 lag group were increased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were decreased significantly in pre-incision morphine 2 μg plus clonidine 5 μg group (P<0.01). However, MWT, TWL and the number of positive cells and pro-tein expression of PKA catalytic subunit in the spinal dorsal horn changed with no statistical significance in pre-incisional morphine 2.5 μg group and pre-incisional clonidine 5 μg group compared with control group. Conclusion lntrathecal clonidine significantly enhances the antinociceptive effect of intrathecal morphine in a rat model of incisional pain, which might be associated with inhibi-tion of the increased expression of PKA catalytic subunit in spinal cord.     

鞘内注射吗啡对切口疼痛大鼠脊髓背角蛋白激酶Cγ免疫反应的影响

目的 研究鞘内注射吗啡对切口疼痛大鼠脊髓背角蛋白激酶Cγ(PKCγ)免疫反应的影响。方法 SD雄性大鼠24只,随机分为4组(每组6只):假手术组(Ⅰ组)、对照组(Ⅱ组)术前30 min鞘内注射人工脑脊液20μl,术后吗啡治疗组(Ⅲ组)、术前吗啡治疗组(Ⅳ组)分别于术后和术前30min鞘内注射吗啡5μg(10 μl)。所有大鼠均按Brennan法制成切口疼痛模型,用免疫组织化学方法观察脊髓背角PKCγ的表达。结果 Ⅱ组术侧脊髓背角PKCγ-IR表达高于非术侧及Ⅰ组(P<0.01)。与Ⅱ组比较,Ⅲ组、Ⅳ组脊髓背角PKCγ-IR表达降低(P<0.05或0.01),而Ⅲ组、Ⅳ组比较差异无显著性。结论 在大鼠切口疼痛模型中,鞘内注射吗啡的镇痛作用可能与抑制脊髓背角的PKCγ-IR免疫反应有关。     

哌替啶中加入中分子右旋糖酐硬膜外注射能延长术后镇痛持续时间

临床上硬膜外注入阿片类药物用于术后镇痛较普及,但硬膜外注入亲脂性阿片类药物如哌替啶镇痛时间较短,为延长其镇痛时间,我们在哌替啶中加入中分子右旋糖酐,取得了较好的效果。资料和方法选择40例行妇产科、下腹部和下肢手术的病例,随机分为两组,每组20例,两组间年龄、性别、手术时间均无显著差异,麻醉前用药、麻醉用药均相同。手术均在腰段连续硬膜外麻醉下施行,麻醉效果均满意。     

若比卡因的临床应用研究进展

本文对若比卡因临床应用有关的文献进行了综述，目前若比卡因已应用于臂丛阻滞，硬膜外麻醉，蛛网膜下腔阻滞麻醉，产科麻醉与分娩镇痛以及术后镇痛等方面，取得了满意效果，具有临床的价值。     

布比卡因心脏中毒的研究进展

布比卡因(Bupivacaine)具有麻醉作用强、持续时间长,治疗指数高等特点。但自1977年出现布比卡因严重并发症的报告。因此,有必要对布比卡因心脏中毒的研究进展作一介绍。     

氯胺酮对大鼠不同脑区NOS活性和NO产量的影响△

目的了解氯胺酮对大鼠脑NOS活性和NO产量的影响。方法16只SD大鼠，随机分为二组，分别ip生理盐水10ml／kg(对照组)和氯胺酮100mg／kg。用分光光度法测定NOS活性和NO产量。结果大鼠ip氯胺酮100mg／kg能明显抑制小脑、大脑皮层、海马的NOS活性和减少NO的产量（     

麻醉用药与组胺

许多麻醉用药可致组胺释放,而产生一系列病理生理改变,已成为麻醉医生关注的问题之一。一、诱发组胺释放的麻醉用药 1939年Alam等用狗的骨骼肌标本作研究时,发现右旋筒箭毒碱(以下简称箭毒)能诱发组胺释放。以后相继在动物实验和人体得到证实。McCullough等给猫静注箭毒0.4mg·kg~(-1)后1min,全血测出的组胺浓度达峰值。Inada等报告静注箭毒     

鞘内注射新斯的明对手术切口引起的大鼠脊髓背角P物质表达的影响

目的:研究鞘内注射新斯的明对术后疼痛大鼠疼痛行为和脊髓背角P物质表达的影响。方法:采用大鼠切口疼痛模型,用累积疼痛评分法评价疼痛行为及免疫组织化学法观察P物质的表达。结果:手术前和手术后鞘内注射新斯的明均可降低累积疼痛评分。左侧后爪足底切口可增加同侧脊髓背角P物质样免疫反应 (0. 6173±0. 0731,vs0. 3792±0. 0874,P<0. 01),手术前鞘内注射新斯的明可明显抑制P物质表达的增多(0. 3789±0. 0388,P<0. 01),手术后鞘内注射新斯的明作用较弱(0. 4982±0. 0653,P>0. 05)。结论:鞘内注射新斯的明的抗伤害作用可能与抑制脊髓背角P物质表达有关。     

术后椎管内注阿片类药止痛的护理

本文介绍了近年来对椎管内注用阿片类药术后镇痛的研究进展,着重对其特点、方法和可能发生的并发症以及禁忌证进行了阐述,提出了对椎管内注用阿片类药术后镇痛病人的护理要点。