急性等容性血液稀释对血浆ET和CGRP水平的影响

目的　探讨急性等容性血液稀释 (ANH)对血浆内皮素 (ET)和降钙基因相关肽(CGRP)水平的影响。方法　选择非心脏手术ASAⅠ～Ⅱ级患者 2 0例 ,麻醉前快速输入复方乳酸钠1 0～ 1 5ml/kg。麻醉后从桡动脉放血 1 0ml/kg ,同时经静脉输入等量的 4 %琥珀酰明胶。观察ANH麻醉前 (T0 )、血液稀释完成后 1 0min(T1 )、2 0min(T2 )、30min(T3 )的血液动力学、血浆ET和CGRP浓度的变化。结果　ANH前后MAP、HR、SpO2 和ECG均较稳定。ANH后 1 0min、2 0min血浆ET水平分别为 (1 4 4 4 7± 1 9 1 7) pg/ml和 (1 5 7 1 7± 1 2 4 5 ) pg/ml,但明显高于ANH前的 (1 2 7 6 8±2 0 92 ) pg/ml(P <0 0 5 )。ANH后 1 0min、2 0min血浆CGRP水平分别为 (5 4 72± 2 5 6 5 )pg/ml和(5 5 32± 1 7 94 )pg/ml,也明显高于ANH前的 (4 4 6 2± 1 6 90 ) pg/ml(P <0 0 5 )。而ET/CGRP比值无明显变化。结论　ANH近期血浆ET和CGRP水平均有一定的增加 ,但ET/CGRP比值的变化无统计学意义 ,同时心血管反应不明显 ,表明血浆ET和CGRP的动态平衡对ANH时的循环稳定起着重要的作用     

磷酸肌酸钠对肝下下腔静脉联合门静脉阻断术围术期心肌酶的影响

目的 探讨磷酸肌酸钠对围术期心肌酶的影响.方法 选择择期采用肝下下腔静脉联合门静脉阻断行肝部分切除手术患者40例,随机均分为两组:Ⅰ组磷酸肌酸钠2.0 g在术前30 min开始输注,术后继续应用磷酸肌酸钠;Ⅱ组未用磷酸肌酸钠,给等剂量生理盐水.记录围术期HR、CVP以及MAP变化.于麻醉前、术后1、3、5 d和7 d抽血测定α-羟丁酸脱氢酶(α-HBD)、磷酸肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、谷丙转氨酶(ALT)和谷草转氨酶(AST).结果 与麻醉前比较,两组术后α-HBD浓度升高并持续到术后7 d(P＜0.05),术后1 d和3 d Ⅰ组增高的幅度比Ⅱ组小(P＜0.05).CK升高并持续到术后5 d(P＜0.05),Ⅰ组增高的幅度均比Ⅱ组小(P＜0.05).CK-MB和LDH分别于术后1 d和3 d升高(P＜0.05),但术后1 d Ⅰ组增高的幅度比Ⅱ组小(P<0.05).ALT升高并持续剑术后7 d,Ⅰ组增高幅度均比Ⅱ组小(P＜0.05).AST升高并持续到术后7 d(P＜0.05),术后1 d和3 d ＜组增高的幅度比Ⅱ组小(P<0.05).结论 围术期给予磷酸肌酸钠可以在一定程度上减轻肝下下腔静脉联合门静脉阻断所引起的心肌酶释放,对心肌损害有一定的保护作用.     

损伤性癫痫模型大鼠海马和额叶突触蛋白的动态表达

Objective To observe the time course of changes in synaptophysin (P38) expression in the cortex and hippocampus of rats with posttraumatic epilepsy (PTE), and explore the role of synaptic plasticity in the epileptogenesis of PTE. Methods Thirty-seven male Sprague-Dawley rats were randomized into normal control group (n=5), sham-operated group (n=12) with intracortical saline injection, and PTE model group (n=20) with stereotactic FeCl<,2> injection (0.1 mol/L, 10 μ1) into the motor cortex. The expression of P38 in the brain cortex and hippocampus of the rats was detected immunohistochemically at 1 h and 7, 14 and 30 days after the injections. Results Most of the rats with FeCl<,2> injection developed isolated epileptiform discharges soon alter the injection. Compared with the sham-operated groups, the rats in PTE group showed significantly decreased P38 expression in the right frontal cortex at all the time points of measurement (P<0.05). At 1 h after FeCl<,2> injection, P38 expression in the polymorphic layer, stratum lacunosum and stratum radiatum of the right hippocampai CA3 area and DG molecular layer underwent no significant changes (P>05), but at 7 days, the expression increased significantly in all the stratum regions of the right hippocampal CA3 area, and this high expression level was maintained till 30 days after the injection. Conclusion Synaptic plasticity alterations in relation to P38 expression changes in the cortex and hippocampus may play an important role in the epileptogenesis of PTE in this rat model.     

损伤性癫痫模型大鼠海马和额叶突触蛋白的动态表达

Objective To observe the time course of changes in synaptophysin (P38) expression in the cortex and hippocampus of rats with posttraumatic epilepsy (PTE), and explore the role of synaptic plasticity in the epileptogenesis of PTE. Methods Thirty-seven male Sprague-Dawley rats were randomized into normal control group (n=5), sham-operated group (n=12) with intracortical saline injection, and PTE model group (n=20) with stereotactic FeCl<,2> injection (0.1 mol/L, 10 μ1) into the motor cortex. The expression of P38 in the brain cortex and hippocampus of the rats was detected immunohistochemically at 1 h and 7, 14 and 30 days after the injections. Results Most of the rats with FeCl<,2> injection developed isolated epileptiform discharges soon alter the injection. Compared with the sham-operated groups, the rats in PTE group showed significantly decreased P38 expression in the right frontal cortex at all the time points of measurement (P<0.05). At 1 h after FeCl<,2> injection, P38 expression in the polymorphic layer, stratum lacunosum and stratum radiatum of the right hippocampai CA3 area and DG molecular layer underwent no significant changes (P>05), but at 7 days, the expression increased significantly in all the stratum regions of the right hippocampal CA3 area, and this high expression level was maintained till 30 days after the injection. Conclusion Synaptic plasticity alterations in relation to P38 expression changes in the cortex and hippocampus may play an important role in the epileptogenesis of PTE in this rat model.     

损伤性癫痫模型大鼠海马和额叶突触蛋白的动态表达

Objective To observe the time course of changes in synaptophysin (P38) expression in the cortex and hippocampus of rats with posttraumatic epilepsy (PTE), and explore the role of synaptic plasticity in the epileptogenesis of PTE. Methods Thirty-seven male Sprague-Dawley rats were randomized into normal control group (n=5), sham-operated group (n=12) with intracortical saline injection, and PTE model group (n=20) with stereotactic FeCl<,2> injection (0.1 mol/L, 10 μ1) into the motor cortex. The expression of P38 in the brain cortex and hippocampus of the rats was detected immunohistochemically at 1 h and 7, 14 and 30 days after the injections. Results Most of the rats with FeCl<,2> injection developed isolated epileptiform discharges soon alter the injection. Compared with the sham-operated groups, the rats in PTE group showed significantly decreased P38 expression in the right frontal cortex at all the time points of measurement (P<0.05). At 1 h after FeCl<,2> injection, P38 expression in the polymorphic layer, stratum lacunosum and stratum radiatum of the right hippocampai CA3 area and DG molecular layer underwent no significant changes (P>05), but at 7 days, the expression increased significantly in all the stratum regions of the right hippocampal CA3 area, and this high expression level was maintained till 30 days after the injection. Conclusion Synaptic plasticity alterations in relation to P38 expression changes in the cortex and hippocampus may play an important role in the epileptogenesis of PTE in this rat model.     

恩丹西酮与氟哌利多预防阑尾炎切除术中恶心呕吐效果比较

在硬膜外麻醉下行阑尾炎切除术，术中常见恶心呕吐。传统做法是在进腹探查前静注半量至全量的氟异合剂或氟芬合剂等辅助药物，使患者入睡，不感牵引内脏之不适，但其效果并不很理想。笔者预防性使用恩丹西酮收到满意效果，现报告如下。     

喉上神经阻滞复合芬太尼和咪达唑仑用于经鼻纤维支气管镜清醒气管插管的效果

目的 观察喉上神经阻滞复合芬太尼和咪达唑仑用于经鼻纤维支气管镜(FOB)清醒气管插管的效果.方法 45例择期经鼻气管插管全身麻醉下手术的患者,在咽喉表面麻醉及静注咪达唑仑60μg/kg和芬太尼0.2μg/kg基础上,随机分为3组:Ⅰ组,未加其他处理(n=15);Ⅱ组,加环甲膜穿刺(h=15);Ⅲ组,加喉上神经阻滞(n=15).3组患者FOB插管操作前均先静脉缓慢注射味达唑仑60μg/kg,5 min后静脉缓慢滴注枸橼酸芬太尼0.2μg/kg,1、2 min后再进行FOB操作.记录麻醉诱导前基础值(T0)、FOB进入咽喉即刻(T1)、FOB进入声门即刻(T2)、插入气管导管即刻(T3)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)以及整个气管插管过程中恶心、呛咳和躁动情况.结果 在Ⅰ组,T1、T2、T3时点MAP和HR均较T0增高和加快(P<0.05).在T1、T2时点,Ⅰ组MAP增高和HR加快比Ⅱ组和Ⅲ组明显(P<0.05).与Ⅰ组比较,Ⅱ组和Ⅲ组呛咳、恶心、躁动发生率明显降低(P<0.05).与Ⅱ组比较,Ⅲ组恶心发生率降低(P<0.05).结论 与其他方法比较,喉上神经阻滞复合芬太尼和咪达唑仑可以更好更快地完成纤维支气管镜引导经鼻清醒插管.     

无肌松药下TCI瑞芬太尼复合丙泊酚诱导纤支镜经口气管插管的可行性

目的探讨TCI瑞芬太尼复合丙泊酚在无肌松药下诱导纤维支气管镜(纤支镜)经口气管插管的可行性。方法择期行气管插管全身麻醉下的手术患者80例,ASAⅠ级。随机分为4组(n=20),瑞芬太尼效应室靶浓度分别为2.5(Ⅰ组)、3.0(Ⅱ组)、3.5(Ⅲ组)和4.0μg/L(IV组)。丙泊酚效应室靶浓度固定为3μg/mL。TCI瑞芬太尼5min后再TCI丙泊酚,10min后行纤支镜气管插管。记录麻醉诱导前基础值,TCI丙泊酚结束时、气管导管置入气管时各时点HR、MAP和脑电双频谱指数(BIS)值,同时进行气管插管条件评分。结果气管插管满意率Ⅰ、Ⅱ、Ⅲ和Ⅳ组分别为45%、55%、75%和80%,Ⅲ和Ⅳ组分别与Ⅰ组相比差异均有显著性(P<0.05)。结论不使用肌松剂的情况下,TCI瑞芬太尼3.5或4.0μg/L复合丙泊酚可提供较好的纤支镜经口气管插管条件,但对血流动力学有一定的负面影响。     

损伤性癫痫模型大鼠海马和额叶突触蛋白的动态表达

Objective To observe the time course of changes in synaptophysin (P38) expression in the cortex and hippocampus of rats with posttraumatic epilepsy (PTE), and explore the role of synaptic plasticity in the epileptogenesis of PTE. Methods Thirty-seven male Sprague-Dawley rats were randomized into normal control group (n=5), sham-operated group (n=12) with intracortical saline injection, and PTE model group (n=20) with stereotactic FeCl<,2> injection (0.1 mol/L, 10 μ1) into the motor cortex. The expression of P38 in the brain cortex and hippocampus of the rats was detected immunohistochemically at 1 h and 7, 14 and 30 days after the injections. Results Most of the rats with FeCl<,2> injection developed isolated epileptiform discharges soon alter the injection. Compared with the sham-operated groups, the rats in PTE group showed significantly decreased P38 expression in the right frontal cortex at all the time points of measurement (P<0.05). At 1 h after FeCl<,2> injection, P38 expression in the polymorphic layer, stratum lacunosum and stratum radiatum of the right hippocampai CA3 area and DG molecular layer underwent no significant changes (P>05), but at 7 days, the expression increased significantly in all the stratum regions of the right hippocampal CA3 area, and this high expression level was maintained till 30 days after the injection. Conclusion Synaptic plasticity alterations in relation to P38 expression changes in the cortex and hippocampus may play an important role in the epileptogenesis of PTE in this rat model.