肠缺血后处理对兔缺血再灌注损伤小肠上皮细胞线粒体形态和功能的影响

目的观察缺血后处理对小肠缺血再灌注损伤的保护作用。方法30只大白兔随机分为3组，每组8只：A组，假手术组；B组，肠缺血再灌注损伤模型组；C组，肠缺血再灌注损伤模型肠缺血后处理组，实验结束后取小肠标本进行小肠上皮细胞形态和呼吸功能指标测定。结果A、C两组线粒体的数目、周长均大于B组，A、C两组问比较，A组较大（P〈0．05）。A、C两组线粒体的面积、最大直径、最小直径、等效直径均小于B组（P〈0．05），A、C两组间比较差异无统计学意义（P〉0．05）。B组线粒体的体积密度小于A组，面积密度、比表面和粒子数密度均小于其余两组（P〈0．05）。A、C两组间三维平面形态计量学各参数比较差异无统计学意义（P〉0．05）；B、C组线粒体呼吸控制比率（RCR）低于A组差异有统计学意义（P〈0．05），与C组比较，B组下降更为明显（P〈0．05）。结论小肠缺血后处理对缺血再灌注损伤肠上皮细胞线粒体形态和功能均有保护作用。     

浅谈新形势下中山大学麻醉学教育

21世纪科学技术特别是生命科学的迅猛发展以及卫生服务体系和模式的变革，将对教育思想、教育管理、人才培养目标和模式、课程体系、教学内容产生深刻的影响。社会对医疗的要求随着人类的进步不断提高，因此，医科大学培养的学生应该拓宽知识面，增加多方面医学领域的技能，以适应社会发展的需要。为了顺应医学教育改革的需要，麻醉学的教育须在原有基础上，进一步加强改革和发展。     

急性超容血液稀释对血流动力学的影响

目的 观察不同人工胶体液行急性超容血液稀释(AHHD)对血流动力学的影响.方法 45例ASA Ⅰ～Ⅱ级腹部手术患者,随机分为3组:对照组(C组)、6%羟乙基淀粉组(H组)及4%琥珀酰明胶组(G组).在麻醉诱导后开始输液或扩容:C组输入林格液15 ml/kg,H、G组输入林格液15 ml/kg和胶体液20 ml/kg,均在40 min内完成.监测3组术前、麻醉诱导后、输液或扩容20 min、输液或扩容40 min时心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI),外周血管阻力(SVR)的变化.监测H、G组患者扩容前后血细胞比容(Hct)的变化.结果 H、G组在扩容末,Hct下降,H组由术前0.385±0.043降至0.304±0.045,G组由术前0.395±0.035降至0.312±0.038.H、G组HR、MAP、CI、CVP、SVR术前值和麻醉诱导后值与C组的差异没有统计学意义(P>0.05).输液或扩容20 min、输液或扩容40 min时H、G组HR、CI、CVP、MAP高于C组,其差异有统计学意义(P<0.05);在扩容20 ml/kg后H组CVP增高达(13.13±3.51)cm H2O(1 cm H2O=0.098 kPa),G组增加达(14.88±1.33)cm H2O.结论 在40 min内静脉输入20 ml/kg的6%羟乙基淀粉、4%琥珀酰明胶,是一种有效的超容血液稀释方法.但会造成心脏负荷的显著增加,使用异氟醚和硝酸甘油能有效地减轻心脏前负倚.     

缺血预处理-后处理对大鼠肠缺血再灌注损伤的影响

Objective To evaluate the effects of ischemic preconditioning-postconditioning on the intestinal ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD weighing 225-275 g were randomly assigned into 5 groups ( n = 8 each): group I sham operation (group S) ; group II intestinal IR (group IIR); group Ⅲ ischemic preconditioning (group Ipr); group IV ischemic postconditioning (group Ipo); group V Ipr+ Ipo. The rats were anesthetized with intraperitonel 20% urethane 5 ml/kg. Superior mesenteric artery (SMA) was occluded for 60 min followed by 60 min reperfusion. In group S, SMA was isolated but not occluded. In group Ipr, SMA was occluded for 10 min followed by 10 min reperfusion, and the rest procedures were performed using the method described in group IIR. In group Ipo, 60 min ischemia was followed by three 30 s episodes of ischemia at 30 s intervals for reperfusion. In group Ipr+ Ipo, Ipr was performed followed by Ipo and the procedures were performed using the methods described in group Ipr and Ipo. The animals were killed at 60 min of reperfusion. The intestinal tissues were immediately removed for determination of MDA content, SOD and MPO activities and the degree of damage to intestinal mucous membrane was scored according to Chiu score. Arterial blood samples were taken for determination of plasma concentrations of TNF-α and 1L-6. Results Compared with group S, Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly increased, whereas SOD activity decreased in the other 4 groups ( P < 0.05). Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly decreased, whereas SOD activity increased in group Ipr, Ipo and Ipr + Ipo as compared with group IIR ( P < 0.05). Chiu score and MDA content were significantly lower, whereas SOD activity higher in group Ipr + Ipo than in group Ipr and Ipo ( P < 0.05). No significant differences were detected in the indices between group Ipr and group Ipo ( P > 0.05). Conclusion Ischemic preconditioning-postconditioning can attenuate the intestinal IR injury in rats, and the efficacy is better than that of either Ipr or Ipo alone.     

大鼠肠缺血再灌注时肺组织β-防御素-2 mRNA表达的变化

目的 观察大鼠肠缺血再灌注时肺组织β-防御素-2(BD-2)mRNA表达的变化.方法 72只雄性SD大鼠随机分为2组(n=36):假手术组(S组)和肠缺血再灌注组(II/R组).采用夹闭肠系膜上动脉(SMA)的方法制备肠缺血再灌注模型.II/R组阻断SMA 1 h后再灌注,S组仅分离SMA.分别于再灌注即刻(T0),再灌注15(T1)、30(T2)、60 min(T3)、3 h(T4)和6 h(T5)时处死6只大鼠,取肺组织,光镜下观察肺组织病理学结果,计算肺通透性指数(PPI),检测肺组织肿瘤坏死因子-α(TNF-α)含量和BD-2 mRNA表达水平.结果 S组肺组织结构未见异常,II/R组出现肺水肿和中性粒细胞浸润.与S组比较,II/R组再灌注各时点PPI升高,BD-2 mRNA表达上调,T0-3时TNF-a含量升高(P＜0.05或0.01).II/R组BD-2 mRNA表达水平与TNF-a含量及PPI的相关系数分别为0.823和-0.615(P＜0.01).结论 大鼠肠缺血再灌注时肺组织BD-2基因表达上调.     

大鼠肠缺血再灌注损伤后肠黏膜差异表达蛋白质组的分离与鉴定

3、醛脱氢酶和醛糖还原酶,前3种酶与改善能量代谢相关,后3种酶与抗氧化应激、抑制凋亡相关.结论 建立了重复性较好的正常与II/R损伤后大鼠肠黏膜组织的双向凝胶电泳图谱.II/R的损伤机制可能与顺乌头酸酶、丙酮酸激酶、细胞色素C还原酶、蛋白二硫化物异构酶A3、醛脱氧酶和醛糖还原酶的下调有关.     

子宫内膜异位症患者在位和异位内膜组织中 人β防御素-2的表达

 【目的】 检测人β防御素-2(hBD-2)在正常子宫内膜&#65380;子宫内膜异位症(内异症)患者的在位和异位内膜组织中的表达,探讨hBD-2在内异症发病中的作用&#65377;【方法】 选择25例内异症患者的卵巢异位内膜组织(异位内膜组)和相应的在位子宫内膜(在位内膜组),以及25例非子宫内膜异位症的子宫肌瘤患者(对照组)的子宫内膜组织&#65377;采用实时荧光定量PCR(Real-Time PCR)和原位杂交技术检测各组内膜组织中hBD-2的基因表达,以及hBD-2在内异症不同临床分期的异位内膜和在位内膜组织中的表达差异&#65377;【结果】 异位内膜组内膜组织中hBD-2的基因表达水平显著高于在位内膜组和对照组(P < 0.05)&#65377;在位内膜组和对照组子宫内膜组织中hBD-2的基因表达水平,差异无统计学意义(P > 0.05)&#65377;异位内膜组中,hBD-2临床分期表达为Ⅰ期高于Ⅲ期和Ⅳ期&#65380;Ⅱ期高于Ⅲ期和Ⅳ期,差异有统计学意义(P < 0.05)&#65377; 【结论】 异位内膜组织中hBD-2的高表达可能参与了内异症的发病&#65377;     

缺血预处理-后处理对大鼠肠缺血再灌注损伤的影响

Objective To evaluate the effects of ischemic preconditioning-postconditioning on the intestinal ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD weighing 225-275 g were randomly assigned into 5 groups ( n = 8 each): group I sham operation (group S) ; group II intestinal IR (group IIR); group Ⅲ ischemic preconditioning (group Ipr); group IV ischemic postconditioning (group Ipo); group V Ipr+ Ipo. The rats were anesthetized with intraperitonel 20% urethane 5 ml/kg. Superior mesenteric artery (SMA) was occluded for 60 min followed by 60 min reperfusion. In group S, SMA was isolated but not occluded. In group Ipr, SMA was occluded for 10 min followed by 10 min reperfusion, and the rest procedures were performed using the method described in group IIR. In group Ipo, 60 min ischemia was followed by three 30 s episodes of ischemia at 30 s intervals for reperfusion. In group Ipr+ Ipo, Ipr was performed followed by Ipo and the procedures were performed using the methods described in group Ipr and Ipo. The animals were killed at 60 min of reperfusion. The intestinal tissues were immediately removed for determination of MDA content, SOD and MPO activities and the degree of damage to intestinal mucous membrane was scored according to Chiu score. Arterial blood samples were taken for determination of plasma concentrations of TNF-α and 1L-6. Results Compared with group S, Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly increased, whereas SOD activity decreased in the other 4 groups ( P < 0.05). Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly decreased, whereas SOD activity increased in group Ipr, Ipo and Ipr + Ipo as compared with group IIR ( P < 0.05). Chiu score and MDA content were significantly lower, whereas SOD activity higher in group Ipr + Ipo than in group Ipr and Ipo ( P < 0.05). No significant differences were detected in the indices between group Ipr and group Ipo ( P > 0.05). Conclusion Ischemic preconditioning-postconditioning can attenuate the intestinal IR injury in rats, and the efficacy is better than that of either Ipr or Ipo alone.     

曲马多与芬太尼用于全麻诱导对患者呼吸循环的影响

目的比较曲马多、芬太尼用于全麻诱导对患者呼吸、循环的影响.方法 20例ASA Ⅰ～Ⅱ级在全身麻醉下行择期手术的患者随机分为两组(n=10):曲马多组(T组)和芬太尼组(F组).T组诱导时静注曲马多 3 mg/kg,F组静注芬太尼 3 μg/kg,随后静注咪唑安定及琥珀胆碱后行气管插管控制呼吸.术中监测HR,SBP,DBP,MAP及SpO2,并监测肌松药应用前的呼吸频率(RR)、分钟通气量(VE)及呼气末二氧化碳(PETCO2).结果①与诱导前值相比,曲马多静注后3 min,VE,RR,SpO2和PETCO2变化不显著;芬太尼静注3 min,RR逐渐下降23.6%(P<0.05),VE下降49.9%(P<0.01),SpO2下降,最低降至79%(P<0.05).②曲马多静注3 min内,SBP上升10.4%,DBP上升10.6%,MAP上升10.8%,与注药前相比差异有显著性(P<0.05).芬太尼静注 3 min,血压变化不大(P>0.05),而心率下降(P<0.01).插管后即刻:T组较诱导前SBP上升31%(P<0.01),DBP上升35.2%(P<0.01),MAP上升31%(P<0.01),HR上升14%(P<0.01);F组血压与诱导前值比较差异无显著性(P>0.05).插管前后T组与F组之间血压变化幅度差异有显著性(P<0.01).结论曲马多对呼吸无抑制作用,但不能抑制气管插管时的心血管反应.芬太尼能抑制气管插管时的心血管反应,但有呼吸抑制作用.     

肌间沟臂丛阻滞复合压迫法在肩锁骨手术中的应用

目的 :观察肌间沟臂丛神经阻滞复合压迫法在肩锁骨手术中的麻醉效果。方法 :5 0例行肩锁骨手术患者 ,随机分为对照组和实验组 ,每组各 2 5例。两组局麻用药均为 0 5 %罗哌卡因 2 0mL。对照组常规肌间沟臂丛神经阻滞操作 ,实验组则用食指或中指压迫阻滞点下方的肌间沟 ,持续按压到注药后 5min。两组均用针刺法测试阻滞平面 ,据患者术中主诉 ,观察麻醉效果。结果 :实验组麻醉效果优良率为 96% ,对照组为 5 2 % ,实验组的优良率明显高于对照组 ,P <0 0 5。结论 :在肩锁骨手术中 ,肌间沟臂丛神经阻滞复合压迫法 ,使体表标志清楚 ,阻滞定位准确 ,操作简单安全 ,麻醉效果好 ,是一种行之有效的麻醉方法 ,临床上值得推广应用