带状疱疹后神经痛的研究进展

近年来随着对带状疱疹后神经痛（PostherpeticPain,简称PHN）的发病机理的深入研究,对PHN的预防和治疗都有较大的突破。 1.发病机理 Carter认为主要是由于局部炎症反应而不是神经轴突的破坏,这个炎症反应涉及到快钠通道mR-NA的调节,引起异常的放电从而产生疼痛[1]。此外,由于外周神经的损伤,整个神经轴都有不同程度的变性。Baron[1]将PHN的机理归成四点:（1）伤害性感受器病理性敏感化,中枢发生继发性改变,脊髓处于高激惹状态,一些机械感受器传入的冲动（如     

基因导向阿片类药物个体化用药新模式

药物反应的个体差异是临床用药中的常见现象，认识和阐明药物反应个体和群体间差异的产生机制可明显提高药物治疗效果，降低并发症。产生药物反应个体差异的原因虽然很多，但主要的因素还是药物代谢和处置的遗传差异和药物作用靶点的遗传多态性。随着人类基因组计划的完成，人类23条染色体上所有基因的序列都已测定，许多功能蛋白的结构以及编码它们的基因都已基本弄清，根据病人的遗传结构制定最佳的用药方案已成为近年来研究的热点之一，阿片类药物也不例外。药物代谢酶、转运蛋白、受体和药物作用靶点的基因多态性是引起阿片类药物效应和副作用个体差异的重要原因。     

低温脑保护在神经外科围术期的应用研究现状

低温脑保护在神经外科的应用日趋普遍,不但用于颅脑外伤和某些特殊手术,还用于一般的颅脑手术。降低脑代谢和氧耗、减少脑细胞蛋白破坏和抑制CSD的扩散是低温脑保护的几个主要机制。降温的时机、温度窗和时间窗以及降温的简易有效方法仍在探索之中。     

乌司他丁与高渗盐水单独或联合预处理对大鼠脑缺血再灌注的影响

【目的 观察和比较乌司他丁（Urinary Trypsin Inhibitor，UTI）与高渗盐水（Hypertonic Saline，HTS）单独或联合预处理对大鼠脑缺血再灌注的影响。方法 SD大鼠60只建立MCAO模型，随机分为4组，均在缺血前10 min预处理：对照组（C组），0.9%NaCl4 ml/㎏ iv；HTS组（H组），7.5%NaCl4 ml/㎏ iv；UTI组（U组），UTI10万U/㎏ iv（以1.5 mlNS溶解）； UTI+HTS组（U+H组），UTI10万U/㎏+7.5%NaCl4 ml/㎏ iv。再灌注22 h后取脑组织切片观察并检测S100β蛋白的含量及梗死体积。结果 预处理组梗死体积及S100β蛋白显著低于C组（P＜0.01），U组梗死体积及S100β蛋白显著高于H组而显著低于U+H组（P＜0.01）。结论 在大鼠脑缺血再灌注，UTI与HTS联合预处理较二者单独应用可提供更好的脑保护作用。 【关键词】 脑缺血再灌注 乌司他丁 高渗盐水 S100β蛋白 梗死体积     

高张盐水在局灶性脑缺血再灌注损伤中的作用及其机制

Objective To investigate the effect of hypertonic saline on cerebral water content, tumor necrosis factor-α (TNF-α) level and neuronal apoptosis following focal cerebral ischemia-reperfusion (IR) injury in rats and explore the mechanisms involved. Methods Ninety-six rats were randomized equally into 4 groups, namely the shame-operated group, untreated IR injury group, and 4.2% and 7.5% hypertonic saline groups (HS-A and HS-B groups, respectively). In the latter 3 groups, cerebral ischcmia was induced by middle cerebral artery occlusion for 2 h followed by administration of the corresponding treatments. Serum sodium concentration was measured at 5 min before and at 30, 60 and 90 min after the reperfilsion. At 22 h of rcperfusion, the rats were sacrificed after neurological deficit evaluation, and brain edema was assessed by measuring the wet-to-dry weight ratio of the brain tissue. TNF-α expression in the ischemic brain tissue was measured by enzyme-linked immunosorbent assay (ELISA), and the neuronal apoptosis was analyzed using TUNEL assay. Results In the saline-treated rats, serum sodium level increased significantly after saline administration, lasting for 60 min before recovering the normal levels in HS-A group and for over 90 min in HS-B group. Compared with that in the sham-operated group, the brain water content in rats of the IR group increased in both of the hemispheres, but more obviously in the ischemic hemisphere. In the two saline-treated groups, the water content decreased significantly in the bilateral hemispheres, which was especially obvious in the ischemic hemisphere;administration of 7.5% saline resulted in greater water content reduction in the ischemic hemisphere than 4.2% saline. Compared with the IR group, the two saline-treated groups showed significant reduction in TNF-α levels and apoptotic cells in the brain along with decreased neurological deficits. Conclusion Hypertonic saline can ameliorate cerebral focal IR injury by decreasing the cerebral water content, TNF-α level and neuronal apoptosis following the injury.     

高张盐水在局灶性脑缺血再灌注损伤中的作用及其机制

Objective To investigate the effect of hypertonic saline on cerebral water content, tumor necrosis factor-α (TNF-α) level and neuronal apoptosis following focal cerebral ischemia-reperfusion (IR) injury in rats and explore the mechanisms involved. Methods Ninety-six rats were randomized equally into 4 groups, namely the shame-operated group, untreated IR injury group, and 4.2% and 7.5% hypertonic saline groups (HS-A and HS-B groups, respectively). In the latter 3 groups, cerebral ischcmia was induced by middle cerebral artery occlusion for 2 h followed by administration of the corresponding treatments. Serum sodium concentration was measured at 5 min before and at 30, 60 and 90 min after the reperfilsion. At 22 h of rcperfusion, the rats were sacrificed after neurological deficit evaluation, and brain edema was assessed by measuring the wet-to-dry weight ratio of the brain tissue. TNF-α expression in the ischemic brain tissue was measured by enzyme-linked immunosorbent assay (ELISA), and the neuronal apoptosis was analyzed using TUNEL assay. Results In the saline-treated rats, serum sodium level increased significantly after saline administration, lasting for 60 min before recovering the normal levels in HS-A group and for over 90 min in HS-B group. Compared with that in the sham-operated group, the brain water content in rats of the IR group increased in both of the hemispheres, but more obviously in the ischemic hemisphere. In the two saline-treated groups, the water content decreased significantly in the bilateral hemispheres, which was especially obvious in the ischemic hemisphere;administration of 7.5% saline resulted in greater water content reduction in the ischemic hemisphere than 4.2% saline. Compared with the IR group, the two saline-treated groups showed significant reduction in TNF-α levels and apoptotic cells in the brain along with decreased neurological deficits. Conclusion Hypertonic saline can ameliorate cerebral focal IR injury by decreasing the cerebral water content, TNF-α level and neuronal apoptosis following the injury.     

棉织布与无纺布尘埃粒子数及抗渗液性能比较研究

目的比较棉织布与无纺布制作的手术衣和手术洞巾等在手术铺巾时空气中的尘埃粒子数及术中抗渗液性能，为有效控制外科切口感染和预防医患交叉感染提供参考。方法将棉织布与无纺布制作的手术布类各备15包，包内内容均相同，经灭菌处理。应用尘埃粒子计数仪测定两组铺巾时、铺巾后及收巾时空气中的尘埃粒子数，同时在手术过程中观察其抗渗液性能。结果无纺布组在铺巾时、铺巾后及收巾时产生的尘埃粒子数显著少于棉织布组（P〈0．05，P〈0．01）；其抗渗液率为100％，而棉织布组为0。结论无纺布抗渗液性能优，可减少手术环境中的尘埃粒子数，从而控制外科切口感染；其阻隔防护效能对患者和医护人员具有双重保护作用。     

曲马多联合地塞米松预防产妇腰硬联合麻醉后寒颤

目的 观察曲马多联合地塞米松预防剖宫产产妇腰硬联合麻醉时的寒颤.方法 将120例准备行剖宫产产妇随机分为4组,每组30例,即A组(生理盐水组),B组(曲马多组),C组(地塞米松组),D组(曲马多联合地基米松组),分别在腰硬联合麻醉前给予生理盐水10 ml,曲马多1.5 mg/kg,地塞米松5 mg,曲马多1.5 mg/kg+地塞米松5 mg.观察麻醉后产妇寒颤和呕吐的发生率,麻醉前,麻醉后5,10,15,30 min时产妇的无创血压和心率的变化,以及新生儿的APgar评分.结果 4组产妇同一时间点之间的血压和心率无显著差异,但各组产妇麻醉后5 min的血压明显降低,同基础值相比,有显著差异(P＜0.05).B组和D组产妇寒颤的发生率以及寒颤产妇中寒颤的平均强度都明显低于A组和C组.各组产妇呕吐的发生率以及呕吐产妇中呕吐的平均强度都无显著差异.各组产妇呕吐前的血压明显低于基础值(P＜0.05).结论曲马多可以预防产妇腰硬联合麻醉后的寒颤,但不会引起明显的呕吐,地塞米松预防寒颤的作用不明显.     

异丙酚在离体鼠心肌再灌注损伤中的保护作用

目的：研究异丙酚在心肌缺血再灌注损伤的作用。方法：采用Ｌａｎｇｅｎｄｒｆｆ离体鼠心脏模型，将３０只ＳＤ鼠随机分为５组，每组６只。对照组（Ｃ组）用Ｋ－Ｈ液恒温恒压持续往离体鼠心脏主动脉逆行流８０分钟；缺血再灌注组（ＩＲ组）用Ｋ－Ｈ液预灌注２０分钟，常温全心停灌３０分钟，再用Ｋ－Ｈ液恢复灌注３０分钟。５０μｍｏｌ／Ｌ异丙酚组（ＰＩ组）、２５μｍｏｌ／Ｌ异丙酚组（Ｐ２组）和脂肪乳剂组（ＩＮ组）从预灌第１     

米力农对犬同种异体原位心脏移植早期血液动力学的影响

米力农（milrinone）是一种磷酸二酯酶抑制剂,具有增强心肌收缩力和扩张血管作用,临床用于治疗充血性心力衰竭。为观察对移植心脏早期血液动力学的影响,我们进行了实验研究,报道如下。