腹裂早产低体重儿产后即刻手术麻醉处理一例

正孕妇,29岁,孕15+1周时B超发现双胎之一胎儿B腹裂,孕35周时B超提示胎儿B腹壁正中偏右侧可见范围约9.6 cm × 8.8 cm × 5.7 cm 的肠管疝出。术前诊断:G1P0孕35+2周双胎待产;双胎之一胎儿腹裂。拟产后即刻行腹裂儿修补术。孕妇入室后吸氧及心电监护,在腰-硬联合麻醉下行剖宫产术。新生儿之一脐部正中偏右侧可见一腹裂口,约10 cm × 8 cm范围的肠管暴露于腹壁外。吸引口咽腔,吸出大量粪染羊水,1 min后     

电视辅助胸腔镜术后持续胸膜外和硬膜外镇痛效果的比较

目的比较电视辅助胸腔镜手术(VATS)术后持续胸膜外镇痛和持续硬膜外镇痛效果的差异。方法择期在VATS下行肺肿瘤切除术的患者48例,年龄18～65岁,ASAⅠ或Ⅱ级,随机均分为胸膜外阻滞组和硬膜外阻滞组,在术后48h内使用罗哌卡因分别进行持续胸膜外和持续硬膜外镇痛。记录患者术后4、12、24、36和48h的静息和运动时的VAS评分,术后48h内吗啡使用量和氟比洛芬酯使用例数,并记录两组患者术后第1、2天的离床活动例数和术后住院天数。记录术后恶心、呕吐、呼吸抑制、瘙痒和尿潴留不良反应发生率。结果胸膜外阻滞组和硬膜外阻滞组在术后4、12、24、36和48h静止和运动时VAS评分差异无统计学意义,两组患者吗啡使用量和氟比洛芬酯使用例数差异无统计学意义,术后恶心、呕吐发生率,术后第1、2天离床活动例数和术后住院天数差异均无统计学意义。结论两种方法在小剂量吗啡辅助下能提供良好的镇痛效果。由于具备安全准确的优点,电视辅助胸腔镜手术后也可选择持续胸膜外镇痛方法。     

喉癌根治术后患者胸腔镜下右肺肿瘤切除麻醉处理1例

目的:探讨喉腔术后颈部解剖结构改变的患者如何选择安全有效的麻醉方法。方法:分析1例喉癌根治术后需在胸腔镜下行右肺肿瘤切除的患者的临床特征及麻醉处理过程。结果:喉切除术破坏了喉和颈部的解剖结构和生理功能,术后喉腔内出现大量瘢痕增生及肉芽生长,颈部解剖结构受到破坏,不同区域的狭窄及程度决定了麻醉方法的选择。结论:对于患有喉部疾病或者曾经因喉部疾病行气管插管全麻的患者,术前必须进行充分的气道评估,在保留自主呼吸的麻醉方式下行气管插管是相对安全的。     

肾上腺素诱发无症状甲状腺功能亢进症患者室性纤维颤动一例

报道1例术中应用肾上腺素诱发无症状甲状腺功能亢进症患者室性纤维颤动的处理。术中急行气管插管、电除颤等处理后，患者恢复良好，甲状腺功能检查异常。需重视术前访视和术中监测，熟练掌握突发室颤的紧急处理。     

盐酸戊乙奎醚对脂多糖诱导的内皮细胞损伤的保护作用

目的 探讨盐酸戊乙奎醚(PHC)对脂多糖(LPS)诱导的内皮细胞损伤的影响及其作用机制.方法 用RPMI 1640培养基将人脐静脉内皮细胞在5%CO2、37℃培养箱中培养,并分为对照组,LPS组及PHC组.检测细胞上清液乳酸脱氢酶(LDH)、细胞中丙二醛(MDA)、超氧化物歧化酶(SOD)和一氧化氮(NO)水平.提取细胞核蛋白,Western blot分析细胞外信号调节激酶1/2(ERK1/2)和c-Jun氨基末端激酶(JNK)磷酸化蛋白的表达.采用SPSS 13.0统计软件进行分析,组间比较采用单因素方差分析,以P<0.05为差异具有统计学意义.结果 与对照组比较.LPS组LDH含量[(1 642±367)U/L vs.(169±33)U/L]、MDA含量[(13.2±1.2)nmol/L vs.(7.2±0.8)nmoL/mL]及NO水平[(143.2±10.3)μmol/L vs.(85.5 4.4.1)μmol/L]明显增多,SOD活性明显下降[(41.2 ±2.7)U/mL vs.(61.1±2.8)U/mL],ERK1/2和JNK磷酸化表达明显增高.PHC可显著降低LDH含量[(392 4.90)U/L],降低MDA[(8.6±1.3)nmol/mL]和NO水平[(92.1 ±6.6)μmol/L],提高SOD活性[(58.0±3.0)U/mL],减弱ERK1/2磷酸化蛋白表达.结论 盐酸戊乙奎醚对脂多糖诱导的内皮细胞损伤具有保护作用,其作用机制可能与抑制ERK1/2磷酸化表达减少过氧化物的产生有关.

Abstract：

Objective To investigate the effects of penehyclidine hydrochloride ( PHC) on lipopolysaccharide (LPS) -induced endothelial cells injury and its mechanism. Methods ECV-304 was cultured in RPMI1640 in a 5% humidified CO2 atmosphere at 37 ℃. Then cultured cells were used to assess the following treatments: control group, LPS group (1 μg/mL) and PHC group(2 μg/mL). At the end of the experiments, supernatant was collected for determination of lactate dehydrogenase ( LDH), and cells were collected for determination of malondialdehyde (MDA), superoxide dismutase (SOD), and nitric oxide (NO) levels. And extracellular regulated kinasel/2( ERKl/2)and JNK MAPK (mitogen-activated protein kinases, MAPK) protein expressions were determined using Western blot technique. Analysis of variance (ANOVA) was used for statistical analysis to compare values among all groups. A significant difference was presumed for a probability value < 0.05. Results Compared with control group, LDH leakage [(1642 ± 367) U/L vs (169±33)U/L], the contents of MDA[(13. 2 ± 1. 2) nmol/L vs (7. 2 ±0. 8)nmol/mL] and NO levels [(143.2 ± 10.3) μmol/L vs(85.5 ±4.1) μmol/L], expressions of ERK1/2 and JNK were remarkably increased and SOD activities[(41.2 ±2.7) U/mL vs (61. 1 ±2.8) U/mL] were obviously decreased in LPS group. PHC markedly decreased LDH leakage [(392 ±90) U/L], MDA contents [(8. 6 ± 1. 3) nmol/ mL] and NO levels [(92.1 ±6.6) μmol/L], ERK1/2 activation and enhanced SOD activities [(58.0± 3.0) U/mL]. Conclusions PHC could protect endothelial cells against LPS-induced cell injury. The effect of PHC is likely mediated through inhibition of ERK1/2 MAPK activation.     

异丙酚对大鼠心肌缺血再灌注时Pim-1表达的影响

目的 探讨异丙酚对大鼠心肌缺血再灌注时Pim-1表达的影响.方法 健康雄性SD大鼠40只,体重220～250 g,采用随机数字表法,将其随机分为5组(n=8):假手术组(S组)、缺血再灌注组(I/R组)、脂肪乳剂组(I组)、低剂量异丙酚组(P1组)和高剂量异丙酚组(P2组).I/R组、I组、P1组和P2组和采用结扎左冠状动脉前降支30 min再灌注的方法制备心肌缺血再灌注损伤模型.P1组和P2组于缺血前10 min经股静脉输注异丙酚6、12 mg·kg-1·h-1至再灌注120 min,I组给予脂肪乳剂1.2 ml·kg-1 ·h-1.再灌注120 min时,取心肌组织,测定心肌梗死面积、细胞凋亡、Pim-1表达和caspase-3活性.结果 与S组比较,I/R组和I组心肌梗死面积、凋亡指数和caspase-3活性升高,心肌组织Pim-1表达下调(P＜0.01);与I/R组比较,P1组和P2组心肌梗死面积、凋亡指数和caspase-3活性降低,心肌组织Pim-1表达上调(P＜0.01),I组上述指标差异无统计学意义(P＞0.05).结论 异丙酚可减轻大鼠心肌缺血再灌注损伤,其机制与上调Pim-1表达有关.     

不同全麻对口腔恶性肿瘤患者免疫功能的影响

目的 评价不同全麻对口腔恶性肿瘤患者免疫功能的影响.方法 择期拟行口腔恶性肿瘤根治术患者60例,年龄49～64岁,体重50～71kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为3组(n=20):Ⅰ组采用全凭静脉麻醉,静脉注射眯达唑仑、瑞芬太尼、顺阿曲库铵和异丙酚麻醉诱导,静脉输注异丙酚和瑞芬太尼维持麻醉;Ⅱ组采用静吸复合麻醉,麻醉诱导同Ⅰ组,吸入七氟醚或静脉输注异丙酚复合瑞芬太尼维持麻醉;Ⅲ组采用吸入全麻,吸入七氟醚,静脉注射瑞芬太尼和顺阿曲库铵麻醉诱导,吸入七氟醚,静脉输注瑞芬太尼维持麻醉.于麻醉诱导前30 min(T0)、麻醉后1、3、5 h、术毕、术后24、48、72 h(T2～7)时采集外周静脉血,采用流式细胞仪测定T淋巴细胞亚群及NK细胞、B淋巴细胞百分比.结果 与T0时比较,Ⅰ组～Ⅲ组T1-5时CD3+、CD4+、CD4+/CD8+比值、NK细胞百分比和B淋巴细胞百分比降低,Ⅱ组和Ⅲ组T6时CD3+、CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05或0.01);与Ⅰ组比较,Ⅱ组T2,3,6时CD4+、CD4+/CD8+比值和Ⅲ组T2～6时CD3+、CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05或0.01);与Ⅱ组比较,Ⅲ组T4.5时CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05).结论 与吸人麻醉和静吸复合麻醉比较,咪达唑仑、瑞芬太尼和异丙酚全凭静脉麻醉对口腔恶性肿瘤患者免疫功能的抑制程度较低.

Abstract：

Objective To investigate the effects of different general anesthesia protocols on immune function in patients with oral malignant tumor. Methods Sixty ASA Ⅰ or Ⅱ patients undergoing elective radical operation for oral malignant tumor were randomly divided into 3 groups ( n = 20 each): group Ⅰ total intravenous anesthesia (TIVA); group Ⅱ combined intravenous-inhalational anesthesia (IV-INH) and group Ⅱ inhalational anesthesia (INN). Anesthesia was induced and maintained with propofol and remifentanll in group Ⅰ; with sevoflurane,propofol and remifentanil in group Ⅱ and with sevoflurane and remifentanil in group Ⅲ. Peripheral venous blood samples were taken at 30 min before (To) and 1 h (T1), 3 h (T2 ) and 5 h (T3) after induction of anesthesia, the end of operation (T4 ) and at 24 h (T5 ), 48 h (T6 ) and 72 h (T7) after operation for determination of the percentages of T lymphocyte subsets (CD3+ , CD4+ , CD8+ , CD4+/CD8+ ratio). Natural killer (NK) cells (CD16+ ,CD56+ ) and B lymphocyte (CD19+ ) with flow cytometer. Results The percentages of CD3+ , CD4+ , NK cells, B lymphocyte and CD4+/CD8+ ratio were significantly decreased during and after operation at T1-5 in all groups and the percentges of CD3+ ,CD4+ ,NK cells and CD4+/CD3+ ratio were decreased at T6 in groups Ⅱ and Ⅲ as compared with the baseline values before anesthesia at To. The percentage of CD4+ cells and CD4+/CD8+ratio were significantly lower during anesthesia at T2,3,6 in group Ⅱ than in group Ⅰ . The percentages of CD4 +and NK cells and CD4+/CD8+ ratio were significantly higher after operation at T4,5 in group Ⅱ than in group Ⅲ.The percentages of CD3 + , CD4 + , NK cells and CD4 +/CD8 + ratio were significantly lower at T2-6 in group Ⅲthan in group Ⅰ . Conclusion TIVA with midazolam, propofol and remifentanil has less impact on immune function than inhalational and combined intravenous-inhalational anesthesia in patients with oral malignant tumor under-going elective radical operation.     

细胞穿透肽PEP-1介导血红素加氧酶-1对大鼠肠缺血再灌注损伤的影响

目的 评价细胞穿透肽PEP-1介导血红素加氧酶-1(HO-1)对大鼠肠缺血再灌注损伤的影响.方法 雄性SD大鼠18只,周龄7～9周,体重210～260 g,采用随机数字表法,将大鼠随机分为3组(n=6):假手术组(S组)、肠缺血再灌注组(IR组)和融合蛋白PEP-1/HO-1+肠缺血再灌注组(HO组).采用夹闭肠系膜上动脉45 min,恢复灌注120 min的方法制备大鼠肠缺血再灌注损伤模型.HO组夹闭肠系膜上动脉前30 min,左侧髂静脉注射融合蛋白PEP-1/HO-1 0.5 mg,S组不夹闭肠系膜上动脉,余操作同IR组.于再灌注120 min时处死大鼠取小肠组织,称重后计算肠湿/干重比,测定丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性和HO-1活性,免疫组化法检测肠组织HO-1蛋白的表达,光镜下观察肠组织结构并进行损伤评分.结果 与S组比较,IR组和HO组肠湿/干重比和MDA含量升高,SOD活性降低,HO-1活性和蛋白表达水平升高,损伤评分升高(P＜0.05);与IR组比较,HO组肠湿/干重比、MDA含量降低,SOD活性升高,HO-1活性和蛋白表达水平升高,损伤评分降低(P＜0.05).HO组大鼠肠组织病理学损伤较IR组减轻.结论 细胞穿透肽PEP-1可将HO-1成功导人大鼠肠组织中的细胞并减轻肠缺血再灌注损伤.

Abstract：

Objective To investigate the effects of heme oxygenase-1 (HO-1) mediated by cell penetrating peptide PEP-1 on intestinal ischemia/reperfusion (I/R) injuiy in tats. Methods Eighteen male SD rats aged 7-9 weeks weighing 210-260 g were randomly divided into 3 groups (re = 6 each): sham operation group (group S) , I/R group and PEP-1/HO-1 + I/R group (group HO) . To establish a model of intestinal I/R injury, intestines were exteriorized and the superior mesenteric artery was exposed and occluded for 45 min ischemia, and then the clamp was removed for 120 min reperfusion. The PEP-1/HO-1 fusion protein 0.5 mg was injected via the left iliac vein 30 min prior to ischemia in group HO. The superior mesenteric artery was exposed but not occluded in group S. At the end of reperfusion, the rats were sacrificed and intestinal tissues obtained to determine the intestinal wet/ dry ratio, malondialdehyde (MDA) level, activities of superoxide dismutase (SOD) and HO-1, and HO-1 protein expression. The histological changes in the intestinal mucosa were examined and the injuiy was scored. Results Compared with group S, the intestinal wet/dry ratio, MDA level, HO-1 activity, HO-1 protein expression and injury score were significantly increased, while the SOD activity was significantly decreased in groups I/R and HO ( P ＜ 0.05) . Compared with group I/R, the intestinal wet/dry ratio, MDA level and injury score were significantly decreased, while the SOD activity, HO-1 activity and HO-1 protein expression increased in group HO ( P ＜ 0.05) . The pathologic changes were significantly attenuated in group HO compared with group I/R.Conclusion HO-1 protein can be successfully delivered into intestinal tissues by PEP-1 and has protective effects against intestinal I/R injury.     

不同剂量布托啡诺对全麻患者气管插管心血管反应的影响

研究表明,气管插管可引起血压升高和心率增快等血液动力学反应[1-4].布托啡诺为阿片受体部分激动药,可激动κ、δ受体,对μ受体有弱的拮抗作用,具有良好的镇痛、镇静作用[5,6],可用于诱导气管插管[7].