氯胺酮鞘内注射对慢性坐骨神经损伤大鼠脊髓 NMDA-2B mRNA表达的影响

目的：探讨氯胺酮连续鞘内注射对慢性坐骨神经损伤大鼠脊髓背角N-甲基-D天冬氨酸亚基（NR2B）mRNA表达的影响。方法：雄性SD大鼠18只，随机分为假手术组、CCI组和氯胺酮组。按Bennett等法制作CCI模型，测von-Frey丝触痛及冷水阈值，采用原位杂交技术检测各组脊髓背角NR2B mRNA表达的变化。结果：CCI组痛阈显著下降，冷水阈显著升高，脊髓背角有大量NR2B mRNA阳性表达（P＜0．01）；氯胺酮组仅出现轻度痛敏症状，NR2B mRNA表达受到明显抑制（P＜0．01）。结论：NR2B mRNA表达上调可能是神经损伤后慢性疼痛的发病机制之一，氯胺酮可抑制其表达从而发挥一定程度的镇痛作用。     

国产舒芬太尼用于术后静脉自控镇痛的疗效和安全性——多中心、随机、双盲、平行对照临床研究

Objective To evaluate efficacy and safety of sulfentanyl (China) for PICA in surgical patients with general anes-thesia in a multiple-center, randomized, double-blind, parallel study. Methods 200 ASA grade Ⅰ -Ⅱ patients aged 18-55 undergo-ing surgery with general aneathesia enrolled from 3 hospitals were randomly and double-blindly divided into 2 groups: sulfentanyl (China, n=100) versus sulfentanyl(German, n=100). Sulfentanyl(China 0.1 μg/kg or German)was given before the end of surgery. VAS scores less than 3 after patient awake and PCA started after extubation(200 μg sulfentanyl was diluted with 50 ml saline solution, background dose 0.5 ml/h,bolus of 0.5 ml with lockout interval 15 min, continuous infusion 48 h). Vital signs including BP, HR, PR, SpO2 and side effects such as nausea, vomiting, urine retention, pruritus, breath depression, etc. And VAS scores with patients in quiet and cough were recorded at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. The total number of PCA, the total effective number of PCA, and the ratio of both and other analgesics as well as the satisfactory degree of patients and the cumulative suffen-tanyl consumption were recorded at 24 h. Results There were no significant difference of BP, HR, PR, SpO2 and the adverse effect and VAS scores in quiet and cough between two groups at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. There were no signifi-cant difference of the total number of PCA, the total effective number of PCA and other analgesics as well as the satisfactory degree of patients and the total dosage of sulfentanyl at 24 h. Conclusion The sulfentanyl (China) had satisfactory effects of postoperative analgesia and had no significant side effects compared with sulfentanyl (German). The efficacy and the side effects of both drugs had no significant difference.     

丙泊酚中枢麻醉作用机制的研究进展

丙泊酚是临床常用的短效静脉麻醉药,因其起效快、苏醒迅速且功能恢复完善,术后恶心、呕吐发生率低等优点,目前广泛用于临床麻醉、重症监护患者的持续镇静以及临床无痛检查、治疗等. 然而,丙泊酚的中枢麻醉作用机制仍未完全明了,有研究[1]发现,丙泊酚作用的中心环节是突触,但其在神经中枢的作用靶点仍未达成共识,抑制局部脑区的活动和扰乱各个脑区功能网络联系这两种途径还存在诸多争议和未解之处. 本文对丙泊酚现在肯定的中枢麻醉作用机制作一综述.     

小儿喉蹼患者麻醉诱导期的管理

目的 探讨小儿喉蹼患者的最佳麻醉管理.方法 回顾性分析我院2009年12月至2013年3月经纤维喉镜、颈部X线或薄层CT确诊喉蹼的24例小儿患者的麻醉管理.结果 所有患儿在术前均有不同程度的呼吸困难,手术的目的是解决通气问题.气管切开13例,其中6例术前先局麻下行气管切开后全麻,7例全麻插管后行气管切开;未行气管切开11例,直接在全麻下行气管内插管.诱导方式:快诱导经气管切口插管6例,快诱导经口插管7例,保留自主呼吸浅全麻诱导10例,1例先采用保留自主呼吸浅全麻诱导,第1次经口喉镜明视下插管失败后,面罩通气良好的情况下,改用快诱导,换管第3次插管成功.插管成功率:5例一次插管成功,10例两次插管成功,3例三次插管成功,平均插管时间12 min.所有患儿均未出现诱导期缺氧,但有13例呼气末二氧化碳分压(PetCO2)明显偏高.所有患儿均安全完成麻醉诱导.结论 术前充分的气道评估、完善的麻醉前准备及良好的团队协作是先天性喉蹼患儿围术期麻醉管理的关键.小儿喉蹼作为已预料的困难气道推荐选用保留自主呼吸浅全麻比较安全.     

国产舒芬太尼用于术后静脉自控镇痛的疗效和安全性——多中心、随机、双盲、平行对照临床研究

Objective To evaluate efficacy and safety of sulfentanyl (China) for PICA in surgical patients with general anes-thesia in a multiple-center, randomized, double-blind, parallel study. Methods 200 ASA grade Ⅰ -Ⅱ patients aged 18-55 undergo-ing surgery with general aneathesia enrolled from 3 hospitals were randomly and double-blindly divided into 2 groups: sulfentanyl (China, n=100) versus sulfentanyl(German, n=100). Sulfentanyl(China 0.1 μg/kg or German)was given before the end of surgery. VAS scores less than 3 after patient awake and PCA started after extubation(200 μg sulfentanyl was diluted with 50 ml saline solution, background dose 0.5 ml/h,bolus of 0.5 ml with lockout interval 15 min, continuous infusion 48 h). Vital signs including BP, HR, PR, SpO2 and side effects such as nausea, vomiting, urine retention, pruritus, breath depression, etc. And VAS scores with patients in quiet and cough were recorded at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. The total number of PCA, the total effective number of PCA, and the ratio of both and other analgesics as well as the satisfactory degree of patients and the cumulative suffen-tanyl consumption were recorded at 24 h. Results There were no significant difference of BP, HR, PR, SpO2 and the adverse effect and VAS scores in quiet and cough between two groups at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. There were no signifi-cant difference of the total number of PCA, the total effective number of PCA and other analgesics as well as the satisfactory degree of patients and the total dosage of sulfentanyl at 24 h. Conclusion The sulfentanyl (China) had satisfactory effects of postoperative analgesia and had no significant side effects compared with sulfentanyl (German). The efficacy and the side effects of both drugs had no significant difference.     

腺苷的生物效应及其应用

腺苷是人体组织产生的一种内源性核苷。本文就有关腺苷的生成、降解及腺的生理，电生理效应作一探讨。另外，腺苷对心脏功能有多方面作用，在调节冠脉血流，评仨冠脉贮备能力，心肌保护、心脏手术及器官移植、缓解肺动脉高压，消除室上性心动过速等方面有重要临床意义。     

腺苷在外周和脊髓的释放及对疼痛的调节

腺苷是中枢神经系统重要的调节因子，通过作用于细胞外腺苷A1、A2A、A2B和A3受体调节多种细胞功能。在脊髓组织，递质释放引起的神经细胞去极化、腺苷激酶、腺苷脱氨酶活性降低，均使腺苷释放增加；细胞外核苷酸可水解为腺苷。在外周组织，炎症引起神经元及其他多种细胞释放腺苷。腺苷抑制痛觉信号在外周和脊髓的转导及某些药物引起的炎症反应。     

N-甲基-D-天冬氨酸-2B受体功能的研究进展

N-甲基-D-天冬氨酸(mDA)受体是一种配体门控型离子通道，由7种亚型(NR1，NR2A，NR2B，NR2C，NR2D，NR3A和NR3B)组成，通过其不同亚型与细胞内多种蛋白相互作用。NR2B受体参与突触信号转导和蛋白之间的调节，与学习、记忆、疼痛感受、进食行为及多种神经疾病有关。本文综述了近年来有关NR2B受体的结构、分布及功能调节等方面的研究进展。