氯胺酮对异丙酚诱导插管期间心血管系统反应的预防作用

异丙酚是一种新型短效静脉麻醉药 ,具有起效快 ,作用时间短 ,但有心血管抑制的不良反应。氯胺酮能引起交感兴奋 ,使血压升高、心率加快。本文旨在观察氯胺酮对异丙酚全麻诱导插管期间心血管系统的变化 ,并与芬太尼及异丙酚全麻诱导进行比较。1　资料和方法1.1　一般资料　 30例 ASA ～ 级成人择期手术患者 ,其中男 16例 ,女 14例 ,年龄 35～ 6 2岁 ,体重 ( 5 3.6± 12 .3) kg。术前均无心血管、内分泌及呼吸系统疾患。术前肌注鲁米那0 .1、阿托品 0 .5 mg。随机分为两组 ( K组和 F组 )。组间年龄、性别、体重无显著差异 ,具有可比性。1.…     

CPB诱发犬急性肺损伤时肺组织转化生长因子β1 mRNA表达的变化

Objective To observe the changes in the transforming growth factor-beta 1 (TGF-β1 ) mRNA expression in the lung in a dog model of cardiopulmonary bypass(CPB)-induced acute lung injury. Methods Thirty-six healthy adult mongrel dogs of both sexes weighing 15-16 kg were randomly assigned into control group and CPB group ( n = 18 each) . Lung injury was produced by CPB according to the method described by Williams. Six animals were killed at each of the following time points: before CPB (T0 ) and 30 and 60 min after termination of CPB (T1 , T2) in each group. Lung specimens were obtained for microscopic examination and determination of TGF-β1 mRNA expression (by RT-PCR) and MDA content. The lungs were lavaged and the protein concentration in the brancho-alveolar lavage fluid (BALF) was determined and pulmonary permeability index (PPI) was calculated. Results Microscopic examination showed massive inflammatory cell infiltration, alveolar capillary dilatation, congestion, widened alveolar septum, massive RBC in the alveolar space and focal atelectasis in the lung in CPB group. The TGF-β1 mRNA expression and MDA content and PPI were significantly higher in CPB group than in control group. The TGF-β1 mRNA expression and MDA was positively correlated to PPI (MDA: r = 0.867, P < 0.01; PPI: r = 0.821, P < 0.01) . Conclusion TGF-β1 mRNA expression in the lung is significantly up-regulated after CPB and is an important factor contributing to CPB-induced acute lung injury.     

CPB诱发犬急性肺损伤时肺组织转化生长因子β1 mRNA表达的变化

目的 观察CPB诱发犬急性肺损伤时肺组织转化生长因子β1(TGF-β1)mRNA表达的变化.方法 成年健康杂种犬36只,体重15～16 kg,随机分为2组(n=18):对照组(C组)和CPB组.CPB组制备CPB诱发急性肺损伤模型,C组除不进行CPB外,其余操作同CPB组.分别于CPB前(T0)、CPB停机后30 min(T1)、60 min(T2)时各处死6只犬,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),测定肺组织TGF-β1 mRNA表达和MDA含量.结果 C组肺组织结构清晰,未见炎性细胞浸润,肺泡壁光滑、完整,肺泡腔及间质无出血和渗出;CPB组肺泡腔内可见水肿液和中性粒细胞浸润,并可见大量的红细胞,肺泡隔增宽,局灶性肺不张.与C组比较,CPB组TGF-β1 mRNA表达上调,MDA含量和PPI升高(P<0.05或0.01).CPB组TGF-β1 mRNA表达水平与MDA含量和PPI呈正相关(MDA:r=0.867,P<0.01;PPI:r=0.821,P<0.01).结论 犬CPB后肺组织TGF-β1 mRNA 表达上调,可能是CPB诱发急性肺损伤发生发展的重要因素之一.     

不同剂量瑞芬太尼复合异丙酚在无痛胃镜检查中对呼吸、循环功能的影响

瑞芬太尼是新合成的超短时强效阿片类镇痛药。具有起效快、作用时间短、恢复迅速和无蓄积作用等优点．故非常适用于门诊小手术。由于瑞芬太尼对循环、呼吸的抑制呈剂量依赖性，本文旨在观察不同剂量的瑞芬太尼复合异丙酚在无痛胃镜检查中对循环、呼吸功能的影响，寻找瑞芬太尼的适宜剂量。     

右美托咪定联合舒芬太尼自控静脉镇痛对妇科腹腔镜手术患者术后镇痛效果炎症细胞因子及早期恢复的影响

目的 探讨右美托咪定联合舒芬太尼自控静脉镇痛(PCIA)对妇科腹腔镜手术患者术后镇痛效果、炎症细胞因子及早期恢复的影响.方法 选择2019年9月—2020年9月在该院接受妇科腹腔镜手术的100例患者作为研究对象.采用随机数表法均分两组,各50例.对照组给予舒芬太尼镇痛,观察组给予右美托咪定联合舒芬太尼镇痛.比较两组术后...     

局部麻醉下控制性降压在功能性鼻内窥镜手术中的应用

功能性鼻内窥镜手术(FESS)可在局部麻醉或全身麻醉下完成。全身麻醉控制性降压能有效减少FESS的出血量、保持术野清晰、缩短手术时间[1]。但目     

老年重型颅脑损伤患者麻醉处理特点分析

重型颅脑损伤的预后不仅取决于原发性损害的性质与程度,而且与继发性损害密切相关,术中影响继发性损害的因素很多,其中许多因素可通过正确的麻醉处理而得以防治,从而改善患者的预后.老年患者由于组织和器官发生退行性改变,功能储备下降,代偿能力降低,且常伴有多种并存疾病,发生重型颅脑损伤的预后也有别于其他年龄患者.现将我院老年重型颅脑创伤患者术中的麻醉处理总结如下.     

不同剂量丙泊酚对儿童麻醉深度、应激反应和血流动力学的影响

目的探讨不同剂量丙泊酚对患儿麻醉深度、应激反应、血流动力学的影响。方法选择下腹部手术患儿60例的临床资料进行回顾性分析,根据丙泊酚的使用剂量分为3组。第1组21例,丙泊酚起始维持剂量10 mg/（kg·h）,后每隔20min减量2 mg/（kg·h）,以6 mg/（kg·h）维持到缝皮;第2组19例,丙泊酚初始维持剂量15 mg/（kg·h）,20 min后减量为10 mg/（kg·h）,40 min后减量为8 mg/（kg·h）维持到缝皮;第3组20例,丙泊酚初始维持剂量20 mg/（kg·h）,后每隔20 min减量5 mg/（kg·h）,以10 mg/（kg·h）维持到缝皮。评价3组患儿不同时间点BIS、血流动力学以及应激反应。结果第2组和第3组在各时间点麻醉深度大于第1组（P〈0.01）。第3组对MAP和心率有明显的抑制作用。第1组的应激反应较第2组和第3组强（P〈0.05）。结论丙泊酚用于儿童全麻按照15 mg/（kg·h）、10 mg/（kg·h）、8 mg/（kg·h）维持麻醉,患儿既可以达到较满意的麻醉深度,并且对应激反应和血流动力学的影响较轻。     

CPB诱发犬急性肺损伤时肺组织转化生长因子β1 mRNA表达的变化

Objective To observe the changes in the transforming growth factor-beta 1 (TGF-β1 ) mRNA expression in the lung in a dog model of cardiopulmonary bypass(CPB)-induced acute lung injury. Methods Thirty-six healthy adult mongrel dogs of both sexes weighing 15-16 kg were randomly assigned into control group and CPB group ( n = 18 each) . Lung injury was produced by CPB according to the method described by Williams. Six animals were killed at each of the following time points: before CPB (T0 ) and 30 and 60 min after termination of CPB (T1 , T2) in each group. Lung specimens were obtained for microscopic examination and determination of TGF-β1 mRNA expression (by RT-PCR) and MDA content. The lungs were lavaged and the protein concentration in the brancho-alveolar lavage fluid (BALF) was determined and pulmonary permeability index (PPI) was calculated. Results Microscopic examination showed massive inflammatory cell infiltration, alveolar capillary dilatation, congestion, widened alveolar septum, massive RBC in the alveolar space and focal atelectasis in the lung in CPB group. The TGF-β1 mRNA expression and MDA content and PPI were significantly higher in CPB group than in control group. The TGF-β1 mRNA expression and MDA was positively correlated to PPI (MDA: r = 0.867, P < 0.01; PPI: r = 0.821, P < 0.01) . Conclusion TGF-β1 mRNA expression in the lung is significantly up-regulated after CPB and is an important factor contributing to CPB-induced acute lung injury.     

局部麻醉下控制性低血压在鼻内镜手术中的应用

目的:探讨局部麻醉下控制件降压在功能性鼻内镜手术中的应用价值.方法:将鼻内镜手术患者随机分为控制性降血压组和对照组.记录2组术前、降压前、手术30 min时及术毕时的平均动脉压(MAP)、心率(HR)、血氧饱和度(SaO2)及血气值、出血量、术野评级、手术时间.结果:手术30 min时2组HR较术前均有明显增快(P＜0.01),SaO2较术前有显著下降(P＜0.01).2组术毕时MAP、HR、SaO2和血气值差异无统计学意义(均P＞0.05).2组出血量、手术时间、术野清晰度评分比较差异均有统计学意义(均P＜0.05).结论:局部麻醉下控制性降压可减少功能性鼻内镜手术的出血量,保持术野清晰,缩短手术时间,具有较高的安全性及临床使用价值.