序贯法测定异丙酚抑制小剂量氯胺酮兴奋循环作用的半数有效剂量

目的：采用序贯法测定异丙酚(丙泊酚)抑制小剂量氯胺酮兴奋循环作用的半数有效剂量(ED50)。方法择期全身麻醉患者21例,按照序贯法给药原则：丙泊酚剂量按等比数列逐级增加,公比为1.2,初始剂量为0.5 mg/kg。根据静脉注射氯胺酮后血压、脉搏变化情况调整丙泊酚的剂量。记录各时间点的血压、脉搏和SpO2数值及镇痛镇静评分(OAA/S),使用加权均数法计算ED50。结果异丙酚抑制小剂量氯胺酮兴奋循环作用的ED50为0.56 mg/kg,95%可信区间为(0.54,0.62)。结论异丙酚可以有效抑制小剂量氯胺酮的交感神经兴奋作用,两药配伍使用血压、脉搏平稳,呼吸抑制轻微。     

大鼠妊娠前后吸入异氟烷或七氟烷对子代脑发育的影响

目的探讨大鼠妊娠前后吸入异氟烷或七氟烷麻醉对子代大鼠脑发育的影响。方法将30只雌性SD大鼠随机分为5组(每组6只):对照组(C组)、妊娠前1 d吸入1.6%异氟烷6 h组(BI组)、妊娠后6、10、14和18 d时吸入1.6%异氟烷6 h组(PI组)、妊娠前1 d吸入2.4%七氟烷6 h组(BS组)及妊娠后6、10、14和18 d吸入2.4%七氟烷6 h组(PS组)。于出生当天(T1)、出生后第7(T2)、14(T3)和28天(T4)时各组按窝别随机取12只子鼠处死取海马,HE染色法观察病理学改变,电镜下观察海马细胞超微结构,免疫组织化学染色法检测caspase-3、神经生长相关蛋白43(GAP-43)和神经型一氧化氮合酶(n NOS)的表达。结果与C组相比,BI组和BS组各时点、PI组和PS组T4时点子代大鼠海马中caspase-3、GAP-43和n NOS的表达差异无统计学意义(P>0.05),HE染色及电镜观察海马组织未见差异。PI组和PS组T1~T3时caspase-3表达增加,GAP-43和n NOS表达减少(P<0.01),PI组HE染色海马结构有较明显的病理改变,电镜观察PI组和PS组海马细胞结构存在损伤;与PI组相比,PS组T1~T3时caspase-3表达减少(P<0.01),GAP-43和n NOS表达增加(P<0.01)。结论大鼠妊娠前吸入异氟烷或七氟烷对子代脑发育无不良影响,而妊娠期吸入异氟烷或七氟烷则可引起子代脑发育的短期异常,且异氟烷毒性作用大于七氟烷。     

Fc融合蛋白在药学领域的研究进展

Fc融合蛋白是指利用基因工程等技术将某种具有生物活性的功能蛋白分子与Fc片段融合而产生的新型重组蛋白,其不仅保留了功能蛋白分子的生物学活性,还具有一些抗体的性质,如通过结合相关Fc受体延长半衰期和引发抗体依赖细胞介导的细胞毒性效应等。对Fc融合蛋白及其在药学领域的研究进展进行了综述。     

Supreme喉罩i-gel喉罩与气管插管在小儿全麻手术气道管理中的比较

目的：探讨气管插管、Supreme喉罩、i-gel喉罩三种通气方式在小儿全麻手术气道管理中的效果,为临床提供参考。方法择期行全麻手术小儿患者90例,随机分为气管插管组（Q组）、Supreme喉罩（S组）和i-gel喉罩（I组）各30例。麻醉诱导后手法置入喉罩或气管插管,成功后记录相关指标。结果三组患者一般资料、手术时间比较,差异无统计学意义（P＞0.05）。S组和I组苏醒时间、麻醉时间更短（P＜0.05）。插管后,S组和I组心率上升幅度明显低于Q组;拔管后,S组和I组通气更好（P＜0.05）。S组首次置入成功率90%,I组93%,两组纤支镜检查对位准确评分比较差异无统计学意义（P＞0.05）。咽喉痛和罩体带血情况S组、I组均低于Q组。结论喉罩在小儿全麻手术中应用效果确切,与Supreme喉罩相比,i-gel喉罩并发症少见。     

咪达唑仑对人肺癌A549细胞裸鼠移植瘤的抑制效应及机制

目的探讨咪达唑仑对人肺癌A549细胞裸鼠移植瘤的抑制效应及机制。方法建立人肺癌A549细胞裸鼠移植瘤模型,共建模成功12只,分为咪达唑仑组与对照组各6只。咪达唑仑组腹腔注射咪达唑仑0. 8 mg/kg,1次/d;对照组给予生理盐水注射。20 d后观察2组荷瘤裸鼠体质量和皮下移植瘤体积变化。处死裸鼠,运用苏木精-伊红染色法(HE)观察咪达唑仑对肺癌移植瘤细胞形态的作用效应;依据细胞凋亡检测法(TUNEL)检测移植瘤中细胞凋亡情况;采用免疫组织化学染色法(IHC)观察移植瘤组织细胞中核蛋白质Ki-67的改变,采用蛋白质印迹法(Western-blot)观察移植瘤组织中信号传导转录激活因子3(STAT3)的改变。结果与对照组相比,咪达唑仑组移植瘤质量、肿瘤体积均显著较小(P 0. 05或P 0. 01); HE染色显示咪达唑仑组移植瘤组织发生大面积坏死; TUNEL法显示咪达唑仑组细胞凋亡数显著高于对照组,IHC染色表明咪达唑仑干预后显著下调移植瘤组织中核蛋白质Ki-67蛋白的表达,咪达唑仑组STAT3蛋白表达显著下调(P 0. 05)。结论咪达唑仑可能是通过调控STAT3的表达显著抑制A549移植瘤组织的生长,诱导肿瘤细胞凋亡。     

急性高容量血液稀释对深静脉血栓患者凝血功能的影响

目的 探讨急性高容量血液稀释(AHH)对深静脉血栓患者凝血功能的影响.方法 30例股静脉血栓行取栓术患者随机分为三组,入手术室以20 mg·kg <'1>·h<'1>的速度输注6%羟乙基淀粉200/0.5(H组)、琥珀酰明胶(G组)、生理盐水(R组)40 min.观察AHH前后血小板计数(Plt)、血小板聚集功能(PAG)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)变化.结果 AHH后H组Plt明显低于AHH前和G、R组(P<0.05或P<0.01);APTT明显长于AHH前和G、R组(P<0.05或P<0.01);AHH后H组PAG明显低于AHH前和R组(P<0.05);AHH后G组FIB明显低于AHH前和H、R组(P<0.01).结论 AHH后胶体液较晶体液对深静脉血栓患者凝血功能影响明显,可改善患者术中血液高凝状态.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

重症溃疡性结肠炎60例中西医结合治疗效果观察

目的 观察中西医结合方法治疗重症溃疡性结肠炎的临床疗效。方法 选择60例重症溃疡性结肠炎患者．急性发作期以水杨酸和皮质激素治疗为主．配合内服中药和苦参槐花合剂保留灌肠．缓解期以口服健脾灵为主．辅以水杨酸制剂维持治疗半年以上．观察其临床疗效和远期随访结果。结果 内科保守治疗55例．完全缓解35例(63．6%)．有效18例(32．7％)．无效及死亡各1例(1．8％)：中转手术治疗5例(8．3％)．完全缓解4例．有效1例。远期随访13例．远期完全缓解率67．4％．癌变率2．3‰．死亡率4．7%．手术率6．9%。结论 中西医结合治疗重症溃疡性结肠炎临床疗效优于单纯西医疗法．能明显降低死亡率和手术率。