超声引导三种神经阻滞技术在肩关节镜手术中的应用比较

目的比较超声引导下锁骨上、肩胛上和肌间沟臂丛神经阻滞在肩关节镜手术中镇痛效果和肺功能的影响。方法共计纳入择期拟行肩关节镜手术患者120例。将所有患者随机分为锁骨上神经阻滞组、肩胛上神经阻滞组和肌间沟神经阻滞组。不同组别均采用0.375%罗哌卡因15ml进行锁骨上、肩胛上或肌间沟神经阻滞。主要研究目标为使用非劣效性分析的数字评定量表疼痛评分(术后PACU中60分钟内完成)。次要研究目标包括阿片类药物消耗量和肺功能评估情况。结果各组术后的平均疼痛评分为:肌间沟=1.9(95%CI,1.3～2.5),锁骨上=2.3(1.7～2.9),肩胛上=2.1(1.5～2.7)。主要研究结果:平均疼痛评分差异结果中,(锁骨上-肌间沟)为0.4(-0.4～1.2;非劣效性P=0.088),(肩胛上-肌间沟)为0.2(-0.5～0.9;非劣效性P=0.012)。次要研究结果:阿片类药物消耗量组间差异无统计学意义。肺活量检测结果显示,与肌间沟组(65%的基线水平值)相比,肩胛上组(91%的基线水平值;P0.001)和锁骨上组(77%的基线水平值;P=0.002)的保持状况更好。结论在肩关节镜手术中,肩胛上水平的神经阻滞能够提供不低于肌间沟水平神经阻滞所具备的镇痛效果;与肌间沟神经阻滞相比,锁骨上和肩胛上神经阻滞对于肺功能的保留程度更好。     

模拟海上颠簸刺激加重严重烧伤家兔休克的研究

目的 了解模拟海上颠簸刺激对烧伤家兔休克的影响. 方法将132只家兔随机分为正常对照组(6只)、单纯颠簸组(行持续颠簸刺激,42只)、单纯烧伤组(行烧伤处理,42只)、烧伤颠簸组(烧伤后即刻进行持续颠簸刺激,42只).后3组家兔于处理后2、6、8、12、24、36、48 h经颈动脉取血,检测血清肌酐(Cr)、血清尿素氮(BUN)、血细胞比容(HCT)和血清乳酸(LA)水平,并取肾脏组织观察其病理学变化,同时留置导尿管持续监测家兔处理后第1、2个24 h的尿量变化;正常对照组家兔亦行上述检测. 结果烧伤颠簸组家兔血Cr、血BUN自处理后24 h起明显高于单纯烧伤组(P<0.01),血LA、HCT各时相点均显著高于单纯烧伤组(P<0.01).烧伤颠簸组家兔肾小球毛细血管和间质血管充血,肾小管上皮细胞肿胀,肾小管炎性细胞浸润及红细胞管型.单纯烧伤组病理变化轻于烧伤颠簸组.单纯烧伤组家兔处理后第1、2个24 h尿量分别为(2.59±0.23)、(2.86±0.29)mL/ h,烧伤颠簸组上述时相点尿量分别为(1.61±0.13)、(1.66±0.16)mL/h,均明显低于正常对照组[(6.06±0.18)mL/h,P<0.01]. 结论模拟海上颠簸刺激,可明显加重严重烧伤家兔休克及肾脏损害.     

家兔颈椎两侧肌肉平衡失调对椎动脉血流的影响

目的 探讨颈椎两侧肌肉平衡失调对椎动脉血流的影响。方法 通过外载荷力的作用，制作家兔椎动脉型颈椎病的动物模型，测定颈椎两侧肌肉张力，并记录各组动物椎动脉血流量的变化。结果 模型组受牵拉侧斜方肌、提肩胛肌、横突间肌等肌肉的肌张力明显高于对侧及正常组，模型组受牵拉侧椎动脉血流量明显低于对侧及正常组。结论 颈椎两侧肌肉平衡状态失调可使受牵拉侧颈部肌肉痉挛，椎动脉血流量明显下降，成功建立了椎动脉颈椎病模型。     

超声引导肩胛上神经阻滞的临床应用

目的 探讨超声引导肩胛上神经阻滞的临床应用价值。方法 对接受肩胛上神经阻滞的75例肩周炎患者行超声检查,观察肩胛上神经、血管及肩胛上横韧带的位置及毗邻关系,选择最佳穿刺点,于实时超声引导下行肩胛上神经阻滞。术后随访12周,应用视觉模拟评分法（VAS）评定术前、术后患者疼痛程度。结果 超声清晰显示71例肩胛上神经,4例不能确定,需利用神经刺激定位仪予以确认;75例均穿刺成功,成功率100%,未发生神经损伤及其他并发症。术前及术后1、4、12周的VAS评分分别为7.71±0.87、3.86±0.57、2.83±0.31及1.97±0.30,各时间点间差异均有统计学意义（P均＜0.01）。结论 超声引导下肩胛上神经阻滞具有实时、安全、无辐射等优点,有望在临床上推广应用。     

经皮电刺激促进周围神经再生的临床应用

目的观察电刺激对臂丛神经、桡神经损伤是否具有促进神经再生的作用。方法选择１９９３年１月～１９９６年１２月收治的臂丛神经损伤７６例、桡神经不完全损伤１７例，随机分为电刺激治疗组和对照组。电刺激组进行经皮电刺激治疗６个月，对照组则不作经皮电刺激治疗。电刺激６个月后观察肌皮神经、肩胛上神经及桡神经的功能恢复情况。结果肘关节屈曲度数、伸腕肌力，电刺激组均优于对照组（Ｐ＜０．０５）。结论经皮电刺激能促进周围神经的再生，可应用于宜保守治疗的周围神经损伤及神经修复后的辅助治疗。     

风寒湿刺激对家兔颈椎间盘MMP-1、MMP-3活性的影响

目的　在建立不同强度风寒湿痹证型颈椎病动物模型的基础上 ,检测实验家兔颈椎间盘组织中胶原酶 (MMP 1)、中性蛋白多糖酶 (MMP 3)活性变化。方法　 8月龄雄性新西兰白兔 2 4只 ,随机分为正常对照组和轻度、中度、重度刺激组。采用刺激条件是温度 5℃± 0 5℃ ,湿度 10 0 % ,风力 6级 ,按轻、中、重度刺激组的不同要求 ,分别给予 32、6 4和 12 8小时的间断重复刺激 ,每日刺激 4小时。分别采用3 H Ⅰ型胶原蛋白法和免疫一步夹心法检测MMP 1、MMP 3活性。结果　各个模型组退变指数都有不同程度上升 ,重度刺激组较正常对照组有统计学差异 (P <0 0 5 )。模型组与对照组比较 ,中、重度刺激组MMP 1和MMP 3活性升高明显 (P <0 0 1) ,轻度刺激组变化不明显 ;模型组之间比较 ,中、重度刺激组MMP 1、MMP 3活性明显高于轻度刺激组 (P <0 0 1)。结论　中、重度风寒湿刺激家兔颈椎间盘退变后使MMP 1和MMP 3活性升高 ,加速椎间盘细胞外基质降解 ,导致颈椎间盘退变。     

超声引导下不同入路肩胛背神经阻滞治疗肩胛间区疼痛

目的 观察超声引导下不同入路肩胛背神经（DSN）阻滞治疗肩胛间区疼痛的效果。方法 针对213例接受DSN阻滞治疗单侧肩胛间区疼痛患者行肌间沟、C5横突后结节（RTFCV）和肩胛骨内侧缘（MES）入路超声扫查,统计DSN识别率;而后将患者随机纳入3组（每组71例）,分别行超声引导下经肌间沟（A组）、RTFCV(B组)及MES(C组)入路DSN阻滞（注射1%利多卡因2ml）,对比3组超声扫查耗时、神经阻滞有效率及不良反应。结果 经肌间沟、RTFCV及MSE入路超声扫查对A、B、C组DSN的识别率分别为91.08%(194/213)、46.01%(98/213)、26.29%(56/213),3组总体差异及两两差异均有统计学意义（P均<0.05）。A组超声扫查平均耗时低于C组,B组神经阻滞有效率高于A组和C组（P均<0.05）。A组神经损伤发生率高于B、C组,A、B组超范围阻滞发生率高于C组（P均<0.05）。结论 超声引导下经RTFCV入路行DSN阻滞治疗肩胛间区疼痛较经肌间沟及肩胛骨内侧缘入路更为安全、有效。     

新生儿肩胛间温度测量替代腋温测量的探讨

为了操作方便 ,根据新生儿通过棕色脂肪产热 ,棕色脂肪分布于中心动脉周围、肩胛间和肾周等处[1] ,且肩胛间有特殊静脉网引流[2 ] 等解剖生理特点 ,于 2 0 0 1年 5～ 12月我们采用肩胛间测量新生儿体温 ,并与腋下温度测量结果进行对照 ,探讨肩胛间皮肤温度测量的科学性和可行性。对象 :在本科新生儿病区住院的新生儿 10 0例为监测对象。其中早产儿 2 0例 ,足月儿 80例 (发热 10例 )。方法 :采用自身对照法 ,将玻璃水银柱体温计 (经常规准确性检测误差 <0 1℃ )常规消毒后 ,对新生儿同时进行肩胛间 (将体温计水银端置肩胛间紧贴皮肤 )和腋下…     

肩胛下胸腔入路与后外侧入路上胸椎结核手术的对照研究

 目的 比较经肩胛下胸腔入路与后外侧入路病灶清除植骨融合内固定术治疗上胸椎结核的疗效。方法 回顾性分析2002年1月至2014年2月行病灶清除植骨融合内固定术治疗的43例上胸椎结核患者,其中采用肩胛下胸腔入路21例、后外侧入路22例。比较两组患者的性别、年龄、病变节段、手术时间、出血量、住院时间、治愈率、术后并发症发生率、Cobb角的矫正及神经功能恢复情况。结果 两组患者性别、年龄、病变节段、术前红细胞沉降率、脊髓功能Frankel分级、Cobb角的差异均无统计学意义。肩胛下胸腔组手术时间（196±10）min,后外侧组（142±13）min,差异有统计学意义。两组出血量、住院时间及治愈率的差异无统计学意义。肩胛下胸腔组与后外侧组分别随访（28.0±14.7）个月和（27.3±15.5）个月。肩胛下胸腔组Cobb角由术前36.5°±4.8°矫正至24.8°±5.6°,矫正率30.9%;后外侧组Cobb角由术前34.5°±5.2°矫正至10.2°±2.6°,矫正率68.5%;后外侧组矫正率优于肩胛下胸腔组,差异有统计学意义。两组术后脊髓功能Frankel分级较术前明显改善,但组间差异无统计学意义。结论 经肩胛下胸腔入路与后外侧入路手术治疗上胸椎脊柱结核均能取得良好的临床疗效。后外侧入路在手术创伤、手术时间及后凸畸形矫正能力方面优于肩胛下胸腔入路。     

不同方法保存的猪软骨行异种移植的实验研究

为了探索不同保存方法对猪肩胛软骨异种移植的影响,采用四种不同方法保存猪肩胛软骨,并按不同保存方法及保存时间分７组移植到日本大耳白兔背部皮下,每组５只动物,共３５只进行观察比较。①γ－射线辐射处理,４℃保存３个月为Ａ组,１个月为Ｂ组;②０．５％戊二醛磷酸缓冲液浸泡,４℃保存３个月为Ｃ组,１个月为Ｄ组;③深低温－８０℃保存３个月为Ｅ组,１个月为Ｆ组;④新鲜软骨为Ｇ组。移植术后每周一次活体检查软骨位置及大小。术后１周、１个月、３个月、６个月,每只动物取一块软骨行大体标本和光学显微镜观察,术后６个月取软骨标本行电子显微镜观察。实验结果显示：０．５％戊二醛浸泡、γ－射线辐射处理可降低软骨抗原性,４℃条件下保存以≤１个月为最佳时限,按软骨被吸收率大小,依次为Ｅ、Ｆ、Ａ、Ｂ、Ｇ、Ｃ、Ｄ组。结论：①猪肩胛软骨可作为异种移植代用材料的最佳供体之一;②猪肩胛软骨异种移植到家兔皮下,可存留达６个月;③本实验四种猪软骨保存方法,按异种移植后软骨抗原性降低和被吸收、变形程度轻重等情况相比较,以０．５％戊二醛浸泡保存方法最佳,γ－射线辐射处理次之;④０．５％戊二醛磷酸缓冲液４℃１个月是保存猪肩胛软骨供异种移植的最佳条件。     

控制性低压灌注对兔脊髓缺血再灌注时磷酸化Akt和磷酸化ERK表达的影响

目的 探讨控制性低压灌注对兔脊髓缺血再灌注时磷酸化蛋白质丝氨酸苏氨酸激酶(p-Akt)和磷酸化细胞外信号调节激酶1/2 (p-ERK1/2)表达的影响.方法 雄性日本大耳白兔36只,3月龄,体重2.0 ～ 2.5 kg,采用随机数字表法,将其随机分为3组(n＝12):假手术组(S组)、脊髓缺血再灌注组(I/R组)和控制性低压灌注组(LP组).I/R组和LP组采用在肾动脉下水平阻断腹主动脉25min行再灌注的方法制备脊髓缺血再灌注损伤模型.LP组再灌注10 min期间维持腹主动脉远端血压45～55 mm Hg.分别于再灌注1、3、7、28 d时进行后肢运动功能功能.每组于再灌注1d时处死动物,取脊髓组织,测定p-Akt、p-ERK1/2表达及神经元凋亡情况,计算凋亡指数,电镜下观察病理学结果.结果 与S组比较,I/R组后肢运动功能评分降低,p-Akt和p-ERK1/2表达上调,凋亡指数升高(P<0.05);与I/R组比较,LP组后肢运动功能评分升高,p-Akt和p-ERK1/2表达上调,凋亡指数降低(P<0.05).LP组脊髓组织病理学损伤程度轻于I/R组.结论 控制性低压灌注减轻兔脊髓缺血再灌注损伤的机制与激活Akt及ERK1/2,抑制神经元凋亡有关.     

NGF和BDNF在炎性痛大鼠背根神经节和脊髓背角的表达

目的 观察神经生长因子(NGF)和脑源性神经营养因子(BDNF)在福尔马林致痛大鼠外周、背根神经节(DRG)和脊髓背角的表达变化及相互关系，探讨神经营养因子在疼痛发生机制中的作用。方法 采用大鼠后足掌皮下注射福尔马林溶液的外周炎性痛模型。成年SD大鼠24只随机分为四组(每组6只)：对照组(A组)；致痛组根据取材时间不同分为，致痛后2h取材(B组)、致痛后24h取材(C组)、致痛后48h取材(D组)。观察致痛1h内疼痛行为变化，应用免疫组织化学方法结合计算机图像分析技术检测致炎足底皮肤、DRG和脊髓背角浅层内NGF的表达，及DRG和脊髓背角浅层表达BDNF的变化。结果 所有致痛组大鼠都表现出明显的两期伤害性反应。在致痛后2h患侧足底皮肤、DRG和24h时脊髓背角浅层表达的NGF开始增加，致痛24h后BDNF在患侧DRG表达开始增加，且与NGF在患侧DRG神经元的表达变化成正相关。48h时BDNF在患侧脊髓背角浅层表达开始增加。结论 NGF不仅是产生炎性痛外周机制的重要介质之一，还可通过促进BDNF在脊髓背角的表达，共同参与中枢敏感化的产生。     

The study of the anesthetic action of halothane on the rat spinal cord by fos immunoreactivity]

This study was performed to examine the anesthetic action of halothane on the spinal cord of rats by using fos immunoreactivity, a marker for neuronal activity following noxious stimulation. Sprague-Dawley rats were injected with 150 microliters of 5% formalin subcutaneously into the left hindpaw. Control group (n = 5) received 100% oxygen for 3 hours after injection. 1 MAC group (n = 5) and 1.5 MAC group (n = 5) of rats were anesthetized with 1 MAC or 1.5 MAC halothane, respectively, for 3 hours after injection. The number of fos immunoreactive cells was counted in the lumbar spinal cord of each rat. All rats showed escape reactions against noxious stimulation in the control group. In the 1 MAC and 1.5 MAC groups, two of five rats showed response to noxious stimulation and the another three showed no response, respectively. There was profound relation between the responding rats and the expression of fos immunoreactivity in the spinal dorsal horn. The number of fos immunoreactive cells decreased in the cord of rats that showed no response to noxious stimulation by halothane 1 or 1.5 MAC. These findings suggest that halothane has analgesic action on spinal nociceptive neurons in the rats on the condition that its reactions to noxious stimulation are suppressed by halothane of any concentration.     

Effect of electrical stimulation of peripheral nerves on neuropathic pain

STUDY DESIGN: Changes in the electrophysiologic response of spinal dorsal horn neurons elicited by peripheral electrical stimulation were examined. OBJECTIVE: To investigate whether the electrical stimulation of peripheral nerves causes an inhibition of pain at the spinal cord level. SUMMARY OF BACKGROUND DATA: The wide dynamic range neurons studied were known to be excited by primary afferent fibers, not only combined A (delta) and C nociceptive fibers, but also low-threshold mechanoreceptive A (beta) fibers and A (delta) fibers of down hairs. The wide dynamic range neurons are classified as nociceptive neurons. METHODS: Responses of wide dynamic range neurons in the lumbosacral dorsal horn to input from C fibers were studied in urethane chloralose-anesthetized cats. The posterior tibial nerve and sciatic nerve were stimulated simultaneously to examine the effect on the C fiber responses elicited by superficial peroneal nerve stimulation. RESULTS: Simultaneous stimulation of the posterior tibial nerve and sciatic nerve was performed with superficial peroneal nerve C fiber stimulation. CONCLUSIONS: This study demonstrated that electrical stimulation of peripheral nerves leads to inhibitory input to the pain pathways at the spinal cord level.     

吗啡对电刺激坐骨神经诱发大鼠脊髓背角突触长时程增强的影响

目的 评价吗啡对电刺激坐骨神经诱发大鼠脊髓背角突触长时程增强(LTP)的影响.方法 雄性SD大鼠27只,日龄60～90 d,体重180～200 g,随机分为4组:对照组(C组,n=7)、吗啡组(M组,n=7)、纳洛酮组(N组,n=6),纳洛酮+吗啡组(MN组,n=7).麻醉下分离左侧坐骨神经,记录电极插入左侧T13～L1脊髓背角,刺激电极刺激左侧坐骨神经,给予15 V、0.5 ms、1/60 Hz单个方波电刺激30 min以诱发场电位,抽取生理盐水10 μl、吗啡10 μl(15 μg/μl)、纳洛酮10 μl(2.5 μg/μl)、纳洛酮(2.5 μg/μl)和吗啡(15 μg/μl)各5 μl的混合液,在脊髓上方3～5 mm,经2 min内缓慢滴注,给药后5 min时,给予4串高频高强度强直电刺激后,再给予15 V、0.5 ms、1/60 Hz单个方波电刺激210 min,记录强直刺激前30 min、强直刺激后即刻～30 min、35～60 min、65～120 min、125～210 min时段平均场电位幅值及潜伏期.结果 与C组比较,M组和MN组平均场电位幅值降低,潜伏期延长(P<0.05或0.01),N组上述指标差异无统计学意义(P>0.05).与M组比较,MN组平均场电位幅值升高,潜伏期缩短(P<0.05或0.01).与强直刺激前30 min比较,C组和N组在强直刺激后各时段平均场电位幅值升高,潜伏期缩短,M组在强直刺激后各时段平均场电位幅值降低,潜伏期延长,MN组在强直刺激后即刻～30 min和35～60 min时段平均场电位幅值升高,强直刺激后即刻～30 min时段潜伏期缩短,65～120 min和125～210 min时段平均场电位幅值降低,潜伏期延长(P<0.05或0.01).结论 吗啡可抑制电刺激坐骨神经诱发大鼠脊髓背角突触LTP,可能是其抑制中枢敏化的机制之一.     

Stepping-like movements in humans with complete spinal cord injury induced by epidural stimulation of the lumbar cord: electromyographic study of compound muscle action potentials

STUDY DESIGN: It has been previously demonstrated that sustained nonpatterned electric stimulation of the posterior lumbar spinal cord from the epidural space can induce stepping-like movements in subjects with chronic, complete spinal cord injury. In the present paper, we explore physiologically related components of electromyographic (EMG) recordings during the induced stepping-like activity. OBJECTIVES: To examine mechanisms underlying the stepping-like movements activated by electrical epidural stimulation of posterior lumbar cord structures. MATERIALS AND METHODS: The study is based on the assessment of epidural stimulation to control spasticity by simultaneous recordings of the electromyographic activity of quadriceps, hamstrings, tibialis anterior, and triceps surae. We examined induced muscle responses to stimulation frequencies of 2.2-50 Hz in 10 subjects classified as having a motor complete spinal cord injury (ASIA A and B). We evaluated stimulus-triggered time windows 50 ms in length from the original EMG traces. Stimulus-evoked compound muscle action potentials (CMAPs) were analyzed with reference to latency, amplitude, and shape. RESULTS: Epidural stimulation of the posterior lumbosacral cord recruited lower limb muscles in a segmental-selective way, which was characteristic for posterior root stimulation. A 2.2 Hz stimulation elicited stimulus-coupled CMAPs of short latency which were approximately half that of phasic stretch reflex latencies for the respective muscle groups. EMG amplitudes were stimulus-strength dependent. Stimulation at 5-15 and 25-50 Hz elicited sustained tonic and rhythmic activity, respectively, and initiated lower limb extension or stepping-like movements representing different levels of muscle synergies. All EMG responses, even during burst-style phases were composed of separate stimulus-triggered CMAPs with characteristic amplitude modulations. During burst-style phases, a significant increase of CMAP latencies by about 10 ms was observed. CONCLUSION: The muscle activity evoked by epidural lumbar cord stimulation as described in the present study was initiated within the posterior roots. These posterior roots muscle reflex responses (PRMRRs) to 2.2 Hz stimulation were routed through monosynaptic pathways. Sustained stimulation at 5-50 Hz engaged central spinal PRMRR components. We propose that repeated volleys delivered to the lumbar cord via the posterior roots can effectively modify the central state of spinal circuits by temporarily combining them into functional units generating integrated motor behavior of sustained extension and rhythmic flexion/extension movements. This study opens the possibility for developing neuroprostheses for activation of inherent spinal networks involved in generating functional synergistic movements using a single electrode implanted in a localized and stable region.     

Effect of alternating current stimulation of the spinal cord on recovery from acute spinal cord injury in rats

The therapeutic value of electrical stimulation of the spinal cord was studied in rats injured by acute compression of the spinal cord. Twenty adult Wistar rats underwent cord compression at T6-7 by the extradural clip compression technique at a force of 125 g for 1 minute. After injury and group randomization, stimulating electrodes were placed extradurally, proximal and distal to the injury site, and attached to a small, implantable receiver-stimulator. The receiver was secured to the paraspinal muscles and implanted subcutaneously, overlying the thoracic spine. The animals were maintained in specially designed cages with encircling antennae attached to radio frequency transmitters. The 10 treatment animals were subjected to a 460-kHz electromagnetic field, pulsed at a frequency of 10 Hz. The receivers converted the pulsed radio frequency into square-wave pulses at the cord electrodes (width 1 ms, frequency 10 Hz). The 10 control animals were exposed to a similar field but with a frequency below the range of the tuned receiver, and therefore they did not receive the square-wave pulse. Clinical recovery was assessed by the inclined plane technique which measures the maximum angle of inclination attained without falling. After 15 weeks of continuous spinal cord stimulation, the inclined plane performance was not significantly different between the two groups (treatment group mean, 44.4 +/- 5.4; control group mean, 41.7 +/- 7.9). This is the first experimental study of the effect of long-term continuous electrical stimulation on spinal cord recovery in mammals. The methods required and the technical aspects involved in achieving continuous stimulation, and the guidelines for future study of this modality are discussed.     

不同频率连续波针刺辅助麻醉用于甲状腺手术的临床研究

目的 探讨不同频率连续波针刺辅助麻醉用于甲状腺手术的麻醉效果及对手术引起的应激反应的影响。方法：将80例ASA为Ⅰ～Ⅱ级的择期甲状腺手术患者随机分为四组。分别在不同频率连续波针刺辅助结合颈丛神经阻滞下行甲状腺手术,A．B．C三组分别选用2Hz、15Hz、100Hz连续波刺激,D组为对照组。观察各组患者术前,术中、术毕各时点的心率、血压、呼吸、SpO2的变化以及术中辅助用药的情况,并且评定术中的镇痛效果,同时检测血液中皮质醇（COR）、去甲肾上腺素（NE）的浓度。结果：15Hz组镇痛效果最好,与对照组相比有显著性差异（P〈0．05）。15Hz组患者在牵拉甲状腺时血浆皮质醇含量最低。与对照组相比有显著性差异（P〈0．05）。2Hz、15Hz、100Hz三组患者在牵拉甲状腺时血浆NE含量与对照组比较有显著性差异（P〈0．05）。结论：15Hz连续波针刺辅助麻醉用于甲状腺手术中,麻醉效果更佳．更能抑制手术引起的应激反应。     

异丙酚对兔脊髓缺血再灌注时脊髓前角神经细胞凋亡的影响

目的 探讨异丙酚对兔脊髓缺血再灌注时脊髓前角神经细胞凋亡的影响.方法 新西兰大耳白兔60只,月龄4～6月,体重2.0～2.5 kg,随机分为6组(n=10):对照组(C组)、10%脂肪乳组(F组)、异丙酚30 mg/kg(P1)组、异丙酚40 mg/kg(P2)组、异丙酚50 mg/kg(P3)组和异丙酚60 mg/kg(P4)组.P1组、P2组、P3组和P4组异丙酚用10%脂肪乳稀释至6 ml/kg,C组和F组给予等容量生理盐水或脂肪乳.全麻下开腹阻断左肾动脉远端的腹主动脉及双侧髂总动脉30 min进行脊髓缺血,自缺血即刻开始,各组以12 ml·kg-1·h-1的速率经股动脉输注生理盐水(C组)、10%脂肪乳(F组)和不同剂量异丙酚(P1～4组),30 min后停止输注,开放腹主动脉行再灌注.再灌注48 h时,取L4～6脊髓组织,光镜下计数脊髓前角正常运动神经细胞;采用TUNEL法计数脊髓前角总细胞和凋亡细胞,计算细胞凋亡指数;采用免疫组化法测定脊髓前角cagpase-3表达.结果 与C组和F组比较,P1～4组脊髓前角正常运动神经元计数升高,凋亡指数降低,caspase-3表达下调(P<0.05);与P1组比较,P2～4组脊髓前角正常运动神经元计数升高,凋亡指数降低,P3组和P4组cagpase-3表达下调(P<0.05);与P2组比较,P3组脊髓前角正常运动神经元计数升高,P4组降低,P3组和P4组凋亡指数降低,caspase-3表达下调(P<0.05);与P3组比较,P4组脊髓前角正常运动神经元计数降低,凋亡指数升高,cagpage-3表达上调(P<0.05).结论 腹主动脉阻断期间,经腹主动脉输注30～60 mg/kg异丙酚可抑制脊髓前角神经细胞凋亡,从而减轻兔脊髓缺血再灌注损伤,且与剂量有关,其机制与下调脊髓cagpage-3表达有关.     

经皮穴位电刺激对咪达唑仑镇静作用的影响

目的:探讨经皮穴位电刺激对咪达唑仑镇静作用的影响。方法:选择在我院择期椎管内麻醉行骨科下肢手术患者80例,随机分为两组:经皮穴位电刺激组和对照组,每组均40例。经皮穴位电刺激组在完成椎管内麻醉后开始给予经皮穴位电刺激,刺激参数频率2/100 Hz,波宽0.2~0.6 ms,调节刺激电流至患者可耐受的最大强度,穴位选择双侧合谷穴、内关穴,20 min后靶控输注咪达唑仑。对照组患者在相应穴位贴电极片,并连接刺激器,不予电刺激。对患者进行警觉/镇静(OAA/S)评分,依据脑电双频指数(BIS)调整咪达唑仑靶控输注浓度。观察并记录OAA/S评分首次为3分时的目标靶浓度(Ce)、BIS、咪达唑仑用量、平均动脉压(MAP)、血氧饱和度(SpO2)、心率(HR)及氟马西尼使用和不良反应发生情况。结果:经皮穴位电刺激组在OAA/S评分首次为3分时咪达唑仑效应室靶浓度较对照组低[(60.3±8.0)ng/mL vs.(66.8±8.5)ng/mL],经皮穴位电刺激组的咪达唑仑用量少于对照组[(4.9±0.6)mg vs.(5.3±0.5)mg],差异均有统计学意义(P<0.05);经皮穴位电刺激组术后应用氟马西尼12例,低于对照组的28例,差异有统计学意义(P<0.05);2组间BIS、SpO2、MAP、HR差异无统计学意义。结论:经皮穴位电刺激能够增强咪达唑仑的镇静作用,减少咪达唑仑用量。