异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用

目的比较异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用。方法拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达5 h左右)病人30例,ASAⅠ或Ⅱ级,年龄18～65岁,随机分为2组(n=15):异丙酚组(Ⅰ组)异氟醚组(Ⅱ组)。用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测。静脉注射罗库溴铵初始剂量0．6 mg·kg-1后气管插管,持续输注罗库溴铵。调整罗库溴铵的输注速率,T1稳定在基础值的10％时(初始状态),Ⅰ组靶控输注异丙酚维持麻醉,Ⅱ组吸入1 MAC异氟醚维持麻醉,持续5 h,术中维持T1在基础值的10％。记录罗库溴铵输注速率、恢复指数(T1恢复25％至75％的时间,T25-75)以及罗库溴铵停止输注到TOFR为0．9的时间。结果与初始状态比较,Ⅰ、Ⅱ组持续给药30 min-5 h时罗库溴铵输注速率下降(P<0．05);Ⅱ组持续给药1～5 h时罗库溴铵输注速率低于Ⅰ组(P<0．05)。两组间恢复指数和罗库溴铵停止输注到TOFR为0．9的时间差异无统计学意义(P>0．05)。结论罗库溴铵可用于长时间持续输注以维持稳定的肌松。维持T1在基础值的10％的情况下,持续输注罗库溴铵5 h时异氟醚麻醉比异丙酚为主的全凭静脉麻醉罗库溴铵输注速率减少30％,但其恢复指数无差异。     

肝功能不全门脉高压病人罗库溴铵的肌松效应

目的 观察罗库溴铵在肝功能不全门脉高压病人中的肌松效应。方法 70例ASA I-Ⅱ级择期行上腹部手术的病人分为两组:门脉高压组(M组,n=36),对照组(C组,n=34),其中门脉高压组肝功能均属Child-Turcottee分级法Ⅱ级,对照组肝功能正常。两组病人麻醉诱导均为静脉注射咪唑安定0.02 mg·kg-1、异丙酚1.0 mg·kg-1、芬太尼5μg·kg-1和罗库溴铵0.6 mg·kg-1,同时进行肌松监测。麻醉维持采用吸入异氟烷及间断静脉注射芬太尼,罗库溴铵微量泵持续静注维持肌松,维持T1在10％-20％直至手术结束。记录罗库溴铵起效时间,TOF无反应时间,首次给药后,T110％恢复时间,停药后T125％恢复时间,恢复指数以及每30 min罗库溴铵维持用量。结果 M组病人肌松药起效时间、TOF完全阻断时间、首次给药后,T110％恢复时间、停药后T125％恢复时间及恢复指数比C组病人延长(P<0.01)。M组病人持续输注罗库溴铵用量明显小于C组病人(P<0.01)。结论 肝功能不全的门脉高压病人罗库溴铵起效、维持时间和肌松恢复时间明显延长,维持用量明显减少。     

不同浓度异氟醚对罗库溴铵肌松作用的影响

目的 观察不同浓度异氟醚对罗库溴铵肌松作用的影响。方法 60例ASA Ⅰ-Ⅱ择期手术患者,随机分为3组,每组20例。组Ⅰ静脉注射罗库溴铵0.6 mg·kg-1;组Ⅱ吸入0.6％异氟醚后静脉注入罗库溴铵0.6mg·kg-1;组Ⅲ吸入1.2％异氟醚后从静脉注入罗库溴铵0.6mg·kg-1。分别记录各组注药后肌松作用的起效时间、作用时间及T1恢复时间。结果 与组Ⅰ相比,组Ⅱ、Ⅲ起效时间明显缩短(P<0.05),TOF无反应期明显延长(P<0.01),T1恢复25％、50％、90％时间明显延长(P<0.01),且组Ⅲ较组Ⅱ延长(P<0.05),恢复指数明显延长,且组Ⅲ较组Ⅱ延长(P<0.05)。结论 吸人异氟醚能明显缩短罗库溴铵起效时间,延长罗库溴铵作用时间,临床合并使用时应注意减少用量。     

罗库溴铵对肾功能正常和肾衰患者的药效学比较

目的 观察罗库溴铵在肾功能正常和肾衰患者单次及重复静注的肌松效应。方法终末期肾衰行肾移植术的患者12例,ASAⅢ级,另以下腹部手术患者ASA Ⅰ-Ⅱ级12例为对照。麻醉诱导以咪达唑仑0.02 mg·kg-1、芬太尼1μg·kg-1、异丙酚1.5～2mg·kg-1静脉注射,其后在10s内静注罗库溴铵0.6 mg·kg-1,待T1完全消失时行气管插管,麻醉维持以吸入50％N2O-O2,间断静注芬太尼,待T1恢复至对照值的25％时追加罗库溴铵0.15 mg·kg-1。结果 诱导剂量的罗库溴铵对肾功能正常和肾衰患者起效时间、无反应时间和T1 25％恢复时间的差异无显著性。各次追加药之无反应时间和T1 25％恢复时间随追加次数增多有逐渐延长的趋势,相对应的时间女性比男性长。用新斯的明拮抗罗库溴铵明显缩短T1 75％恢复时间。结论 罗库溴铵在肾功能正常患者和肾衰患者的首次应用和维持追加作用时间差异无显著性;随追加次数增多,有作用逐渐延长趋势;女性比男性更明显。     

腹部手术患者罗库溴铵不同给药方式肌松效应的比较

目的比较腹部手术患者罗库溴铵靶控输注(TCI)、持续输注(CI)和间断静脉注射(IBI)三种给药方式的肌松效应。方法择期全麻下行腹部手术患者45例,ASAⅠ或Ⅱ级,随机分为TCI组、CI组和IBI组(n=15)。麻醉诱导：三组均静脉注射咪唑安定0．1mg·kg~(-1)、瑞芬太尼1．5μg·kg~(-1)和TCI异丙酚2．5μg·ml~(-1),TCI组以效应室浓度3μg·ml~(-1)TCI罗库澳铵,CI组和IBI组均静脉注射罗库溴铵0．6 mg·kg~(-1)。麻醉维持：三组均维持T_1=5％,TCI组以效应室浓度增减0．1μg·ml~(-1)调控罗库溴铵TCI；CI组以初始速率为600μg·kg~(-1)·h~(-1),每隔5分钟以10％～20％幅度调整输注速率；IBI组间断静脉注射0．15mg·kg~(-1)。结果在肌松监测指导下,TCI组和CI组均可维持T_1=5％的肌松深度,TCI组效应室浓度呈下调趋势,CI组可达到稳态输注,调控次数高于TCI组,IBI组每间隔(27±7)min给药一次,每次间隔时间相似。TCI组罗库溴铵麻醉诱导用量多于CI组和IBI组(P＜0．05),三组维持用量差异无统计学意义。TCI组罗库溴铵诱导起效时间长于CI组和IBI组(P＜0．01)。恢复时间TCI组和CI组相似,短于IBI组(P＜0．01),但三组罗库溴铵的恢复指数差异无统计学意义。结论TCI罗库溴铵延长了起效时间,不适于麻醉诱导；但其肌松效应稳定,停止输注后恢复较快,适于麻醉维持。     

七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应影响的比较

目的 比较七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应的影响.方法 择期腹部手术患者60例,年龄45～64岁,ASAⅡ级,其中Ⅱ型糖尿病患者30例,随机分为2组(n=15):异丙酚组(PD组)和七氟烷组(SD组);非糖尿病患者30例,随机分为2组(n=15):异丙酚组(PN组)和七氟烷组(SN组).静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测,PD组和PN组静脉注射罗库溴铵0.6 mg/kg后气管插管,静脉输注异丙酚维持麻醉;SD组和SN组1%地卡因充分表面麻醉后气管插管.吸入七氟烷(呼气末浓度1.71%)10 min后静脉注射罗库溴铵0.6 mg/kg,吸入七氟烷(呼气末浓度1.71%)维持麻醉.记录肌松起效时间、维持时间和恢复指数.于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120 min时记录T1/T0比值及TOF比值(T4T1比值).结果 PN组与PD组、SN组与SD组、PD组与SD组间罗库溴铵起效时间、维持时间比较差异无统计学意义(P>0.05).与SN组和PD组比较,SD组恢复指数延长(P<0.05).静脉注射罗库溴铵后60～120 min,SD组T1/T0比值和TOF比值较PD组降低(P<0.05);静脉注射罗库溴铵后80～120 min,SD组TOF比值较SN组降低(P<0.05).结论 与非糖尿病患者相比,七氟烷对糖尿病患者罗库溴铵肌松效应的强化作用进一步增强.     

地氟醚七氟醚对糖尿病患者罗库溴铵肌松效应影响的比较

目的 比较地氟醚和七氟醚对糖尿病患者罗库溴铵肌松效应的影响.方法 择期2型糖尿病腹部手术患者60例,年龄45～64岁,ASA分级Ⅱ级,采用随机数字表法分为3组,每组20例:地氟醚组(DD组)、七氟醚组(SD组)和异丙酚组(PD组).静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测,3组分别用异丙酚、地氟醚和七氟醚维持麻醉.记录肌松维持时间和恢复指数.于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120 min时记录T1/T0比值及T4/T1比值[四个成串刺激(train-of-four stimulation, TOF)比值].结果 DD组和SD组患者罗库溴铵的维持时间[(61±17),(60±18) min]、恢复指数[(36±12),(35±10) min]之间差异无统计学意义(P＞0.05),且均大于PD组(P＜0.05).DD组、SD组患者静脉注射罗库溴铵后60～120 min时T1/T0比值和TOF比值差异无统计学意义(P＞0.05),且均大于PD组(P＜0.05).结论 地氟醚和七氟醚对糖尿病患者罗库溴铵肌松效应的影响差异无统计学意义.     

活体肝移植术供体右半肝切除后罗库溴铵用量的变化

目的 探讨活体肝移植术供体右半肝切除术后罗库溴铵用量的变化.方法 择期拟行右半肝切除术的肝移植术供体病人16例,年龄21～49岁,体重51～86 kg,ASA Ⅰ级.麻醉诱导:静脉注射咪达唑仑和芬太尼,靶控输注异丙酚和罗库溴铵(血浆靶浓度3 μg/ml),采用肌松监测,待T1/Tc=0时进行气管插管,机械通气.气管插管后罗库溴铵血浆靶浓度降至1.0 μg/ml,调整罗库溴铵浓度,维持0相似文献   

性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响

目的 探讨性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响.方法 择期全麻手术患者240例,年龄20～60岁,ASA分级Ⅰ或Ⅱ级,BMI 20～30 kg/m2,随机分为2组(n=120):顺阿曲库铵组和罗库溴铵组,各组按性别和麻醉药再分4个亚组(n=30):女性异丙酚组、男性异丙酚组、女性七氟醚组和男性七氟醚组.各异丙酚组靶控输注异丙酚,血浆靶浓度2～6 μg/ml,各七氟醚组吸入七氟醚,于靶控输注或待呼气末七氟醚浓度稳定于1.71%5 min后,静脉注射顺阿曲库铵0.15 mg/kg或罗库溴铵0.6 mg/kg.记录肌松起效时间、肌松作用峰值时间、T1 25%恢复时间和TOFR25%恢复时间.结果 与异丙酚麻醉比较,女性患者七氟醚麻醉时,罗库溴铵TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,男性患者七氟醚麻醉时,罗库溴铵起效时间缩短,肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长(P＜0.05或0.01);七氟醚麻醉时与男性患者比较,女性患者罗库溴铵T1 25%恢复时间和TOFR 25%恢复时间缩短,顺阿曲库铵起效时间缩短(P＜0.05或0.01).结论 七氟醚对罗库溴铵肌松的增强作用存在性别差异,男性强于女性;对顺阿曲库铵肌松的增强作用无明显性别差异.     

054滴注罗库溴铵对氟烷、异氟醚或七氟醚麻醉下儿童的影响

罗库溴铵是蓄积作用不明显的中效非去极化肌松药,可以持续滴注。氟烷、异氟醚、七氟醚以及地氟醚都能增强罗库溴铵的肌松效果。作者为了研究儿童在芬太尼-氧化亚氮、氟烷、异氟醚或七氟醚麻醉时,连续滴注罗库溴铵的用量问题,特选择40例体质良好的3～11岁儿童(ASA Ⅰ～Ⅱ级)随机分成4组,术前均口服咪达唑伦0.3 mg·kg-1。①FN组(芬     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.